Oral hygiene habits, denture cleanliness, presence of yeasts and stomatitis in elderly people

Pathophysiological microenvironments in oral candidiasis

Oral candidiasis (OC), a prevalent opportunistic infection of the oral mucosa, presents a considerable health challenge, particularly in individuals with compromised immune responses, advanced age, and local predisposing conditions. A considerable part of the population carries Candida in the oral cavity, but only few develop OC. Therefore, the pathogenesis of OC may depend on factors other than the attributes of the fungus, such as host factors and other predisposing factors. Mucosal trauma and inflammation compromise epithelial integrity, fostering a conducive environment for fungal invasion. Molecular insights into the immunocompromised state reveal dysregulation in innate and adaptive immunity, creating a permissive environment for Candida proliferation. Detailed examination of Candida species (spp.) and their virulence factors uncovers a nuanced understanding beyond traditional C. albicans focus, which embrace diverse Candida spp. and their strategies, influencing adhesion, invasion, immune evasion, and biofilm formation. Understanding the pathophysiological microenvironments in OC is crucial for the development of targeted therapeutic interventions. This review aims to unravel the diverse pathophysiological microenvironments influencing OC development focusing on microbial, host, and predisposing factors, and considers Candida resistance to antifungal therapy. The comprehensive approach offers a refined perspective on OC, seeking briefly to identify potential therapeutic targets for future effective management.

Behaviors, hygiene habits, and sources of care among removable complete and partial dentures wearers: A multicenter cross-sectional study

OBJECTIVES

There is a lack of data regarding the hygiene practices and sources of care among individuals in Yemen who wear removable complete and partial dentures. The purpose of this study was to explore the behaviors, hygiene habits, and sources of care information among patients who utilize complete and partial dentures in Yemen.

MATERIALS AND METHODS

A descriptive cross-sectional research design was utilized, and a sample of 217 consecutive participants who wore removable complete and/or partial dentures were enlisted. A questionnaire was employed to collect data on demographic information, educational attainment, denture habits, denture cleaning practices, and encountered difficulties. Statistical analysis was conducted using SPSS software, and significance was determined using chi-square tests, with a significance level of .05.

RESULTS

The data analysis revealed that a majority of the participants were male (72.4%) and had an average age of 65.14 years. Fifty-three percent of the participants wore partial dentures, while 34.6% wore complete dentures. Only 6.5% of the participants wore both complete and partial dentures, and 6% wore overdentures. The majority of participants (88.47%) had dentures made of acrylic material. Additionally, 43% of participants wore dentures while sleeping, and 61.3% stored their dentures in dry places without a water-filled container when not in use. The most commonly reported cleaning methods were water only (24.4%), followed by water and soap (19.4%). Furthermore, a large portion of the participants (59.4%) received denture care information from dentists. However, the majority (59%) did not visit a dentist for regular denture maintenance or any denture-related issues. The data analysis did not reveal any significant association between age or education level and denture cleaning methods.

CONCLUSION

This cross-sectional survey provides insight into the hygiene knowledge and practices of removable denture wearers in Yemen. The findings underscore the necessity for enhanced oral hygiene education and awareness within this population. The study offers valuable insights for oral health professionals to design targeted interventions and educational initiatives aimed at promoting proper denture care and maintenance. These efforts have the potential to enhance the oral health and overall well-being of removable denture wearers.

Strategies for Preventing and Treating Oral Mucosal Infections Associated with Removable Dentures: A Scoping Review

Oral infections occur due to contact between biofilm rich in Candida albicans formed on the inner surface of complete dentures and the mucosa. This study investigated historical advances in the prevention and treatment of oral mucosal infection and identified gaps in the literature. Bibliographic research was conducted, looking at PubMed, Embase, Web of Science, and Scopus, where 935 articles were found. After removing duplicates and excluding articles by reading the title and abstract, 131 articles were selected for full reading and 104 articles were included. Another 38 articles were added from the gray literature. This review followed the PRISMA-ScR guidelines. The historical period described ranges from 1969 to 2023, in which, during the 21st century, in vitro and in vivo studies became more common and, from 2010 to 2023, the number of randomized controlled trials increased. Among the various approaches tested are the incorporation of antimicrobial products into prosthetic materials, the improvement of oral and denture hygiene protocols, the development of synthetic and natural products for the chemical control of microorganisms, and intervention with local or systemic antimicrobial agents. Studies report good results with brushing combined with sodium hypochlorite, and new disinfectant solutions and products incorporated into prosthetic materials are promising.

Biofilm removal effect of diatom complex on 3D printed denture base resin

For patients who have difficulty in mechanical cleaning of dental appliances, a denture cleaner that can remove biofilm with dense extracellular polymeric substances is needed. The purpose of this study is to evaluate the efficacy of diatom complex with active micro-locomotion for removing biofilms from 3D printed dentures. The diatom complex, which is made by doping MnO2 nanosheets on diatom biosilica, is mixed with H2O2 to generate fine air bubbles continuously. Denture base resin specimens were 3D printed in a roof shape, and Pseudomonas aeruginosa (107 CFU/mL) was cultured on those for biofilm formation. Cleaning solutions of phosphate-buffered saline (negative control, NC), 3% H2O2 with peracetic acid (positive control, PC), denture cleanser tablet (DCT), 3% H2O2 with 2 mg/mL diatom complex M (Melosira, DM), 3% H2O2 with 2 mg/mL diatom complex A (Aulacoseira, DA), and DCT with 2 mg/mL DM were prepared and applied. To assess the efficacy of biofilm removal quantitatively, absorbance after cleaning was measured. To evaluate the stability of long-term use, surface roughness, ΔE, surface micro-hardness, and flexural strength of the 3D printed dentures were measured before and after cleaning. Cytotoxicity was evaluated using Cell Counting Kit-8. All statistical analyses were conducted using SPSS for Windows with one-way ANOVA, followed by Scheffe's test as a post hoc (p < 0.05). The group treated with 3% H2O2 with DA demonstrated the lowest absorbance value, followed by the groups treated with 3% H2O2 with DM, PC, DCT, DCT + DM, and finally NC. As a result of Scheffe's test to evaluate the significance of difference between the mean values of each group, statistically significant differences were shown in all groups based on the NC group. The DA and DM groups showed the largest mean difference though there was no significant difference between the two groups. Regarding the evaluation of physical and mechanical properties of the denture base resin, no statistically significant differences were observed before and after cleaning. In the cytotoxicity test, the relative cell count was over 70%, reflecting an absence of cytotoxicity. The diatom complex utilizing active micro-locomotion has effective biofilm removal ability and has a minimal effect in physical and mechanical properties of the substrate with no cytotoxicity.

Denture Plaque Biofilm Visual Assessment Methods: A Systematic Review

Denture plaque, a biofilm that develops on denture surfaces, could contribute to many oral and systemic afflictions. Hence, a quantitative assessment of denture plaque is important to evaluate the denture hygiene of denture wearers, particularly to prevent plaque biofilm-associated diseases. The aim of this systematic review, therefore, was to review and summarize the visual denture hygiene assessment methods using denture plaque indices and with planimetries published in the literature. English language studies published up to March 2022 in four electronic databases, PubMed, Medline, Embase, and Cochrane Library, were searched, followed by a manual search of Google Scholar by two assessors. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) whenever possible. Details of the visual assessment methods, including the types of denture assessed, its materials and its surfaces, as well as the use of a disclosing agent, were the main outcomes. Of 492 screened studies, 74 were included per the inclusion and exclusion criteria. Of these, 60 studies utilized various denture plaque indices while 18 used planimetries. 43 out of 60 studies with indices and 17 out of 18 studies with planimetries used disclosing agents for visual evaluation of plaque. A total of 21 indices were described in the included studies, of which seven graded a divided denture surface, while the remainder graded entire denture surface. Of the 18 planimetric assessments, one study quantified squares of the disclosed plaques on denture images, 16 studies quantified such pixels with computer programs, and a single study quantified points, pixels, and contour of plaque areas. In summary, denture plaque indices appear to be popular in denture plaque assessment due to their simplicity. Computerized planimetric assessment, though more time-consuming, provides a more accurate assessment of plaque load as it is less prone to subjectivity and assessor errors.

Cutaneous Fungal Infections in Older Adults

The population of older adults continues to increase in the United States, leading to a concomitant increase in cutaneous disease. Fungal disease, specifically, commonly affects this population but often goes undiagnosed for too long. It is therefore important that providers be aware of common fungal pathogens, recognizable symptoms of disease, and treatment options. This article discusses 3 groups of pathogens: dermatophytes, Candida species, and Pityrosporum species, all of which cause a host of conditions that can be debilitating for older adults.

