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Dental Health Professional Recommendation and Consumer Habits in Denture Cleansing

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Acrylic dentures represent the common treatment for total and, in some cases, partial loss of teeth. Many species of microorganisms found in biofilm adherent to the base material of dentures, usually presenting micro-fissures and cracks or having the roughness of the surface increased, can lead to many mucosal/oral diseases installation when conditions are favorable. In this respect, efficient daily cleaning of dentures is essential to maintain a good oral health. The effectiveness of a number of denture-cleaning techniques have been clinically assessed and reported in the literature: among others the denture mechanical brushing, immersion in effervescent tablets or antiseptics and the microwave sterilization.

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Regular cleaning of dentures is recognized as an important part of oral hygiene for denture wearers. Dentures predispose the wearer to denture stomatitis, and microorganisms, including potential pathogens,2 can be harbored on dentures. Ineffective denture cleaning may also lead to esthetic problems such as staining or bad breath. Denture wearers often suffer from the anxiety of further oral care problems. Furthermore, denture wearers fear that the esthetic problems of denture malodor and staining may reveal denture wearing to others. A number of studies have evaluated typical methods used by denture wearers to clean dentures. These have generally found quite a range of methods, with brushing and use of water and toothpaste being commonplace

Another study related awareness of denture cleaning to socioeconomic status and disease, while variations were also found by sex, with women found to clean their dentures more than men. However, in general, a lack of knowledge was often found among patients, with a general understanding that “I should do something,” but with methods being variable. Often, patients reported never having been instructed by their dentists as to how to clean their dentures.Many studies have looked at the efficacy of a range of cleaning products or methodologies, including those specifically designed for use with dentures. Other oral care products (toothpastes, mouthwashes) through to soaps, dishwashing liquids, and bleaches have also been studied. However, in terms of evaluating the relative merits of various denture cleaning regimens, few articles are mentioned in the scientific literature. As a result, the recommendations of professional bodies are relatively limited. For example, the American Dental Association (ADA) recommends not using toothpaste because it can be too harsh for cleaning dentures, although “some people use hand soap or mild dishwashing liquid to clean their dentures, both of which are acceptable. However, most household cleaners are too abrasive and should not be used for cleaning dentures”. Although the need for professional recommendations on appropriate denture cleaning is clear, little is available in the way of national or international guidelines for dental health care professionals (DHCPs) on the most appropriate, evidence-based methods of cleaning dentures effectively. A data collection exercise by a manufacturer of oral health care products (GlaxoSmithKline) showed that in 10 countries in Europe, North and South America, and Asia, the majority of professional bodies did not make specific recommendations on denture cleaning (data on file). When made, recommendations usually focused on the use of either brushes designed specifically for dentures or soft brushes. There was some mention of avoiding abrasives. While denture cleanser tablets were mentioned, a number of bodies recommended dishwashing soap or vinegar. Most web site information seemed not to be evidence-based. Furthermore, where recommendations were found, they were often too vague to help the consumer select a suitable product.

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The high prevalence of edentulousness and associated DS highlight the importance of having consistent effective denture care regimens which patients can follow with confidence. However, the clinical and laboratory evidence to support one regime over another is not yet clear. To date, two systematic reviews featuring a total of six randomised controlled trials (RCTs) have been published. These reviews concluded that there was lack of evidence on which to base guidelines and that further RCTs are required. Recent guidelines based on the available evidence suggest that removal of ‘bacterial biofilm’ is of paramount importance to sustaining good oral and systemic health and preventing DS. These guidelines also advocate the reduction and maintenance of low levels of microbial denture plaque through daily soaking and/or brushing with an effective, non-abrasive cleanser, but there is a lack of clarity as to how this is best achieved. Subsequent meta-analyses indicate that in addition to existing methods, antiseptic mouthwashes, disinfection agents, natural antimicrobial substances, photodynamic therapy and microwave disinfection could all be effective adjunctive strategies for the management of denture hygiene. Dentures are colonised when placed in the mouth by a complex microbial plaque biofilm, which contains numerous species of bacteria and fungi (Ramage G, Zalewska A, 2012). Plaque development and microbial retention are aided and enhanced by the irregular topographical surface including cracks and crevices which can exist within denture acrylic surfaces. This environment also provides protection from chemotherapeutic agents and mechanical disruption methods, meaning that some denture surfaces can carry up to 1011 microbes per milligram of plaque. Denture plaque biofilm also represents a reservoir for potential opportunistic respiratory pathogens. There is a lack of consensus around suitable cleaning agents, with many denture wearers opting to use toothpaste to mechanically clean their dentures. However, this has been shown to induce abrasions, resulting in physical defects on the denture acrylic that may lead to enhanced microbial adhesion through altered surface topography. Guidance on the frequency of cleansing is also lacking, although laboratory and clinical studies report that the sporadic use of denture cleansers facilitates the build-up of mature denture plaque biofilms

Many chemotherapeutic interventions recommended are effective against planktonic oral bacteria, but unfortunately live intact biofilms are able to persist even after treatment with sodium hypochlorite. These studies taken collectively suggest that denture cleansing is important, but more difficult to achieve than previously thought (Mainieri VC, Beck J, 2011).

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As can be seen, denture wearers used products and methods similar to those recommended by DHCPs. Toothpaste, water, and mouthwash were used more frequently than denture tablets. More than 75% of denture wearers reported using denture cleanser tablets for more than 5 minutes, whereas soap and toothpaste were typically used for less than 2 minutes

DHCP recommendations and denture wearer habits are diverse, with no consensus on the most appropriate denture cleaning methods. This reflects a lack of clear, systematic evidence upon which to base recommendations.

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Mainieri VC, Beck J, Oshima HM, et al. Surface changes in denture soft liners with and without sealer coating following abrasion with mechanical brushing. Gerodontology. 2011;28:146–151.

Sorgini DB, Silva-Lovato CH, de Souza RF, et al. Abrasiveness of conventional and specific denture-cleansing dentifrices. Braz Dent J. 2012;23:154–159.

Apratim A, Shah SS, Sinha M, et al. Denture hygiene habits among elderly patients wearing complete dentures. J Contemp Dent Pract. 2013;14:1161–1164.

Lucena-Ferreira SC, Ricomini-Filho AP, Silva WJ, et al. Influence of daily immersion in denture cleanser on multispecies biofilm. Clin Oral Invest. 2014;18:2179–2185.

Ramage G, Zalewska A, Cameron DA, et al. A comparative in vitro study of two denture cleaning techniques as an effective strategy for inhibiting Candida albicans biofilms on denture surfaces and reducing inflammation. JProsthodont. 2012

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