Caracterización de la estomatitis subprotésica en portadores de prótesis removible en clínicas de la Universidad San Gregorio de Portoviejo, Ecuador / Characterization of subprosthetic stomatitis in patients with removable prosthesis. San Gregorio de Portoviejo University

RESUMEN Introducción: La estomatitis subprotésica es un proceso inflamatorio de la mucosa bucal que se encuentra cubierta por una prótesis removible, de causa multifactorial y alta prevalencia. Objetivo: Caracterizar la estomatitis subprotésica en pacientes portadores de prótesis removible atendidos en las clínicas odontológicas de la Universidad San Gregorio de Portoviejo en el período marzo-noviembre de 2019. Método: Se realizó un estudio descriptivo transversal, con los criterios de inclusión siguientes: mayores de 18 años, ambos sexos, buen estado de salud general, no practicar hábitos tóxicos, usar prótesis removible, total o parcial, confeccionada de acrílico o metales. Todos los sujetos de la investigación firmaron el consentimiento informado antes de realizarles la historia clínica de odontología del Ministerio de Salud Pública del Ecuador de donde se extrajeron los datos sociodemográficos, signos clínicos y características de la prótesis. Resultados: Fueron evaluados 100 pacientes. El 45 %, presentaba signos clínicos de estomatitis subprotésica; predominó el sexo femenino con el 33 % y el grupo de edad de 40 a 59 años con un 26 %. La mayoría de las prótesis no se ajustan ni adaptan de manera correcta, y tienen un mal estado físico, en el 80, 82,2 y el 91 %, respectivamente. El 84,4 % de los pacientes utilizaba prótesis parcial removible, confeccionadas con acrílico, por un periodo de 1 a 6 años en el 60 % de los casos. Conclusiones: El diagnóstico de estomatitis subprotésica se asocia con el mal estado físico, desajuste e inadecuada adaptación de las prótesis removibles, lo que indica la necesidad de la institución para el establecimiento de estrategias docentes hacia la comunidad para su prevención y diagnóstico temprano.

ABSTRACT Introduction: Subprosthetic stomatitis is an inflammatory process of the mucosa in the oral cavity covered by a removable prosthesis, with a multifactorial cause and high prevalence. Objective: To characterize subprosthetic stomatitis in patients with removable prosthesis treated at the dental clinics of San Gregorio University in Portoviejo in the period March-November 2019. Method: A cross-sectional descriptive study was conducted, with the following inclusion criteria: patients over 18 years old, both sexes, good general health, no toxic habits, use of removable prosthesis, total or partial, made of acrylic or metals. All the patients involved in the research signed their consent, information given to them before taking their dental records taken by the Ministry of Public Health of Ecuador, from which socio-demographic data, clinical signs and characteristics of the prosthesis were extracted. Results: 100 patients were evaluated. Forty-five per cent showed clinical signs of subprosthetic stomatitis; the female sex (33%) predominated and the age group 40-59 years with (26%). Most of the prosthesis did not fit or adapt correctly and were in poor physical condition in 80%, 82.2% and 91% respectively. 84.4% of the patients used removable partial prosthesis, made of acrylic, for a period of 1 to 6 years, (60%) of the cases. Conclusions: The diagnosis of subprosthetic stomatitis is associated with poor physical condition, maladjustment and inadequate adaptation of removable prostheses, which indicates the need for the institution to establish educational strategies towards the community for prevention and early diagnosis.

The effect of nanodiamonds on candida albicans adhesion and surface characteristics of PMMA denture base material - an in vitro study

Abstract Candida albicans is the main causative pathogen of denture stomatitis, which affects many complete denture patients. Objective: To evaluate the effect of different concentrations of nanodiamonds (NDs) added to polymethyl methacrylate (PMMA) denture base material on Candida albicans adhesion as well as on surface roughness and contact angle. Methodology: Acrylic resin specimens sized 10×10×3 mm3 were prepared and divided into four groups (n=30) according to ND concentration (0%, 0.5%, 1%, 1.5% by wt). Surface roughness was measured with a profilometer, and the contact angle with a goniometer. The effect of NDs on Candida albicans adhesion was evaluated using two methods: 1) slide count and 2) direct culture test. Analysis of variance (ANOVA) and Tukey's post hoc test were used in the statistical analyses. Results: Addition of NDs decreased the Candida albicans count significantly more than in the control group (p<0.05), with a lowest of 1% NDs. Addition of NDs also significantly decreased the surface roughness (p<0.05), but the contact angle remained the same. Incorporation of NDs into the PMMA denture base material effectively reduced Candida albicans adhesion and decreased surface roughness. Conclusion: PMMA/NDs composites could be valuable in the prevention of denture stomatitis, which is considered one of the most common clinical problems among removable denture wearers.