Relation between the risk factors for the severity of denture stomatitis and quality of life of complete edentulous individuals: a cross-sectional study

OBJECTIVE

To assess the association between risk factors for developing denture stomatitis (DS) and oral health-related quality of life (OHRQoL) in complete denture wearers.

METHODOLOGY

Participants of both sexes, wearing complete dentures, were classified using the modified Newton classification for the absence or the severity of DS and allocated to groups Normal or zero, IA, IB, II, and III. Lifestyle, oral and denture history, and medication use were assessed using specific questionnaires; clinical parameters such as anatomical characteristics of support were evaluated with the Kapur classification; salivary flow (SF) was calculated by the volume of unstimulated saliva per minute; and microbial load was determined by counting colony forming units (CFU) of target microorganisms present in the biofilm collected from dentures and palate. OHIP-EDENT assessed the OHRQoL. Kendall's tau_b and Spearman tests were applied with a significance level of 5%.

RESULTS

184 patients (143 female and 41 male) aged 65.5 ± 6.8 years were evaluated. Positive correlations were found for sex (women; p=0.013, r=0.16), individuals who started to consume alcoholic beverages as a young adult (18-27 years) (p=0.008, r=0.22), CFU of Candida spp. (p<0.001, r=0.27 denture; p<0.001, r=0.31 palate); Candida albicans (p=0.004, r=0.22 denture; p=0.003, r=0.25 palate), and Candida glabrata (p=0.004, r=0.22 denture; p=0.001, r=0.27 palate). Moreover, negative correlations with DS were found for CFU of Staphylococcus spp. (p=0.004, r=-0.20 palate) and enterobacteria (p=0.002, r=-0.24 palate), as well as a negative correlation between SF (p=0.009, r=-0.193) and DS. The CFU of Staphylococcus spp. and enterobacteria on the palate significantly correlated with OHRQoL.

CONCLUSION

Being female, consuming alcoholic beverages as a young adult, CFU of Candida spp., Candida albicans, Candida glabrata, and salivary flow may be the most significant risk factors for DS. The microbial load of Staphylococcus spp. and enterobacteria seems to influence the quality of life for complete denture wearers.

Microbial Analysis of Obturators During Maxillofacial Prosthodontic Treatment Over an 8-Year Period

The aim of the study was to investigate the microbial colonization (by Candida species, anaerobic and facultative anaerobic bacteria) of maxillary obturators used for the restoration of maxillary defects, including during radiotherapy.

Retrospective cohort study.

Fifteen patients requiring a maxillary obturator prosthesis had swabs of their obturators and adjacent tissues taken at different stages of their treatment over a period of 8 years.

Identification of microbial species from the swabs was carried out using randomly amplified polymorphic DNA polymerase chain reaction (RAPD PCR) analysis, checkerboard DNA-DNA hybridization, CHROMagar Candida chromogenic agar, and DNA sequencing.

Candida species were detected in all patients and all patients developed mucositis and candidiasis during radiotherapy which was associated with an increase in colonization of surfaces with Candida spp., particularly C albicans. Microbial colonization increased during radiotherapy and as an obturator aged, and decreased following a reline, delivery of a new prosthesis, or antifungal treatment during radiotherapy.

Microbial colonization of maxillary obturators was related to the stage of treatment, age of the obturator material, radiotherapy and antifungal medications, and antifungal treatment may be recommended if C albicans colonization of palatal tissues is greater than 105 colony-forming units per cm2 following the first week of radiotherapy.

Feasibility of microencapsulated phytochemical as disinfectant for inhibition of Candida albicans proliferation on denture base produced by digital light processing

BACKGROUNDS

A proper disinfection of denture is vital to prevent a fungal infection. A study on the feasibility of microencapsulated phytochemical as complementary disinfectant and its interaction with effervescent tablet immersion on denture base resin is lacking.

OBJECTIVES

The aim of this study was to examine the feasibility of phytochemical-filled microcapsules as disinfectant for the inhibition of Candida albicans (C. albicans) attachment on the denture base produced by digital light processing (DLP).

METHODS

54 denture base specimens uniformly mixed with or without 5wt% phytochemical-filled microcapsules were prepared using DLP. Fungal cells were inoculated onto the surfaces of the specimens, which were divided into three different disinfection treatment groups (n = 9): 1) none, 2) sterile tap water immersion for 15 min, and 3) effervescent tablet immersion for 15 min. After each treatment, the biofilm on denture surface was stained with a crystal violet solution to measure the absorbance. The number of fungal colonies was counted as colony-forming units (CFU) per mL. Morphological changes were examined by microscopy. An aligned rank transform analysis of variance was performed to analyze the interaction of presence of microcapsule and disinfection condition, with statistical significance set at P < 0.05.

RESULTS

Both for the absorbance and CFU, there was no significant interaction between the presence of microcapsules and disinfection conditions (P = 0.543 and P = 0.077, respectively). The presence of microcapsules was statistically significant (both P < 0.001), while the effect of disinfection condition was not significant (P = 0.165 and P = 0.189, respectively). Morphological changes in fungi were detected in the groups containing microcapsules, whereas undamaged hyphal structures were found in those without microcapsules, irrespective of disinfection treatments.

CONCLUSIONS

The presence of phytochemical-filled microcapsules significantly reduced the adhesion of C. albicans and inhibited its proliferation on denture surfaces, regardless of disinfection conditions.

Appraisal and characterization of candida load isolated from the oral cavity of smokers

Cigarette smoking is regarded as a major global health risk, therefore the aim of this work was to investigate the association of oral Candida spp. as one of the etiological agents of denture stomatitis with smokers of cigarette, hookah (shisha), and electronic smoking, also a dose-response relationship between the duration of smoking and the probability of denture stomatitis between volunteers. Oral rinse samples were collected from 47 male volunteers including 34 smokers and 13 non-smokers, also data of volunteers were collected via a questionnaire forum. Patterns of smoking were shown that smokers using tobacco cigarettes 17 (36.2 %), electronic cigarettes 16 (34.04 %), and hookah smokers 8 (17.02 %). A comparison of smokers and non-smokers regarding effects on oral health showed significantly finding (P < 0.05) indicating that smoking affects oral health in all evaluated parameters (an oral mucosal abnormality, mouth ulcers, bad breath, and feeling of dry mouth). Out of 19 Candida isolates, 18 (94.7 %) were identified as Candida albicans and 1 (5.3 %) as Candida tropicalis. Among the volunteers who presented with oral Candida (19 volunteers), 17 (89.5%) were smokers, while non-smoker volunteers were 2 (10.5 %), so it can be concluded that smoking was a significant positive correlation to the presence of Candida in the oral cavity. Five volunteers suffered from chronic diseases; 4 (8.5%) diabetes mellitus and 1 (2.1%) anemia as a systemic predisposing factor for oropharyngeal infection. Amphotericin and Nystatin had varying degrees of activity against isolated Candida isolates.

Medium-chain fatty acids as an alternative treatment for denture stomatitis in older people

OBJECTIVE

To determine the effect of medium-chain fatty acids (MCFA) on the severity of denture stomatitis (DS) and the counts of Candida spp. in older people (OP) wearing removable prostheses (RP).

MATERIALS AND METHODS

This randomized, controlled and triple-blind study included forty-three OP presenting DS. The control group was treated with 0.12% chlorhexidine (CHX) and the experimental group with MCFA, 2 × /day for 15 days. Intraoral examination and counts of Candida spp. were performed at 0, 7, and 15 days. The differences between both groups in the decrease of the severity of DS and the viability of Candida spp. were determined clinically and microbiologically, respectively.

RESULTS

OP carriers of RP treated with MCFA presented remission of the clinical signs of DS, but the Candida spp. counts only decreased significantly in the CHX-treated group at 7 days of treatment (p < 0.05). Besides, MCFA was shown to reduce the clinical signs of DS after the first week of application, while CHX after the second week.

CONCLUSIONS

The MCFA is effective in reducing the clinical signs of DS associated with oral candidiasis in subjects with RP. Both treatments showed a significant decrease in severity, for MCFA after the first week and for CHX two weeks after starting the corresponding treatment.

CLINICAL RELEVANCE

The MCFA is an effective, harmless, and accessible treatment alternative against DS, since it manages to reduce the severity of the lesion in the milder cases of DS in the oral mucosa of OP carriers of RP.

