Action of chitosan-based solutions against a model four-species biofilm formed on cobalt-chromium and acrylic resin surfaces

OBJECTIVE

To evaluate the anti-biofilm action of chitosan, nanoparticulate chitosan, and denture cleanser Nitradine™ against biofilms comprising Candida albicans, Candida glabrata, Staphylococcus aureus, and Streptococcus mutans.

BACKGROUND

Biofilm removal from removable partial dentures (RPD) is important for success in prosthetic rehabilitation.

MATERIALS AND METHODS

The anti-biofilm action of the experimental chitosan-based solutions and Nitradine™ was evaluated on acrylic resin and cobalt-chromium alloy through assessing cell viability, cell metabolism, residual aggregated biofilm, and extracellular polymeric substance and biofilm morphology.

RESULTS

Only chitosan reduced the viability of C. albicans on cobalt-chromium alloy surface, by 98% (a 1.7 log10 reduction in cfu). Chitosan-based solutions neither promoted substantial alteration of the metabolic activity of the four-species biofilm nor reduced the amount of the aggregated biofilm. After immersion in chitosan and nanoparticulate chitosan, viable microorganisms and extracellular polymeric substances distributed over the entire specimens' surfaces were observed. Nitradine™ reduced the viability and metabolic activity of biofilm grown on both surfaces, but it did not remove all aggregated biofilm and extracellular polymeric substances. After immersion in Nitradine™, approximately 35% of the specimens' surfaces remained covered by aggregated biofilm, mainly composed of dead cells.

CONCLUSION

Although chitosan and Nitradine™ promoted changes in the viability of microorganisms, neither solution completely removed the four-species biofilm from the Co-Cr and acrylic resin surfaces. Thus, isolated use of hygiene solutions is not indicated for biofilm control on RPDs; this requires complementary mechanical removal.

Antimicrobial Activity of Experimental Chitosan Solutions on Acrylic Resin and Cobalt-Chromium Surfaces

PURPOSE

To evaluate the application of chitosan as a cleanser in the control of biofilm formation on cobalt-chromium (Co-Cr) alloy and acrylic resin surfaces.

MATERIALS AND METHODS

In total, 172 Co-Cr discs and 172 acrylic resin discs (14 mm x 3 mm) were contaminated with Streptococcus mutans, Staphylococcus aureus, Candida albicans, or Candida glabrata and incubated for 48 hours. Then, specimens were randomly divided into groups and immersed in the following solutions for 15 minutes: solution without chitosan (WC/control); chitosan solution (CH: 5 mg/mL); chitosan nanoparticle solu.on (CN: 3.8 mg/mL); and effervescent tablet (ET). Biofilm recovery rates (n = 9) were evaluated by counting the colony-forming units (CFU/mL). Biofilm morphology was evaluated using scanning electron microscopy (SEM). Data were compared using the Kruskal-Wallis or ANOVA tests followed by the Tukey post hoc test.

RESULTS

For acrylic resin, ET showed the lowest number of CFU for S aureus and S mutans (P < .001). CH exhibited intermediate values for S mutans, S aureus, and C albicans; CN exhibited intermediate values for S mutans and S aureus. For C glabrata, there was no sta.s.cal difference between the solu.ons (P = .264). For Co-Cr, ET showed the highest level of antimicrobial action against all microorganisms (P < .001), and CH showed an intermediate level of action against S mutans and S aureus. Against C albicans and C glabrata, there was no significant difference among CH, CN, and WC.

CONCLUSIONS

Although ET had a broader spectrum of antimicrobial action, CH showed promise as a denture cleanser. Int J Prosthodont 2023;36:e61-e73.

Comparative analysis of Candida spp. isolated from complete denture wearers with and without an HIV diagnosis

STATEMENT OF PROBLEM

Denture-related stomatitis (DRS), an inflammation frequently present in human immunodeficiency virus-positive (HIV+) individuals, can be attributable to colonization by Candida spp., which is considered a main factor. The virulence factors of these species are often modulated by the systemic condition of their hosts.

PURPOSE

The purpose of this clinical study was to evaluate the incidence, virulence, and morphology of Candida spp. isolated from biofilms of complete denture wearers with DRS, with and without an HIV diagnosis. In addition, the interaction of the systemic condition with the ability of Candida spp. to colonize was evaluated.

MATERIAL AND METHODS

Fifty-five complete denture wearers diagnosed with DRS were divided into 2 groups: experimental (HIV+) and control (human immunodeficiency virus-noninfected participants [HIV-]). Biofilm was collected by a standardized method of ultrasonification of prostheses. The incidence was evaluated by a chromogenic method and polymerase chain reaction (PCR). The virulence factors were assessed by using the capacity for biofilm formation by counting colony-forming units (CFUs/mL), biofilm metabolism by tetrazolium salt metabolization, and proteinase and phospholipase production by using a fluorimetric kit. Morphology was verified by using the hyphae-inducing test, and participants' health data were collected with a form. Data were analyzed by using the Student t, Mann-Whitney U, Spearman, and Fisher tests (α=.05).

RESULTS

The results of incidence were related to 55 participants (22 experimental and 33 control); in total, 63 Candida spp. samples were isolated, showing 28 Candida albicans and 36 nonalbicans strains. No significant difference was found between groups in baseline CFU/mL counts, biofilm formation capacity, cell metabolism, and phospholipase production. Proteinase production was higher for C. albicans in the control (P=.031) and for nonalbicans in the experimental (P=.016) groups. Relative to health data, the experimental group showed a moderate negative correlation between the CFU count/mL at baseline for nonalbicans and DRS classification (P=.020).

CONCLUSIONS

C. albicans was the most prevalent species. No difference was found in the Candida spp. of complete denture wearers with DRS, with and without an HIV diagnosis, with regard to virulence factors (except for proteinase production) and morphology.

Effect of a Hygiene Protocol on Denture-Related Stomatitis Remission, Local Inflammatory Factors, and Hemodynamic Responses by Arterial Pressure

Denture-related stomatitis (DRS) is frequent oral inflammation in complete denture wearers. This study evaluated the effect of a hygiene protocol on DRS remission, local inflammatory factors, and hemodynamic responses. Thirty-three individuals were enrolled in the study. The outcomes were measured before and after 10 days of a hygiene protocol treatment consisting of brushing the palate with a soft brush and water and denture brushing with a denture-specific brush and mild soap, as well as immersion of the denture for 20 min in a 0.25% sodium hypochlorite solution. Data were analyzed by paired Wilcoxon for biofilm removal and CFU count of microorganisms. The paired T test was used to assess salivary MUC 1, cytokines, and arterial pressure (p < 0.05). A significant difference was found in the DRS degree (p < 0.001), biofilm (p < 0.001), microbial load of Candida spp. (p < 0.001), Gram-negative (p < 0.004), Staphylococcus spp. (p < 0.001), and S. mutans (p < 0.001) of the denture, and S. mutans (p < 0.001) of the palate after use of the protocol. The salivary flow (p = 0.2) and pH (p = 0.97) did not change; there was an increase of MUC 1 (p = 0.049) and a decrease in IL-6 (p = 0.038), IL-2 (p = 0.04), IL-10 (p = 0.041), and IFNγ (p = 0.04). There was also a decrease in systolic (p = 0.012) and mean arterial pressure (p = 0.02). The current hygiene protocol reduced the inflammation degree of DRS and promoted an improvement of local inflammatory factors and a reduction in the systolic arterial pressure of the patients.

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. Results were compared by Kruskal-Wallis, between-group by the Dunn test, and Wilcoxon tests between times (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 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. This article is protected by copyright. All rights reserved.

Comparative effects on acrylic resin properties of short- and long-term immersion in alkaline peroxide solution

PURPOSE

To evaluate the color stability (ΔE), surface roughness (ΔRa), and flexural strength of denture base acrylic resin after short (20 minutes) and long-term (8 hours) immersions simulating a period of 5 years of use.

