Clinical trial for evaluation of Ricinus communis and sodium hypochlorite as denture cleanser.

OBJECTIVE: This study evaluated Ricinus communis and sodium hypochlorite solutions in terms of biofilm removal ability, remission of candidiasis, antimicrobial activity, and participant satisfaction. MATERIAL AND METHODS: It was conducted a controlled clinical trial, randomized, double-blind, and crossover. Sixty-four denture wearers with (n=24) and without candidiasis (n=40) were instructed to brush (3 times/day) and immerse their dentures (20 min/day) in different storage solutions (S1 / S2: 0.25% / 0.5% sodium hypochlorite; S3: 10% R. communis; S4: Saline).The trial period for each solution was seven days and a washout period of seven days was used before starting the use of another solution. The variables were analyzed at baseline and after each trial period. The biofilm of inner surfaces of maxillary dentures was disclosed, photographed, and total and dyed areas were measured (Image Tool software). The percentage of biofilm was calculated. Remission of candidiasis was assessed by visual scale and score were attributed. Antimicrobial activity was assessed by the DNA-Checkerboard hybridization method. Patient satisfaction was measured using a questionnaire. RESULTS: S1 (4.41±7.98%) and S2 (2.93±5.23%) were more effective then S3 (6.95±10.93%) in biofilm remotion(P<0.0001). All solutions were different from the control (11.07±11.99%). S3 was the most effective solution in remission of candidiasis (50%), followed by S1 (46%). Concerning antimicrobial action, S1/S2 were similar and resulted in the lowest microorganism mean count (P=0.04), followed by S3. No significant differences were found with patient's satisfaction. CONCLUSIONS: 10% R. communis and 0.25% sodium hypochlorite were effective in biofilm removal, causing remission of candidiasis and reducing the formation of microbial colonies in denture surfaces. All solutions were approved by patients.

Clinical trial for evaluation of Ricinus communis and sodium hypochlorite as denture cleanser

Abstract The development of opportunistic infections due to poor denture hygiene conditions justified the search for effective hygiene protocols for controlling denture biofilm. Objective This study evaluated Ricinus communis and sodium hypochlorite solutions in terms of biofilm removal ability, remission of candidiasis, antimicrobial activity, and participant satisfaction. Material and Methods It was conducted a controlled clinical trial, randomized, double-blind, and crossover. Sixty-four denture wearers with (n=24) and without candidiasis (n=40) were instructed to brush (3 times/day) and immerse their dentures (20 min/day) in different storage solutions (S1 / S2: 0.25% / 0.5% sodium hypochlorite; S3: 10% R. communis; S4: Saline).The trial period for each solution was seven days and a washout period of seven days was used before starting the use of another solution. The variables were analyzed at baseline and after each trial period. The biofilm of inner surfaces of maxillary dentures was disclosed, photographed, and total and dyed areas were measured (Image Tool software). The percentage of biofilm was calculated. Remission of candidiasis was assessed by visual scale and score were attributed. Antimicrobial activity was assessed by the DNA-Checkerboard hybridization method. Patient satisfaction was measured using a questionnaire. Results S1 (4.41±7.98%) and S2 (2.93±5.23%) were more effective then S3 (6.95±10.93%) in biofilm remotion(P<0.0001). All solutions were different from the control (11.07±11.99%). S3 was the most effective solution in remission of candidiasis (50%), followed by S1 (46%). Concerning antimicrobial action, S1/S2 were similar and resulted in the lowest microorganism mean count (P=0.04), followed by S3. No significant differences were found with patient's satisfaction. Conclusions 10% R. communis and 0.25% sodium hypochlorite were effective in biofilm removal, causing remission of candidiasis and reducing the formation of microbial colonies in denture surfaces. All solutions were approved by patients.

Candida spp. in complete dentures of institutionalized elderly individuals / Candida spp. en prótesis dentales totales de personas mayores institucionalizadas

The objective of this study was to evaluate the prevalence of Candida spp. in complete dentures of institucionalized elderly, aged 60 or more, in a city of northeast of Brazil. A survey was conducted of the health profile and quantification of Candida spp. from isolation in Sabouraud agar. Our results showed that from 181 institutionalized elderlies, only 17 (66-84 years) met the inclusion criteria. 47.1 % were totally dependent, and 58.8 % needed help with hygiene. The most commonly used drugs were antihypertensive. The results showed a high prevalence of Candida spp. (64.5 %) in the dentures of institutionalized elderly and this may be a reflection of poor oral hygiene.