Biocompatibilidade in vivo de material resiliente temporário para base de prótese modificado por antimicrobianos para tratamento da estomatite protética / Biocompatibility in vivo of temporary soft denture liner for denture base modified by antimicrobials agents for denture stomatitis treatment

Reembasadores resilientes temporários contendo fármacos antifúngicos foram sugeridos como um tratamento adjunto para estomatite protética. No entanto, antes de utilizar clinicamente estes reembasadores modificados em humanos, é importante avaliar a sua biocompatibilidade em modelos animais. Este estudo avaliou a biocompatibilidade in vivo de um reembasador resiliente temporário para base de prótese (Trusoft) modificado por agentes antimicrobianos em suas mínimas concentrações inibitórias (MCIs) para biofilme de Candida albicans. Dispositivos acrílicos intra-orais (DIOs) foram confeccionados individualmente para 60 ratos Wistar. Os ratos foram divididos em 6 grupos (n=5): 3 grupos controle (Negativo: sem DIO; Geral: DIO sem reembasamento; Positivo: DIO reembasado com Trusoft sem fármacos) e 3 grupos experimentais (DIOs reembasados com Trusoft modificados por fármacos em suas respectivas MCIs: 0,032 g de nistatina, 0,064 g de diacetato de clorexidina e 0,128 g de cetoconazol). Os ratos com ou sem os DIOs foram eutanasiados após 7 e 14 dias de avaliação. A análise histopatológica qualitativa foi realizada comparando-se fotomicrografias de secções histológicas, que foram obtidas utilizando um microscópio óptico que abrangeu transversalmente a região intermolares. As alterações morfológicas no epitélio e queratina foram analisadas quantitativamente através da realização de planimetria computadorizada. Os dados quantitativos foram analisados utilizando ANOVA 2-fatores e teste de Tukey (=0,05). A análise quantitativa mostrou que apenas o grupo com DIO contendo cetoconazol diminuiu significativamente a espessura e a área do estrato córneo em comparação com os outros grupos (p<0,05), que não apresentaram diferenças significativas entre si (p>0,05). Estes resultados estiveram de acordo com os obtidos para análise qualitativa. A incorporação de MCIs de nistatina e diacetato de clorexidina no Trusoft não induziram alterações histopatológicas na mucosa palatina de ratos, sugerindo a biocompatibilidade in vivo deste protocolo para o tratamento de estomatite protética.(AU)

Temporary resilient denture liners containing antifungal drugs have been suggested as an adjunct treatment for denture stomatitis. However, before clinically using these modified liners in humans, it is important to assess their biocompatibility in animal models. This study evaluated the in vivo biocompatibility of a temporary soft denture liner (Trusoft) modified by antimicrobial agents at their minimum inhibitory concentrations (MICs) for biofilm formation by Candida albicans. Methods: Acrylic intraoral devices (IODs) were individually made for 60 Wistar rats. The rats were divided into the following 6 groups (n=5): 3 control groups (Negative: without IOD; General: IOD without relining; Positive: IOD relined with Trusoft without drugs) and 3 experimental groups (IOD relined with Trusoft modified by drugs at MICs: 0.032 g for nystatin, 0.064 g for chlorhexidine diacetate, and 0.128 g for ketoconazole). The rats with or without the IODs were sacrificed after 7 or 14 days of evaluation. Histopathological qualitative analysis was performed by comparing photomicrographs of histological sections, which were obtained using an optical microscope that transversely covered the inter-molar region. Morphological changes in the epithelium and keratin were quantitatively analyzed by performing computerized planimetry. Quantitative data were analyzed using 2-way ANOVA and Tukey's test (=0.05). Quantitative analysis showed that only the group with IOD containing ketoconazole significantly decreased the thickness and area of the stratum corneum compared with the other groups (p<0.05), which showed no significant differences between each other (p>0.05). These results were in accordance with those obtained for qualitative analysis. Incorporation of MICs of nystatin and chlorhexidine diacetate in Trusoft did not induce histopathological changes in the palatal mucosa of rats, suggesting the in vivo biocompatibility of this protocol for treating denture stomatitis.(AU)

