Anti-biofilm effectiveness of protocols for cleaning complete dentures in hospitalized patients: a randomized controlled trial.

BACKGROUND: Denture biofilm acts as a potential reservoir for respiratory pathogens, considerably increasing the risk of lung infections, specifically aspiration pneumonia, mainly 48h after hospital admission. The establishment of a straightforward, affordable, and applicable hygiene protocol in a hospital environment for the effective control of denture biofilm can be particularly useful to prevent respiratory infections or reduce the course of established lung disease. OBJECTIVES: To evaluate the anti-biofilm effectiveness of denture cleaning protocols in hospitalized patients. METHODOLOGY: The maxillary complete dentures (MCDs) of 340 hospitalized participants were randomly cleaned once using one of the following 17 protocols (n=20): brushing with distilled water, toothpaste, or neutral liquid soap (controls); immersion in chemical solutions (1% sodium hypochlorite, alkaline peroxide, 0.12% or 2% chlorhexidine digluconate), or microwave irradiation (650 W for 3 min) combined or not with brushing. Before and after the application of the protocols, the biofilm of the intaglio surface of the MCDs was evaluated using two methods: denture biofilm coverage area (%) and microbiological quantitative cultures on blood agar and Sabouraud Dextrose Agar (CFU/mL). Data were subjected to the Wilcoxon and Kruskal-Wallis tests (α=0.05). RESULTS: All 17 protocols significantly reduced the percentage area of denture biofilm and microbial and fungal load (P<0.05). The highest percentage reductions in the area of denture biofilm were observed for 1% hypochlorite solution with or without brushing and for 2% chlorhexidine solution and microwave irradiation only in association with brushing (P<0.05). The greatest reductions in microbial and fungal load were found for the groups that used solutions of 2% chlorhexidine and 1% hypochlorite and microwave irradiation, regardless of the association with brushing (P<0.05). CONCLUSIONS: A single immersion for 10 min in 1% sodium hypochlorite, even in the absence of brushing, proved to be a straightforward, rapid, low-cost, and effective protocol for cleaning the dentures of hospitalized patients.

Mucoadhesive delivery systems for oral candidiasis treatment: A systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the clinical and mycological effectiveness of mucoadhesives as vehicles for drugs or natural products in the treatment of oral candidiasis. MATERIALS AND METHODS: The search for articles was carried out in the Medline/PubMed, SCOPUS, EMBASE, Web of Science, Cochrane Library, and SciELO databases before August 2023. We selected the studies, extracted the data, evaluated the study quality, graded the evidence, performed the risk of bias, and carried out meta-analysis. RESULTS: A total of 389 potentially relevant articles were identified, and 11 studies (1869 participants) met the inclusion criteria of the systematic review. The overall risk of bias was considered low. The most common presentation of mucoadhesives was tablets, with miconazole being the most frequently drug used in the delivery system. Mucoadhesives demonstrated comparable efficacy with topical or systemic antifungal agents, with no significant differences between treatments in terms of clinical (RR = 0.907; 95CI = 0.3-1.297; p = 0.591; I2 = 64.648) or mycological (RR = 0.95; 95CI = 0.667-1.360; p = 0.789; I2 = 73.271) efficacy. CONCLUSIONS: Mucoadhesives may be a suitable alternative to conventional treatments, with the advantage of reducing the frequency of application by up to 5 times and the daily dosage by up to 20 times.

Anti-Candida activity and in vitro toxicity screening of antifungals complexed with ß-cyclodextrin.

