Efficacy of chemical and photoactivated disinfectants against Candida Albicans and assessment of hardness, roughness, and mass loss of acrylic denture base resin.

AIM: The present study aimed to assess the antimicrobial efficacy of hematoporphyrin derivative, sodium hypochlorite (NaOCl), glutaraldehyde (GaH), and a chlorhexidine (CHX) on mass loss (ML), microhardness, and surface roughness (Ra) of acrylic denture base colonized with C. Albicans. MATERIAL AND METHODS: A total of 40 heat cure acrylic resin dentures were fabricated and inoculated by the American Type Culture Collection (ATCC) of C. Albicans in an in-vitro situation. Specimens were divided into four groups (n = 10) based on the method of disinfection. Hematoporphyrin derivatives, 1% NaOCl, 2% GaH, and 4% CHX.The pre and post candida (CFU/ml) counts were recorded before and after immersion. ML, microhardness, and Ra of acrylic denture were also assessed. Statistical analysis was executed for CFU/mL (log10) for exposed C. Albicans by two-way ANOVA and Tukey's multiple tests (p > 0.05). For normality of the data, Dunnet's Simultaneous test was performed. RESULTS: In terms of candida strain analysis, pretreatment to posttreatment comparisons revealed a reduction in mean Candida count in all groups (p < 0.05). The highest ML value after post candida disinfection of acrylic denture was observed in 2% GaH (1.587 ± 0.25) treated specimens. The least microhardness value was found in group 1 when treated with hematoporphyrin (0.97 ± 0.22 VHN) which was significantly different from other groups (p < 0.05). Group 1 surface treated with hematoporphyrin derivate (1.84 ± 0.22 µm) showed the highest Ra values (p < 0.05). CONCLUSION: Acrylic denture base resin colonized with C. Albicans when treated with a chemical disinfectant of 4% chlorhexidine displayed the highest antimicrobial efficacy with reduced mass loss, less surface roughness, and maximum denture hardness.

Development of a United Kingdom-centric cost-effectiveness model for denture cleaning strategies.

STATEMENT OF PROBLEM: Denture stomatitis is a prevalent condition in denture wearers. Economic evaluations of health care can help stakeholders, including patients, make better decisions about treatments for a given condition. Economic models to assess the costs and benefits of different options for managing denture stomatitis are lacking. PURPOSE: The purpose of this study was to explore the feasibility of developing a cost-effectiveness model to assess denture cleaning strategies aimed at preventing denture stomatitis from a denture-wearer perspective in the United Kingdom. MATERIAL AND METHODS: A model was developed to identify and estimate the costs and effects associated with 3 denture cleaning strategies. These were low care (LC)-cleaning by brushing and soaking overnight in water; medium care (MC)-brushing with toothpaste and soaking overnight in water; and optimum care (OC)-brushing and soaking overnight in water and antimicrobial denture cleanser. Costs, outcome measures (denture stomatitis-free days), and probabilities (incidence of stomatitis, unscheduled dentist visits, prescription charges, self-medication) associated with each strategy were defined. A sensitivity analysis was used to identify key drivers and test the robustness of the model. RESULTS: The model showed that the total costs for 2015 ranged from £1.07 (LC) to £18.42 (OC). Costs associated with LC were derived from unscheduled dentist visits and use of medication and/or prescription charges. Incremental costs per denture stomatitis-free day were £0.64 (MC) and £1.81 (OC) compared with LC. A sensitivity analysis showed that varying either or both key parameters (baseline incidence of denture stomatitis and relative effectiveness of MC and OC strategies) had a substantial effect. Incremental cost-effectiveness ratios ranged from £4.11 to £7.39 (worst-case scenario) and from £0.21 to £0.61 (best-case scenario). CONCLUSIONS: A model was developed to assess the relative cost-effectiveness of different denture cleaning strategies to help improve denture hygiene. An important finding of the study was the lack of evidence on the relative effectiveness of different cleaning strategies, meaning that several assumptions had to be incorporated into the model. The model output would therefore likely be considerably improved and more robust if these evidence gaps were filled.

Factors Associated with Undergoing Regular Dental Check-ups in Healthy Elderly Individuals.