METHODS

120 disk-shaped (16 mm x 4 mm) and 120 rectangular (65 mm x 10 mm x 3.3 mm) specimens were prepared (Lucitone 550) and distributed into three groups (n=20): distilled water (Control); Corega Tabs (CT) and Polident (Po), for immersions of 20 minutes and 8 hours. ΔE were determined by a colorimeter, ΔRa by a profilometer and the flexural strength by a universal testing machine. Data were evaluated by two-way ANOVA followed by Tukey's test and Bonferroni correction (α= 0.05).

RESULTS

Short-term immersions for 20 minutes resulted in significant differences in ΔE, as CT values (1.46 ± 1.41) were higher than Po (0.55 ± 0.25) and Control (0.47 ± 0.21). Specimens immersed for 8 hours showed more extensive alterations overall than the control (ΔE [Po: 7.27 ± 0.53; CT: 5.58 ± 0.49; Control: 1.26 ± 0.23]; 916;Ra [Po: 0.16 ± 0.08; CT: 0.12 ± 0.11; Control: 0.07 ± 0.06]; flexural strength [Po: 42.99 ± 9.34; CT: 63.96 ± 12.98; Control: 64.59 ± 12.87]). The tested alkaline peroxide-based solutions promoted significant alteration on acrylic resin properties after overnight immersion. Therefore, short-term immersions seem to be more suitable for daily denture hygiene.

CLINICAL SIGNIFICANCE

Alkaline peroxides were able to alter color stability, surface roughness and flexural strength of acrylic resin after overnight immersions, in a 5-year-simulated period of use.

Action of disinfectant solutions on adaptive capacity and virulence factors of the Candida spp. biofilms formed on acrylic resin

BACKGROUND

Understanding the behavior of Candida spp. when exposed to denture disinfectants is essential to optimize their effectiveness. Changes in the virulence factors may cause increased resistance of Candida spp. to disinfectant agents.

OBJECTIVE

To evaluate the microbial load, cellular metabolism, hydrolytic enzyme production, hyphae formation, live cell and biofilm quantification of Candida albicans, Candida tropicalis and Candida glabrata after exposure to disinfectant solutions.

METHODOLOGY

Simple biofilms were grown on heat-polymerized acrylic resin specimens, and divided into groups according to solutions/strains: distilled water (control); 0.25% sodium hypochlorite (NaOCl 0.25% ); 10% Ricinus communis (RC 10%); and 0.5% Chloramine T (CT 0.5%). The virulence factors were evaluated using the CFU count (microbial load), XTT method (cell metabolism), epifluorescence microscopy (biofilm removal and live or dead cells adhered), protease and phospholipase production and hyphae formation. Data were analyzed (α=0.05) by one-way ANOVA/ Tukey post hoc test, Kruskal-Wallis test and Wilcoxon test.

RESULTS

NaOCl 0.25% was the most effective solution. CT 0.5% reduced the number of CFUs more than RC 10% and the control. RC 10% was effective only against C. glabrata. RC 10% and CT 0.5% decreased the cellular metabolism of C. albicans and C. glabrata. Enzyme production was not affected. Hyphal growth in the RC 10% and CT 0.5% groups was similar to that of the control. CT 0.5% was better than RC 10% against C. albicans and C. tropicalis when measuring the total amount of biofilm and number of living cells. For C. glabrata, CT 0.5% was equal to RC 10% in the maintenance of living cells; RC 10% was superior for biofilm removal.

CONCLUSIONS

The CT 0.5% achieved better results than those of Ricinus communis at 10%, favoring the creation of specific products for dentures. Adjustments in the formulations of RC 10% are necessary due to efficacy against C. glabrata. The NaOCl 0.25% is the most effective and could be suitable for use as a positive control.

Complete denture hygiene solutions: antibiofilm activity and effects on physical and mechanical properties of acrylic resin

BACKGROUND

Appropriated denture hygiene is a predictive factor for longevity of rehabilitation treatment and maintenance of the oral mucosal health. Although, disinfectant solutions are commonly used as denture cleansers, the impact of these solutions on acrylic resin-based dentures remain unclear.

OBJECTIVE

To evaluate, in vitro, the antibiofilm activity of complete denture hygiene solutions and their effects on physical and mechanical properties of acrylic resin.

METHODOLOGY

For antibiofilm activity measurement acrylic resin specimens were contaminated with Candida albicans, Candida glabrata and Streptococcus mutans. After biofilm growth, the specimens were assigned to the hygiene solutions: Distilled water (Control); 0.2% Sodium hypochlorite (SH); Efferdent Power Clean Crystals (EPC) and 6.25% Ricinus communis (RC). The viability of microorganisms was evaluated by agar plate counts. In parallel, physical, and mechanical properties of the acrylic resin were evaluated after simulating a 5-year period of daily immersion in the previously mentioned solutions. The changes in surface roughness, color, microhardness, flexural strength, impact strength, sorption and solubility were evaluated. Data were compared by ANOVA followed by the Tukey test or Kruskal-Wallis followed by the Dunn test depending on the distribution (α=0.05).

RESULTS

Regarding antibiofilm action, SH eliminated all microorganisms while EPC and RC exhibited moderate action against S. mutans (p=0.001) and C. glabrata (p<0.001), respectively. Relative to effects on the physical and mechanical properties of the acrylic resin, RC led to higher values of color change (p=0.030), hardness (p<0.001), surface roughness (p=0.006) and flexural strength (p<0.001). Moreover, RC induced the highest values of changes in solubility (p<0.001). EPC promoted greater changes in surface morphology, whereas immersion in SH retained the initial appearance of the acrylic resin surface. All hygiene solutions reduced the impact strength (p<0.05).

CONCLUSION

SH presented the most effective antibiofilm activity. In addition, changes on properties were observed after immersion in RC, which were considered within acceptable limits.

Expression of virulence factors by Pseudomonas aeruginosa biofilm after bacteriophage infection

The use of bacteriophages for the treatment of bacterial infections has been extensively studied. Nonetheless, the stress response regarding bacteriophage infection and the expression of virulence factors of Pseudomonas aeruginosa after phage infection is poorly discussed. In this study, we evaluated biofilm formation capacity and expression of virulence factors of P. aeruginosa after bacteriophage infection. Biofilm growth rates, biofilm morphology, pyocyanin production and elastase activity were evaluated after 2, 8, 24 and 48 h of co-cultivation with bacteriophages that was recently characterized and showed to be infective towards clinical isolates. In parallel, quantitative real-time polymerase chain reactions were carried out to verify the expression of virulence-related genes. Bacteriophages promoted substantial changes in P. aeruginosa biofilm growth at early co-culture time. In addition, at 8 h, we observed that some cultures developed filaments. Although bacteriophages did not alter both pyocyanin and protease activity, changes on the expression level of genes related to virulence factors were detected. Usually, lasI, pslA, lasB and phzH genes were upregulated after 2 and 48 h of co-culture. These results highlight the need for extensive investigation of pathways and molecules involved in phage infection, since the transcriptional changes would suggest a response activation by P. aeruginosa.

Using denture cleansers to control biofilm from dentures and brushes: A randomized crossover clinical trial

PURPOSE

To evaluate the effects of 0.2% sodium hypochlorite, Efferdent (Prestige Consumer Healthcare), and 6.25% Ricinus communis on biofilm removal and antimicrobial action on dentures and brushes using nonimmersion or immersion protocols for the brushes.

MATERIALS AND METHODS

A total of 45 denture wearers were randomly assigned to a denture immersion protocol for 7 days: 0.85% saline solution for 20 minutes (control); 0.2% sodium hypochlorite for 20 minutes (SH); Efferdent for 3 minutes; or 6.25% Ricinus communis for 20 minutes (RC). The participants were also randomized to immersion (n = 23) or no immersion (n = 22) of their brushes with their dentures in the same solutions. For biofilm evaluation, the dentures were stained and photographed, and the area of the biofilm was measured using Image Tool 3.0 (University of Texas Health Science Center). To evaluate microbial load on dentures and brushes, the biofilm was collected, and the Candida spp and Streptococcus mutans colonies were counted.