El objetivo fue asociar el uso de prótesis dentales totales y la prevalencia de Candida spp. en ancianos institucionalizados con 60 o más años de edad, en una ciudad del Nordeste de Brasil. Se llevó a cabo un estudio del perfil de salud y cuantificación de Candida spp. por aislamiento con agar Sabouraud. A partir de 181 ancianos institucionalizados, sólo 17 (66­84 años) cumplieron los criterios de inclusión. 47,1 % eran totalmente dependientes y 58,8 % necesitó ayuda con la higiene. Los fármacos más utilizados fueron antihipertensivos. Los resultados mostraron una alta prevalencia de Candida spp. (64,5 %) en las prótesis dentales totales de los ancianos institucionalizados y esto tal vez sea un reflejo de la deficiente higiene oral.

Influence of denture plaque biofilm on oral mucosal membrane in patients with chronic obstructive pulmonary disease.

Patients with chronic obstructive pulmonary disease (COPD) have the lower airways colonized with pathogenic bacteria in a stable period of the disease and during exacerbations. The etiology of bacterial exacerbations of COPD depends on the underlying disease, the frequency of exacerbations and antibiotic therapy. Microorganisms can be aspirated off the denture plaque biofilm into the lower respiratory tract and could reduce the patient's immunity and cause pneumonia. COPD patients, who are using acrylic dentures in oral cavity, are exposed to denture stomatitis and oral candidiasis. The aim of this study was to establish the composition of denture plaque biofilm and its impact on the oral mucosa in COPD patients. The study included patients in a stable phase of COPD using removable denture and the control group included healthy wearer's appliances. Examinations concerned the oral mucosal membrane and the hygienic condition of prosthetic restorations. Microbiological examinations were performed by taking a direct swab from the surface of acrylic dentures. Seventeen bacterial and fungal strains were isolated from denture plaque of COPD patients, which could be a reservoir of pathogens in the upper and lower airways. The results showed a greater frequency of prosthetic stomatitis complicated by mucosal infections among COPD patients compared to healthy subjects.

Crossover clinical trial of the influence of the use of adhesive on biofilm formation.

STATEMENT OF PROBLEM: Contrasting results have been reported regarding the influence of the use of adhesive on biofilm formation. PURPOSE: The purpose of this study was to evaluate the influence of the use of adhesive on the formation of biofilm on the internal surface of complete dentures and the palatal mucosa of denture wearers. MATERIAL AND METHODS: Thirty participants with well-fitting complete dentures were randomly divided according to the experimental design: protocol 1, adhesive use during the first 15 days, followed by no use of adhesive over the next 15 days; protocol 2, no use of adhesives during the first 15 days, followed by adhesive use over the next 15 days. After each period, material from the mucosa and intaglio of the maxillary dentures was collected. Replicate aliquots were plated onto Petri dishes containing selective media for Candida spp, Streptococcus mutans, and a nonselective culture medium. Colony-forming units were expressed as log (CFU+1)/mL. In addition, the internal surfaces of the maxillary and mandibular complete dentures were stained and photographed. From the photographs, the total internal surface and the surface stained with biofilm were quantified (software ImageTool 3.00), and the percentage of the biofilm-covered area (%) on the maxillary and mandibular dentures was calculated and compared with 2-way ANOVA. For the nonselective culture medium, data were compared with the paired-sample t test, and the Wilcoxon signed rank test was performed to compare the colony counts of Candida spp and Streptococcus mutans (α=.05). RESULTS: Similar colony counts were found with or without the use of adhesive for the mucosa and internal surfaces of maxillary dentures, irrespective of the culture medium (P>.05). The area of dentures covered with biofilm was influenced by the use of adhesive (P=.025), regardless of the type of denture (P=.121). CONCLUSIONS: The use of adhesive did not alter the colony counts of microorganisms from the palatal mucosa and maxillary dentures of complete denture wearers during the 15-day period, but it did influence the area covered with biofilm on the internal surfaces of the complete dentures.

Prevalence of Candida spp. associated with bacteria species on complete dentures.

OBJECTIVE: This study evaluated the prevalence of Candida spp., Streptococcus mutans and Staphylococcus aureus isolated from complete upper dentures. BACKGROUND: Factors that may increase the number of microorganisms in the oral cavity include denture-wearing and deficient denture hygiene. MATERIALS AND METHODS: Ninety denture wearers participated in this study. Collection of biological material from each denture was performed on all denture surfaces. Conventional biochemical methods were used to identify the microorganisms. Descriptive statistical analysis was performed on percentage data. RESULTS: Candida spp. were the most frequent microorganisms found on dentures (65.5%), while Strep. mutans and Staph. aureus were present in 53.3 and 34.4%, respectively. CONCLUSION: Candida species were the most frequent microorganisms on dentures, followed by Strep. mutans and Staph. aureus.