The purpose of this study was to determine the distribution of healthy elderly individuals undergoing regular dental check-ups and identify any environmental or associated oral factors. A cross-sectional questionnaire survey was used to interview 216 individuals attending 2 welfare facilities for the elderly, of whom 160 were included in the final analysis. Items comprised age, sex, number of residual teeth, frequency of teeth/denture cleaning, subjective chewing ability, denture use, oral status, regular dental check-ups, visitation of the same dentist, number of dental visits in the past year, General Oral Health Assessment Index (GOHAI) (Japanese version) score, living situation, and use of routine medication. Individuals undergoing regular dental check-ups were defined as those with a primary dentist whom they saw for dental check-ups at least once a year. The rate of individuals undergoing regular dental check-ups was 75.0% in men aged 60-74 years, 58.8% in women aged 60-74 years, 70.0% in men aged 75 years or over, and 45.3% in women aged 75 years or over. Logistic regression analysis revealed a higher number of residual teeth (odds ratio [OR]=2.664 in comparison with those with fewer than 20 teeth, p=0.0427); cleaning teeth/dentures 3 or more times per day (OR=2.546 in comparison with cleaning them twice per day or less, p=0.0157); and a higher GOHAI score (OR=2.742 in comparison with those with a GOHAI score of less than 58, p=0.0263) as factors significantly correlated with undergoing regular dental check-ups. In conclusion, the results revealed that individuals undergoing regular dental check-ups had 20 or more residual teeth, cleaned their teeth/denture 3 or more times per day, and had a higher GOHAI score. This indicates that the best predictive factor for undergoing regular dental check-ups in healthy elderly individuals is their GOHAI score.

Properties of an acrylic resin after immersion in antiseptic soaps: Low-cost, easy-access procedure for the prevention of denture stomatitis.

Denture stomatitis triggered by Candida species requires better preventive measures. This study evaluated the physical and biological properties of a denture base acrylic resin after immersion in antiseptic soaps. Acrylic resin specimens were prepared and stored in distinct solutions for 0, 7, 14, 21, and 28 days. The solutions were as follows: DW: distilled water at 37°C (control group); DS: cycles of daily immersion in Dettol soap for 8 hours at room temperature, followed by immersion in distilled water for 16 hours at 37°C; PS: cycles of daily immersion in Protex soap, as described for the previous group; LS: cycles of daily immersion in Lifebuoy soap, as described for the DS group. The parameters evaluated at each time point were the following: biofilm formation capacity by Candida albicans and reduction of preformed fungal biofilms, cytotoxicity, surface roughness, hardness, and color change. For the fungal adhesion phase, the type of soap had a statistically significant effect (p = 0.0292), but after 24 hours, no differences were found between solutions or between storage times. Regarding the efficacy of biofilm reduction, there was a significant difference when the groups were compared to each other (p = 0.014). Dettol and Lifebuoy eliminated the preformed biofilm on the specimens. Moreover, all the soaps were classified as non-cytotoxic (on HaCaT cell line) because there was no difference in cell viability between the different groups, except after 21 days, when a decrease in cell viability occurred, regardless of the type of soap. Regarding the roughness, there was no statistically significant difference (p > 0.05) between the groups. Lifebuoy decreased resin hardness regardless of storage time (p = 0.003). After 21 and 28 days of storage, there was an increase in hardness value, regardless of the type of soap. The specimens' color, according to the National Bureau of Standards values, ranged from 0.27 to 0.58 (i.e., imperceptible or mild color changes). In general, the disinfectant soaps were not able to prevent biofilm formation, but all the soaps were effective in reducing the preformed biofilm. In addition, all soaps were non-cytotoxic and did not change surface roughness, hardness (except Lifebuoy), and color (except Lifebuoy). Therefore, immersion in two antiseptic soaps (Protex and Dettol) may be a cheap and easy procedure for preventing denture stomatitis.

