Prevention and treatment of Candida colonization on denture liners: a systematic review.

ABSTRACT

STATEMENT OF PROBLEM: Denture liners are well known for their poor physical properties that favor the accumulation of plaque and colonization by Candida species, which can irritate the oral tissues and lead to denture stomatitis. PURPOSE: A systematic review was conducted to determine the feasibility of a prevention protocol for Candida colonization in denture liners and an effective treatment after the fungi has colonized the material. MATERIAL AND METHODS: Clinical and in vitro investigations that assessed the treatment and/or prevention of Candida colonization and biofilm formation in denture liners were selected according to the PRISMA statement. Seven electronic databases were searched from 1950 to April 2012 with the keywords "denture liner" OR "reline*" OR "tissue conditioner" AND "Candida" OR "denture stomatitis" OR "oral candidiasis" OR "antifungal agents" OR "denture clean*". RESULTS: The incorporation of nystatin (in general, 500 000 units) into tissue conditioners to prevent the onset of the disease and immersion in sodium hypochlorite for disinfection were the methods most often described in this systematic review, and both methods were able to prevent or inhibit Candida colonization, depending on their concentrations. The 0.5% sodium hypochlorite concentration can disinfect tissue conditioners and denture liners. Microwave irradiation has also been described an alternative method of disinfection. Because of a lack of standardized results (especially with regard to the method used to perform microbial counts), a meta-analysis could not be performed. CONCLUSIONS: The literature suggests that the use of 0.5% sodium hypochlorite can help disinfect denture liners and tissue conditioners. The incorporation of nystatin in those materials is also able to treat or prevent oral candidiasis. However, as most of the studies were in vitro, there is insufficient reliable evidence to truly provide recommendations regarding the ideal cleaning method or whether the addition of antifungal agents is worthwhile. Well-designed randomized controlled trials are needed to provide answers to these questions.