The emergence of resistant fungal species and the toxicity of currently available antifungal drugs are relevant issues that require special consideration. Cyclodextrins inclusion complexes could optimize the antimicrobial activity of such drugs and create a controlled release system with few side effects. This study aimed to assess the in vitro toxicity and antifungal effectiveness of nystatin (Nys) and chlorhexidine (Chx) complexed or not with ß-cyclodextrin (ßCD). First, a drug toxicity screening was performed through the Artemia salina bioassay. Then, the minimum inhibitory concentrations (MICs) against Candida albicans were determined with the broth microdilution test. After MICs determination, the cytotoxicity of the drugs was evaluated through the methyl-thiazolyl-tetrazolium (MTT) and neutral red (NR) assays and through cell morphology analysis. The PROBIT analysis was used to determine the median lethal concentration (LC50), and the cell viability values were submitted to one-way analysis of variance(ANOVA)/Tukey (α = 0.05). Overall, the ßCD-complexed antifungals were less toxic against A. salina than their raw forms, suggesting that inclusion complexes can reduce the toxicity of drugs. The MICs obtained were as follows: Nys 0.5 mg/L; Nys:ßCD 4 mg/L; Chx 4 mg/L; and Chx:ßCD 8 mg/L. Chx showed significant cytotoxicity (MTT: 12.9 ± 9.6%; NR: 10.6 ± 12.5%) and promoted important morphological changes. Cells exposed to the other drugs showed viability above 70% with no cellular damage. These results suggest that antifungals complexed with ßCD might be a biocompatible option for the treatment of Candida-related infections.

Anti-biofilm effectiveness of protocols for cleaning complete dentures in hospitalized patients: a randomized controlled trial

Abstract Denture biofilm acts as a potential reservoir for respiratory pathogens, considerably increasing the risk of lung infections, specifically aspiration pneumonia, mainly 48h after hospital admission. The establishment of a straightforward, affordable, and applicable hygiene protocol in a hospital environment for the effective control of denture biofilm can be particularly useful to prevent respiratory infections or reduce the course of established lung disease. Objectives To evaluate the anti-biofilm effectiveness of denture cleaning protocols in hospitalized patients. Methodology The maxillary complete dentures (MCDs) of 340 hospitalized participants were randomly cleaned once using one of the following 17 protocols (n=20): brushing with distilled water, toothpaste, or neutral liquid soap (controls); immersion in chemical solutions (1% sodium hypochlorite, alkaline peroxide, 0.12% or 2% chlorhexidine digluconate), or microwave irradiation (650 W for 3 min) combined or not with brushing. Before and after the application of the protocols, the biofilm of the intaglio surface of the MCDs was evaluated using two methods: denture biofilm coverage area (%) and microbiological quantitative cultures on blood agar and Sabouraud Dextrose Agar (CFU/mL). Data were subjected to the Wilcoxon and Kruskal-Wallis tests (α=0.05). Results All 17 protocols significantly reduced the percentage area of denture biofilm and microbial and fungal load (P<0.05). The highest percentage reductions in the area of denture biofilm were observed for 1% hypochlorite solution with or without brushing and for 2% chlorhexidine solution and microwave irradiation only in association with brushing (P<0.05). The greatest reductions in microbial and fungal load were found for the groups that used solutions of 2% chlorhexidine and 1% hypochlorite and microwave irradiation, regardless of the association with brushing (P<0.05). Conclusions A single immersion for 10 min in 1% sodium hypochlorite, even in the absence of brushing, proved to be a straightforward, rapid, low-cost, and effective protocol for cleaning the dentures of hospitalized patients.

What is the Best Tooth-Supported Attachment System for Distal-Extension Removable Partial Dentures? A Systematic Review with Meta-Analysis.

PURPOSE: To evaluate the published literature on tooth-tissue supported removable partial dentures (RPDs) and determine the attachment system that provides the best clinical outcome. MATERIALS AND METHODS: A comprehensive search of studies published up to November 2021 was performed in the PubMed/MEDLINE, Web of Science, and Cochrane Library databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The study protocol was approved and was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42021268449). The PICO question was, "What is the best attachment system used in Kennedy class I and II removable partial dentures?" RESULTS: The search identified 871 articles, of which 21 met the inclusion criteria. The evaluation period in the studies ranged from 3 to 282 months. A total of 1,357 patients were included, of which 526 used prostheses with attachments. The mini SG attachment (extracoronal) was the most commonly used attachment, and the survival rate ranged from 37% to 98.1% in 10 studies, with no significant differences between the systems. Among the 10 studies selected for quantitative analysis, the meta-analysis revealed an overall failure rate of 16.6% (95% confidence interval: 10.4-25.4%), and heterogeneity of I²=65.725 (Q-value: 26.258, P=.002). CONCLUSION: Clinical studies comparing different attachment systems for rehabilitation are lacking. Our findings suggest that attachment-retained RPDs have good retention and better esthetics than conventional RPDs and that the extracoronal attachment system is the most viable choice for treatment at the free end.