Surface change assessment of Co-Cr alloy subjected to immersion in denture cleansers

Choosing the right chemical cleanser for removable partial dentures is a challenge, because they present an acrylic and a metallic portion, which should be cleaned and not damaged. Aim: The aim of this study was to assess surface changes of cobalt chromium alloys immersed in diferente cleaners solutions: 0.05% sodium hypochlorite, 4.2% acetic acid, 0.05% sodium salicylate, sodium perborate (Corega Tabs®) and 0.2% peracetic acid. Material and Methods: One hundred and twenty circular specimens (10 mm in diameter) of two commercial available Co-Cr alloys were tested: GM 800 ® (Dentaurum) and Co-Cr® (DeguDent). The samples were randomly divided into tem experimental groups (n=10), according to the trend mark of alloy and cleaners solutions in which they were immersed, and two control groups, in which the samples of the two alloys were immersed in distilled water. Evaluations were performed through roughness measurement (rugosimeter Surftest 211, Mitutoyo), visual evaluation with stereomicroscope (Stereo Discovery 20, Carl Zeiss) and scanning electron microscope surface (JSM, 6360 SEM, JEOL), at experimental times T0 ­ before immersions, T1 - after one immersion, and T2 - after 90 immersions. Intergroup comparison for the effect of immersion in the different cleanser agents was evaluated through ANOVA/Tukey tests (p≤0.05). The effect of the time in the immersion of each alloy was evaluated by t-pared test (p≤0.05). The two alloys were compared using the t-Student test. Results: The analysis of roughness and microscopy showed that surface changes were significantly greater in groups submitted to 0.05% sodium hypochlorite after 90 immersions (T2). When comparing the two alloys, a similar behavior of roughness was observed for the cleaning agents. However, alloy GM 800® showed significant statistical difference for roughness variations in experimental times (Δ1 and Δ2), when immersed in sodium 0.05% hypochlorite. The number of exposures of the alloys to the cleaning agents showed a negative influence when using sodium hypochlorite solution. Conclusions: It is possible to conclude that 0.05% sodium hypochlorite has caused the greatest apparent damage to alloy surface. (AU)

Influence of educational materials on the hygiene and utilization habits of denture wearers.

The objective of this study was to investigate the influence of educational materials on the denture hygiene and utilization habits of 70 adult volunteers who had been using complete dentures for at least 5 years. On the day they received new dentures, 32 patients were provided with an illustrated leaflet and verbal instructions on oral hygiene and utilization habits, while the remaining 38 participants were advised to continue cleaning and wearing their new dentures as they had their previous dentures. After a 6- to 10-week period, 66 of 70 subjects were interviewed about socioeconomic factors, denture hygiene, and utilization habits. The percentage of patients with a proper denture care routine was low in both groups, suggesting that patients had a tendency not to change old habits. However, statistical analysis showed a positive correlation between receiving instruction and performing denture care in a way that is closer to the recommended method: brushing without toothpaste, using a specific brush; soaking in a sodium hypochlorite solution; and removing the prosthesis at night. Within the limitations of this study, it was concluded that this approach to patient education could be applied to improve the hygiene and utilization habits of denture wearers as well as encourage the correct use of complete dentures.

Assessment of hygiene habits and attitudes among removable partial denture wearers in a university hospital.

AIMS: The aim of this study was conducting a survey of hygiene habits and use of removable partial dentures (RPDs) and correlate them with the social conditions of the interviewees. METHODS: A total of 145 RPD wearers were interviewed by experienced clinical staff using a structured questionnaire. A Chi-squared test was performed to evaluate statistical significance between the variables, and the level of significance was P<0.05. RESULTS: A total of 72 (49%) patients reported that they had not been well informed by the dentists. Brushing was the most frequent cleaning method (57.6%). 77 (53.1%) patients did not take off their dentures at night. The frequency of cleaning dentures and using cleansing tablet was significantly higher in females than in males (P<0.05). The frequency of denture cleaning, cleaned parts of denture, use of cleansing tablet, removal of dentures at night, frequency of tooth brushing, does not show any significant difference according to age, educational status or duration of denture usage (P>0.05). RPD wearers did not clean their dentures and natural teeth satisfactorily and had limited knowledge of denture cleansing and oral hygiene maintenance. CONCLUSIONS: Hygiene habits and attitudes may be affected by gender, but education level and hygiene attitudes may not always present positive correlation. Dentists should thoroughly inform patients about the harmful effects of overnight wearing and motivate to clean metal parts of RPD's and cleansing tablet use in order to minimize the abrasive effect of widely preferred cleaning method of brushing with toothpaste.

Evaluation of the Candida albicans removal and mechanical properties of denture acrylics cleaned by a low-cost powered toothbrush.