RESULTS

The SH, Efferdent, and RC groups showed reduced biofilm and Candida spp on dentures regardless of the immersion protocol for the brushes. However, no difference was found in the Candida spp counts collected from the brushes immersed compared to the brushes not immersed in the solutions. The SH and Efferdent groups showed reduced S mutans on both dentures and brushes, except for in the nonimmersion subgroups.

CONCLUSION

All solutions reduced denture biofilm and microbial load. However, immersion of brushes in the solutions did not contribute to reducing the microbial load.

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.

Genomic identification of microbial species adhering to maxillofacial prostheses and susceptibility to different hygiene protocols

This study investigated the microbial colonization of maxillofacial prostheses and support tissues using the Checkerboard DNA-DNA hybridization method, and the efficacy of 0.12% chlorhexidine gluconate, 10% Ricinus communis solutions, or brushing, on colony forming unit (CFU) reduction in monospecies biofilms (Candida glabrata, Staphylococcus aureus, Streptococcus mutans, Escherichia coli, Enterococcus faecalis, and Pseudomonas aeruginosa) formed on two silicones (MDX 4-4210 and Bio-Skin). Biofilm was harvested from 43 maxillofacial prosthesis wearers for detection of 38 species of microorganisms. The CFU counts of the six above mentioned species were recorded after using the hygiene protocols. All 38 investigated species were identified in prostheses and tissues, with a higher prevalence in the prostheses. 0.12% chlorhexidine gluconate immersion showed the greatest antimicrobial effectiveness, followed by mechanical brushing protocols. MDX 4-4210 silicone produced lower CFU counts than Bio-Skin.

In Vitro Evaluation of Resilient Liner after Brushing with Conventional and Experimental Ricinus communis-Based Dentifrices

PURPOSE

To evaluate the effect of experimental (Ricinus communis) and commercial dentifrices used for denture cleaning on abrasiveness (gravimetric method; roughness), hardness, and color stability of a resilient relining material.

MATERIALS AND METHODS

Sixty circular (15 × 3 mm) specimens were distributed into four groups: C (control; brushing with water); CO (brushing with Colgate - for natural teeth); CB (brushing with Corega Brite - for complete dentures); RC (brushing with experimental dentifrice). Brushing was performed in a toothbrushing machine with a soft brush and a dentifrice suspension for 50 minutes, calculated to correspond to 1 year of regular brushing. Variables were measured initially and after the trial period. For the gravimetric method, the difference in mass was considered. The surface roughness was measured by a rugosimeter, and the hardness test was performed by a Shore A durometer. Color changes (ΔE; CIE L*a*b* and NBS systems) were measured by a portable spectrophotometer. Results were analyzed by ANOVA/Tukey's test (α = 0.05).

RESULTS

The largest mass variation (μg; p < 0.0001) occurred in C (-6.21 ± 3.18). Concerning roughness, CB (0.26 ± 0.04) showed the lowest value, followed by RC (0.29 ± 0.08) and CO (0.34 ± 0.24) (p < 0.0001). Group C produced the greatest surface roughness (0.72 ± 0.25). Hardness values decreased after brushing with water (p = 0.014). No significant differences were found among RC (50.31 ± 1.03), CO (49.11 ± 1.31), CB (49.17 ± 1.23), and C (48.02 ± 1.26). Color stability was similar in all groups (p = 0.135; C: 2.3 ± 0.77; CO: 2.6 ± 0.54; CB: 2.2 ± 0.44; RC: 2.9 ± 1.56).

CONCLUSIONS

The use of experimental dentifrice could be indicated, as it showed similar results to the specific dentifrice, keeping the resilient material properties within acceptable values.

Antimicrobial action and long-term effect of overnight denture cleansers

PURPOSE

To evaluate two denture cleansers for overnight soaking (0.5% sodium hypochlorite and peroxide alkaline) regarding efficacy against Candida spp. biofilms (randomized clinical trial) and their effects on the physical properties of a denture base acrylic resin simulating a period of 5 years of use (laboratory study). The Candida spp. were identified and their resistance to main antifungal agents was evaluated.

METHODS

32 complete denture wearers were instructed to brush their dentures three times a day and to soak them (≥8 hours) in: control - water (C); alkaline peroxide (AP); or 0.5% sodium hypochlorite (SH). According to a randomized sequence, each solution was used for three alternate periods of 7 days. The antimicrobial action was performed by counting the colony forming units (CFU) of Candida spp. For collection of the biofilm, each upper complete denture was placed in a Petri dish, the internal surface was brushed (Tek brush) with saline solution for 2 minutes and the suspension was transferred to a test tube. After dilutions (10 0 to 10-3), aliquots of 50 µL were seeded inside Petri dishes containing Candida Chromagar. After incubation, the colonies were counted and the values of CFU/mL calculated. Data were transformed in log10 (CFU +1) and analyzed by the Friedman test (α= 0.05) followed by Wilcoxon and Bonferroni tests (α= 0.05). Each of the different species identified perfunctorily has been confirmed through the identification of yeasts kit. The resistance to antifungal agents (amphotericin B, nystatin, flucytosine, econazole, ketoconazole, miconazole and fluconazole) was also evaluated. Adverse effects were estimated on heat-polymerized resin specimens, simulating a 5-year period of overnight use. Acrylic resin specimens were randomly distributed into three groups: C: Control (distilled water); AP: alkaline peroxide; and SH: 0.5% sodium hypochlorite. Color change, surface roughness and flexural strength were evaluated at baseline and after immersion procedures. Data were compared by Kruskall-Wallis followed by Dunn's test (color change and surface roughness) and one-way ANOVA (flexural strength) (α= 0.05).

RESULTS

There was a reduction of Candida spp. counts after using both solutions (AP and SH). The Candida spp. most often isolated was C. albicans, followed by the C. glabrata. Only 24.7% of isolate strains were resistant to at least one of the tested antifungals, highlighting azole compounds. Immersion in AP [ 5.73 (5.45-5.91)] caused significantly higher color change, with lower ΔE values for C [1.12 (1.15-1.37) ] followed by SH [3.70 (3.51-3.98) ]. The NBS values were classified as "slight" for C (1.12) group and " considerable" for AP (5.27) and SH (3.40). No solution altered surface roughness significantly. Flexural strength (in MPa) was significantly lower for C (64.59), AP (63.96 ± 12.98) and SH (62.84 ± 8.62) when compared to a group without any immersion (109.12 ± 8.37).

CLINICAL SIGNIFICANCE

Both solutions tested presented antimicrobial action against Candida spp. and may be useful for denture biofilm control, but should be used with caution as an overnight immersion solution since they may damage denture bases in the long-term. Candida was most frequently isolated at baseline and after using the products. Only 24.7% of isolate strains were resistant to at least one of the tested antifungals, especially with azole compounds.

Effects of Denture Cleansers on Heat-Polymerized Acrylic Resin: A Five-Year-Simulated Period of Use

This study evaluated color stability, surface roughness and flexural strength of acrylic resin after immersion in alkaline peroxide and alkaline hypochlorite solutions, simulating a five-year-period of use. Sixty disc-shaped (16 x 4 mm) and 60 rectangular specimens (65 x 10 x 3.3 mm) were prepared from heat-polymerized acrylic resin (Lucitone 550) and assigned to 3 groups (n = 20) of immersion (20 min): C1: distilled water; AP: warm water and one alkaline peroxide tablet; SH: 0.5% NaOCl solution. Color data (∆E) were determined by a colorimeter and also quantified according to the National Bureau of Standards units. A rugosimeter was used to measure roughness (μm) and the flexural strength (MPa) was measured using a universal testing machine. Data were evaluated by Kruskal-Wallis followed by Dunn tests (color stability and surface roughness) and by one-way ANOVA and Bonferroni test (flexural strength). For all tests was considered α = 0.05. AP {0.79 (0.66;1.42)} caused color alteration significantly higher than C1 {0.45 (0.37;0.57)} and SH {0.34 (0.25;0.42)}. The mean ∆Ε values quantified by NBS were classified as "trace" for C1 (0.43) and SH (0.31) and "slight" for AP (0.96). SH {-0.015 (-0.023;0.003)} caused significantly higher ΔRa than the C1 {0.000 (-0.004;0.010)} and AP {0.000 (-0.009;0.008)} groups. There was no statistically significant difference among the solutions for flexural strength (C1: 84.62 ± 16.00, AP: 85.63 ± 12.99, SH: 84.22 ± 14.72). It was concluded that immersion in alkaline peroxide and NaOCl solutions simulating a five-year of 20 min daily soaking did not cause clinically significant adverse effects on the heat-polymerized acrylic resin.