Effect of simulated brushing with dentifrices on surface roughness and the mass loss of acrylic resin: A systematic review and meta-analysis of in vitro studies.

STATEMENT OF PROBLEM: Brushing with dentifrice is the most commonly used denture cleaning method. However, it can result in the mass loss of acrylic resin and an increase in surface roughness, which favors the adherence of microorganisms. PURPOSE: The purpose of this systematic review and meta-analysis of in vitro studies was to assess the influence of simulated brushing by using dentifrices and water on surface roughness and the mass loss of acrylic resins. MATERIAL AND METHODS: Searches were performed in PubMed, Scopus, Web of Science, Lilacs, Embase, Open Gray, and Google Scholar databases in September 2022. The study selection process, data extraction, and risk of bias analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol of this systematic review was registered in the Open Science Framework (DOI number 10.17605/OSF.IO/QD4GH). Meta-analysis was performed by using a random effects model (α=.05) in the RevMan (Cochrane Collaboration) software program. RESULTS: A total of 14 studies were included in the qualitative synthesis and 2 studies in the quantitative synthesis. The manual toothbrush was the most analyzed (n=9), followed by the electric toothbrush (n=5) and denture brush (n=1). Denture base resin (n=8) was evaluated more than acrylic resin for the abrasiveness of toothpaste (n=6). Most studies used conventional toothpaste (n=12), whereas 6 used specific dentifrices. The period of brushing corresponding to 1 year was the most predominant (n=6). Surface roughness (n=13) was evaluated more than mass loss (n=4). In general, dentifrices resulted in greater surface roughness than water. According to meta-analysis results, brushing by using dentifrices reported higher mass loss values than brushing with distilled water (P<.05). CONCLUSIONS: Brushing acrylic resins with dentifrice was more abrasive than brushing with water.

Reabilitação oral com próteses parciais removíveis após restabelecimento de dimensão vertical de oclusão e tratamento multidisciplinar: relato de caso / Oral rehabilitation with removable partial dentures after restoration of the vertical dimension of occlusion and multidisciplinary treatment: case report

As próteses parciais removíveis (PPRs) são uma alternativa de tratamento viável na prática clínica para reabilitar arcos parcialmente desdentados. Entretanto, o planejamento dessas próteses e preparo bucal prévio são frequentemente negligenciados. O presente artigo tem como objetivo relatar o caso clínico de uma reabilitação oral com PPRs superior e inferior após abordagem multidisciplinar, de modo a enfatizar as fases de um planejamento criterioso e de preparo prévio dos dentes pilares, visando o sucesso e a longevidade da reabilitação. Paciente do sexo masculino de 57 anos de idade compareceu à clínica da Faculdade de Odontologia de Bauru, Universidade de São Paulo, queixando-se da estética de seu sorriso e de algumas ausências dentárias. O indivíduo utilizava uma PPR provisória inferior insatisfatória e apresentava perda de dimensão vertical de oclusão (DVO). Após o exame clínico, radiográfico e estudo do caso em articulador semi-ajustável, realizou-se o planejamento com abordagens restauradoras, endodônticas, periodontais e protéticas. Após tratamento periodontal, foi realizada endodontia dos elementos 12, 15 e 47, confecção de núcleos e coroas nos dentes 12 e 15, restauração a nível gengival para apoio residual no dente 47, restaurações nos dentes 11, 13, 22, 24 e 44 e, por fim, a confecção das PPRs superior e inferior. A abordagem multidisciplinar utilizada neste caso clínico viabilizou o restabelecimento da DVO e possibilitou o sucesso da reabilitação protética(AU)