Assessing the Antifungal Activity of a Soft Denture Liner Loaded with Titanium Oxide Nanoparticles (TiO2 NPs)

Aim: Soft denture lining materials are susceptible to be colonized by different microorganisms, especially by Candida albicans (C. albicans), causing denture-induced stomatitis. This study was designed to evaluate the effectiveness of incorporating titanium dioxide nanoparticles (TiO2 NPs) into a soft denture liner towards reducing microbial activity. Method: A total of 40 PEMA-TiO2 nanocomposites samples were fabricated by adding 0.0 wt.% (control), 1.0 wt.%, 1.5 wt.%, and 2 wt.% TiO2 NPs to a heat cured soft denture lining material (polyethyl methacrylate, PEMA). The prepared samples were divided into four groups (n = 10) according to the content of TiO2 NPs. The uniformity of TiO2 NPS distribution within the denture liner matrix was assessed using a Scanning Electron Microscope (SEM). The viable count of C. albicans was evaluated to test the antifungal resistance of the developed composite. Results: The SEM images showed fairly homogeneous dispersion, with patches of TiO2 NPs agglomeration within the PEMA matrix and an increasing concentration of NPs with higher NP content. The particle map and EDX analysis confirmed the evidence of the TiO2 NPs. The mean viable count results for the control (0.0 wt.%) and 1.0 wt.%, 1.5 wt.%, and 2 wt.% TiO2 groups were 139.80, 12.00, 6.20, and 1.00, respectively, with a significant difference from the control group (p < 0.05). The antifungal activity also increased with the increase in the concentration of TiO2 NPs. Conclusions: The addition of TiO2 NPs into a heat-cured soft denture liner provided antifungal activity as evidenced by the reduced colonization of C. albicans. The antimicrobial activity of the liner material increased with the increased concentration of TiO2 NPS.

Removal effect of Candida albicans biofilms from the PMMA resin surface by using a manganese oxide nanozyme-doped diatom microbubbler

To prevent oral candidiasis, removal of the Candida biofilms from dentures is important. However, common denture cleaners are insufficiently effective in removing biofilms. A manganese oxide (MnO₂) nanozyme-doped diatom microbubbler (DM) can generate oxygen gas microbubbles by a catalase-mimicking activity in hydrogen peroxide (H₂O₂). DM can invade and destroy biofilms with the driving force of continuously generated microbubbles. In this study, the Candida biofilm removal efficiency by co-treatment of DM and H₂O₂ was investigated. Diatom particles were reacted with (3-aminopropyl)triethoxysilane to prepare amine-substituted diatom particles. These particles were reacted with potassium permanganate to fabricate DMs. The morphology and components of DM were analyzed by using a scanning electron microscope (SEM). Four types of denture base resin specimens on which biofilms of Candida albicans were formed were treated with phosphate-buffered saline (PBS group), Polident 5-Minute (Polident group), 0.12% chlorhexidine gluconate (CHX group), 3% H₂O₂ (H₂O₂ group), and co-treatment of 3 mg/mL of DM and 3% H₂O₂ (DM group). The biofilm removal effect of each group was quantitatively analyzed by crystal violet assay, and the results were visually confirmed by SEM images. After each treatment, the remaining C. albicans were stained with Hoechst 33342/propidium iodide, and observed with confocal laser scanning microscopy (CLSM) to evaluate the viability. MnO₂ nanozyme sheets were successfully doped on the surface of the fabricated DM. Although biofilms were not effectively removed in the Polident and CHX groups, CLSM images showed that CHX was able to effectively kill C. albicans in the biofilms on all resin specimen types. According to the crystal violet analysis, the H₂O₂ groups removed the biofilms on heat-activated and 3D-printed resins (P < .01), but could not remove the biofilms on autopolymerizing and milled resins significantly (P = .1161 and P = .1401, respectively). The DM groups significantly removed C. albicans from all resin specimen types (P < .01).

Assessing the Effect of Curcumin on the Oral Mucosal Cytomorphometry and Candidal Species Specificity in Tobacco Users: A Pilot Study

Objectives: Tobacco consumption is of major concern for public health. Compromised oral hygiene accentuated by tobacco leads to alteration in the oral mucosa and microbiome, including Candida, and its species can be identified rapidly using CHROMagar. Curcumin, a naturally available compound possesses antioxidant, anti-inflammatory, anti-microbial, anti-carcinogenic, anti-fungal, and immunomodulatory properties. Hence, a comprehensive study was planned. Aim: To evaluate and compare cytomorphometric analysis and Candida colonization and speciation in tobacco users before and after the use of curcumin gel. Materials and Methods: The study comprised a total of 120 participants (the study (tobacco habit) group, n = 60 and control (healthy) group, n = 60). The intervention was the application of curcumin gel over the lesion area three times daily for 2 months. All participants’ oral health status was assessed, followed by cytomorphometric analysis and Candida colonization and speciation using CHROMagar. Results: Cytomorphometric analysis showed statistically significant differences in the control and study group for cell diameter (CD), nuclear diameter (ND), CD:ND ratio, and micronuclei (p = 0.0001). Candida colonization had a significantly higher number of colonies in the habit group when compared to the control group. Candida tropicalis was predominant in the study group, whereas Candida albicans was predominant in the control group. In the study group, after intervention with curcumin, a statistically significant difference was seen in nuclear diameter, CD:ND ratio, and micronuclei. There was a reduction in the number of Candida colonies, and Candida albicans was the predominant species observed in the study group after the intervention of curcumin and discontinuation of habit. Conclusion: Curcumin was found to reduce the number of micronuclei and also decreased Candida colonization, along with the discontinuation of habit in tobacco users.

Denture cleanliness and hygiene: an overview

Dentures are an excellent treatment modality for partial and edentate patients; however, improper denture care and hygiene can result in both decreased longevity of the prosthesis and increased risk of developing dental caries, periodontal disease and oral candidosis. Previously, it has been shown that patients and dental professionals are unaware of the different materials and methods available for optimum denture care and hygiene. This article provides an overview of the key legislation and main commercially available methods for denture cleanliness and hygiene, and serves as a basis for providing tailored denture hygiene for denture wearers.

Patients typically demonstrate poor levels of denture hygiene which impacts oral health.

Denture hygiene instructions comprise mechanical and chemical methods; both should be tailored to the denture wearer.

Denture base and denture teeth materials had different compatibility with different denture cleaning methods.

Properties and characteristics of foam denture cleaners as denture adhesive removers

The need for denture adhesives is increasing worldwide, but few denture-care products target denture adhesive users. Foam denture cleaners have been recently marketed to assist brush denture cleaning, but there is a lack of objective evaluation. In this study, we compared the detergency of denture adhesives using six commercial foam-denture cleaners. For removing the adhesives, most of the tested cleaners were effective in immersion experiments, and three cleaners were more effective in the denture cleaning experiment compared to control water. However, only one could effectively remove the slime that is derived from the adhesive and detergency of artificial dirt. The surface roughnesses of the denture base and the relining material revealed that prolonged immersion in some cleaners could be affected. The results suggest that different commercial foam denture cleaners have different detergency levels, and that some cleaners may affect the properties of denture materials upon long-term use.

Raman Spectroscopy of Oral Candida Species: Molecular-Scale Analyses, Chemometrics, and Barcode Identification

Oral candidiasis, a common opportunistic infection of the oral cavity, is mainly caused by the following four Candida species (in decreasing incidence rate): Candida albicans, Candida glabrata, Candida tropicalis, and Candida krusei. This study offers in-depth Raman spectroscopy analyses of these species and proposes procedures for an accurate and rapid identification of oral yeast species. We first obtained average spectra for different Candida species and systematically analyzed them in order to decode structural differences among species at the molecular scale. Then, we searched for a statistical validation through a chemometric method based on principal component analysis (PCA). This method was found only partially capable to mechanistically distinguish among Candida species. We thus proposed a new Raman barcoding approach based on an algorithm that converts spectrally deconvoluted Raman sub-bands into barcodes. Barcode-assisted Raman analyses could enable on-site identification in nearly real-time, thus implementing preventive oral control, enabling prompt selection of the most effective drug, and increasing the probability to interrupt disease transmission.