Colonisation of the oral cavity by periodontopathic bacteria in complete denture wearers.

OBJECTIVE: The purpose of this study was to investigate colonisation by periodontopathic bacteria and the sites of colonisation in elderly upper and lower complete denture wearers. We also investigated the relationship between level of oral hygiene and colonisation by periodontopathic bacteria. MATERIALS AND METHODS: Forty edentulous and 37 dentate volunteers participated in this study. Samples were collected from whole saliva, and levels of Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia and Fusobacterium nucleatum were determined by PCR Invader technology. Detection of these species on oral mucosal and denture surfaces was performed by PCR. Fisher's exact test was used for the statistical analysis. Cluster analysis was employed to investigate trends in the periodontopathic bacteria flora in each sampling area. RESULTS: Detection rates of periodontopathic bacteria in whole saliva were lower under edentulous conditions than under dentulous conditions, except for A. actinomycetemcomitans and F. nucleatum (p < 0.01). Detection rate of F. nucleatum was the highest in all areas. A positive correlation was observed between DNA quantification of P. gingivalis and number of Candida species in saliva. Cluster analysis of the test species identified two clusters. Tongue-coating status was associated with the detection rate of all periodontopathic bacteria investigated, and denture plaque status was associated with the detection rate of T. denticola and F. nucleatum. CONCLUSION: Results indicate the presence of periodontopathic bacteria under edentulous conditions and that the status of oral hygiene of the mucosal or denture surfaces affects colonisation by T. denticola and F. nucleatum.

In vivo biofilm formation on a soft denture liner in elderly patients with controlled diabetes.

OBJECTIVES: This in vivo study evaluated the influence of controlled diabetes on biofilm formation on a soft denture liner in elderly patients. BACKGROUND: Soft denture lining materials are more susceptible to microbial colonisation than denture base acrylic resins. Especially in the elderly, several predisposing factors may accumulate leading to an increased probability of biofilm development that may result in candidiasis, a significant clinical oral disease. MATERIALS AND METHODS: Volunteers wearing complete dentures were divided into two groups (n = 20): diabetic patients with controlled glycaemia, and healthy patients. In both groups, a silicone-based soft liner was placed in a recess created at the base of the maxillary dentures. Subjects cleaned the prosthesis three times a day. Biofilm formed on the liner was quantified at various time points (baseline, two, four and six weeks). Data were analysed by two-way repeated measures ANOVA and Tukey's test (α = 0.05). RESULTS: There was no statistical difference in biofilm formation for any of the time points between controlled diabetes patients and healthy patients. CONCLUSION: The results suggest that the control of diabetes in elderly patients provides the same levels of biofilm formation when compared to healthy individuals.

Examination of denture-cleaning methods based on the quantity of microorganisms adhering to a denture.

OBJECTIVES: To investigate effective denture-cleaning methods, we examined the relationships between the quantity of microorganisms adhering to dentures and the use of a denture brush and the frequency of use of a denture cleanser. SUBJECTS AND METHODS: Denture plaque was collected from the mucosal surface of the examined dentures, which were 142 and 80 upper and lower complete dentures, respectively, worn by 96 outpatients (mean age: 71.9 years) of a university hospital and 41 nursing home residents (mean age: 84.8 years). The collected microorganisms were counted in terms of isolated representative colonies that were cultured and identified using standard methods. The use of a denture brush, the frequency of use, and the type and soaking time of denture cleansers as denture-cleaning methods were surveyed. RESULTS: The quantity of microorganisms was significantly lower in dentures of denture brush users than in those of non-users in the outpatients (p < 0.01, Mann-Whitney U test). The quantity of microorganisms was significantly lower in the dentures of outpatients who used a denture cleanser daily or 3-4 times a week than in those who used one once or less per month and in the dentures of nursing home residents who used one daily than in those who used one at other frequencies (p < 0.05, Kruskal-Wallis test, followed by Dunn's Multiple Comparison test). CONCLUSION: Within the limitations of this study, it was concluded that the use of a denture brush and daily use of denture cleanser should be recommended to complete dentures wearers as denture-cleaning methods that effectively reduce the quantity of microorganisms adhering to dentures.

Denture stomatitis treated with photodynamic therapy: five cases.