Removable partial dentures (RPDs) are a viable treatment alternative in clinical practice to rehabilitate partially edentulous arches. However, the planning of these dentures and prior oral preparation are often neglected. This article aims to report the clinical case of an oral rehabilitation with upper and lower RPDs after a multidisciplinary approach, to emphasize the phases of careful planning and prior preparation of the abutment teeth, aiming at the success and longevity of the rehabilitation. A 57-year-old male patient came to the clinic of the Bauru School of Dentistry, University of São Paulo, complaining about the esthetics of his smile and some missing teeth. The subject was using an unsatisfactory lower provisional prosthesis and had a loss of vertical dimension of occlusion (OVD). After the clinical and radiographic examination and the case study in a semi-adjustable articulator, planning was carried out with restorative, endodontic, periodontal and prosthetic approaches. After periodontal treatment, endodontics were performed on elements 12, 15 and 47, creation of cores and crowns on teeth 12 and 15, restoration at the gingival level for residual support on tooth 47, restorations on teeth 11, 13, 22, 24 and 44 and, finally, the making of the upper and lower PPRs. The multidisciplinary approach used in this clinical case enabled the restoration of the OVD and enabled the success of the oral rehabilitation(AU)

Characterization and antifungal activity of chlorhexidine:ß-cyclodextrin inclusion complexes.

Aim: This study aimed to develop, characterize and analyze the antifungal activity of chlorhexidine:ß-cyclodextrin inclusion complexes (Chx:ßCD). Materials & methods: Chx:ßCD were characterized by physicochemical techniques and the susceptibility of nine Candida strains was assessed. The inhibition of Candida albicans biofilm growth was evaluated in a denture material modified with the incorporation of Chx:ßCD. Results: Chx was better complexed in 1:2 molar ratio by freeze-drying. Chx:ßCD presented antifungal activity against all Candida strains. When incorporated into the denture material, Chx:ßCD showed better antifungal activity, as it required about 7.5% of Chx concentration compared with the raw Chx for 14 days. Conclusion: The improved characteristics of Chx:ßCD can result in new formulations to treat oral candidiasis and denture stomatitis.

Many people who wear dentures can get a fungal infection called denture stomatitis. Treating this infection is hard because it often comes back. There are many reasons why it can come back, like not following instructions, taking the wrong amount of medicine or having a bad reaction to the drugs. Using old and poorly fitting dentures and the difficulty to maintain the medicine in the right place can also make it harder to get better. One idea to make treatment easier is to add stronger drugs with fewer side effects to the material used to make dentures. That way, patients would only need to wear dentures with the right amount of medicine for a certain time to treat the infection.

Silver nanoparticles in denture adhesive: An antimicrobial approach against Candida albicans.

OBJECTIVE: To evaluate the antimicrobial potential of silver nanoparticles (Ag NPs) synthesized using three different routes (ultraviolet light, Turkevich, and green chemistry method using Glycine max extract) associated with COREGA® denture powder adhesive. METHODS: Heat-cured acrylic resin specimens were treated with different Ag NPs associated with the adhesive (AD + Ag UV, AD + Ag Turk, and AD + Ag Gm groups). As controls, the specimens were treated with a combination of adhesive and nystatin (AD + Nyst group), only adhesive (AD group), or submerged on the surface of the specimens (PBS group). After the treatments, biofilms of C. albicans developed for 3, 6, and 12 h on the specimen surfaces. The biofilm was quantified using colony-forming units per milliliter, colorimetric assay, and confocal laser scanning microscopy. RESULTS: Regardless of the period, we observed an inhibition of fungal load and a reduction in metabolic activity and biofilm mass in the resin specimens treated with the combinations AD/Ag NPs, compared to AD and PBS. The antimicrobial action of the AD + Turk and AD + Ag Gm groups was similar than that for the AD + Nyst group in all periods and viability tests, except for the biofilm mass (12 h). CONCLUSIONS: The COREGA® adhesive with Ag NPs, mainly those synthesized using the Turkevich and Glycine max methods, showed excellent antimicrobial activity against C. albicans biofilms, maintained for up to 12 h. CLINICAL SIGNIFICANCE: The association of Ag NPs to the adhesive can add preventive or therapeutic effects against denture stomatitis, to this prosthetic material.