Evaluation of microhardness in two types of denture bases after using sodium hypochlorite and NatureDent disinfecting agents

Background. Chemical agents, in combination with mechanical methods, play an important role in reducing microbial plaque on denture surfaces. However, these methods might change the mechanical behavior of acrylic resins, including microhardness and surface roughness. This in vitro study investigated the effect of two disinfectants, i.e., water and sodium hypochlorite, on the microhardness of conventional heat-cured and TiO₂ nanoparticle-reinforced acrylic resins. Methods. Sixty acrylic resin specimens were divided into two groups, and the samples in each group were randomly assigned to three subgroups (n=10). Heat-cured specimens and 1 wt% TiO₂ acrylic resin were prepared and immersed in three solutions: water, a solution prepared with NatureDent pills, and 1% sodium hypochlorite for 30, 60, and 90 days. Microhardness tests were performed on each sample at each immersion stage. The data were analyzed using descriptive statistical methods, three-way and one-way ANOVA, repeated-measures t test, and Tukey HSD tests using SPSS 17. P values<0.05 were considered significant. Results. All three independent parameters, including resin, solution, and time, significantly affected microhardness (P<0.05). The microhardness of both specimen types, i.e., conventional heat-cured and TiO₂ nanoparticle-reinforced acrylic resins, immersed for 30, 60, and 90 days, was the highest and lowest in water and hypochlorite solutions, respectively. Regarding 90 days, the microhardness values of conventional heat-cured and TiO₂ nanoparticle-reinforced acrylic resins were 17.050±0.094 and 19.953±0.053 in water, 15.675±0.069 and 18.965±0.037 in hypochlorite, and 16.713±0.122 and 19.39±20.113 in NatureDent solutions, respectively. Conclusion. Disinfecting two types of acrylic resin specimens decreased their microhardness as a function of immersion time for up to 90 days in the three solutions. However, the magnitude of hardness lost was less for TiO₂ nanoparticles-reinforced acrylic resin.

Comparative evaluation of vegetable matter involved lesions with oral parasitic infections in the oral cavity

The current research aims to perform a comparative evaluation of vegetable matter involved lesions with oral parasitic infections found in oral mucosa, presenting histochemical methods to differentiate their microscopic similarities. Eight cases were selected out of a sample of 1.975 reports from a single Oral and Maxillofacial Pathology Service of the author's institution from 2012 to 2019. Specimens were examined by hematoxylin and eosin staining (HE), periodic acid-Schiff (PAS) staining, Gomori-Grocott staining, Ziehl-Neelsen staining, Giemsa, and mucicarmine staining. Microscopic analysis included fluorescence, polarized light, and confocal microscopy. Microscopically, in HE coloration, hookworm eggs showed as eosinophilic. Inflammatory multinucleated giant cells and lymphocytes, were usually related to the nematode eggs, forming an intense inflammatory infiltrate. Biofluorescent properties of eggs and larvae revealed to be sensitive in the detection of parasitic structures contrasting with the inflamed connective tissue. Vegetable presence was confirmed by polarized light microscopy and it was found to be associated with microbial biofilms. Confocal microscopy has showed to be an excellent method for morphotype differentiation of parasitic eggs. Parasitic infection and vegetable matter displayed similarities in the inflammatory response, but the latter can rot and agglomerate biofilms. The microscopic diagnosis of such infections requires the interpretation of challenging morphological features since the parasites are usually sectioned and mixed with an inflammatory reaction. These histochemical approaches proved to be excellent to distinguish both lesions.

Evaluation of the time-dependent efficacy of commercial denture or orthodontic appliance cleansers: An in vitro study

The aim of this study was to evaluate the antimicrobial, stain and protein removal efficacy of denture or orthodontic appliance cleansers using in vitro test methods. Experimental cleansers were applied for experimental time in each evaluation method. To evaluate the microorganism removal efficacy, C. albicans and S. mutans removal rate was calculated from the specimen surface. Stain and protein removal rate was calculated using the spectrophotometer. Experimental cleansers significantly affected the microorganism removal rate for both C. albicans and S. mutans, as well as the stain and protein removal rates, at each experimental time (p<0.05). As the application time increased, the stain and protein removal rates of all experimental cleansers significantly increased (p<0.05). The present study provided in vitro evaluation methods to assess the efficacy of denture or orthodontic appliance cleansers. Also, manufacturers and researchers can predict clinical outcomes and ensure proper hygiene management of dentures or orthodontic appliances.

Inhibition of Candida albicans and Mixed Salivary Bacterial Biofilms on Antimicrobial Loaded Phosphated Poly(methyl methacrylate)

Biofilms play a crucial role in the development of Candida-associated denture stomatitis. Inhibition of microbial adhesion to poly(methyl methacrylate) (PMMA) and phosphate containing PMMA has been examined in this work. C. albicans and mixed salivary microbial biofilms were compared on naked and salivary pre-conditioned PMMA surfaces in the presence or absence of antimicrobials (Cetylpyridinium chloride [CPC], KSL-W, Histatin 5 [His 5]). Polymers with varying amounts of phosphate (0–25%) were tested using four C. albicans oral isolates as well as mixed salivary bacteria and 24 h biofilms were assessed for metabolic activity and confirmed using Live/Dead staining and confocal microscopy. Biofilm metabolism was reduced as phosphate density increased (15%: p = 0.004; 25%: p = 0.001). Loading of CPC on 15% phosphated disks showed a substantial decrease (p = 0.001) in biofilm metabolism in the presence or absence of a salivary pellicle. Salivary pellicle on uncharged PMMA enhanced the antimicrobial activity of CPC only. CPC also demonstrated remarkable antimicrobial activity on mixed salivary bacterial biofilms under different conditions displaying the potent efficacy of CPC (350 µg/mL) when combined with an artificial protein pellicle (Biotene half strength).

Epidemiological factors associated with Candida albicans in patients using complete denture: a scoping review

Objective: This study undertakes a scoping review of research on epidemiological factors of Candida albicans in patients using complete denture (CD). Methods: PubMed, LILACS, Embase, SciELO, Web of Science, and Scopus databases were used. Searches were conducted in December 2020. Keywords used in this search were Candida albicans, Complete Denture, Mouth, and Microbiology. Results: Initially, 89 articles were identified; 19 of these comprised the final sample after applying the exclusion/inclusion criteria. There was a greater tendency for females to use DC. In addition, among all samples evaluating the incidence of the fungus (n = 2,724), approximately 44.7% (n = 1,218) had C. albicans-associated prosthetic stomatitis. Conclusion: Prosthetic stomatitis is a condition that mainly affects women aged 50–70 years and has a multifactorial predisposition. Also, Newton's classification proposed in 1962 is the most used for the clinical diagnosis of oral candidiasis. The CD's hygiene status is a crucial factor for the progression of candidosis, in the same way that the C. albicans fungus plays an important role in the progression of this pathogenesis in the host.

Phytotherapy in the management of denture stomatitis: A systematic review and meta-analysis of randomized controlled trials

Medicinal plant extracts are commonly applied for infectious diseases and are perceived as alternatives to conventional antimicrobial agents. We aimed to confirm the efficacy of phytotherapy for denture stomatitis compared with conventional therapies and placebo. A comprehensive literature search was conducted in Pubmed, Embase, Cochrane Library (CENTRAL), Scopus, and Web of Science, in addition to manual searching. Randomized controlled trials (RCTs) published in English, and studying the treatment of denture stomatitis with herbal medicines, were included. The outcome measures included the relief of clinical signs, reduced Candida colony counts, adverse effects, and patient satisfaction. Nineteen RCTs were included for a systematic review based on selection criteria. Two of them were analyzed using a random-effects model. There was no difference in the relief of clinical signs (odds ratio (OR) = 0.96; 95% confidence interval (CI): 0.43-2.15) and microbiological improvement (OR = 1.74; 95% CI: 0.55-5.45) between propolis and miconazole. Most of the included studies showed that phytomedicines had fewer side effects and more patient satisfaction than antifungals or disinfectants. However, further RCTs with more standardly prepared herbal formulations are required to verify the clinical efficacy of phytotherapy as an alternative or adjunctive therapy for denture stomatitis.

Evaluating the role of local host factors in the candidal colonization of oral cavity: A review update

Human oral cavity is home to a number of organisms, Candida albicans being one of them. This review article aims at understanding the correlation between the oral candidal colonization and the local host factors that may influence it with special emphasis on congenital craniofacial anomalies such as cleft lip and palate (CLP). Various scientific databases were searched online and relevant articles were selected based on the inclusion criteria. A comparative study was done to understand the interdependence of various factors (including CLP) and oral candidal colonization. The results revealed a strong association of certain local host factors which may influence the oral colonization of Candida species. Factors such as mucosal barrier, salivary constituents and quantity of saliva, congenital deformities like CLP, oral prostheses such as dentures/palatal obturators and fixed orthodontic appliances (FOAs) were identified. All these factors may directly affect the growth of Candida in the oral cavity. Although numerous studies have pointed a positive correlation between Oral Candidal colonization and local host factors such as oral prostheses, FOA, and oral mucosal barrier only one study has been done, in the Indian subcontinent with respect to the correlation of candidal colonization and CLP. After the evaluation of all the factors mentioned in various case studies, it can be concluded that the presence of local host factors such as orofacial clefts, dental prostheses, FOA, xerostomia, and atrophy of the oral mucous membrane lead to significant increase in candidal colonization, but since very few studies in regard to CLP have been done worldwide and in India, in particular, further studies are warranted.