OBJECTIVE: Photodynamic therapy (PDT) is an effective method for Candida spp. inactivation in vitro and in vivo, but as yet, no clinical trial has been conducted. This report describes 5 cases of denture stomatitis (DS) treated with PDT. STUDY DESIGN: Five subjects with clinical and microbiologic diagnosis of DS were submitted to 6 sessions of PDT 3 times a week for 15 days. In each session, patients' dentures and palates were sprayed with 500 mg/L Photogem, and, after 30 minutes of incubation, irradiated by light-emitting diode light source at 455 nm (37.5 and 122 J/cm(2), respectively). Cultures of Candida spp. from dentures and palates and standard photographs of the palates were taken at baseline (day 0), at the end of the treatment (day 15), and at follow-up time intervals (days 30 and 60). RESULTS: Four patients showed clinical resolution of DS (no inflammation) after PDT sessions, and only 1 subject demonstrated reduction in palatal inflammation. Recurrence of DS was observed in 2 patients during the follow-up period. CONCLUSIONS: PDT appears to be an alternative treatment for DS.

Avaliação clínica e microbiológica de prótese total deidosos em instituições assistenciais / Assessment clinical and microbiological of complete dentures in aged from health care institution

Introdução: O Brasil possui mais de sete milhões de idosos desdentados e a prótese totaldentária ainda é a principal forma de reabilitar esses indivíduos. O objetivo deste trabalhofoi avaliar clínica e microbiologicamente próteses totais usadas por idosos de instituiçõesassistenciais. Métodos - Foram avaliados 55 idosos, acima de 60 anos de idade, portadoresde prótese total superior. Foi utilizado um questionário para coleta de informações. Exameclínico do palato foi realizado para detecção de lesões inflamatórias, seguido de quantificaçãoda placa bacteriana visível e colheita de biofilme microbiano da região de palato da prótesetotal superior. As amostras de biofilme foram processadas para cultivo de leveduras do gêneroCandida. Resultados - O tempo de uso da prótese foi superior a 10 anos, com conservaçãoinsatisfatória. A higienização prevalente foi o uso de escova dental com dentifrício, comfrequência de três vezes ao dia, mas 56,4% das próteses apresentaram higienização precária.Lesões inflamatórias estavam presentes em 72,7% dos idosos e a colonização por Candidafoi detectada em 60% das próteses. O estudo das correlações revelou significância estatísticado padrão de higienização com a colonização de levedura e também com a presença de lesãono palato, enquanto o aumento no número de colônias de espécies de Candida correlacionou--se com lesões inflamatórias no palato. Conclusão - Os idosos são portadores de prótesesantigas e deterioradas, com higienização inadequada. As lesões inflamatórias fúngicas sãoprevalentes no palato. Faltam informações adequadas e programas de atendimento ao idosopara garantir melhores condições de saúde bucal.

Introduction: There are more than seven millions of completely edentulous aged in Braziland complete dentures are still the main way of rehabilitating these individuals. The purposeof this study was to appraise clinically and microbiologically complete dentures in aged fromhealth care institutions. Methods - 55 aged have been evaluated, over 60 years old, usingupper complete dentures. Questionnaire is used for take information about patients. Palateclinical examinations were made in order to detect de inflammatory lesions, in accordancewith the quantification of the visible bacterial plaque and collection of microbial biofilmof the palate region from upper complete denture. The biofilm samples were processed forcultivation of yeasts of Candida. Results - Used time of the prosthesis was above 10 years,which presented an unpleasant state of conservation. The common form of hygienization wasthe toothbrush with dentifrice, with frequency of three times a day, but 56,4% of the prosthesispresented precarious hygienization. The inflammatory lesions were present in 72,7% ofthe aged and the colonization by Candida was detected in 60% of the prosthesis. The studyof the correlations revealed statistical significance of the hygienization pattern along withthe colonization of yeasts and also with the presence of inflammatory lesions in the palate.Conclusion - The aged are users of old and damaged prosthesis, with inadequate hygienization.The colonization of Candida is prevalent, as well as the inflammatory lesions. Thereis a lack of appropriate information and assisting programs to aged in order to guaranteebetter mouth health conditions.

Inflammatory papillary hyperplasia of the palate: quantitative analysis of candida albicans and its negative correlation with microscopic and demographic aspects.

Inflammatory papillary hyperplasia of the palate (IPHP) is a tissue-reactive overgrowth characterized by hyperemic mucosa with nodular or papillary appearance in the palate. The exact pathogenesis is still unclear. In this study, the presence of Candida albicans in the epithelial lining was evaluated using the indirect immunofluorescence staining technique. Strongly stained C albicans was observed only in the lesions of the IPHP group. Therefore, the detection of C albicans in almost all samples from IPHP tissue enabled a suggestion as to the microbial etiology of the disease, since the use of dental prostheses was reported.