PURPOSE: To investigate the effects of using a low-cost powered toothbrush for cleaning on dental prostheses made of heat polymerized poly(methyl methacrylate), PMMA. METHODS: Heat cured PMMA specimens beam with the dimensions of 45.0 mm×6.5 mm×4.5mm were fabricated. The specimens were kept in water storage at 37 °C constant temperature for 0, 1, 7, 15, 30 and 60 days and randomly assigned for testing or control. Test specimens underwent brushing by using a powered toothbrush at an applied force of 2.00 N for 22 min with water as medium. Surface roughness measurement (Ra), flexural strength and efficacy of brushing to remove coated Candida albicans biofilm were investigated. RESULTS: The results of the mean surface roughness value and the flexural strength were analysed by using two-way ANOVA and Tukey post hoc test at 5% significance level. In general, the specimens showed no significant changes in flexural strength after brushing. However, the flexural strength and the surface roughness value were significantly lower in specimens group after 7 days in water storage compared to the control. SEM micrographs of post-brushed specimens revealed satisfactory removal of C. albicans biofilm. CONCLUSION: A low-cost powered toothbrush together with a liquid medium successfully removed C. albicans biofilm on dental acrylic PMMA-based prostheses, without compromising the mechanical properties.

Effects of denture maintenance on satisfaction levels of Taiwanese elderly using removable partial dentures: a pilot study.

OBJECTIVE: The aim of this study was to evaluate the correlation between patient satisfaction with removable partial dentures and denture maintenance by patients, including regular application of denture adhesives and cleansers. BACKGROUND: The success of removable partial dentures depends on patient satisfaction with dentures and their regular denture maintenance. MATERIALS AND METHODS: Demographic information, the Oral Impacts on Daily Performance (OIDP) indicator and details of denture maintenance (including the use of denture cleansers and adhesives) were collected from 193 (41.5% men and 58.5% women) participants by using questionnaires. A dentist performed oral examinations to evaluate denture function according to the OIDP items photographically and recorded the number of remaining teeth and Kennedy's classification. RESULTS: Most participants were satisfied with their removable partial dentures and tended to have higher satisfaction levels than the dentist's estimation. Further, those using denture adhesives and cleansers had higher satisfaction levels than those not using such denture maintenance. CONCLUSIONS: Appropriate education regarding denture use is important because regular denture maintenance by patients affects their degree of satisfaction with dentures, as well as the dentist's skill and the patient's oral condition. Dentists could use this information to predict the potential success of dentures.

Evaluation of in vivo denture plaque assessment methods.

BACKGROUND: Measurement and assessment of denture plaque can provide valuable information regarding an individual's oral health status and assessment of new treatments or products. Current methods tend to rely on subjective indices or image analysis derived planimetric (area measurement) assessment of stained plaque on dentures. Plaque indices are most commonly used to assess plaque coverage without image capture. This is not ideal because the methods are subjective, examiner bias may occur, there is no reproducibility between studies, the methods have lower accuracy and sensitivity than image analysis, and there is no record. To the authors' knowledge, no standardised published method of denture plaque assessment is currently employed for product development and testing. METHOD: In this study visual and planimetric plaque assessment methods were compared using reference dentures. In addition, an in vivo study compared these methods for evaluating denture cleanser efficacy. RESULTS AND CONCLUSIONS: The results show that blinded image scoring is more representative of the true plaque area coverage than 'live' denture scoring, detecting significant decreases in plaque coverage. Planimetric analysis provides a more sensitive and less subjective technique with greater differentiation between treatments. However, analysis is very time consuming. Thus, a number of recommendations are made regarding quantification of denture plaque for the assessment of cleanser products.

Oral health care in private and small long-term care facilities: a qualitative study.