The Effectiveness of Waist-Shaped and Straight-Shaped Interdental Brushes in Cleaning Implant Overdenture Attachments: A Self-Controlled Clinical Trial

Elderly patients often find it challenging to remove plaque accumulated on the attachments of implant overdentures (IODs) using conventional cleaning instruments. Further, excessive plaque accumulation can lead to peri-implant diseases and occasionally to respiratory diseases. Therefore, here, we aimed to compare the effectiveness of waist-shaped interdental brushes (WIBs) with that of straight-shaped interdental brushes (SIBs) in plaque removal from the locator attachments of IODs. Twenty participants with 2 locator attachments retaining mandibular IODs participated in this study. After the baseline cleaning, the participants refrained from oral hygiene maintenance for 3 days. A dentist cleaned 1 of the attachments using the WIB and the other attachment using the SIB. The pre- and post-cleaning modified plaque index (mPLI) scores were recorded. After another 3 days free from oral hygiene maintenance, the trained participants repeated the same cleaning procedure using the WIB and SIB. Pre- and post-cleaning mPLI scores were recorded. Regardless of the type of brush used, the post-cleaning mPLI scores were lower than the pre-cleaning scores. After the cleaning procedure, the overall mean mPLI score was lower in the WIB group than in the SIB group. The post-cleaning mPLI scores at the line angles and on the axial surfaces of the attachments were also lower in the WIB group than in the SIB group. There was no difference in the cleaning effectiveness between the dentist and participants when they used the same type of interdental brush. The WIB was significantly more efficient in plaque removal than the SIB, especially at the line-angle sites.

Effects of denture cleaning solutions on the retention of Hader bar clips

STATEMENT OF PROBLEM

The clinical performance of implant-retained overdentures (IODs) with plastic bar clips made of different materials in the same design and dimensions may vary according to the patient's daily home care procedures. However, information about the effects of denture cleaning solutions on the retention of Hader bar clips is lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the retention of Hader bar clips made of different polymers after being soaked in denture cleaning solutions.

MATERIAL AND METHODS

Ninety Hader bar clips made of polyamide (PA, n=30), polytetrafluoroethylene (PTFE, n=30), and polyetherketoneketone (PEKK, n=30) materials were tested. Two multiunit abutments were screwed onto the implant analogs and embedded into an acrylic resin block in a standardized position. The digital scanning of the abutments was acquired, and the bar patrix of each material system milled from a cobalt-chromium (Co-Cr) alloy disk by using computer-aided design and computer-aided manufacturing (CAD-CAM). After the milled bar patrices were screwed onto abutments and the metal housings of the bar clips were embedded into acrylic resin blocks, they were connected passively at the same angulation to a universal testing machine. The initial retention values of all Hader bar clips were measured, and each material system was divided into 3 subgroups (n=10) before soaking in the cleaning solutions: distilled water (DW), 5% sodium hypochlorite (NaOCl), or sodium bicarbonate-sodium perborate (SBSP). Each material was soaked for the equivalent of 3 months of clinical use. The final retention values of each Hader bar clip were measured. The data were statistically analyzed by using a 2-way analysis of variance (ANOVA), the Tukey honestly significant difference (HSD) test, and the paired sample t test (α=.05).

RESULTS

The 2-way ANOVA showed that the denture cleaning solution, the clip material, and their interactions led to significantly different retention values (P<.001). A decrease was observed for the retention values of all test groups after soaking in the cleaning solutions (P<.05). No retention was observed for the PTFE clips after soaking in the 5% NaOCI solution.

CONCLUSIONS

The denture cleaning solutions negatively affected the retention of Hader bar clips, regardless of the type of solution and clip material. The 5% NaOCI solution not only decreased the retention of PTFE clips but also completely degraded it. It is recommended that 5% NaOCI solution be avoided for the daily care of IODs with PTFE clips.

Development of a European consensus from dentists, dental hygienists and physicians on a standard for oral health care in care-dependent older people: An e-Delphi study

OBJECTIVES

This study aimed to obtain a consensus on oral health policy, access to dental care, oral hygiene measures and training levels.

BACKGROUND

Poor oral health is widespread in care-dependent older people, but no consensus for a minimum standard of oral health care exists yet.

METHODS

The e-Delphi approach was applied to a selected panel of interdisciplinary experts. Data analysis was based on three measurements: (a) ≥70% of experts' opinion fall into category "agree or strongly agree," (b) median score on the 5-point Likert scale ≥4, (c) interquartile range ≤1.

RESULTS

A total of 31 experts from 17 European countries participated in this survey. Agreement was achieved for a compulsory dental examination when an elder is admitted to a long-term care (LTC) facility. Older people should brush their teeth twice/day and regularly clean interproximal spaces and oral mucosa. Dentures should be rinsed after meals and cleaned twice/day. The use of denture cleansing tablets was considered necessary. Dentures should be removed before sleeping and stored dry. A 5000 ppm fluoride toothpaste should be applied daily in elder with high caries risk. A short report on the oral health status of the elder should be included in the geriatric assessment. All experts concluded that the knowledge and the training in oral health care for caregivers and family members of care-dependent older people were imperative.

CONCLUSIONS

Using the e-Delphi method, multidisciplinary healthcare professionals from different countries agreed on certain cardinal recommendations for a standard oral health care for care-dependent older people.

Investigating the Level of Knowledge of the Community about Oral and Dental Health

Objectives  This study aimed to determine the knowledge and approaches of the participants about oral and dental health.

Materials and Methods  This was a questionnaire-based cross-sectional survey. Participants’ demographic characteristics, tooth brushing habits, selection of toothpaste, and reasons for visiting the dentist were examined in this study. Participants’ knowledge levels of fluoride and their attitudes toward the most common fluoride applications among preventive treatments were also evaluated. Data entry and analyses were performed using SPSS statistical software. Descriptive and inferential statistics and chi-square test were used for analyzes.

Results  A total of 2,744 voluntary participants including 1,938 (70.6%) females and 806 (29.4%) males responded; 1,391 (50.7%) participants know the contents of their toothpaste; 1,680 (61.2%) participants point out that fluoride is effective in preventing dental caries. Female participants reported a statistically significant difference in their knowledge of what is fluoride when compared with male participants ( p = 0.0001). The knowledge level of participants who had higher levels of education were statistically significantly different when compared with the participants who had lower education levels about fluoride and fluoride applications ( p = 0.0001).

Conclusions  The results of this study indicate that participants’ attitudes toward oral health and dental care need to be improved.

Brushing associated with oral irrigation in maintaining implants and overdentures hygiene - a randomized clinical trial

Evaluate, through a randomized clinical trial, the efficacy of brushing associated with oral irrigation in maintaining implant and overdenture hygiene. Thirty-eight participants, who had a clinically acceptable conventional maxillary complete denture and mandibular overdenture retained by either implants or mini-implants using an O-ring-retained system, were enrolled to participate in the study. They were instructed to use two different hygiene methods, in a random sequence for a period of 14 days, with a 7-day wash-out interposed period: (I) mechanical brushing (MB); (II) association of mechanical brushing with oral irrigation (WP). Biofilms from both subgingival sulci and overdentures were collected and processed by Checkerboard DNA-DNA hybridization method at baseline and after using the proposed hygiene protocols. Comparisons were performed using Wilcoxon test and Friedman test with Benjamini-Hochberg false discovery rate, followed by Conover post-hoc test (α = 0.05). In the subgingival sulci-related biofilm, a lower number of microbial cells were detected, after WP compared to the MB method (P < 0.001). The findings of overdenture-related biofilm suggest that both methods were similar (P = 0.607) being the identified microbiota qualitatively coincident after each method. Despite the number of microbial counts, it was concluded that the association of mechanical brushing with oral irrigation was more effective in reducing microorganisms in the subgingival sulci biofilm; however, the same outcome was not observed in the overdentures.

Antifungal Effect of Silver Nitrate on Prosthodontic Dentures

Background/Aim: Although there are studies about the antimicrobial activity of silver, there is no study evaluating it as a denture disinfectant. The purpose of this study was to explore the effectiveness of 6 disinfectant solutions (50% vinegar, 100% vinegar, 1% silver nitrate, 2% silver nitrate, %1 sodium hypochlorite, 0,12% chlorhexidine digluconate) in the disinfection of acrylic resin specimens contaminated in vitro by Candida albicans, as measured by residual colony-forming unit (CFU).

