Effect of Denture Hygiene Protocols on Patient Satisfaction, Oral Health-Related Quality of Life, and Salivary Parameters: A Randomized Clinical Trial.

PURPOSE: This randomized controlled trial compared four denture hygiene protocols in terms of patient satisfaction, oral health-related quality of life (OHRQoL), and salivary parameters in complete denture wearers with denture stomatitis. MATERIAL AND METHODS: For this randomized, double-blind, controlled clinical trial, 108 participants were assigned to soak their dentures in one of the following solutions: (1) 0.25% sodium hypochlorite (positive control), (2) 0.15% Triclosan, (3) denture disinfecting tablets, or (4) denture disinfecting tablets plus palatine mucosa brushing solution. The outcomes of patient satisfaction, OHRQoL, and salivary parameters (salivary flow rate and pH) were measured at baseline and after 10 days. The Kruskal-Wallis and Dunn tests (between groups), and Wilcoxon test (between times) were used to compare the results. (α = 0.05). RESULTS: After the hygiene protocols, and when compared with baseline, the overall patient satisfaction, maxillary denture satisfaction, maxillary denture comfort, and maxillary denture retention were ameliorated. A significant improvement was noted in OHRQoL in 3 of 4 domains evaluated (orofacial pain and discomfort, masticatory discomfort and disability, and psychological disability and discomfort). The salivary flow rate (unstimulated and stimulated) and salivary pH were not significantly affected at the times evaluated. CONCLUSIONS: Complete denture wearers may feel more satisfied with their complete dentures when treated for denture stomatitis. The tested treatments lead to similar improvement in terms of patient satisfaction and OHRQoL.

Effects of Different Forms of Denture Adhesives on Biofilm Formation, Adhesive Strength and Hygiene of Complete Dentures.

PURPOSE: To evaluate the effect of different forms of denture adhesives on the formation of biofilm and on adhesive strength, as well as the effectiveness of hygiene protocols for their removal. MATERIALS AND METHODS: Samples of the heat-cured polymethyl methacrylate denture base resin were made and divided into four groups: control (no adhesive), ultra Corega cream, Corega strip adhesive, and ultra Corega powder (GlaxoSmithKline). Biofilm formation was evaluated by counting colony-forming units and fluorescence microscopy. To evaluate the effectiveness of the hygiene protocols, the samples were divided into five subgroups: brushing with distilled water; brushing with Protex soap; brushing with Colgate toothpaste; immersion in Corega Tabs; and immersion in Corega Tabs followed by brushing with the solution itself. The remaining adhesive was quantified with ImageJ software. The adhesive strength was tested at different time intervals after application. After verifying the data distribution using Shapiro-Wilk test, parametric or nonparametric analysis was applied (α = .05). RESULTS: Candida albicans formed more biofilm in strip (P = .007) and powder (P = .001), Pseudomonas aeruginosa in cream (P < .001) and powder (P < .001), and Staphylococcus aureus in strip (P < .001). All forms of the adhesives promoted higher biofilm formation when compared to control (P = .003). Brushing with Colgate and Protex was most effective for removing the adhesives (P < .05). Independently, Powder had the highest adhesive strength (P < .05). Only Strip showed a change in adhesive strength, with higher values after 3 hours of application (P = .004). CONCLUSION: Daily treatments with mechanical cleaning of the prosthesis are important for removing the adhesives, since the presence of this material can favor biofilm accumulation. The adhesive strength may vary depending on the commercial type, but all forms can be effective in retaining prostheses for a satisfactory period of time.

Effectiveness of Brushing Associated With Oral Irrigation in Maintenance of Peri-Implant Tissues and Overdentures: Clinical Parameters and Patient Satisfaction.

Hygiene of implant-supported prostheses and the health of peri-implant tissues are considered to be predictive factors of successful prosthetic rehabilitation. Therefore, the purpose of this study was to evaluate the effectiveness of brushing associated with oral irrigation measured as biofilm-removing capacity, maintenance of healthy oral tissues, and patient satisfaction. A randomized, crossover clinical trial was conducted with 38 patients who wore conventional maxillary complete dentures and mandibular overdentures retained by the O-ring system. The patients were instructed to use the following hygiene methods for 14 days: mechanical brushing (MB; brush and dentifrice, control) and MB with oral irrigation (Waterpik [WP], experimental). Biofilm-removing capacity and maintenance of healthy oral tissues were evaluated by the modified plaque index (PI), gingival index (GI), probing depth (PD), and bleeding on probing index (BP) recorded at baseline and after each method. In parallel, patients answered a specific questionnaire using a visual analog scale after each hygiene method. Data were analyzed by Friedman and Wilcoxon tests (α = .05). The results showed significantly lower PI, GI, PD, and BP after application of the hygiene methods (P < .001) than those observed at baseline. However, no significant difference was found between MB and WP. The responses to the satisfaction questionnaire for both methods showed high mean values for all questions, with no statistically significant difference found between the answers given after the use of MB and WP (P > .05). The findings suggest that WP was effective in reducing PI, GI, PD, and BP indices and provided a high level of patient satisfaction.