OBJECTIVE: Elderly people who are institutionalised receive qualified care. Among the services supplied, oral health care has not always been a priority. The aim of this study was to identify the characteristics of oral health care provided to the elderly residents in long-term care facilities (LTC) in Porto Alegre/RS city. METHODS: Twelve private and small-size LTCs (less than 20 residents) participated in this study. All supervisors and 36 carers were interviewed. The data obtained were organised according to the offer of oral health under the following categories: responsibility for oral care, oral care routines, difficulties carrying out oral care routines. RESULTS: The procedures used most often in order of frequency were tooth brushing, prostheses cleaning, use of mouthwashes, soaking of prostheses and cleaning of the tongue. Among the difficulties mentioned were the high cost of dental assistance, the lack of co-operation both by family members and by the elderly themselves, the oral and general health status of the elderly and the limited time available for carers to carry out the tasks. Oral care is conducted empirically, and the responsibility is left to the carers. CONCLUSIONS: Analysis of the statements given reveals that oral care does not follow any kind of protocol or standardisation. The persistence of this situation could lead to unsatisfactory oral health care in private and small LTC facilities.

Assessment of flexural strength and color alteration of heat-polymerized acrylic resins after simulated use of denture cleansers

O objetivo deste estudo foi avaliar a resistência à flexão e alterações de cor de resinas acrílicas termopolimerizáveis imersas em higienizadores de prótese por diferentes períodos de tempo. Corpos-de-prova retangulares (65x10x3mm) de três resinas acrílicas (Lucitone 550, QC-20 e Triplex) foram divididos em três grupos de higienizadores de prótese (Bony Plus, Corega Tabs e Efferdent Plus) e um grupo controle (imersão em água). Foram realizadas imersões por 15 min e 8 horas, simulando 30 dias de uso. O teste de resistência à flexão foi realizado com 105 corpos-de-prova em máquina de ensaios universais. Alterações de cor foram avaliadas por meio de fotografias tiradas de 21 corpos-de-prova. Os resultados de resistência à flexão (em MPa) foram submetidos à análise de variância e teste de Tukey, com nível de significância de 5%. Houve diferenças significantes (p<0.01) entre as resinas Lucitone (89,439 ± 7,962); Triplex (88,024 ± 5,167) and QC-20 (83,379 ± 7,153). Não foram encontradas diferenças significantes (p>0.05) entre os higienizadores de prótese (Bony Plus = 87,693 ± 6,943; Corega Tabs = 86,955 ± 7,114; Efferdent Plus = 86,195 ± 7,865; e controle = 86,536 ± 7.012) nem entre os períodos de imersão (15 min = 86,875 ± 7,625 e 8 h = 87,432 ± 7,355) durante os ciclos de imersão que simularam 30 dias de uso. A inspeção visual não detectou qualquer alteração de cor. Os achados desse estudo revelaram que os higienizadores de prótese, quando usados de acordo com as instruções dos fabricantes, não afetaram a resistência à flexão nem causaram alterações de cor nas resinas acrílicas termopolimerizáveis após um período de uso simulado de 30 dias.

Assessment of flexural strength and color alteration of heat-polymerized acrylic resins after simulated use of denture cleansers.

The purpose of this study was to assess flexural strength and color alteration of acrylic resins immersed in denture cleansers for different periods of time. Rectangular specimens (65 x 10 x 3mm) made from three heat-polymerized acrylic resins (Lucitone 550, QC-20 and Triplex) were assigned to three denture cleansers groups (Bony Plus, Corega Tabs and Efferdent Plus) and a control group (immersion in water). Soaking trials of 15 min and 8 h simulated 30 days of use. Flexural strength testing was carried out with 105 specimens on a universal testing machine. Color alterations were visually assessed by examination of photographs taken from 21 specimens. Flexural strength means (in MPa) were analyzed statistically by analysis of variance and Tukey's test at 5% significance level. There were significant differences (p<0.01) among the resins Lucitone (89.439 +/- 7.962), Triplex (88.024 +/- 5.167) and QC-20 (83.379 +/- 7.153). No significant differences (p>0.05) were found either among the denture cleansers (Bony Plus = 87.693 +/- 6.943; Corega Tabs = 86.955 +/- 7.114; Efferdent Plus = 86.195 +/- 7.865 and control = 86.536 +/- 7.012) or between the soaking periods (15 min = 86.875 +/- 7.625 and 8 h = 87.432 +/- 7.355) throughout the soaking cycles simulating 30 days of use. No color alterations were identified by visual examination. The findings of this study showed that chemical denture cleansers used according to the manufacturers' specifications did not cause flexural strength alterations or color changes in heat-polymerized acrylic resins submitted to soaking cycles that simulated 30 days of use.