Material and Methods: 66 pieces of 10mmx2mm acrylic resin disc samples were prepared and incubated in 1x106 cell/ml suspension of C. albicans ATCC 18804 for 24 h (one of them as a control, n=11/group). The specimens were then transferred into tubes containing 10 ml of the tested disinfectants and kept for 10 minutes in the disinfectant. After washing with saline, the specimens were vortexed to remove the microorganisms adhered to the surfaces. Colony counting of the collected microorganisms was performed on Sabouroud dextrose medium using 10−1, 10−2 and 10−3 dilutions. The results were analysed using Kruskal-Wallis and Mann-Whitney U tests (p<0,05).

Results: The results showed that 1% sodium hypochlorite, %1 silver nitrate and 2% silver nitrate were the most effective against Candida Albicans (p<0,05), followed by 100% vinegar, 0,12% chlorhexidine digluconate and 50% vinegar (p<0,05).

Conclusions: Within the boundaries of this study, we conclude that 1% silver nitrate is a promising alternative disinfectant to 1% sodium hypochlorite and performs better compared to 0,12 % chlorhexidine gluconate, 50% and 100% vinegar.

The influence of Azadirachta indica, Melaleuca alternifolia, and Cocos nucifera on Candida albicans strain in tissue conditioner at varying time intervals

Aim:

The search for alternative therapies for oral candidiasis is a necessity and the use of medicinal plants seems to be one such promising solutions. Incorporation of phytotherapeutic agents, Azadirachta indica (neem oil), Melaleuca alternifolia oil (tea tree oil), and Cocos nucifera oil (coconut oil), were tested for their efficacy as antifungal agents against Candida albicans. Next, the efficacy of these three antifungal agents when incorporated in a soft relining material at minimum inhibitory concentration (MIC) was evaluated.

Settings and Design:

Evaluative - In-vitro study design.

Materials and Methods:

The MIC against C. albicans ATCC 24433 was calculated for M. alternifolia oil, A. indica oil, and C. nucifera oil using the broth microdilution method. Based on the preliminary screening results for MIC, tissue conditioner samples were prepared to evaluate the zone of inhibition (ZOI) and MIC. Antifungal activity of the MIC of the three oils was assessed and compared by measuring the mean ZOI. Antifungal activity of the three oils was assessed using one-way analysis of variance (ANOVA) and post hoc test.

Statistical Analysis Used:

Oneway ANOVA and post hoc Tukey honestly significant difference test.

Results:

Inhibition against C. albicans was exhibited when 20% v/v, 25% v/v, and 15% v/v of C. nucifera oil, M. alternifolia oil, and A. indica oil were used, respectively. The results of ANOVA and post hoc test at the end of 48 h and 7 days suggested that all three oils were significantly different from each other (P = 0.000) and A. indica/neem oil with 15% concentration had the best antifungal activity at the end of 48 h and 7 days.

Conclusion:

The antimycotic activity of M. alternifolia, C. nucifera, and A. indica mixed with the Visco-gel tissue conditioner can be used as an alternative therapy for denture stomatitis.

Hygiene protocols for the treatment of denture-related stomatitis: local and systemic parameters analysis - a randomized, double-blind trial protocol

Background

Denture-related stomatitis (DS) is chronic multifactorial inflammation, strongly related to the presence of the biofilm that is the complex structure formed by microorganisms held together by a mucus-like matrix of carbohydrate that adheres to different surfaces, including the denture surface. DS has recently been correlated with deleterious cardiovascular alterations. The potential effect of hygiene protocols in the control of DS and randomized clinical trials that address this oral condition with cardiovascular complications are important in clinical decision-making.

Material/design

A clinical trial, randomized, double-blind, and with parallel groups, will be conducted in Brazil The sample will consist of 100 patients without teeth in both arches, users of at least maxillary complete dentures, and diagnosed with DS, who will be allocated to groups (n = 25 per group) according to the different hygiene protocols: (1) brushing of the palate and immersion of the prosthesis in 0.25% sodium hypochlorite solution (positive control); (2) brushing of the palate and immersion of the prosthesis in 0.15% triclosan solution; (3) brushing of the palate and immersion of the prosthesis in lactose monohydrate; or (4) brushing the palate with citric acid and immersing the prosthesis in lactose monohydrate. The response variables will be heart rate variability and alteration of blood pressure (systemic level), remission of DS, removal of biofilm, reduction of microbial load (colony-forming units (CFU)), mouth and prosthesis odor level, expression of MUC1, proinflammatory cytokines, C-reactive protein (CRP), viscosity, pH and salivary flow (locally); patient-centred qualitative analysis will also be undertaken. Measurements will be performed at baseline and 10 days after the interventions. The results obtained will be statistically analyzed as pertinent, with a level of significance of 0.05.

Discussion

This study will provide a guideline for clinical practice regarding the use of hygiene protocols in the treatment of oral diseases (DS) mediated by biofilm. Also, it may provide evidence of correlation of oral manifestation with cardiac risk.

Trial registration

Brazilian Registry of Clinical Trials, RBR-4hhwjb. Registered on 9 November 2018.

Relationship between oral hygiene and fungal growth in patients: users of an acrylic denture without signs of inflammatory process

Objectives

To answer to the following questions: is there any relationship between oral hygiene and the growth of yeast in patients without mucosal inflammation; and is there a need for mycological examination patients without mucosal inflammation?

Background

Patients with candidiasis may report varied symptoms, but such infections are most often asymptomatic. In addition to its high incidence in denture users (60%-100%), there is a concern that Candida species from the oral cavity may colonize the upper gastrointestinal tract and lead to septicemia, which has a 40%-79% mortality rate and can require a prolonged hospital stay. It is thus important for all physicians to be aware of the risk factors, diagnosis, and treatment of oral candidiasis in older patients.

Methods

A retrospective study was carried out on a group of patients who had undergone mycological examination and assessment of the intensity of yeast growth, and oral hygiene.

Results

Ninety-one denture wearers who lacked signs of clinical inflammation were included in the study. The growth of Candida albicans was as follows: 14 patients had up to 20 colonies; 19 patients had over 20 colonies. Ten percent of patients with good oral hygiene proved to have more than 20 yeast colonies. 5% of patients with bad oral hygiene had more than 20 colonies.

Conclusions

There was no relationship found between hygiene and the growth rate of fungal microorganisms. In patients without clinical symptoms of stomatitis, mycological examination should be considered.

Effect of Terminalia catappa Linn. on Biofilms of Candida albicans and Candida glabrata and on Changes in Color and Roughness of Acrylic Resin

This study aimed to investigate the effect of the n-butanol fraction of Terminalia catappa Linn., (FBuTC) on biofilm of Candida albicans and Candida glabrata, as well as changes in color and roughness of polymethyl methacrylate resin (PMMA). The susceptibility of C. albicans and C. glabrata to FBuTC was evaluated by means of the Minimum Inhibitory and Minimum Fungicidal Concentration (MIC and MFC). PMMA acrylic resin discs (N= 108) were fabricated. For the susceptibility tests, biofilms of C. albicans and C. glabrata were developed on discs for 48 h and immersed in phosphate-saline buffer solution (PBS), 1% sodium hypochlorite (SH 1%), or FBuTC at MIC, 5xMIC, or 10xMIC. For the color and roughness change tests, the discs were immersed in distilled water, SH 1%, or FBuTC in the concentrations of 0.25 mg/mL, 2.5 mg/mL, or 25.0 mg/mL. After 28 days of incubation, color change was evaluated by spectrophotometry and roughness, by using a profilometer. The biofilms were investigated by one-way ANOVA and, the color and roughness changes (two-way ANOVA and the Tukey test; α=0.05). For both MIC and MFC the value of 0.25 mg/mL of FBuTC was observed for the planktonic cells of C. albicans and C. glabrata. Exposure to FBuTC at 10xMIC had a significant effect on the biofilm of C. albicans, showing a reduction in cell counts when compared with PBS, (p=0.001). For the biofilm of C. glabrata, the MIC was sufficient for significantly reducing the cell count (p<0.001). No important changes in color and roughness of the acrylic resin were observed, even after 28 days, irrespective of the concentration of FBuTC used (p >0.05). It could be concluded that the immersion of acrylic resin for dental prosthesis in FBuTC was effective in reducing the biofilms of C. albicans and C. glabrata without evidence of change in roughness and color of this substrate.

Evaluation of the treatment of halitosis with photodynamic therapy in older patients with complete denture: Protocol for a randomized, controlled trial

BACKGROUND

Halitosis is the term used to define an unpleasant odor emanating from the mouth. However, no studies have evaluated the causes and treatment of halitosis in the population of older adults with denture.