Alkaline Peroxides Versus Sodium Hypochlorite for Removing Denture Biofilm: a Crossover Randomized Trial

This study evaluated the efficacy of cleanser solutions on denture biofilm removal by a crossover randomized clinical trial. Thirty two edentulous patients were instructed to brush their dentures (specific brush and liquid soap) three times a day (after breakfast, lunch and dinner) and to soak them (≥ 8 h) in: (C) control -water; (AP): alkaline peroxide; or (SH) 0.5% sodium hypochlorite. Each solution was used for 21 days (three cycles of 7 days). At the end of each cycle, the inner surfaces of maxillary dentures were disclosed (1% neutral red) and photographed (HX1 - Sony). Areas (total and stained biofilm) were measured (Image Tool software) and the percentage of biofilm calculated as the ratio between the area of the biofilm multiplied by 100 and total surface area of the internal base of the denture. Data were compared by means of generalized estimating equation (α=5%) and multiple comparisons (Bonferroni; α=1.67%). Immersion in SH reduced biofilm (%) (8.3 ± 13.3B) compared to C (18.2 ± 14.9A) and AP (18.2 ± 16.6A). The 0.5% sodium hypochlorite solution was the most efficacious for biofilm removal. Alkaline peroxides may not lead to further biofilm removal in patients with adequate denture maintenance habits.

Antimicrobial activity of complete denture cleanser solutions based on sodium hypochlorite and Ricinus communis - a randomized clinical study

To preserve oral health and to maintain the prosthetic devices, it is important not only to improve the properties of commonly known hygiene products, but also to investigate new materials with antimicrobial action.

Antimicrobial efficacy of complete denture cleansers

PURPOSE

To evaluate the in vitro antimicrobial efficacy of alkaline peroxides against microbial biofilms on acrylic resin surfaces.

METHODS

Denture base acrylic resin (Lucitone 550; n= 360) circular specimens (15 x 3 mm) were obtained from a circular metal matrix and sterilized with microwave irradiation (650 W, 6 minutes). The specimens were then contaminated with suspensions [106 colony-forming units (CFU)/mL] of Candida albicans (Ca), Candida glabrata (Cg), Staphylococcus aureus (Sa), Streptococcus mutans (Sm), Bacillus subtilis (Bs), Enterococcus faecalis (Ef), Escherichia coli (Ec), and Pseudomonas aeruginosa (Pa). After contamination, the specimens were incubated at 37 degrees C for 48 hours and then placed in a stainless steel basket, which was immersed in a beaker with one of the following solutions prepared and used according to the manufacturers' instructions (n= 10 per group): Group PC (positive control), phosphate-buffered saline (PBS) solution; Group MI, NitrAdine, Medical Interporous; Group EF, Efferdent Plus; Group CT, Corega Tabs; and Group NC (negative control; n= 5), no contamination and immersed in PBS. After incubation (37 degrees C, 24 hours), the number of colonies with characteristic morphology was counted, and CFU/mL values were calculated. The data were processed following the transformation into the formula log" (CFU + 1) and statistically analyzed by the Kruskal-Wallis and Dunn's tests (alpha = 0.05).

RESULTS

There were significant differences between the groups for the evaluated microorganisms with a significant reduction in the CFU/mL. MI was effective for Ca, Cg, Sa, Sm, Ef, Ec and Pa; EF was effective for Cg, Sm, Ef, Ec and Pa; and CT was effective for Sa, Bs and Ec, when compared with the PC group.

Trial of an experimental castor oil solution for cleaning dentures

Denture hygiene is essential because denture biofilm is involved in oral infections and systemic diseases. Although there are chemical agents available on the market, none of them have ideal properties and research on such products is still necessary. The aim of this study was to evaluate the efficacy of a castor bean (Ricinus communis)-based solution for removing denture biofilm, compared to two traditional products (sodium hypochlorite and alkaline peroxide). Fifty maxillary complete denture wearers were instructed to brush their dentures after meals and to immerse their dentures once a day in the following solutions: Saline (20 min; control), Polident alkaline peroxide (3 min), NaOCl (20 min) and 2% castor oil solution (20 min). Participants used each solution for a period of 7 consecutive days, according to a random sequence. After each period, the internal surfaces of maxillary complete dentures were stained with a disclosing solution (1% neutral red), photographed and the disclosed biofilm was quantified with the aid of specific software. The influence of treatments on results was verified by the Friedman test (α=0.05). Tested solutions presented significant difference (Fr=51.67; p<0.001). Saline and NaOCl were significantly different (median: 2.0% and 0.0%) whereas Polident and castor oil presented intermediate results (median: 1.0% and 1.5%, respectively). It can be concluded that the castor oil solution tested in this study was comparable to alkaline peroxide in terms of efficiency in denture biofilm removal.

Effect of toothbrushes and denture brushes on heat-polymerized acrylic resins

It is important to choose an appropriate brush for denture cleaning to prevent damage to the surface properties of prosthetic devices. The purpose of this study was to evaluate the abrasiveness of toothbrushes and denture brushes on boiled and microwave-processed acrylic resins. Specimens of 4 resin brands were prepared (n = 30). Five brands of brushes (n = 6) were used in a toothbrushing machine, first for 17,800 strokes and then for an additional 35,600 strokes (total of 53,400), at a load of 200 g. An analytical balance and a profilometer were used to assess the weight and surface roughness, respectively, before and after 17,800 and 53,400 strokes. Analysis of variance and Tukey tests were used for data analysis (α = 0.05). Weight loss increased with time, while surface roughness remained the same. There were no statistically significant differences among toothbrushes and denture brushes in the resulting weight loss (17,800 strokes, 1.83 mg; 53,400 strokes, 3.78 mg) or surface roughness (17,800 or 53,400 strokes, 0.14 µm). The weight loss values after 53,400 brush strokes indicated that Clássico (2.28 mg) and VIPI Wave (2.75 mg) presented significantly greater abrasion resistance than Lucitone 550 (3.36 mg) and Onda-Cryl (2.85 mg) (P < 0.05). The type of brush and the polymerization method did not influence resin wear after brushing.

Antimicrobial action of sodium hypochlorite and castor oil solutions for denture cleaning - in vitro evaluation

The objective of this in vitro study was to evaluate the antimicrobial action of sodium hypochlorite (0.25% and 0.50%) and 10% castor oil solutions against specific microorganisms, by counting Colony Forming Units (CFU) of clinically important bacteria and Candida species. Acrylic resin specimens (n = 320; Lucitone 550) were obtained from square metal matrices (10 x 10 x 2 mm), sterilized by microwave (650W, for 6 minutes) and contaminated by Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans, Bacillus subtilis, Escherichia coli, Streptococcus mutans, Enterococcus faecalis and Candida glabrata. The specimens were immersed for 20 minutes in one of the following hygiene solutions (n = 10/each): A - 0.25% Sodium hypochlorite; B - 0.5% Sodium hypochlorite; C - 10% Castor oil solution; and D (Control) - saline. Adhered cells were suspended and inoculated into a selective solid medium (37ºC for 24 h). The Student's t-test (α = 0.05) was performed to compare log10(CFU+1)/mL between Groups C and D. The results showed that sodium hypochlorite (0.25% and 0.5%) completely eliminated all detectable microorganisms. The castor oil solution eliminated B. subtilis and reduced counts for other strains. Differences between C and D were significant (p < 0.05) for all species except for E. faecalis. Both sodium hypochlorite solutions (0.25% and 0.5%) were effective in eliminating all microorganisms evaluated, and may be useful as cleaning solutions for complete dentures. The castor oil solution provided moderate efficacy and performed differently on the tested species, with the strongest effect on B. subtilis and with non-significant action on E. faecalis.