Prevalence of mutans streptococci isolated from complete dentures and their susceptibility to mouthrinses.

The aims of this study were to evaluate the incidence of mutans streptococci (MS - sessile form) on complete maxillary dentures after use of a specific denture paste, and to determine the minimum inhibitory concentration (MIC) and maximum inhibitory dilution (MID) of 3 oral mouthrinses: Cepacol, Plax and Periogard. Seventy-seven complete denture wearers were randomly assigned into 2 groups, according to the product used for denture cleaning: Control group - conventional dentifrice (Kolynos-Super White); and Test group: experimental denture cleaning paste. Denture biofilm was collected at baseline and after 90 and 180 days after treatment by brushing the dentures with saline solution. After decimal serial dilution, samples were seeded onto agar sucrose bacitracin to count colonies with morphological characteristics of MS. MS identification was performed by the sugar fermentation tests. After this procedure, brain heart infusion broth (BHI) was added to oral mouthrinses (Plax, Cepacol e Periogard) and seeded on Petri dishes. The colonies were seeded using the Steers multiplier and, after the incubation, the MIC and MID of the mouthrinses were calculated. The results showed an incidence of 74.0% (n=57) of MS in the 77 complete dentures examined in the study, being 76.3% (n=29) of the Control group (conventional dentifrice) and 71.8% (28) of the Test group (experimental denture cleaning paste). In both groups, the number of positive cases for MS decreased from day 0 to day 180. In the Test group there was a slight decrease in the incidence of Streptococcus mutans 90 days after use of the experimental denture cleaning paste, which was not observed in the Control group. As regards to mouthrinses, for both groups, Periogard showed antimicrobial action with the highest dilution, followed by Cepacol and Plax. In conclusion, the incidence of MS in complete dentures was high and Periogard was the mouthrinse with the strongest antimicrobial action against MS. The experimental denture cleaning paste showed a slight action against S. mutans after 90 days of treatment.

Effect of a denture cleanser on the concentration of volatile sulphur compounds and denture biofilm in institutionalised elderly.

OBJECTIVE: To determine the effectiveness of a denture cleanser in reducing the concentration of volatile sulphur compounds (VSC) and its antimicrobial action. BACKGROUND: Micro-organisms from the denture biofilm can cause local and systemic disease and halitosis. Denture cleansers are important adjuncts in oral care, but there is limited investigation on their effect in malodour compounds. MATERIAL AND METHODS: Nineteen institutionalised elderly who wore at least an upper denture were selected; their VSC concentrations were measured and the denture biofilm was collected. In phase 1, the subjects wore their old denture and data were collected before (B0) and after 7(A1), 14(A2), 28(A3) days of continuous daily use of the denture cleanser. In phase 2, new dentures were inserted and measurements were made at 30(A1.1), 60(A2.2), 90(A3.3) days of treatment. RESULTS: The VSC concentration increased from B0 to A1 (p<0.05), but no differences were found for the others intervals of times. Total micro-organism data did not show a statistical difference between times in Phase I, but in Phase II, there was a statistical difference (p<0.05) and a progressive re-colonisation was observed. CONCLUSION: Within the limits of this study, it was concluded that the denture cleanser had no antimicrobial effect and VSC levels were not reduced.

Produção de citocinas pelos monócitos de idosos com estomatite protética associada a Candida / Cytokine production by monocytes from elderly patients with Candida-associated denture stomatitis