Susceptibilidad in vitro de Candida albicans y no albicans Aisladas de Prótesis Dentales de Pacientes con Estomatitis Protésica a Tres Sustancias de Desinfección / In vitro Susceptibility of Candida albicans and Non-albicans Isolated fro Dental Prothesis in Patients with Denture Stomatitis to Three Disinfectants

A pesar del gran número de productos disponibles para la limpieza de prótesis dentales, el 60% de los portadores hace uso de ellos, posiblemente por la situación económica. El objetivo fue determinar la susceptibilidad antifúngica in vitro que presenta Candida y sus especies a tres sustancias utilizadas para la desinfección de prótesis (hipoclorito de sodio, ácido acético y solución de superoxidación). Se obtuvieron aislados clínicos de Candida de pacientes portadores de prótesis diagnosticados con estomatitis protésica, para su posterior estudio de susceptibilidad in vitro a las diferentes sustancias. El hipoclorito de sodio al 0,5% mostró in vitro una mayor inhibición para las cepas de Candida albicans y Candida no albicans. El ácido acético y la solución de superoxidación no mostraron inhibición in vitro frente a ambas cepas. El hipoclorito de sodio al 0,5% tiene un efecto inhibitorio in vitro sobre las cepas de C. albicans y Candida no albicans.

Despite the large number of products available for denture cleaning, less than 60% of denture wearers use them, possibly due to the economic situation. The aims were to determine the in vitro anti-fungal susceptibility of Candida species to three denture disinfectants (Sodium hypochlorite, acetic acid and super oxidized solution). Clinical isolates were obtained from denture wearers diagnosed with denture stomatitis for its posterior in vitro susceptibility study to the different substances. 0.5% Sodium hypochlorite showed the higher in vitro inhibitory effect on Candida albicans and non-albicans. Acetic acid and super oxidized solution showed no inhibition in both species. 0.5% Sodium hypochlorite has an in vitro inhibitory effect on Candida species.

Clinical and antimicrobial efficacy of NitrAdineTM-based disinfecting cleaning tablets in complete denture wearers

OBJECTIVE: This study evaluated the efficacy of NitrAdineTM-based disinfecting cleaning tablets for complete denture, in terms of denture biofilm removal and antimicrobial action. MATERIAL AND METHODS: Forty complete denture wearers (14 men and 26 women) with a mean age of 62.3±9.0 years were randomly assigned to two groups and were instructed to clean their dentures according to two methods: brushing (control) - 3 times a day with denture brush and tap water following meals; brushing and immersion (Experimental) - brushing the denture 3 times a day with denture brush and tap water following meals and immersion of the denture in NitrAdineTM-based denture tablets (Medical InterporousTM). Each method was used for 21 days. Denture biofilm was disclosed by a 1 percent neutral red solution and quantified by means of digital photos taken from the internal surface before and after the use of the product. Microbiological assessment was conducted to quantify Candida sp. RESULTS: An independent t-test revealed a significant lower biofilm percentage for the experimental group (4.7, 95 percent CI 2.4 to 7.9) in comparison with the control group (mean 37.5, 95 percent CI 28.2 to 48.1) (t38=7.996, p<0.001). A significant reduction of yeast colony forming units could be found after treatment with Medical InterporousTM denture tablets as compared to the control group (Mann-Whitney test, Z=1.90; p<0.05). CONCLUSION: The present findings suggest that NitrAdineTM-based disinfecting cleaning tablets are efficient in removal of denture biofilm. In addition, a clear antimicrobial action was demonstrated. Therefore, they should be recommended as a routine denture maintenance method for the prevention of the development of microbial biofilm induced denture stomatitis.

Estudo da função dos neutrófilos nos mecanismos de defesa contra a estomatite por dentadura em indivíduos idosos / Study of neutrophils from elderly in the defense mechanisms against Candida-related denture stomatitis