Adverse Effects on PMMA Caused by Mechanical and Combined Methods of Denture Cleansing

This study evaluated the abrasiveness of mechanical and combined methods of denture hygiene, by the analysis of mass loss and surface roughness. Acrylic resin specimens (Plexiglass) were brushed by a tooth brushing machine (Mavtec) with a soft brush (Tek) and water (control) or four dentifrices (Sorriso, Colgate, Polident and Corega) (Experimental groups) for 50 min, representing one year of brushing (mechanical method). After brushing, the specimens were immersed in 0.5% sodium hypochlorite simulating a daily cleaning of 20 min for one year (combined method). Distilled water (23 ºC) was employed as control. The mass loss (g) was analyzed by an analytical balance and the surface roughness (μm) by a rugosimeter. Data were subjected to ANOVA and Bonferroni test (α=0.05). Polident dentifrice showed lowest values of mass loss for both methods (mechanical: -0.0072±0.0017, combined:-0.011±0.002) and the combined method resulted in greater mass loss than the mechanical, except for Corega. For the surface roughness, after the mechanical method, the lowest values were registered for water (-0.007±0.016) and Polident (0.402±0.378); for the combined method, water (-0.063±0.013) showed the lowest values; there was no statistically significant difference between methods. It was concluded that Polident was the less abrasive dentifrice and the association between chemical and mechanical methods increased the mass loss but did not change the surface roughness of specimens.

Clinical trial of an experimental cleaning solution: antibiofilm effect and integrity of a silicone-based denture liner

AIM

This study evaluated the antibiofilm effect of an experimental solution of 2% Ricinus communis (R. communis) on a silicone-based denture liner by means of a randomized clinical trial, as well as the integrity of such liner following a cleansing regimen with such solution.

MATERIALS AND METHODS

About 30 complete denture wearers had their lower dentures relined with a silicone-based denture liner and randomly allocated to cleanse their dentures by means of: (A) a specific toothbrush for complete dentures and dentifrice; (B) soaking in an experimental 2% R. communis solution; and (C) association of A and B. Considered outcomes were biofilm coverage area (%), microbial counts by means of the deoxy-ribonucleic acid (DNA) checkerboard hybridization technique and physical integrity of the soft liner, assessed during a time interval of 60 days. Mean group values were compared by analysis of variance (ANOVA) and Tukey tests or generalized linear method (α = 0.05).

RESULTS

The mechanical method presented the lowest biofilm percentage (1.45 ± 1.03) if compared to the chemical method (2.96 ± 1.98) and the associated one (2.71 ± 1.76). After 60 days (3.37 ± 2.04), biofilm accumulation was higher than at 15 days (1.28 ± 0.77) and 30 days (2.46 ± 1.54). The denture liner was less deteriorated and kept its physical integrity when the mechanical method was applied. The chemical method presented higher effectiveness against microorganisms, including some Candida species.

CONCLUSION

The 2% R. communis solution presented stronger antimicrobial capacity than brushing on a silicone-based denture liner after immersion. However, it was not superior to the mechanical method in preserving the physical integrity of the material and in biofilm removal.

CLINICAL SIGNIFICANCE

Soft denture liners hygiene is a very important issue and not conclusive in the literature. The experimental solution of 2% R. communis evaluated presented promising antimicrobial potential and should be more explored to be recommended as cleanser.

In Vitro Antimicrobial Activity of an Experimental Dentifrice Based on Ricinus Communis

This study evaluated the antimicrobial activity of a Ricinus communis-based experimental dentifrice for denture hygiene against the following standard strains: Staphylococcus aureus, Escherichia coli, Streptococcus mutans, Enterococcus faecalis, Candida albicans and Candida glabrata. The minimum inhibitory concentration (MIC) assay was performed with R. communis in pure oil at 2.5%. Only E. coli was not inhibited by R. communis, but the MIC (0.0781%) was effective against the other microorganisms. From these results it was determined the R. communis concentrations for experimental dentifrices, 1, 2, 5 and 10%, which were evaluated by the test-well diffusion in agar. The commercial dentifrices Colgate, Trihydral and Corega Brite were tested for comparative purposes. The diameter of the zones of bacterial growth inhibition produced around the wells was measured (in mm) with a rule under reflected light. Data were analyzed statistically by analysis of variance and Tukey's post-hoc test (α=0.05). Neither the commercial nor the experimental dentifrices were effective against E. coli. The experimental dentifrices containing R. communis at 2, 5 and 10% presented action against S. mutans, S. aureaus and E. faecallis. The experimental dentifrices showed no antimicrobial activity against Candida spp. and E. coli in any of the tested concentrations. Trihydral was the most effective. Comparing the experimental dentifrices, the product with 10% R. communis produced the largest zones of bacterial growth inhibition and had similar antimicrobial activity to the commercial dentifrices, except against S. aureus.

Effect of cleanser solutions on the color of acrylic resins associated with titanium and nickel-chromium alloys

This study evaluated the effect of cleanser solutions on the color of heat-polymerized acrylic resin (HPAR) and on the brightness of dental alloys with 180 immersion trials. Disk-shaped specimens were made with I) commercially pure titanium, II) nickel-chromium-molybdenum-titanium, III) nickel-chromium molybdenum, and IV) nickel-chromium-molybdenum beryllium. Each cast disk was invested in the flasks, incorporating the metal disk into the HPAR. The specimens (n=5) were then immersed in solutions containing: 0.05% sodium hypochlorite, 0.12% chlorhexidine digluconate, 0.500 mg cetylpyridinium chloride, a citric acid tablet, one of two different sodium perborate/enzyme tablets, and water. The color measurements (∆E) of the HPAR were determined by a colorimeter in accordance with the National Bureau of Standards. The surface brightness of the metal was visually examined for the presence of tarnish. The results (ANOVA; Tukey test-α=0.05) show that there was a significant difference between the groups (p<0.001) but not among the solutions (p=0.273). The highest mean was obtained for group III (5.06), followed by group II (2.14). The lowest averages were obtained for groups I (1.33) and IV (1.35). The color changes in groups I, II and IV were slight but noticeable, and the color change was considerable for group III. The visual analysis showed that 0.05% sodium hypochlorite caused metallic brightness changes in groups II and IV. It can be concluded that the agents had the same effect on the color of the resin and that the metallic alloys are not resistant to the action of 0.05% sodium hypochlorite.

Color Stability, Surface Roughness and Flexural Strength of an Acrylic Resin Submitted to Simulated Overnight Immersion in Denture Cleansers

This study evaluated color stability, surface roughness and flexural strength of acrylic resin specimens after immersion in alkaline peroxide and alkaline hypochlorite, simulating a period of one and a half year of use of overnight immersion. Sixty disc-shaped (16X4 mm) and 80 rectangular specimens (65X10X3.3 mm) were prepared from heat-polymerized acrylic resin (Lucitone 550) and distributed into 4 groups (n=20): C1: without immersion, C2: 8 h immersion in distilled water; AP: 8 h immersion in alkaline peroxide effervescent tablet; SH: 8 h immersion in 0.5% NaOCl solution. Properties were evaluated at baseline and after the immersion. Color data were also calculated according the National Bureau of Standards (NBS). Results were analyzed statistically by ANOVA and Tukey's HSD test (α=0.05). AP (2.34 ± 0.41) caused color alteration significantly higher than C2 (0.39 ± 0.30) and SH (1.73 ± 0.52). The mean ΔE values were classified as indicial for C2 (0.36 ± 0.29) and noticeable for AP (2.12 ± 0.39) and SH (1.59 ± 0.48). SH (0.0195 ± 0.0150) caused significantly higher ΔRa (p=0.000) than the C2 (0.0005 ± 0.0115) and PA (0.0005 ± 0.0157) groups. There was no statistically significant difference (p=0.063) among the solutions for flexural strength (C1: 105.43 ± 14.93, C2: 100.30 ± 12.43, PA: 97.61 ± 11.09, SH: 95.23 ± 10.18). In conclusion, overnight immersion in denture cleansing solutions simulating a year and a half of use did not alter the flexural strength of acrylic resin but caused noticeable color alterations, higher for alkaline peroxide. The 0.5% NaOCl solution caused increase in surface roughness.