Fast-Setting Calcium Silicate-Based Pulp Capping Cements-Integrated Antibacterial, Irritation and Cytocompatibility Assessment.

Calcium silicate-based cements (CSCs) are endodontic materials widely used in vital pulp-capping approaches. Concerning the clinical application, the reduced set time and pre-mixed formulations are relevant characteristics during the operative management of pulpal exposure, aiming to optimise the work time and improve cross-infection/asepsis control. Additionally, clinical success seems to be greatly dependent on the biological performance of the materials that directly contact the living pulp. As such, this work approaches an integrative biological characterisation (i.e., antibacterial, irritation, and cytocompatibility assays) of three fast-setting CSCs-BiodentineTM, TotalFill® BC RRM™ Fast Putty, and Theracal LC®. These cements, after setting for 24 h, presented the expected topography and elemental composition (assessed by scanning electron microscopy, coupled with EDS analysis), in accordance with the information of the manufacturer. The set cements displayed a significant and similar antibiofilm activity against S. mutans, in a direct contact assay. Twenty-four-hour eluates were not irritant in the standardised CAM assay, but elicited distinct dose- and time-dependent cytotoxicity profiles on fibroblastic cells-i.e., Biodentine was devoid of toxicity, TotalFill presented a slight dose-dependent initial toxicity that was easily overcome, and Theracal LC was deleterious at high concentrations. When compared to long-setting ProRoot MTA cement, which highlighted the pursued integrative approach, Biodentine presented a similar profile, but TotalFill and Theracal LC displayed a poorer performance regarding antibiofilm activity/cytocompatibility features, and Theracal LC suggested eventual safety concerns.

Arch Symmetry in Patients Without and With Cleft Lip and Palate After Orthodontic/Rehabilitative Treatment-A Stereophotogrammetry Study.

To evaluate and compare the dental arch symmetry of individuals with and without cleft lip and palate after orthodontic/rehabilitation treatment.Cross-sectional study.Tertiary cleft center in Brazil.Fifty-five participants aged between 18 and 30 years were divided into 3 groups according to treatment. Patients that received either a fixed partial denture (FPD) or implant-supported crown (ISC) in the cleft area or only orthodontic treatment, noncleft patients (NC).An analysis was performed using digitized dental casts scanned by laser and software. The following linear measurements were evaluated: incisor-canine; canine-molar; incisor-molar; surface and volume of the palatal region.Three-way ANOVA was used to compare the study factors: group (FPD/ISC/NC) and side (right/left) followed by the Tukey test to verify their interaction (α = .05).The results showed statistically significant differences among groups for the maxillary linear measurements canine-molar and incisor-molar, but not for incisor-canine. No statistically significant differences were found regarding the side for the maxillary measurements, while the factor interaction showed similarity only for incisor-canine. The mandibular measurements showed no statistical differences among groups, sides, or factor interactions. In surface and volume, all values in patients with cleft presented lesser than in without cleft patients.Regardless of the rehabilitation, arch symmetry can be achieved in the incisor-canine dimension in the cleft area.

Characterization, Antifungal Evaluation against Candida spp. Strains and Application of Nystatin: ß-cyclodextrin Inclusion Complexes.