METHODS

A randomized, controlled trial is proposed. The patients will be divided into 2 groups: G1: older adults who wear complete dentures and will be treated with tongue scraper (n = 20); G2 older adults who wear complete dentures and will be treated with PDT (n = 20). If the halitosis persists, the participants will be submitted to hygiene procedures for the mucosa and dentures. The evaluation of halitosis will be made before and after treatments, with OralChroma. If the halitosis is solved, the participants will return after 1 week for an additional evaluation. Oral Health Impact Profile (OHIP-14) will be administered by a calibrated examiner on the day the patient history is taken (baseline) and 1 week after treatment for halitosis.

DISCUSSION

This protocol will determine the effectiveness of photodynamic therapy regarding the reduction of halitosis in older adults with complete denture.

TRIAL REGISTRATION

This protocol was registered in ClinicalTrial.gov, under number NCT03960983. It was first posted and last updated in May 23, 2019. https://clinicaltrials.gov/ct2/show/NCT03960983.

Effect of oral hygiene programmes on oral opportunistic pathogens during stroke rehabilitation

OBJECTIVES

This study was to assess the effectiveness of a conventional oral hygiene care programme (COHCP) and an advanced oral hygiene care programme (AOHCP) on prevalence and viable counts of oral opportunistic pathogens among patients undergoing stroke rehabilitation.

METHODS

A total of 94 patients were randomized to two groups. Subjects were block randomized to either (a) COHCP: manual toothbrushing with oral hygiene instruction (OHI); or (b) AOHCP: powered toothbrushing, mouthrinsing with chlorhexidine and OHI. Prevalence and viable counts of oral opportunistic pathogens including yeasts, aerobic and facultative anaerobic gram-negative bacilli, Staphylococcus aureus, were assessed at baseline, the end of 3 and 6 months.

RESULTS

No significant difference was observed in the prevalence of oral opportunistic pathogens within each group over the clinical trial period. A significant decrease in the viable counts of S. aureus was found over the clinical trial period within AOHCP group (p < 0.05), while the viable counts of yeasts and anaerobic gram-negative bacillus (AGNB) remained stable within each group. Regression analysis failed to detect an association between intervention and the prevalence/viable counts of oral opportunistic pathogens.

CONCLUSIONS

Neither oral healthcare programme significantly affects AGNB, yeast or S. aureus over the study period in terms of prevalence and viable counts.

Cytokine gene polymorphism in denture stomatitis patients: A clinical study

OBJECTIVE

This clinical study investigated the association between cytokine gene polymorphism and Candida growth in denture stomatitis (DS) patients.

SUBJECTS AND METHODS

Saliva and blood samples of 160 complete denture wearers (80 healthy controls and 80 with DS) were collected for mycological and gene polymorphism testing, respectively. Salivary Candida growth and TNF-α, TGF-β, IL-6, and IL-10 genotypes were investigated. Data were analyzed using Student's t test, Mann-Whitney U test, chi-square analysis, and continuity (yates) correction tests (p < .05).

RESULTS

Candida albicans colony counts in saliva were significantly higher in the DS group and in the TNF-α GG genotype (p < .05). TGF-β TC GG and TGF-β CC GG haplotypes were significantly higher in DS and control groups, respectively (p < .05). C. albicans colony counts were significantly higher in control group in the TGF-β TC GG haplotype (p < .05). Candida glabrata colony counts were significantly higher in the DS group than the control group in IL-6 GG genotype (p < .05). The difference between DS types in IL-6 genotypes was significant with lower expression level in DS type 3 than DS type 1 and also type 2 (p ≤ .01).

CONCLUSION

The significant differences in some genotypes of the TNF-α, TGF-β, and IL-6 in DS patients are promising in understanding the host defense in DS.

Properties of an acrylic resin after immersion in antiseptic soaps: Low-cost, easy-access procedure for the prevention of denture stomatitis

Denture stomatitis triggered by Candida species requires better preventive measures. This study evaluated the physical and biological properties of a denture base acrylic resin after immersion in antiseptic soaps. Acrylic resin specimens were prepared and stored in distinct solutions for 0, 7, 14, 21, and 28 days. The solutions were as follows: DW: distilled water at 37°C (control group); DS: cycles of daily immersion in Dettol soap for 8 hours at room temperature, followed by immersion in distilled water for 16 hours at 37°C; PS: cycles of daily immersion in Protex soap, as described for the previous group; LS: cycles of daily immersion in Lifebuoy soap, as described for the DS group. The parameters evaluated at each time point were the following: biofilm formation capacity by Candida albicans and reduction of preformed fungal biofilms, cytotoxicity, surface roughness, hardness, and color change. For the fungal adhesion phase, the type of soap had a statistically significant effect (p = 0.0292), but after 24 hours, no differences were found between solutions or between storage times. Regarding the efficacy of biofilm reduction, there was a significant difference when the groups were compared to each other (p = 0.014). Dettol and Lifebuoy eliminated the preformed biofilm on the specimens. Moreover, all the soaps were classified as non-cytotoxic (on HaCaT cell line) because there was no difference in cell viability between the different groups, except after 21 days, when a decrease in cell viability occurred, regardless of the type of soap. Regarding the roughness, there was no statistically significant difference (p > 0.05) between the groups. Lifebuoy decreased resin hardness regardless of storage time (p = 0.003). After 21 and 28 days of storage, there was an increase in hardness value, regardless of the type of soap. The specimens’ color, according to the National Bureau of Standards values, ranged from 0.27 to 0.58 (i.e., imperceptible or mild color changes). In general, the disinfectant soaps were not able to prevent biofilm formation, but all the soaps were effective in reducing the preformed biofilm. In addition, all soaps were non-cytotoxic and did not change surface roughness, hardness (except Lifebuoy), and color (except Lifebuoy). Therefore, immersion in two antiseptic soaps (Protex and Dettol) may be a cheap and easy procedure for preventing denture stomatitis.

Examination of 2-methacryloyloxyethyl phosphorylcholine polymer coated acrylic resin denture base material: surface characteristics and Candida albicans adhesion

The aim of this study is to evaluate the effects of 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer coating with various concentrations onto acrylic resin denture base material on surface characteristics such as contact angle and surface roughness and on Candida albicans adhesion which is the major factor of denture stomatitis. Specimens, prepared from heat-polymerized acrylic denture base material, were divided into control and three test groups, randomly. Surfaces of the specimens in test groups were coated with poly(MPC) (PMPC) by graft polymerization of MPC in different concentrations (0.25 mol/L; 0.50 mol/L and 0.75 mol/L), while no surface treatment was applied to the control group. Contact angles and surface roughness were examined, and chemical composition of the surfaces was analyzed by Attenuated Total Reflectance-Fourier Transform Infrared Spectroscopy (FTIR) to verify the presence of PMPC coatings. Then, specimens were incubated with C. albicans for 18 h and the number of adhered cells was determined. Upon PMPC coating, the contact angle values statistically decreased, but no difference was found in surface roughness values. A statistically significant decrease was observed in C. albicans adhesion in parallel with the increase in the MPC polymer concentration. There was no significant difference between 0.50 mol/L and 0.75 mol/L groups in terms of adhesion. These findings indicated that graft polymerization of MPC on acrylic denture base material reduces the adhesion of C. albicans, and may be evaluated as a coating for prevention of denture stomatitis.

Dependence on others for oral hygiene and its association with hand deformities and functional impairment in elders with a history of leprosy

OBJECTIVE

To analyse the frequency of dependence on others for oral hygiene and its association with hand deformities, frailty and dependence on others for basic activities of daily living (BADL) among elders with a history of leprosy.

BACKGROUND

Dependence on others for oral hygiene has not been considered in multifunctional geriatric assessments.

MATERIAL AND METHODS

Edentulous elders with a history of leprosy who used complete dentures and resided in a former leprosy colony were classified as independent or partially/completely dependent on others for brushing their dentures or rinsing and for BADL, and as frail or robust. The presence of hand deformities was assessed by an occupational therapist.

RESULTS

28.4% and 14.9% were completely/partially dependent on others for brushing and rinsing, respectively. The dependence for BADL was observed in 21.6% and hand deformities in 17.6%. A higher odds of dependence for brushing/rinsing was found among elders who were dependent on others for BADL. Brushing dependence (61.5%) was more frequent among participants with hand deformities than those without this condition (21.3%) (OR: 6.8; 95% IC: 1.2-37.9; P = .028). There was no association between frailty and brushing (P = .068) or rinsing (P = .202) dependence.

CONCLUSION

Approximately one-third of elders have a dependence on others for brushing; a smaller proportion is dependent on others for rinsing. Older people who are dependent on others for BADL and who present hand deformities are more likely to be dependent on others for denture brushing and rinsing. Elders may perform oral self-care even when they present frailty.