Complete denture biofilm after brushing with specific denture paste, neutral soap and artificial saliva

This study compared the levels of biofilm in maxillary and mandibular complete dentures and evaluated the number of colony-forming units (cfu) of yeasts, after using auxiliary brushing agents and artificial saliva. Twenty-three denture wearers with hyposalivation and xerostomia were instructed to brush the dentures 3 times a day during 3 weeks with the following products: Corega Brite denture dentifrice, neutral liquid soap, Corega Brite combined with Oral Balance (artificial saliva) or tap water. For biofilm quantification, the internal surfaces of the dentures were disclosed, photographed and measured using a software. For microbiological analysis, the biofilm was scrapped off, and the harvested material was diluted, sown in CHROMagar™ Candida and incubated at 37°C for 48 h. Data were analyzed statistically by two-way ANOVA and Tukey's test (α=0.05). Mandibular dentures presented a mean biofilm percentage (µ=26.90 ± 21.10) significantly greater than the maxillary ones (µ=18.0 ± 15.0) (p<0.05). Brushing using Corega Brite combined with Oral Balance (µ=15.87 ± 18.47) was more effective (p<0.05) than using the denture dentifrice (µ=19.47 ± 17.24), neutral soap (µ=23.90 ± 18.63) or tap water (control; µ=32.50 ± 20.68). For the microbiological analysis, the chi-square test did not indicate significant difference between the hygiene products for either type of denture. The more frequently isolated species of yeasts were C. albicans, C. tropicalis and C. glabrata. In conclusion, mandibular dentures had more biofilm formation than maxillary ones. Denture brushing with Corega Brite dentifrice combined with the use of Oral Balance was the most effective method for reduction of biofilm levels, but the use of products did not show difference in yeast cfu counts.

Abrasiveness of conventional and specific denture-cleansing dentifrices

This study analyzed the weight loss and surface roughness caused in Plexiglass specimens by conventional dentifrices (Sorriso, Colgate and Close Up) and specific dentifrices used for cleaning of dentures (Corega and Dentu Creme). Plexiglass specimens were divided into 6 groups (n=6) including: a control (distilled water - DW) and experimental groups. Brushing was performed in a toothbrushing machine with a soft brush and a dentifrice suspension and DW according to different brushing times (50, 100, 200 and 250 min -18,000, 36,000, 72,000 and 90,000 cycles, respectively, calculated to correspond to 1, 2, 4 and 5 years of regular brushing). The results of weight loss and surface roughness were analyzed by ANOVA and Tukey's test at 5% significance level. In all tested times, the effect of DW was insignificant. Dentifrices differed significantly from DW in the initial period. Corega dentifrice caused greater mass loss in all studied times, followed by Close Up. Dentifrices resulted in a surface roughness similar to the DW at 50 min. In the other times, Sorriso, Colgate and Corega caused more surface roughness than DW. In conclusion, specific dentifrices caused larger mass loss and lower surface roughness as conventional dentifrice.

Effect of experimental Ricinus communis solution for denture cleaning on the properties of acrylic resin teeth

This study evaluated Knoop hardness, surface roughness and color alteration of artificial teeth for dentures after immersion in water, 1% sodium hypochlorite and an experimental solution of 2% Ricinus communis (RC). Thirty specimens of Vipi, Biolux and Trilux were analyzed. Tests of Knoop hardness, surface roughness and color alteration were conducted immediately after specimen preparation (T0) and after two immersion protocols for 15 days (ΔT(15)) and 183 days (ΔT(183)). Data variation (ΔT) were subjected to ANOVA and Tukey's test (p<0.05). At ΔT(15), Vipi presented hardness increase and Biolux presented the highest variation (p=0.01). RC caused the highest increase in hardness (p=0) and the lowest increase (p=0.005) in roughness. Biolux presented the lowest color alteration (p =0). At ΔT(183), Trilux underwent the highest hardness variation (p=0). Biolux presented an increase in roughness (p=0). There was no significant differences in color alteration among the artificial teeth (p=0.06) and among solutions (p=0.08) after 183 days of immersion. All solutions (distilled water, 1% sodium hypochlorite and 2% RC) caused alterations on the analyzed properties. Both immersion protocols caused alterations on the analyzed properties.

The effectiveness of chemical denture cleansers and ultrasonic device in biofilm removal from complete dentures

Adequate denture hygiene can prevent and treat infection in edentulous patients. They are usually elderly and have difficulty for brushing their teeth.

Trial of experimental toothpastes regarding quality for cleaning dentures

The aim of this study was to evaluate the efficacy of experimental toothpastes for removing denture biofilm by means of a randomized crossover trial. Thirty volunteers brushed their dentures using a brush and four pastes: (1) Corega refreshing mint (control), (2) 0.2% chloramine T, (3) 1.0% chloramine T, and (4) 0.01% fluorosurfactant. Each paste was used for 7 days, and participants were randomized to use them according to one of four sequences. Biofilm was disclosed (neutral red) after each period, photographed, and quantified by means of a software program. All experimental toothpastes were similar to the control in terms of posttreatment biofilm coverage.

Effect of denture cleansers on metal ion release and surface roughness of denture base materials

Chemical disinfectants are usually associated with mechanical methods to remove stains and reduce biofilm formation. This study evaluated the effect of disinfectants on release of metal ions and surface roughness of commercially pure titanium, metal alloys, and heat-polymerized acrylic resin, simulating 180 immersion trials. Disk-shaped specimens were fabricated with commercially pure titanium (Tritan), nickel-chromium-molybdenum-titanium (Vi-Star), nickel-chromium (Fit Cast-SB Plus), and nickel-chromium-beryllium (Fit Cast-V) alloys. Each cast disk was invested in the flasks, incorporating the metal disk to the heat-polymerized acrylic resin. The specimens (n=5) were immersed in these solutions: sodium hypochlorite 0.05%, Periogard, Cepacol, Corega Tabs, Medical Interporous, and Polident. Deionized water was used as a control. The quantitative analysis of metal ion release was performed using inductively coupled plasma mass spectrometry (ELAN DRC II). A surface analyzer (Surftest SJ-201P) was used to measure the surface roughness (µm). Data were recorded before and after the immersions and evaluated by two-way ANOVA and Tukey's test (α=0.05). The nickel release proved most significant with the Vi-Star and Fit Cast-V alloys after immersion in Medical Interporous. There was a significant difference in surface roughness of the resin (p=0.011) after immersion. Cepacol caused significantly higher resin roughness. The immersion products had no influence on metal roughness (p=0.388). It could be concluded that the tested alloys can be considered safe for removable denture fabrication, but disinfectant solutions as Cepacol and Medical Interporous tablet for daily denture immersion should be used with caution because it caused greater resin surface roughness and greater ion release, respectively.

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

Objective

This study evaluated the efficacy of NitrAdine^TM-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 NitrAdine^TM-based denture tablets (Medical Interporous^TM). Each method was used for 21 days. Denture biofilm was disclosed by a 1% 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% CI 2.4 to 7.9) in comparison with the control group (mean 37.5, 95% 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 Interporous^TM denture tablets as compared to the control group (Mann-Whitney test, Z=1.90; p<0.05).

Conclusion

The present findings suggest that NitrAdine^TM-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.