BACKGROUND: Nystatin (Nys) is a fungicidal drug commonly prescribed for candidiasis disease in several administration routes. However, Nys is a class IV drug, according to the Biopharmaceutical Classification System, that possesses limited bioavailability and is used for local activity. OBJECTIVE: This study developed and characterized nystatin:ß-cyclodextrin (Nys:ßCD) inclusion complexes and evaluated their activity against Candida spp. METHODS: Complexes were characterized by physicochemical techniques and drug dissolution profiles. The susceptibility of C. albicans, C. krusei, C. parapsilosis, C. glabrata, C. guilliermondii, C. tropicalis, and C. auris was assessed using the broth microdilution method. The applicability of Nys:ßCD inclusion complex was evaluated by incorporating it into a temporary soft material for denture stomatitis treatment. RESULTS: Nys was better complexed in a 1:1 molar ratio by freeze-drying and spray-drying methods. The inclusion complexes show bi-exponential release, an initial burst release followed by a sustained manner, presenting higher dissolution efficiency than raw Nys. The 1:1 freeze-drying Nys:ßCD complex presents antifungal activity against all evaluated Candida strains, showing the maintenance of the drug effectiveness. The inclusion complex incorporated into a tissue conditioner material for denture stomatitis treatment effectively inhibited more than 90% of C. albicans biofilm growth during 7 and 14 days, in a half dose compared to raw Nys. CONCLUSION: This work represents a significant contribution to treating a wide variety of diseases caused by the Candida species, optimizing the drug bioavailability and compliance to the treatment due to improved drug solubility, dissolution, and sustained delivery.

The challenge of dietary management in soft drink consumption and its oral and systemic repercussions.

Background:Soft drinks are drinks high in sugar and acidity, but low in nutritional benefits. Despite its great popularity, its consumption is alerted due to the numerous systemic harm caused. Aim:This work aims to provide information and critically review the literature on the risk of soft drink consumption in an integrative view with nutritional, dental, and medical aspects. Methods:A search was carried out based on the identification of the theme, determination of inclusion and exclusion criteria, selection of databases for research and, finally, the reading, interpretation, and discussion of the selected sources. A search was conducted using the keywords: "soft drinks" AND "obesity" OR "dental erosion" OR "diabetes" OR "hypertension" OR "mental health" OR "multimorbidities" in databases PubMed, SciELO, and LILACS between 2017 and 2022. Results:Seventy-six studies were included in the article after the qualitative synthesis. Conclusion:We conclude that the high consumption of soft drinks is associated with oral and general diseases. Therefore, a multi-professional approach to guide patients to moderate the consumption of these beverages is extremely important.

A novel rat model of denture stomatitis and the role of antibiotics in the development of the disease.

This study compared different conditions to establish a rat model of denture stomatitis. Immunocompetent Wistar rats were divided into two groups (n = 35): Tetracycline = administration of 0.83 mg/ml of tetracycline hydrochloride 7 days before induction of denture stomatitis and amoxicillin = administration of 0.156 mg/ml of amoxicillin with clavulanic acid 4 days before induction of denture stomatitis. A suspension of Candida albicans was inoculated on the palate followed by the use of a palatal device contaminated with C. albicans inoculum for 4 days to induce denture stomatitis. As controls, some rats were not submitted to any procedure or used a sterile palatal device for 4 days. The development of denture stomatitis was confirmed by visual analysis, colony-forming units per milliliter (CFU/ml) count, histopathological and immunohistochemical analyses, and through myeloperoxidase (MPO) and N-acetylglucosaminidase (NAG) assays. Rats were euthanized right after device removal (T0), 4 (T4), or 6 (T6) days after device removal. Tetracycline improved the development of the disease, with more severe clinical signs at T0. Similar results were observed in the CFU/ml count and in the histometric and immunohistochemical analyses. Higher MPO expression was detected in the palates of the tetracycline group (P = .006). Despite the subtle differences between antibiotics, tetracycline showed better results in inducing and maintaining denture stomatitis for at least 4 days after device removal.

Denture stomatitis is an oral inflammatory disease with high recurrence rates. Different animal models have been reported in the literature, but some gaps still need to be addressed. A reproducible in vivo model should be established to test new treatment approaches.

Impact of COVID-19 on gender gap in dental publications: a retrospective cohort with three Brazilian journals.