Estomatite protética associada a Cândida (EPC), a lesão mais frequente em usuários de próteses removíveis, principalmente os idosos, caracteriza-se por uma inflamação da mucosa bucal que suporta a prótese. Está fortemente associada com Candida Albicans, bem como com fatores locais e sistêmicos, como a deficiência da resposta imune. Os monócitos são importantes na resposta protetora contra o fungo, produzindo citocinas que recrutam e ativam leucócitos. Existem alterações funcionais dessas células com o avanço da idade. Não foi possível encontrar na literatura dados referentes à função imunomodulatória dos monócitos de idosos com EPC. O presente trabalho pretendeu avaliar a produção de citocinas por essas células, estimuladas in vitro com C. albicans, obtidas do sangue periférico de idosos usuários de prótese total superior (PTS) com EPC, comparando-se com idosos usuários de PTS sem EPC, e com idosos e jovens não usuários de PTS. Os monócitos isolados foram cultivados em placas de cultura de 24 poços, na ausência ou presença de lipopolissacarídeo (LPS) ou C. albicans ATCC 90028 morta pelo calor. Após 18 horas, o sobrenadante foi coletado e submetido ao ensaio de imunoabsorção por ligação enzimática (ELISA) para dosagem das citocinas pró- inflamatórias fator de necrose tumoral- (TNF-), interleucina-6 (IL-6), IL-1, CXCL8 e proteína quimiotática de monócito (MCP-1), e anti-inflamatórias IL-10 e fator transformador de crescimento- (TGF-). Os resultados estão expressos como média ± desvio padrão dos valores obtidos para cada grupo, e foram analisados por meio de testes estatísticos não-paramétricos. Valores de p<0,05 foram considerados estatisticamente significativos. Os resultados demonstraram, de uma forma geral, alterações nos monócitos oriundos dos idosos com EPC, em comparação aos outros grupos: menor produção espontânea de CXCL8 e de MCP-1; menores níveis de TNF-, de IL-6, de IL-1, de CXCL8, de MCP-1 e de IL-10, após estímulo com LPS; e menor...

Candida-associated denture stomatitis (DS), the most frequent lesion among denture wearers, especially the elderly, is characterized by inflammation of the denture-bearing mucosa. It is strongly associated with Candida albicans, as well as with local and systemic factors, such as impaired immune response. Monocytes are important in the protective immune response against the fungus, by the production of cytokines that recruit and activate leukocytes. There are functional changes of these cells with advancing age. No data were found in the literature concerning the immunomodulatory function of these phagocytes in elderly patients with DS. This study aimed to evaluate the cytokine production by monocytes, challenged in vitro with C. albicans, obtained from peripheral blood of elderly denture wearers with DS, compared with elderly denture wearers without DS and elderly and young non-denture wearers. The isolated monocytes were cultivated in 24-well flat-bottomed culture plates, in the absence or presence of lipopolysaccharide (LPS) or heat-killed C.albicans ATCC 90028. After 18 hours, the supernatant was collected and submitted to the enzyme-linked immunosorbent assay (ELISA) for determination of the pro-inflammatory cytokines tumor necrosis factor-alpha (TNF-), interleukin-6 (IL-6), CXCL8, IL-1, monocyte chemotactic protein-1 (MCP-1) and anti-inflammatory cytokines IL-10 and transforming growth factor- (TGF-). The results are expressed as mean ± standard deviation of the values obtained for each group, and were analyzed using nonparametric statistical tests; p values <0.05 were considered statistically significant. The results demonstrated, in general, changes in monocytes from the elderly with DS, as compared to other groups: lower spontaneous production of CXCL8 and MCP-1; lower levels of TNF-, IL-6, IL-1, CXCL8, MCP-1 and IL-10 after stimulation with LPS; and reduced production of TNF- and IL-6 after stimulation with C. albicans. Comparing...

Prevalence of mutans streptococci isolated from complete dentures and their susceptibility to mouthrinses

The aims of this study were to evaluate the incidence of mutans streptococci (MS - sessile form) on complete maxillary dentures after use of a specific denture paste, and to determine the minimum inhibitory concentration (MIC) and maximum inhibitory dilution (MID) of 3 oral mouthrinses: Cepacol, Plax and Periogard. Seventy-seven complete denture wearers were randomly assigned into 2 groups, according to the product used for denture cleaning: Control group - conventional dentifrice (Kolynos-Super White); and Test group: experimental denture cleaning paste. Denture biofilm was collected at baseline and after 90 and 180 days after treatment by brushing the dentures with saline solution. After decimal serial dilution, samples were seeded onto agar sucrose bacitracin to count colonies with morphological characteristics of MS. MS identification was performed by the sugar fermentation tests. After this procedure, brain heart infusion broth (BHI) was added to oral mouthrinses (Plax, Cepacol e Periogard) and seeded on Petri dishes. The colonies were seeded using the Steers multiplier and, after the incubation, the MIC and MID of the mouthrinses were calculated. The results showed an incidence of 74.0 percent (n=57) of MS in the 77 complete dentures examined in the study, being 76.3 percent (n=29) of the Control group (conventional dentifrice) and 71.8 percent (28) of the Test group (experimental denture cleaning paste). In both groups, the number of positive cases for MS decreased from day 0 to day 180. In the Test group there was a slight decrease in the incidence of Streptococcus mutans 90 days after use of the experimental denture cleaning paste, which was not observed in the Control group. As regards to mouthrinses, for both groups, Periogard showed antimicrobial action with the highest dilution, followed by Cepacol and Plax. In conclusion, the incidence of MS in complete dentures was high and Periogard was the mouthrinse with the strongest antimicrobial action against MS. The experimental denture cleaning paste showed a slight action against S. mutans after 90 days of treatment.