Prevalence of mutans streptococci isolated from complete dentures and their susceptibility to mouthrinses

The aims of this study were to evaluate the incidence of mutans streptococci (MS - sessile form) on complete maxillary dentures after use of a specific denture paste, and to determine the minimum inhibitory concentration (MIC) and maximum inhibitory dilution (MID) of 3 oral mouthrinses: Cepacol, Plax and Periogard. Seventy-seven complete denture wearers were randomly assigned into 2 groups, according to the product used for denture cleaning: Control group - conventional dentifrice (Kolynos-Super White); and Test group: experimental denture cleaning paste. Denture biofilm was collected at baseline and after 90 and 180 days after treatment by brushing the dentures with saline solution. After decimal serial dilution, samples were seeded onto agar sucrose bacitracin to count colonies with morphological characteristics of MS. MS identification was performed by the sugar fermentation tests. After this procedure, brain heart infusion broth (BHI) was added to oral mouthrinses (Plax, Cepacol e Periogard) and seeded on Petri dishes. The colonies were seeded using the Steers multiplier and, after the incubation, the MIC and MID of the mouthrinses were calculated. The results showed an incidence of 74.0% (n=57) of MS in the 77 complete dentures examined in the study, being 76.3% (n=29) of the Control group (conventional dentifrice) and 71.8% (28) of the Test group (experimental denture cleaning paste). In both groups, the number of positive cases for MS decreased from day 0 to day 180. In the Test group there was a slight decrease in the incidence of Streptococcus mutans 90 days after use of the experimental denture cleaning paste, which was not observed in the Control group. As regards to mouthrinses, for both groups, Periogard showed antimicrobial action with the highest dilution, followed by Cepacol and Plax. In conclusion, the incidence of MS in complete dentures was high and Periogard was the mouthrinse with the strongest antimicrobial action against MS. The experimental denture cleaning paste showed a slight action against S. mutans after 90 days of treatment.

Behaviors and hygiene habits of complete denture wearers

In this study, a questionnaire was applied to patients from Ribeirão Preto Dental School, University of São Paulo, Brazil, to evaluate the hygiene methods and habits concerning the use of complete dentures, the age of dentures, and whether patients have been instructed on how to clean their dentures. The mean age of patients was 63.35 years, and most of them were females (82.08%). The results showed that 62.26% of the respondents had been using the same maxillary complete denture for more than 5 years, and 49.06% used the same mandible complete denture for more than 5 years. Of the patients interviewed, 58.49% slept with the dentures. Mechanical brushing was the most used cleaning method by the patients (100%), using water, dentifrice and toothbrush (84.91%). Most patients (51.89%) reported never having been instructed by their dentists as to how to clean their dentures. Based on the limitations of this study, it was concluded that the patients interviewed had limited knowledge about prosthetic hygiene and oral care. The method more used by patients was the mechanical method of brushing, most patients used the same complete dentures for more than 5 years and slept with the dentures.

Efficacy of biofilm disclosing agent and of three brushes in the control of complete denture cleansing

Objective:

This report evaluated the efficacy of three brushes and one biofilm disclosing agent in complete denture cleansing. Methods: Twenty-seven wearers of maxillary dentures were distributed into three groups and received different brushes: Oral B40, conventional toothbrush (Oral B); Denture, denture-specific brush (Condor); Johnson & Johnson, denture-specific brush (Johnson & Johnson). The 60-day experimental period was divided into two techniques: I - brushing (brush associated with a paste - Dentu Creme, Dentco) three times a day; II - brushing and daily application of 1% neutral red on the denture internal surface. Biofilm quantification was carried out weekly and the areas with dye biofilm were obtained by means of Image Tool 2.02 software.

Results:

Biofilm removal was more effective during Technique II (Wilcoxon test: p=0.01) for the three groups of brushes. When the brushes were compared in Technique I, the Kruskal Wallis test indicated statistical difference between Denture X Johnson & Johnson and Denture X Oral B40, in which the Denture was more efficient. For Technique II, there was no statistical difference between brushes (p>0.05).

Conclusion:

The disclosed application promoted more efficacy on biofilm removal, regardless of the brush used. Denture (Condor) was more efficient than the other brushes during Technique I.

Weight loss of five commercially available denture teeth after toothbrushing with three different dentifrices

Brushing is the most common cleansing method employed on complete dentures and it may damage the integrity of acrylic resin, the main component of this type of prosthesis. This study evaluated the abrasion resistance of artificial teeth with different number of acrylic layers, and the abrasiveness of specific and non-specific dentifrices for denture cleaning. The abrasion test was conducted by a tooth brushing device, using soft toothbrushes under load (200g). Sixty artificial teeth specimens were manufactured, 12 from each brand: Vipi-Dent Plus (Dental Vipi), Trubyte Biotone (Dentsply), Trilux (Ruthinium), Ivostar (Ivoclar) and SR Vivodent PE (Ivoclar). Three brands of dentifrices were selected: Colgate (Colgate-Palmolive), Bonyplus (Bonyf AG) and Dentu-Creme (Dentco). Distilled water was used as control. The brushing time was 100 minutes, at 356 strokes/minute. The specimens were weighed on an analytical balance before and after the abrasion test. Analysis of dentifrices' abrasive particles was made by scanning electron microscopy (SEM). Two-way ANOVA and Tukey tests were employed (a=0.05). The general mean of weight loss values were obtained: 6.1 mg (Ivostar); 6.0 mg (Trilux); 5.9 mg (Trubyte); 5.8 mg (Vipi); 5.3 mg (Vivodent). The abrasiveness difference among teeth brands was not statistically significant. The Colgate dentifrice produced the greatest weight reduction (10.1 mg), followed by Dentu-Creme (7.6 mg). Bonyplus was the least abrasive (2.4 mg), similar to the distilled water used as control group (3.1 mg) (p=0.05). It was concluded that all acrylic teeth presented similar abrasion resistance. Specific dentifrices for dentures tend to cause less damage to acrylic resin.

Efficacy of three denture brushes on biofilm removal from complete dentures

The aim of this study was to compare the efficacy of three denture brushes (Bitufo-B; Medic Denture-MD; Colgate-C) on biofilm removal from upper and lower dentures using a specific dentifrice (Corega Brite). The correlation between biofilm levels on the internal and external surfaces of the upper and lower dentures was also evaluated. A microbiological assay was performed to assess the growth of colony-formed units (cfu) of Candida yeasts on denture surface. Thirty-three patients were enrolled in a 10-week trial divided in two stages: 1 (control) - three daily water rinses within 1 week; 2 - three daily brushings within 3 weeks per tested brush. Internal (tissue) and external (right buccal flange) surfaces of the complete dentures were disclosed (neutral red 1%) and photographed. Total denture areas and disclosed biofilm areas were measured using Image Tool 3.00 software for biofilm quantification. Dentures were boxed with #7 wax and culture medium (CHROMagar Candida) was poured to reproduce the internal surface. Statistical analysis by Friedman's test showed significant difference (p<0.01) between control and brushing stages. No difference was found among the brushes with respect to their efficacy on biofilm removal (p>0.01). Analysis by the Correlation test showed higher r values (B=0.78; MD=0.8341, C=0.7362) for the lower dentures comparing the surfaces (internal and external) and higher r values (B=0.7861, MD=0.7955, C=0.8298) for the external surface comparing the dentures (upper and lower). The results of the microbiological showed no significant difference (p>0.01) between the brushes with respect to the frequency of the species of yeasts (chi-square test). In conclusion, all denture brushes evaluated in this study were effective in the removal of biofilm. There was better correlation of biofilm levels between the surfaces for the lower dentures, and between the dentures for the external surface. There was no significant difference among the brushes regarding the frequency of yeasts.

Interventions for cleaning dentures in adults

BACKGROUND

Removing denture plaque may be essential for maintaining the oral health of edentulous people. Brushing and soaking in chemical products are two of the most commonly used methods of cleaning dentures.

OBJECTIVES

To evaluate the effectiveness and safety of different methods for cleansing removable dentures.

SEARCH STRATEGY

We searched the following databases: the Cochrane Oral Health Group Trials Register (to May 2009); CENTRAL (The Cochrane Library 2009, Issue 2); MEDLINE (1965 to May 2009); EMBASE (1980 to May 2009); LILACS (1980 to May 2009); and CINAHL (1997 to May 2009). There were no language restrictions.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing any mechanical method (e.g. brushing or ultrasound) or chemical (e.g. enzymes, sodium hypochlorite, oral rinses or peroxide solutions) in adults over the age of 18 wearing removable partial dentures or complete dentures.The primary outcomes considered were the health of denture bearing areas (soft tissues, periodontal tissues and teeth) and participants' satisfaction and preference. Secondary outcomes included denture plaque coverage area, indicators of halitosis and microbial counts on abutment teeth, soft tissues or denture base or saliva.