Prosthodontics Status and Treatment Needs among the Elderly in the Republic of Macedonia

BACKGROUND

Oral health care management among the elderly differs from the rest of the population, due to some specific physiological changes and general health status related to age. We know very little about the oral health in elderly in the Republic of Macedonia, because there are only a few articles published about dental health status and edentulism of this population.

AIM

The study aimed to evaluate the prosthodontic status of older adults over 65 years in the Republic of Macedonia, about their socio-economic status and individual factors.

MATERIAL AND METHODS

A cross-sectional study was conducted in 8 regions, in rural and urban areas of Macedonia and a representative sample of 432 people (age > 65 years) was examined. Statistical analyses of the data were made by chi-square tests and the corresponding C-coefficient.

RESULTS

Only 6% of all participants had not any prosthetic appliance, 9.5% had more than one bridge, 28.7% of examinees had partial dentures, both bridge(s) and partial denture(s) had 10.7% participants, and 45.1% of examinees were toothless. There was a significant difference between patients who visited the dentist more than once a year and those who did not (χ² = 14.2; df = 4, p < 0.01). From all of the participants, 40.3% used public dental care organisations.

CONCLUSIONS

We found a high prevalence of edentulousness among older adults over 65 years in Macedonia. The study confirmed the necessity for establishing healthcare educational programs for the dental treatment of elderly in Macedonia.

Cytotoxic potential of denture base and reline acrylic resins after immersion in disinfectant solutions

STATEMENT OF PROBLEM

The daily immersion of dentures in disinfectant solutions can cause the incorporation of toxic substances in the acrylic resins, and studies evaluating the cumulative effect of disinfectant solutions on cell culture are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the cytotoxic potential of cell cultures of denture base and reline acrylic resins after immersion in disinfectant solutions.

MATERIAL AND METHODS

Disk-shaped specimens (14×1.2 mm) were obtained and divided into groups (n=9) according to the disinfectant solutions (distilled water [control], 2% chlorhexidine digluconate, 3.8% sodium perborate, 0.5% sodium hypochlorite, and apple vinegar) and to the storage period (0, 1, 3, and 6 months). Solutions were changed daily. After the different storage periods, specimens were immersed in culture medium for 24 hours, and extracts were obtained. Human keratinocytes were cultivated, and the cellular metabolism was evaluated by using Alamar Blue. Data were submitted to 3-way analysis of variance and Games-Howell post hoc tests (α=.05).

RESULTS

Both of the acrylic resins tested showed similar biocompatibility properties after immersion in different solutions (P=.400). Immersion in distilled water, 3.8% sodium perborate, and 0.5% sodium hypochlorite did not affect the cellular metabolism of the keratinocytes (P>.05), regardless of the immersion period and the type of acrylic resin (P>.05). Immersion in 2% chlorhexidine digluconate or apple vinegar resulted in high cytotoxicity over time, until the third month (P<.05), after which no changes were observed (P>.05).

CONCLUSIONS

The type of acrylic resin (base or reline) had no significant effect on the viability of cells. Vinegar and chlorhexidine digluconate solutions increased in cytotoxic effect over time, and were strongly cytotoxic after 6 months of immersion. Sodium perborate and sodium hypochlorite were noncytotoxic in all periods of time tested.

Effect of Alkaline Peroxides on the Surface of Cobalt Chrome Alloy: An In Vitro Study

PURPOSE

Removable denture hygiene care is very important for the longevity of the rehabilitation treatment; however, it is necessary to analyze the effects that denture cleansers can cause on the surfaces of prostheses. Thus, this study evaluated the effect of alkaline peroxide-effervescent tablets on the surface of cobalt-chromium alloys (Co-Cr) used in removable partial dentures.

MATERIALS AND METHODS

Circular metallic specimens (12 × 3 mm) were fabricated and were immersed (n = 16) in: control, Polident 3 Minute (P3M), Steradent (S), Efferdent (E), Polident for Partials (PFP), and Corega Tabs (CT). The surface roughness (μm) (n = 10) was measured before and after periods of cleanser immersion corresponding to 0.5, 1, 2, 3, 4, and 5 years. Ion release was analyzed (n = 5) for Co, Cr, and molybdenum (Mo). Scanning electron microscopy (SEM) analysis and an Energy-dispersive X-ray spectroscopy (EDS) were conducted in one specimen. The surface roughness data were statistically analyzed (α = 0.05) with the Kruskal-Wallis test to compare the solutions, and the Friedman test compared the immersion durations. Ion release analysis was performed using 2-way ANOVA and Tukey's test.

RESULTS

There was no significant surface roughness difference when comparing the solutions (p > 0.05) and the immersion durations (p = 0.137). Regarding ion release (μg/L), CT, E, and control produced a greater release of Co ions than S (p < 0.05). CT produced a greater release of Cr ions than control, S, and P3M (p < 0.05). Finally, E caused the greatest release of Mo ions (p < 0.05). SEM confirmed that the solutions did not damage the surfaces and EDS confirmed that there were no signs of oxidation.

CONCLUSION

The various solutions tested did not have any deleterious effects on the Co-Cr alloy surface. Steradent, however, presented the smallest ionic release.

Determination of the effective anticandidal concentration of denture cleanser tablets on some denture base resins

Objective

Although the effectiveness of chemical cleansing against Candida albicans biofilm has been shown, the effective concentration of denture cleanser tablets has not been studied. The aim of this study was to assess the effect of three denture materials against Candida albicans biofilm and to determine effective concentrations of denture cleanser tablets.

Material and methods

The surface-roughness of Acron-hi™, QC-20™ and Deflex™ (n=45 per resin) resins was standardized by using a profilometer and their contact angle or surface free energy was calculated. C. albicans biofilm was formed on all three resins and were treated with Polident 3 min™, Corega™ and Fittydent™ cleanser solutions at various concentrations and both resin-biofilm and cleanser-biofilm interest were determined by using a MTT protocol according to the European Committee on Antimicrobial Susceptibility Testing's antifungal susceptibility testing (AFST-EUCAST). Scanning electron microscopy was used to compare the efficacy of different resin materials against C. albicans biofilm. Anticandidal activity and surface free energy statistical parameters were calculated by using 3-way and 1-way ANOVA, respectively (p<0.05).

Results

Polident 3 min™ and Corega™ tablets significantly inhibited (p<0.05) the proliferation of C. albicans against all denture resins at 27-37 mg/mL. Scanning electron microscopy results indicated that there was no significant difference among resin specimens regarding biofilm formation on dentures. We failed to find a significant relationship between surface free energy and the anticandidal effect of resin types. However, the polarity value of the resins was statistically associated with their anticandidal activity.

Conclusions

The polarity of the resins, the concentrations of tablets and the chemical content of the cleanser may directly affect C. albicans biofilm formations. Polident 3 min™ and Corega™ tablets should be suggested for patients who use any denture resin types, whereas the Fittydent™ tablet should only be proposed for those who use Deflex™, when two tablets are dropped into 150 mL water.

Presence of different Candida species at denture wearers with type 2 diabetes and clinically healthy oral mucosa: Pilot study

Background/Aim: The aim of this study was to examine prevalence of different Candida spp. at diabetics and nondiabetics wearing dentures without clinical signs of Denture Stomatitis (DS) and to study if some local and systematic factors are confounders for harboring Candida at these subjects. Material and Methods: Total of 60 subjects wearing partial or complete upper acrylic denture having at least half of palatal mucosa covered by denture were selected and stratified into three experimental groups: systematically health subjects; patients with diagnosed Type 2 Diabetes (T2D) and good glycoregulation; and T2D subjects with poorly regulated blood sugar level. Cotton swab samples were obtained from each patient from hard palate mucosa and denture surface. Swab cultures were made on Sabouraud dextrose agar and ChromAgar Media for distinciton of various Candida spp. Density growth was also measured. Results: Frequency of Candida spp. findings were similar between groups. At healthy subjects, only C.albicans was detected. At diabetics, C.albicans was the most common isolated species, followed by C.glabrata and C.tropicalis. Negative finding of yeasts on palatal mucosa, but positive on denture surface were detected at all groups, with the highest frequency (33.4%) at diabetics with poor glycoregulation. Denture surface was heavier colonized than hard palate mucosa. Duration of diabetes in years were only independent predictors for harboring Candida spp. at denture surface (Exp B=1.186, CI=1.047-1.344, p=0.007). Conclusions: Prosthesis of denture wearers without DS may serve as reservoir of Candida spp. Presence of more pathogenic and resistant non-albicans species are related to diabetics, even without clinical signs of DS.