O objetivo deste estudo foi avaliar a incidência de estreptococos do grupo mutans (forma séssil) de próteses totais superiores após o uso de uma pasta específica para higienização de próteses totais, bem como determinar a concentração inibitória mínima (CIM) e diluição inibitória máxima (DIM) de 3 enxaguatórios bucais: Cepacol, Plax e Periogard. Setenta e sete usuários de próteses totais foram distribuídos em 2 grupos: (A) grupo Controle: dentifrício convencional (Kolynos Super Branco) e (B) grupo Teste: pasta experimental para higiene de próteses (1). O biofilme das próteses foi coletado no início e após 90 e 180 dias dos tratamentos, por meio de escovação das próteses com solução salina. Após a diluição decimal seriada, as amostras foram semeadas em agar sacarose bacitracina para a contagem de colônias características de estreptococos do grupo mutans. A identificação dos estreptococos do grupo mutans foi realizada por meio de testes de fermentação de açúcares. Após este procedimento, o caldo de infusão de cérebro e coração (BHI) foi adicionado aos antissépticos (Plax, Cepacol e Periogard) e semeado em placas de Petri. As colônias foram semeadas usando o mutiplicador de Steers e após a incubação, a concentração inibitória mínima e a concentração inibitória máxima dos enxaguatórios foram calculadas. Os resultados mostraram que a incidência de estreptococos do grupo mutans nas 77 próteses totais examinadas foi de 74,0 por cento (n=57), sendo 76,3 por cento (n=29) do grupo Controle (pasta convencional) e 71,8 por cento (n=28) do grupo Teste (pasta experimental). Em ambos os grupos, o número de casos positivos para estreptococos do grupo mutans diminuiu, do início (0 dias) para 180 dias. Houve uma pequena diminuição da incidência de Streptococcus mutans após 90 dias do uso da pasta experimental, o que não foi observado no grupo controle. Com relação aos enxaguatórios, para ambos os grupos, o Periogard apresentou atividade antimicrobiana com diluições maiores, seguido do Cepacol e Plax. Pôde-se concluir que a incidência de estreptococos do grupo mutans em próteses totais foi elevada e que o Periogard foi o enxaguatório com melhor ação antimicrobiana contra os estreptococos do grupo mutans. A pasta experimental mostrou uma pequena ação contra S. mutans após 90 dias de tratamento.

In vivo efficacy of alkaline peroxide tablets and mouthwashes on Candida albicans in patients with denture stomatitis.

OBJECTIVE: Effective cleaning of dentures is important for the maintenance of good oral hygiene for denture stomatitis patients. The in vivo efficacy of three different brands of alkaline peroxide tablets (Polident, Efferdent, and Fittydent) and two mouthwashes (CloSYS II and Corsodyl) to eliminate Candida albicans on dentures was evaluated in this in vivo study. MATERIAL AND METHODS: Ninety denture wearers with clinical evidence of denture stomatitis were randomly divided into 5 test groups and 1 control group. Each group was further divided into three subgroups in which the dentures were subjected to 15-, 30-, and 60-min disinfection procedures. The dentures of each test group were treated with one of the cleaners, while those of the control group were treated with distilled water. Swab samples from the palatal surfaces (2 cm x 2 cm template delimited area) of the upper dentures were obtained before and after 15, 30, and 60 min periods of cleaner use and examined mycologically. RESULTS: The reduction in the number of colony-forming units (CFU) of C. albicans before, and after 15, 30, and 60 min of use of CloSYS II and Corsodyl was significantly greater than that of the control group (p<0.05). Moreover, there was no statistically significant difference (p>0.05) among Polident, Efferdent and the control group in any of the treatment periods. Dentures treated with Fittydent appeared to have a significantly greater reduction in the number of Candida spp. only after 60 min of treatment. CONCLUSIONS: The results of this study showed that the use of mouthwashes significantly reduced the number of microorganisms on dentures.

Non-oral bifidobacteria and the aciduric microbiota of the denture plaque biofilm.