This was a retrospective cohort study to investigate the impact of COVID-19 pandemic on the gender gap in articles submitted to three international dental journals based in Brazil. All submissions performed to Brazilian Dental Journal, Brazilian Oral Research, and Journal of Applied Oral Science before (2019) and during the pandemic (2020) were assessed. Gender of the first, last, and corresponding authors were collected. Other variables collected were journal, continent studied by authors and stage of their careers (classified according to authors' highest degree), and final decision reached in the article. Absolute and relative frequencies with 95% confidence intervals, Pearson's Chi-square tests, and Fisher's Exact test were used (α = 0.05). In total, 4,726 unique submissions were analyzed. A higher proportion of early-career authors was observed during the pandemic (44.8% to 49.3%, p = 0.021). Most articles were rejected but without association with gender. Increased proportion of male first authors from before to during the pandemic was observed (39% to 42.1%, p = 0.034). Drop in the proportion of articles with women as first authors was observed for researchers in their early- (65.9% to 58.8%, p = 0.02) and mid-career stages (63% to 55.8%, p = 0.014). Reduction in women as first authors was observed during the pandemic in South and Central Americas (66.7% to 61.5%, p = 0.010), and when the last author was a female, or the corresponding author was a male. In conclusion, a disproportionate impact on female dental researchers in submitting articles in the period from before to during the pandemic was observed when considering first authorship, suggesting that the COVID-19 may have increased the gender inequality in dental science.

Resilient liner modified by antimicrobials for denture stomatitis treatment: A randomized controlled trial.

OBJECTIVES: This randomized clinical trial evaluated the effectiveness of an interim denture resilient liner (Trusoft) modified with minimum inhibitory concentrations (MICs) of antimicrobial agents for Candida albicans biofilm in the denture stomatitis (DS) treatment. METHODS: Forty participants with DS and maxillary complete denture (MCD) wearers were randomly assigned to one of the treatments for 14 days (n=10): nystatin oral suspension (Control-100,000IU/mL; 4 × /day), MCD relined with Trusoft either without (Tru) or with nystatin (Ny) or chlorhexidine diacetate (Chx) at MICs. Cytological smears and mycological quantitative cultures were taken from the palate and denture before treatment (baseline), at the end of treatment (day 14), and at follow-up (days 30, 45, and 60). Photographs of the palate were made at each visit. Data were analyzed by the Cochran and χ2 tests, ANOVA and the Tukey test or the Friedman and Kruskal-Wallis tests (α=0.05). RESULTS: Palatal smears of the Ny and Chx groups exhibited no mycelial Candida (0%) on day 14, and, at the 60-day follow-up, it was observed for only 1 participant from Chx group. MCD smears showed reduction in mycelial forms for all groups on day 14 (P<0.05), but this difference was maintained at follow-up only for the relined dentures (P<0.05). Unlike Tru and the control groups, Ny and Chx groups evidenced a significant reduction in CFU/mL values and DS severity throughout the trial (P<0.05). CONCLUSIONS: The addition of nystatin and chlorhexidine at MICs to an interim resilient liner is a promising treatment for DS, with better results than those for conventional therapy with nystatin suspension, including the follow-ups. CLINICAL SIGNIFICANCE: Compared with conventional topical antifungal therapy, modifying a denture reline material with antimicrobials provided a therapeutic option for denture stomatitis. This non-invasive, straightforward therapeutic approach can be easily adopted by dentists and has the advantage of not requiring patient compliance while maintaining therapeutic concentrations on the denture base.

A modified Newton classification for denture stomatitis.

The effectiveness of denture stomatitis (DS) treatment should be evaluated by associating clinical and mycological parameters. Although widely used in clinical studies, the Newton classification does not accurately represent the degree of severity of palatal inflammation in terms of extent of the lesions and intensity of the erythema. Therefore, a modified Newton classification has been proposed considering the coverage area of palatal inflammation and the erythema level. This consistent and direct ranking will help standardise randomised clinical trials, as well as the statistical comparison among blind evaluations of the obtained scores within and between studies.

Quantifying the facial proportions in edentulous individuals before and after rehabilitation with complete dentures compared with dentate individuals: A 3D stereophotogrammetry study.

