07 December 2020

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Denture Cleaning: the right method to fight stomatitis

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Denture stomatitis is an oral inflammation commonly affecting denture wearers. It is mostly observed on the palatal mucosa, accompanied by erythema, mucous membrane inflammation and sometimes pain or burning, and easily diagnosed during routine oral examination.  

Denture stomatitis is the main indicator of poor oral health among the edentulous population, as the etiology of this condition is biofilm -mediated. In fact the literature suggests that microorganisms commonly found in oral biofilms can play a role in the development of denture stomatitis. Many other factors have been associated to this mucosal lesion, such as trauma consequent from incongruous denture, long-term denture use, nutritional deficiency, diabetes, immune deficiency, and some other systemic elements. 

However evidence identify in Candida albicans the main risk factor and in antifungals the treatment most commonly prescribed by oral health professionals. Nonetheless, a high recolonization rate by  Candid after cessation of antifungal therapy are widely reported, with consequent retreatment with the same agents. This uncontrolled use of antifungal may lead  patients to adverse effects over time, most notably antifungal resistance. 

This findings highlight the need of practice guidelines based on new and stronger supporting evidences. 

The Authors in this study aim to compare the role of denture cleaning methods in combination with overnight storage conditions on biofilm mass and composition on acrylic removable dentures.

Materials and Methods
in a Belgian long-term care facility for frail older persons 13 residents were enrolled for this cross-over randomized controlled clinical stud. All study participants were subjected, in a random sequence, to 4 consecutive test conditions with 2 different mechanical denture cleaning methods and 2 overnight storage conditions were considered: 

1. brushing and overnight storage in water without a cleansing tablet (B-T)

2. brushing and overnight storage in water with a cleansing tablet (B+T)

3. ultrasonic cleaning and overnight storage in water without a cleansing tablet (U-T)

4. ultrasonic cleaning and overnight storage in water with a cleansing tablet (U+T)

Each test condition was performed for 5 consecutive days, preceded by a 2-days wash-out period. During this period the standard of care of the institution (mechanical brushing with water and soap and dry denture overnight storage) was performed. Participants and their providers were requested not to clean the dentures themselves during the entire study. Biofilm  samples were taken at baseline (control) and at the end of each test period. Total and individual levels of selected oral bacteria (n = 20), and of Candida  albicans were identified using the PCR technique. Denture biofilm  coverage was scored using an analogue denture plaque score. 

Results 
-  Overnight denture storage in water with a cleansing tablet significantly reduced the total bacterial count compared to overnight denture storage in water without a cleansing tablet (p<0.01). This effect was more pronounced in case of ultrasonic cleaning (p<0.01) compared to brushing (p<0.05).

-  significantly lower amounts of bacteria of the green and the purple complex were observed in case a cleansing tablet was used (p<0.05). This indicates that the use of a cleansing tablet not only affected biofilm  mass (total bacterial count), but also the biofilm  composition.

-  No significant difference in biofilm  mass and composition was found between the 2 mechanical cleaning methods.

- No significant effect was observed on the amount of Candida  albicans nor on the analogue plaque scores.

Conclusions
  Denture stomatitis  is the most prevalent oral disease and the main indicator of poor oral health among the completely edentate population, affecting individuals wearing removable dental prostheses. Appropriate oral hygiene is required to maintain oral health in denture wearers, as according to the common belief that colonization by Candida  is the main cause of denture stomatitis. 

The use of cleansing tablets during overnight denture storage in addition to mechanical denture cleaning  did not affect Candida  albicans count, but reduced the total bacterial count on acrylic removable dentures. Recent findings showed that even brushing the palate is an effective habit. 

For additional information: Impact of Denture Cleaning Method and Overnight Storage Condition on Denture Biofilm Mass and Composition: A Cross-Over Randomized Clinical Trial