The microbiota of the denture plaque biofilm colonizing the fitting surface of dentures in edentulous subjects with healthy palates (n = 20) and in edentulous subjects with denture stomatitis (n = 20) was studied. The numbers of bacteria colonizing the dentures of healthy subjects was significantly less than the numbers colonizing the dentures of stomatitis subjects. The proportions and frequency of isolation of mutans streptococci, lactobacilli, bifidobacteria and yeasts were significantly (P < 0.05) greater in the subjects with denture stomatitis. The proportions of these organisms in the denture plaque biofilm of the subjects with denture stomatitis were similar to those found in carious lesions, indicating that the site is a low pH environment. The predominant bifidobacterial species in the mouths of dentate subjects is Bifidobacterium dentium but in the edentulous subjects wearing dentures B. dentium was isolated from only one of the 20 subjects with denture stomatitis and from none of the 20 subjects with healthy palates. Instead, Bifidobacterium breve, Bifidobacterium scardovii and Bifidobacterium longum subsp. longum were isolated. Only a single non-oral bifidobacterial species was isolated from each individual and repetitive extragenic palindromic- and BOX-polymerase chain reaction typing methods indicated that the same genotypes were shared between subjects. Using deferred antagonism spot plate assays, interspecies inhibition was demonstrated between oral isolates of B. dentium, B. breve, B. scardovii and B. longum subsp. longum. Here we have shown that bifidobacteria and caries-associated microbiota are present in denture plaque at levels similar to those of carious lesions and B. dentium cannot be maintained in an edentulous mouth.

In vivo efficacy of alkaline peroxide tablets and mouthwashes on Candida albicans in patients with denture stomatitis

OBJECTIVE: Effective cleaning of dentures is important for the maintenance of good oral hygiene for denture stomatitis patients. The in vivo efficacy of three different brands of alkaline peroxide tablets (Polident, Efferdent, and Fittydent) and two mouthwashes (CloSYS II and Corsodyl) to eliminate Candida albicans on dentures was evaluated in this in vivo study. MATERIAL AND METHODS: Ninety denture wearers with clinical evidence of denture stomatitis were randomly divided into 5 test groups and 1 control group. Each group was further divided into three subgroups in which the dentures were subjected to 15-, 30-, and 60-min disinfection procedures. The dentures of each test group were treated with one of the cleaners, while those of the control group were treated with distilled water. Swab samples from the palatal surfaces (2 cm x 2 cm template delimited area) of the upper dentures were obtained before and after 15, 30, and 60 min periods of cleaner use and examined mycologically. RESULTS: The reduction in the number of colony-forming units (CFU) of C. albicans before, and after 15, 30, and 60 min of use of CloSYS II and Corsodyl was significantly greater than that of the control group (p<0.05). Moreover, there was no statistically significant difference (p>0.05) among Polident, Efferdent and the control group in any of the treatment periods. Dentures treated with Fittydent appeared to have a significantly greater reduction in the number of Candida spp. only after 60 min of treatment. CONCLUSIONS: The results of this study showed that the use of mouthwashes significantly reduced the number of microorganisms on dentures.

Evaluation of three indices for biofilm accumulation on complete dentures.

OBJECTIVES: The objective of this study was to evaluate the accuracy and reproducibility of three complete denture biofilm indices (Prosthesis Hygiene Index; Jeganathan et al. Index; Budtz-Jørgensen Index) by means of a computerised comparison method. BACKGROUND: Clinical studies into denture hygiene have employed a large number of biofilm indices among their outcome variables. However, the knowledge about the validity of these indices is still scarce. MATERIALS AND METHODS: Sixty-two complete denture wearers were selected. The internal surfaces of the upper complete dentures were stained (5% erythrosine) and photographed. The slides were projected on paper, and the biofilm indices were applied over the photos by means of a scoring method. For the computerised method, the areas (total and biofilm-covered) were measured by dedicated software (Image Tool). In addition, to compare the results of the computerised method and Prosthetic Hygiene Index, a new scoring scale (including four and five graded) was introduced. For the Jeganathan et al. and Budtz-Jørgensen indices, the original scales were used. Values for each index were compared with the computerised method by the Friedman test. Their reproducibility was measured by means of weighed kappa. Significance for both tests was set at 0.05. RESULTS: The indices tested provided similar mean measures but they tended to overestimate biofilm coverage when compared with the computerised method (p < 0.001). Agreement between the Prosthesis Hygiene Index and the computerised method was not significant, regardless of the scale used. Jeghanathan et al. Index showed weak agreement, and consistent results were found for Budtz-Jorgensen Index (kappa = 0.19 and 0.39 respectively). CONCLUSION: Assessment of accuracy for the biofilm indices showed instrument bias that was similar among the tested methods. Weak inter-instrument reproducibility was found for the indices, except for the Budtz-Jørgensen Index. This should be the method of choice for clinical studies when more sophisticated approaches are not possible.