STATEMENT OF PROBLEM: Facial collapse is associated with edentulism, and while the provision of complete dentures promotes masticatory function and esthetics, whether complete dentures restore facial proportions to the natural appearance found in dental individuals is unclear. PURPOSE: The purpose of this clinical study was to assess the facial profiles of edentulous individuals before and after treatment with complete dentures and compare these profiles with those of dentate individuals matched by age as the control. MATERIAL AND METHODS: Sixty White participants were recruited as 2 groups: 30 edentulous participants provided with complete dentures in both arches and 30 participants with natural teeth and normal occlusion. Facial analysis was performed through 3D stereophotogrammetry. Linear, angular, surface, and perimeter facial measurements were made and statistically analyzed with paired and independent t tests (α=.05). RESULTS: The mean age ±standard deviation was 63.16 ±7.33 years for the edentulous participants and 60.43 ±5.34 years for the dentate controls, without statistical differences between ages (P=.105). The facial profiles of the edentulous group with and without complete dentures were statistically different (P<.05) in 6 linear and 5 angular measurements. After quantifying the facial collapse by comparing edentulous individuals without complete dentures and the control dentate group, the results showed that the majority of differences occurred in the middle and lower third of the face, evidencing shortening in these areas with differences in facial measures of around 2 to 5 mm less in the edentulous group. However, statistically significant differences between the participants with complete dentures and the control dentate group were found in only 2 linear measurements (the distance between the right and the left exocanthion to cheilion), in the sealed lip angle and the left gonial angle, and in the surface and perimeter (P<.05). CONCLUSIONS: Tooth loss affected the facial proportions in the lower third of the face. The provision of complete dentures restored their facial appearance but not precisely to the facial proportions of individuals with a natural dentition, as considerable differences were detected in surface and perimeter measurements.

Effect of denture liners surface modification with Equisetum giganteum and Punica granatum on Candida albicans biofilm inhibition.

Aim: This study investigated the effect of denture liners surface modification with Equisetum giganteum (EG) and Punica granatum (PG) on Candida albicans biofilm inhibition supposing its usage as a sustained-release therapeutical delivery system for Candida-associated denture stomatitis. Materials & methods:C. albicans biofilm (SC5314 or ATCC 90028) was formed on soft liners superficially modified by a primer mixed to drugs at minimum inhibitory concentrations (0.100 g for EG and PG or 0.016 g for nystatin per ml of primer). After 24 h, 7 or 14 days, antibiofilm activity was evaluated by colony-forming unit counts. Results: Not all groups were equi-efficient to nystatin after 24 h and 7 days. After 14 days, EG and PG efficacies were not different from nystatin (almost 100% inhibition). Conclusion: The proposed protocol presents a promising option to allopathic drugs for Candida-associated denture stomatitis treatment.

Does microwave disinfection affect the dimensional stability of denture base acrylic resins? A systematic review.

OBJECTIVE: To systematically evaluate the effect of microwave disinfection on the dimensional stability of denture base acrylic resins. BACKGROUND: Microwave disinfection has been considered as an alternative method for disinfecting complete dentures to help prevent and treat denture stomatitis. However, data on the impact of microwave disinfection on the dimensional stability of acrylic resins are still scarce. METHODS: The PubMed/Medline, SCOPUS and EMBASE databases were searched in order to assess articles published in English up to January 2021 (CRD42021212267). We included studies that have assessed the effect of microwave disinfection, on the dimensional stability of acrylic resins, comparing them with negative or positive controls. RESULTS: A total of seven in vitro studies were included. The qualitative synthesis demonstrated that, in general, microwave disinfection produced more distortion on the materials than do immersion in sodium hypochlorite, chloride solution, chlorhexidine, and water immersion. However, considering the dimensional stability of the specimens, microwave disinfection at 500 W for 3 minutes, and at 450 W for 5 minutes, produced similar or better outcomes than did control groups. CONCLUSION: In general, microwave disinfection promotes changes in the dimensional stability of denture base acrylic resins, and should thus be used with caution. However, microwave disinfection protocols at lower power settings (500 and 450 W) and exposure times (3 and 5 minutes) produces similar or less distortion than chemical disinfection. More studies are still required in order to evaluate the clinical and long-term implications of microwave disinfection.