Effect of local hygiene protocols on denture-related stomatitis, biofilm, microbial load, and odor: A randomized controlled trial.

STATEMENT OF PROBLEM: Denture stomatitis affects complete denture wearers and is frequently treated with antifungals drugs, as well as treating the denture with sodium hypochlorite. Whether the limitations of these treatments can be overcome with local hygiene protocols that do not damage the denture materials or adversely affect the patient is unclear. PURPOSE: The purpose of this randomized controlled trial was to evaluate the effect of denture hygiene protocols on complete denture wearers with denture stomatitis. MATERIAL AND METHODS: For this randomized, double-blind controlled clinical trial, 108 participants were assigned to parallel groups: 0.25% sodium hypochlorite (positive control) 0.15% Triclosan, denture cleaning tablets, or denture cleaning tablets plus gingival cleaning tablets. The participants were instructed to brush the dentures and the palate and immerse the denture in the solutions. The outcomes of denture stomatitis remission, biofilm removal, decrease of microbial load (colony-forming units), and odor level of the mouth and denture were measured at baseline and after 10 days. Descriptive analyses were used for sociodemographic characterization of the participants; the Pearson chi-square test was used to compare participant frequency with different degrees of denture stomatitis. The data were not normally distributed (Shapiro-Wilks test) or homogeneous (Levene test). So, the Kruskal-Wallis and Dunn post hoc tests and Wilcoxon test were used to compare the effects of solutions and time on the variables (α=.05). RESULTS: The frequency of the highest to lowest denture stomatitis scores was significantly different for the 0.15% Triclosan and denture cleaning tablets groups. No significant difference was found among the groups in terms of denture stomatitis scores, biofilm, or colony-forming unit count of Candida spp. or C. albicans and S. mutans; a significant reduction was found in these parameters. The 0.25% sodium hypochlorite and 0.15% Triclosan treatments caused a significant reduction in Gram-negative microorganisms; these 2 protocols, and the denture cleaning tablets showed a significant reduction in Staphylococcus spp.; all protocols had similar effects. Only the S. mutans count of the palate decreased after 10 days. The odor level of the mouth and the denture was not significantly different (P=.778). CONCLUSIONS: The evaluated protocols can be recommended for the hygiene of complete dentures, since they were effective for all the variables studied.

The McGill Denture Satisfaction Questionnaire revisited: Exploratory factor analysis of a binational sample.

OBJECTIVES: To examine the McGill Denture Satisfaction Questionnaire (MDSQ) in terms of dimensionality, item reduction and construct validity in a binational sample of complete denture wearers. MATERIALS AND METHODS: We conducted secondary analyses of baseline data from two studies on implant-retained overdentures: a quasi-experimental study in the United States (n = 145) and a randomised trial in Brazil (n = 120). All participants wore upper/lower dentures and responded at baseline to the MDSQ items concerning their original mandibular dentures. A putative model of the MDSQ items resulted in two question subsets: (a) overall satisfaction, retention/stability, aesthetics, cleaning, speech and comfort, plus general chewing ability; (b) mastication of specific foods. Analyses focused on the internal consistency of each subset and possible item reduction, using Cronbach's alpha (Cα), inter-item correlation and exploratory factor analysis (EFA). RESULTS: The 1st subset showed high inter-item correlation for most question combinations and no redundancy (r ≤ .8). An item on cleaning had low correlation, but its removal does not increase internal consistency (Cα ≥ .83). Results were similar for both studies, with EFA showing a single significant factor (namely "overall satisfaction, lower denture") able to explain nearly 54% of the variance. The 2nd subset also shows strong internal consistency (Cα ≥ .95) and inter-item correlation, with a single factor representing 65% of the variation. CONCLUSIONS: This study discloses the reliability and construct validity of the MDSQ for patient-centred evaluation of complete dental prostheses in the edentulous mandible. Findings also support the use of both "overall satisfaction" and "masticatory ability" as summary scores, for improved outcome assessment.

Hygiene protocols for the treatment of denture-related stomatitis: local and systemic parameters analysis - a randomized, double-blind trial protocol.

BACKGROUND: Denture-related stomatitis (DS) is chronic multifactorial inflammation, strongly related to the presence of the biofilm that is the complex structure formed by microorganisms held together by a mucus-like matrix of carbohydrate that adheres to different surfaces, including the denture surface. DS has recently been correlated with deleterious cardiovascular alterations. The potential effect of hygiene protocols in the control of DS and randomized clinical trials that address this oral condition with cardiovascular complications are important in clinical decision-making. MATERIAL/DESIGN: A clinical trial, randomized, double-blind, and with parallel groups, will be conducted in Brazil The sample will consist of 100 patients without teeth in both arches, users of at least maxillary complete dentures, and diagnosed with DS, who will be allocated to groups (n = 25 per group) according to the different hygiene protocols: (1) brushing of the palate and immersion of the prosthesis in 0.25% sodium hypochlorite solution (positive control); (2) brushing of the palate and immersion of the prosthesis in 0.15% triclosan solution; (3) brushing of the palate and immersion of the prosthesis in lactose monohydrate; or (4) brushing the palate with citric acid and immersing the prosthesis in lactose monohydrate. The response variables will be heart rate variability and alteration of blood pressure (systemic level), remission of DS, removal of biofilm, reduction of microbial load (colony-forming units (CFU)), mouth and prosthesis odor level, expression of MUC1, proinflammatory cytokines, C-reactive protein (CRP), viscosity, pH and salivary flow (locally); patient-centred qualitative analysis will also be undertaken. Measurements will be performed at baseline and 10 days after the interventions. The results obtained will be statistically analyzed as pertinent, with a level of significance of 0.05. DISCUSSION: This study will provide a guideline for clinical practice regarding the use of hygiene protocols in the treatment of oral diseases (DS) mediated by biofilm. Also, it may provide evidence of correlation of oral manifestation with cardiac risk. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials, RBR-4hhwjb. Registered on 9 November 2018.

Focusing on outcomes and methods in removable prosthodontics trials: a systematic review.

OBJECTIVES: The aim of this study was to systematically examine the outcomes of interest of trials in removable prosthodontics and to assess their overall quality. MATERIAL AND METHODS: Electronic databases were searched up to August 2011 and complemented by hand searching for published randomized controlled trials (RCTs) in the field of removable prosthodontics in the six major prosthodontic and implant journals. The primary outcome of RCTs was considered as the outcome of interest of this review, and only manuscripts in which the study's primary outcome was reported in the abstract were included. Outcomes were classified according to the Strength of Recommendation Taxonomy (SORT) classification. The quality of individual reports of RCTs was assessed following the Cochrane Handbook for Systematic Reviews of Interventions (Higgins & Green, www.cochrane-handbook.org). RESULTS: The search retrieved 86 reports of RCTs. Among these publications, 43% reported a patient-oriented primary outcome. Most of the publications did not present a clear description of sequence generation (54%) or allocation concealment (65%). Blinding of participants, clinicians, and outcomes assessors was not applicable or reported in most trials. Handling of withdrawals and losses was adequate in 52% of trials. CONCLUSIONS: Although published RCTs in removable prosthodontics have increased over time, efforts should be made to increase patient-reported outcomes and the methodological quality of these reports. Such improvement will lead to a better body of evidence in the field, thus providing increased support for clinical decision-making.