In Vitro Antimicrobial Activity of Effervescent Denture Tablets on the Components of Removable Partial Dentures.

PURPOSE: To evaluate the antimicrobial activity of effervescent tablets on the surfaces of cobalt-chromium (Co-Cr) and heat-polymerized resin. MATERIALS AND METHODS: From a metal matrix, 55 circular wax patterns (Ø 12 × 3 mm) were obtained and cast in Co-Cr alloy. Muffles for acrylic resin were prepared from circular wax patterns (Ø 20 × 5 mm). The metal specimens were positioned in the muffle, and the resin was pressed into its surroundings to simulate the composition of a removable partial denture (RPD). The mixed specimens were sterilized and contaminated with Streptococcus mutans, Staphylococcus aureus, Candida albicans, and Candida glabrata, composing a multispecies biofilm, and subsequently immersed according to the manufacturer's instructions in four cleansing solutions: Polident 3 Minute denture cleanser (P3M), Polident for Partials (PP), Corega Tabs (CT), and NitrAdine (Ni); as well as distilled water (positive control) and no contamination (negative control). After cleansing, viable microorganisms were quantified by counting the number of colony-forming units (CFU/mL). From the CFU values, log10(CFU + 1) values were calculated for statistical analysis. Kruskal-Wallis test with Dunn post hoc test were performed (α = .05). RESULTS: There was a significant reduction (P = .001) of S mutans after immersion in Ni (median [95% CI] 3.27 [2.92; 3.45]) compared to the CT (3.86 [3.75; 4.01]) and control (4.08 (3.73; 4.22]) groups, while the PP (3.63 [3.28; 4.11]) and P3M (3.83 [3.61; 4.04]) groups presented an intermediate action. The effervescent tablets did not present antimicrobial action against S aureus (P = .537), C albicans (P = .795), or C glabrata (P = .519). CONCLUSION: Ni exhibited moderate antimicrobial action. The effervescent tablets did not promote reduction of multispecies biofilm, and their daily use should be carefully considered.

Effect of sodium hypochlorite and Ricinus communis solutions on control of denture biofilm: A randomized crossover clinical trial.

STATEMENT OF PROBLEM: The prevalence of complete edentulism remains high in the elderly, and previous data have shown that poor denture hygiene is common among patients with edentulism. PURPOSE: The purpose of this randomized crossover trial was to evaluate the efficacy of denture cleansers in terms of biofilm removal, antimicrobial action, and the remission of denture stomatitis. MATERIAL AND METHODS: Fifty denture wearers with denture stomatitis were instructed to brush their dentures (brush and soap) and to soak them (20 minutes/14 days) in 4 solutions, as follows: C (control), 0.85% saline; SH1, 0.1% sodium hypochlorite; SH2, 0.2% sodium hypochlorite; and RC, 8% Ricinus communis. The biofilm in the intaglio surface of maxillary dentures was stained, photographed, and quantified by software (Image Tool). It was then collected (brushed with saline solution), and the obtained suspension was diluted (100 to 10-3) and seeded (50 µL) in CHROMagar for Candida spp. After incubation, colony-forming units per milliliter values were calculated. Denture stomatitis remission was classified according to the Newton classification. Data were analyzed by Friedman (α=.05) and Wilcoxon tests and corrected by the Bonferroni test (α=.005). RESULTS: SH1 (mean rank [MR]=1.98) and SH2 (MR=1.64) showed lower biofilm coverage than C (MR=3.73) that was similar to RC (MR=2.92). SH1 (MR=2.43) and SH2 (MR=2.10) showed antimicrobial action for Candida spp, and RC (MR=3.36) showed similar results to C (MR=3.51) and baseline (MR=3.50). Clinical signs of denture stomatitis were reduced by SH1 (MR=2.44), while SH2 (MR=2.56) and RC (MR=2.74) showed intermediate results. CONCLUSIONS: The two sodium hypochlorite solutions were the most effective means of biofilm control. All tested solutions were effective in reducing the signs of denture stomatitis.