Os neutrófilos são as primeiras células a migrar para sítios de infecção e desempenham importante papel na defesa contra vários patógenos, especialmente Candida albicans. A função dos neutrófilos envolve fagocitose e destruição de leveduras e formas filamentosas do fungo, além de produção de citocinas e quimiocinas, capazes de ativar outras células envolvidas na eliminação de C. albicans. Recentemente, tem sido mostrado que estas células apresentam prejuízos com o avanço da idade e estes fenômenos fazem parte de uma área da Imunologia conhecida como Imunossenescência. A estomatite protética é a lesão oral mais verificada em idosos e a sua persistência é diretamente relacionada com a presença de espécies de Candida, principalmente C. albicans, nas lesões e na superfície interna de próteses, especialmente totais superiores (PTS). Com o objetivo de avaliar possíveis alterações em neutrófilos que poderiam predispor usuários de prótese total superior à estomatite protética, foram analisados neutrófilos de sangue e de saliva de idosos e jovens com estomatite protética associada à Candida (EPC), bem como de indivíduos controles. No primeiro capítulo foi avaliada a positividade de Candida e as diferentes espécies deste patógeno em lesões de estomatite protética e superfície interna de PTS. C. albicans foi a espécie mais detectada em lesões de EP e na PTS. No segundo capítulo, os neutrófilos do sangue dos indivíduos da pesquisa foram caracterizados quanto ao fenótipo ex vivo, função fagocítica e produção de citocinas e quimiocinas após desafio com C. albicans. Neutrófilos do sangue de indivíduos com EPC, bem como de idosos sem EPC, apresentaram características relacionadas com suscetibilidade às doenças causadas por C. albicans. No terceiro capítulo, os neutrófilos salivares dos indivíduos foram caracterizados quanto ao fenótipo ex vivo e função fagocítica após desafio com C. albicans. Além disso, níveis de citocinas e quimiocinas relacionadas com resposta imune de...

Neutrophils are the first line of immune cells to migrate into infection sites, playing an important role against pathogens, especially Candida albicans. These cells phagocytose and destroy yeasts or filamentous forms of this fungus, beyond secrete cytokines and chemokines that activate other immune cells to eliminate C. albicans. Nowadays, it has been shown that the ageing damages neutrophil function and such events are described as part of Imunosenescence. Denture stomatitis is the most oral lesion present in elderly, and its persistence is related to Candida species, especially C. albicans, in the lesions and prosthesis fitting surface, particularly maxillary prosthesis (MP). In order to evaluate possible neutrophil alterations predisposing denture wearers to Candida- related denture stomatitis (DS), blood and salivary neutrophils from elderly and younger individuals with DS, as well control ones, were analyzed. Thus, the first chapter addresses the presence of Candida species on the denture stomatitis lesions and MP fitting surface. C. albicans was the most species detected in DS lesions and MP. On the second chapter, blood neutrophils from the individuals were characterized about ex vivo phenotype, phagocytic function, and cytokines and chemokines production after challenged with C. albicans. Blood neutrophils from DS individuals, as well elderly without DS, presented characteristics of susceptibility to C. albicans diseases. On the third chapter, salivary neutrophils from the individuals were characterized about ex vivo phenotype and phagocytic function against C. albicans. In addition, salivary cytokines and chemokines involved with resistance or susceptibility to C. albicans infection were detected. Results indicated differences in salivary neutrophils and soluble components from patients with DS. In addition, alterations observed in neutrophils by immunosenescence could facilitate Candida...

Vinegar as an antimicrobialagent for control of Candida spp. in complete denture wearers

The use of denture is known to increase the carriage of Candida in healthy patients, and the proliferation of Candida albicans strains can be associated with denture-induced stomatitis. The aim of this study was to evaluate the use of vinegar as an antimicrobial agent for control of Candida spp. in complete upper denture wearers. Fifty-five patients were submitted to a detailed clinical interview and oral clinical examination, and were instructed to keep their dentures immersed in a 10%vinegar solution (pH less than 3) overnight for 45 days. Before and after the experimental period, saliva samples were collected for detection of Candida, counting of cfu/mL and identification of species by phenotypical tests (germ tube formation, chlamidoconidia production, and carbohydrate fermentation and assimilation). The results were analyzed using Spearman's correlation and Student's t-test (p£0.05). Candida yeasts were present in 87.3% of saliva samples before the treatment. A significant reduction was verified in CFU/mL counts of Candida after treatment. A positive correlation between Candida and denture stomatitis was verified, since the decrease of cfu/mL counts was correlated with a reduction in cases of denture stomatitis. Although it was not able to eliminate C. albicans, the immersion of the complete denture in 10% vinegar solution, during the night, reduced the amounts (cfu/mL) of Candida spp. in the saliva and the presence of denture stomatitis in the studied patients.