DATA COLLECTION AND ANALYSIS

Two independent review authors screened and extracted information from, and independently assessed the risk of bias in the included trials.

MAIN RESULTS

Although six RCTs were included in this review, the wide range of different interventions and outcome variables did not permit pooling of data in a meta-analysis. Isolated reports indicated that chemicals and brushing appear to be more effective than placebo in the reduction of plaque coverage and microbial counts of anaerobes and aerobes on complete denture bases.

AUTHORS' CONCLUSIONS

There is a lack of evidence about the comparative effectiveness of the different denture cleaning methods considered in this review. Few well designed RCTs were found. Future research should focus on comparisons between mechanical and chemical methods; the assessment of the association of methods, primary variables and costs should also receive future attention.

Use of the DNA Checkerboard hybridization method for detection and quantitation of Candida species in oral microbiota

The DNA Checkerboard method enables the simultaneous identification of distinct microorganisms in a large number of samples and employs up to 45 whole genomic DNA probes to gram-negative and gram-positive bacterial species present in subgingival biofilms. Collectively, they account for 55%-60% of the bacteria in subgingival biofilms. In this study, we present the DNA Checkerboard hybridization as an alternative method for the detection and quantitation of Candida species in oral cavities. Our results reveal that DNA Checkerboard is sensitive enough and constitutes a powerful and appropriate method for detecting and quantifying Candida species found in the oral cavity.

Evaluation of three indices for biofilm accumulation on complete dentures

OBJECTIVES

The objective of this study was to evaluate the accuracy and reproducibility of three complete denture biofilm indices (Prosthesis Hygiene Index; Jeganathan et al. Index; Budtz-Jørgensen Index) by means of a computerised comparison method.

BACKGROUND

Clinical studies into denture hygiene have employed a large number of biofilm indices among their outcome variables. However, the knowledge about the validity of these indices is still scarce.

MATERIALS AND METHODS

Sixty-two complete denture wearers were selected. The internal surfaces of the upper complete dentures were stained (5% erythrosine) and photographed. The slides were projected on paper, and the biofilm indices were applied over the photos by means of a scoring method. For the computerised method, the areas (total and biofilm-covered) were measured by dedicated software (Image Tool). In addition, to compare the results of the computerised method and Prosthetic Hygiene Index, a new scoring scale (including four and five graded) was introduced. For the Jeganathan et al. and Budtz-Jørgensen indices, the original scales were used. Values for each index were compared with the computerised method by the Friedman test. Their reproducibility was measured by means of weighed kappa. Significance for both tests was set at 0.05.

RESULTS

The indices tested provided similar mean measures but they tended to overestimate biofilm coverage when compared with the computerised method (p < 0.001). Agreement between the Prosthesis Hygiene Index and the computerised method was not significant, regardless of the scale used. Jeghanathan et al. Index showed weak agreement, and consistent results were found for Budtz-Jorgensen Index (kappa = 0.19 and 0.39 respectively).

CONCLUSION

Assessment of accuracy for the biofilm indices showed instrument bias that was similar among the tested methods. Weak inter-instrument reproducibility was found for the indices, except for the Budtz-Jørgensen Index. This should be the method of choice for clinical studies when more sophisticated approaches are not possible.

Comparison of physical and mechanical properties of microwave-polymerized acrylic resin after disinfection in sodium hypochlorite solutions

This study evaluated the color stability, surface roughness and flexural strength of a microwave-polymerized acrylic resin after immersion in sodium hypochlorite (NaOCl), simulating 20 min of disinfection daily during 180 days. Forty disk-shaped (15 x 4 mm) and 40 rectangular (65 x 10 x 3 mm) specimens were prepared with a microwave-polymerized acrylic resin (Onda-Cryl). Specimens were immersed in either 0.5% NaOCl, 1% NaOCl, Clorox/Calgon and distilled water (control). Color measurements were determined by a portable colorimeter. Three parallel lines, separated by 1.0 mm, were registered on each specimen before and after immersion procedures to analyze the surface roughness. The flexural strength was measured using a 3-point bending test in a universal testing machine with a 50 kgf load cell and a crosshead speed of 1 mm/min. Data were analyzed statistically by ANOVA and Tukey's test (?=0.05). There was no statistically significant differences (p>0.05) among the solutions for color, surface roughness and flexural strength. It may be concluded that immersion in NaOCl solutions simulating short-term daily use during 180 days did not influence the color stability, surface roughness and flexural strength of a microwave-polymerized acrylic resin.

In vitro and clinical evaluation of specific dentifrices for complete denture hygiene

OBJECTIVES

To study the physical properties of two experimental dentifrices for complete denture hygiene, their effect on denture biofilm removal and antimicrobial properties by means of a clinical trial.

MATERIALS AND METHODS

The experimental dentifrices comprised two compositions. One was based on the addition of 1% chloramine T (D1) and the other on the presence of 0.01% fluorosurfactant (D2). Measurements of density, pH, consistency, rheological features and abrasiveness were conducted. Sixty complete denture wearers were randomly assigned to three groups and were instructed to brush their dentures with a specific toothbrush: (1) Water (control); (2) D1; or (3) D2. Each method was used for 21 days. Denture biofilm was disclosed by a 1% neutral red solution and quantified by means of digital photos taken from the internal surface. Microbiological assessment was conducted to quantify Candida sp. and mutans streptococci. Data were evaluated by one-way anova and Tukey HSD, or Kruskal-Wallis (alpha = 0.05).

RESULTS

Both dentifrices decreased biofilm coverage when compared with the control group. D1 was the most efficacious treatment to reduce mutans streptococci, whereas D2 showed an intermediate outcome (ANOVA, p < 0.040). No treatment influenced Candida albicans or non-albicans species (Kruskal-Wallis, p = 0.163 and 0.746, respectively).

CONCLUSION

It can be concluded that brushing complete dentures with the experimental dentifrices tested could be effective for the removal of denture biofilm.

Distribution of biofilm on internal and external surfaces of upper complete dentures: the effect of hygiene instruction

OBJECTIVES

The purpose of this study was to evaluate biofilm distribution over internal and external surfaces of upper complete dentures. It was also aimed at assessing the effect of oral hygiene instructions before and after home use of a disclosing solution.

MATERIALS AND METHODS

The sample consisted of 29 complete denture wearers whose upper prostheses were evaluated. Surface biofilm was disclosed by means of a 1% neutral red solution and quantified with regard to internal and external surfaces. Oral hygiene information was provided on an individual basis. During the second stage, an amount of disclosing solution was given for domestic use.

RESULTS

Internal and external surfaces presented a similar amount of biofilm, which was concentrated over the area of the posterior teeth area, palatal rugae and the internal vestibular incline of the distobuccal flange. This pattern was maintained during the study. However, overall amounts were reduced following denture hygiene information. The use of disclosing solution by subjects at home resulted in a further reduction.

CONCLUSIONS

It was concluded that biofilm deposits were similar over assessed surfaces, regardless of the type of procedure but irregular areas presented greater amounts. Oral health instruction was effective in reducing the biofilm, in particular when associated with home use of a disclosing agent.

Modified functional impression technique for complete dentures

This report describes the use of a removable acrylic resin tray handle that can be easily attached to custom impression trays to produce an improved peripheral sealing zone. This device can be indicated to develop functional impressions for complete dentures using the patient-conducted muscular motion technique. In upper trays, the handle is fixed in the midline with acrylic resin, while in lower trays the centrally positioned handle is removed before border molding. This removable handle allows patient's suction and free tongue movements. Final impression is carried out in two stages: peripheral sealing (low fusion compound) and recording of the main supporting region of the denture (zinc oxide and eugenol paste). All border records are obtained from the patient's own movements (handle suction and tongue motion). The removable handle is simple to use, is reusable, can be adapted to any individual acrylic resin trays and allows accurate registration of the peripheral sealing zone (border tissues).