Self-reported oral hygiene practices among adults in Denmark.

OBJECTIVES: To assess the present level of oral hygiene practices in the Danish adult population aged 16 or above, in particular to analyse how self-care practices in terms of oral hygiene habits and cleaning of dentures are affected by socio-economic factors, dental status, actual dental visiting habits, and the experience of oral health care during school years. BASIC RESEARCH DESIGN AND PARTICIPANTS: A cross-sectional study of 5802 persons, randomly sampled amongst the Danish population aged 16 years or above. Data were collected by means of personal interviews and self-administered questionnaires. The response rate was 66%. RESULTS: Toothbrushing twice-a-day was reported by 68% of the dentates while 32% brushed their teeth once-a-day or less frequent. Daily use of toothpicks was reported by 28% while daily use of dental floss was reported by 11%. Oral hygiene habits were more frequent amongst women. Toothbrushing twice-a-day was related to regular dental visits, dental care during school years, and a high level of education. Daily use of toothpicks was more common among females and older persons. Regular dental visits, having 20 or more teeth in situ, and regular dental service through school years were predictors for daily use of toothpicks. Amongst denture wearers, one-third cleaned their dentures twice-a-day. Frequency of denture cleaning was significantly associated with gender, age, number of teeth left, and educational level. CONCLUSION: Intensive population-directed strategies for oral health education should be considered in order to further improve the oral hygiene practices of the entire population.

Assessment of plaque prevention on dentures using an experimental cleanser.

STATEMENT OF PROBLEM: Adequate plaque control is essential for the maintenance of a healthy oral mucosa. Denture cleansers are a popular method used by denture wearers for cleaning. The clinical effectiveness of a new cleanser in tablet form has not been tested in vivo. Methods used for the in vivo assessment of denture cleanser effectiveness are often not standardized. PURPOSE: The aims of this in vivo study were to develop a new method for assessing plaque levels on dentures by using digital imaging and to use this methodology, together with a validated visual scoring method, to evaluate plaque buildup on dentures. MATERIAL AND METHODS: Thirty-five subjects were randomized to 1 of 2 treatment groups: (1) dentures soaked in a new cleanser, or (2) dentures soaked in water. The treatment period lasted 14 days. Plaque was assessed at baseline and on days 2 and 14 by using digital image analysis and a visual scoring technique. Results were analyzed with ANOVA at the 95% confidence interval. RESULTS: The new cleanser showed a statistically significant reduction in mean visual plaque of 51% at day 2 (P = 0.0002) and 42% (P = 0.0014) at day 14 compared with water. Similar results were seen with digital imaging. CONCLUSION: The new denture cleanser proved to be effective at preventing plaque accumulation on dentures. The analysis of digital images gave similar results as the visual scoring method.

Assessment of a recently introduced fluoroelastomeric soft lining material.

The clinical usefulness of soft denture-lining materials is well established. This laboratory-based comparative study of a heat-processed silicone (Molloplast-B) and a recently introduced fluoroelastomeric soft lining material (Novus) evaluated absorption behaviour in distilled water; the softness of the materials at different thicknesses, both dry and after immersion in water; and their compatibility with denture cleansers. A significant absorption of water, greater than 5% by weight, was displayed by Novus after 4 months' immersion. The softness of different thicknesses of Novus (up to 1.35 mm) increased significantly upon immersion over the same period when compared to Molloplast-B, which showed no change. Some surface degradation of Novus was evident upon exposure to denture cleansers that was not apparent with Molloplast-B.

Assessment of antimicrobial treatment of denture stomatitis using an in vivo replica model system: therapeutic efficacy of an oral rinse.

Five denture stomatitis patients demonstrating Candida albicans on both maxillary dentures and palates volunteered to test the effects of Peridex oral rinse in treating their oral disease. They used Peridex rinse both as a mouthrinse and as a denture soak for a period of 24 days. Agar replicas of the tissue-fitting surfaces of the maxillary dentures revealed elimination of C. albicans. Significant decreases in palatal inflammation were also noted, although some inflammation was still evident. Several weeks after the termination of Peridex oral rinses, inflammation increased as concentrations of C. albicans on the denture surface returned to pretreatment levels. A marked similarity in the site-specific localization of this yeast species on the denture was noted before and after Peridex rinse treatment.