Estomatite por prótese: orientaçäo ao C.D. quanto à prevençäo e terapêutica / Stomatitis by prosthesis: orientation to D.S. for prevention and therapeutics

Os autores indicam a terapêutica empregada nas estomatites por próteses e enfatizam a importância das orientaçöes aos pacientes portadores de próteses removíveis visando a prevençäo dessas lesöes

Denture hygiene and denture stomatitis: incidence and control

The objectives of this study were to collect data about the popular methods and materials used for cleaning dentures among complete and partial denture wearers in Jordan, and to determine the relationship between denture base plaque and mucosal inflammation under the dentures. Materials and This study was divided into two sections. The first section was a questionnaire consisting of six simple questions regarding denture hygiene practices and cleaning products used by 321 denture wearers who attended the prosthodontic clinics at King Hussein Medical Center and Marka Health Center for the replacement or adjustment of their dentures in the period from the first of August 1995 until 27th of December 1996. The second section included oral examination and the examination of dentures. The relationship between denture hygiene and inflammation under the dentures was studied. of the 321 denture wearers surveyed, 203 [63%] were males and 240 [75%] were completely edentulous. The majority of denture wearers 288 [90%] were in the age range of 50-80 years. The most popular method of cleaning dentures was brushing, 235 [73%] patients used the brush to clean their dentures, 45 [14%] used water only and 23 [7%] used a commercial denture cleanser soaking agent. Half of the denture wearers 160 [50%] never removed their dentures at night, and 157 [49%] of the patients had unhygienic dentures. Of all denture wearers, 94 [29%] had denture stomatitis and most of those; 75 [80%] did not remove their dentures at night. 73 [78%] of patients who had denture stomatitis had unhygienic dentures. A large number of people do not know how to clean their dentures properly, either as a result of never having been given advice or not following that given. The analysis of this survey showed that there was a statistically significant relationship between poor denture hygiene and not removing the denture at night on one side and denture stomatitis on the other side

Eficacia de limpiador químico de prótesis: estudio clínico e in vitro / Efficacy of prosthesis chemical cleanser: clinical and in vitro study

Los limpiadores de prótesis dentales removibles, pueden ser divididos en aquellos que ejercen su acción en forma mecánica o química. Nuestro propósito principal fue investigar la eficacia de estos agentes limpiadores en la prevención y control de la estomatitis subprótesis. Comparamos en 50 pacientes desdentados completos los efectos de un cepillado, solo, sobre prótesis y mucosas y el cepillado más el uso de tabletas limpiadoras. Notamos disminución significativa de la inflamación palatina y controles in vitro de muestras de las dentaduras revelaron la total eliminación de la cándida albicans mediante el cepillado más procedimiento químico. Se recomienda el uso de estas tabletas efervescentes en base a peróxidos como coadyuvante al cepillado convencional de prótesis

Assessment of candida albicans growth level on different acrylic denture base materials, vacuum and non vacuum mixed

Candida species and microbial plaque on the tissue fitting surface of a maxillary complete denture and the palatal mucosa are the chief etiologic agent in the development and maintenance of denture stomatitis [Santarpia et al., 1988]. Denture stomatitis is a multifactorial condition associated with the wearing of a removable prosthesis. Predisposing factors include trauma [Bastiaan, 1976], candida infection [Budtz-Jorgensen and Bertram, 1970] [Renner et al., 1979] bacterial infection [Van Reenen, 1973] [Budtz-Jorgensen et al., 1983] and denture wearing habits [Etting, 1975] Candida albicans organism is part of the normal oral flora of healthy dentate adults [Young et al., 1951] as well as edentulous persons [Budtz-Jorgensen et al., 1975]. The change of candida albicans from commensalism to a pathogen in denture wearers is most probably due to alteration in the oral environment of the host rather than the alteration of the yeast itself [Young et al., 1951]The chief method of prevention and treatment of denture stomatitis is aimed at the : Ielimination of yeast and bacterial species from the denture tissue-fitting surface and denture supporting mucosa by means of an effective denture and oral hygiene cleansing regimen[Augsbruger and Elahi 1982] [Palenikand Miller, 1984]. However, a completely effective denture hygiene program for the treatment of denture stomatitis has not yet been developed [Santarpia et al., 1988]. This study was conducted to determine the level of candida albicans growth on: 1- Heat polymerized resin and auto polymerized resin bases non vacuum mixed 2-Heat polymerized resin and autopolymerized resin bases vacuum mixed 3- Trial VLC resin base