The effectiveness of two disinfectants on denture base acrylic resin with an organic load

Antimicrobial effects of nano titanium dioxide and disinfectants on maxillofacial silicones

STATEMENT OF PROBLEM

Deficient hygiene of maxillofacial prostheses can be a source of infection, and various disinfectants, including nano-oxides, have been suggested for the disinfection of silicone prostheses. While maxillofacial silicones involving nano-oxides at different sizes and concentrations have been evaluated in terms of their mechanical and physical properties, reports are lacking on the antimicrobial effect of nano titanium dioxide (TiO₂) incorporated into maxillofacial silicones contaminated by different biofilms.

PURPOSE

The purpose of this in vitro study was to evaluate the antimicrobial effects of 6 different disinfectants and nano TiO₂ incorporation into maxillofacial silicone contaminated with Staphylococcus aureus, Escherichia coli, and Candida albicans biofilms.

MATERIAL AND METHODS

A total of 258 silicone specimens (129 pure silicones and 129 nano TiO₂-incorporated silicones) were fabricated. Specimens in each silicone group (with or without nano TiO₂) were divided into 7 disinfectant groups (control, 0.2% chlorhexidine gluconate, 4% chlorhexidine gluconate, 1% sodium hypochlorite, neutral soap, 100% white vinegar, and effervescent) in each biofilm group. Contaminated specimens were disinfected, and the suspension of each specimen was incubated at 37 °C for 24 hours. Proliferated colonies were recorded in colony-forming units per mL (CFU/mL). The differences in microbial levels among specimens were evaluated to test the effect of the type of silicone and the disinfectant (α=.05).

RESULTS

Significant difference was found among disinfectants regardless of the silicone type (P<.05). Nano TiO₂ incorporation showed an antimicrobial effect on S aureus, E coli, and C albicans biofilms. Nano TiO₂ incorporated silicone cleaned with 4% chlorhexidine gluconate had statistically less C albicans than pure silicone. Using white vinegar or 4% chlorhexidine gluconate led to no E coli on either silicone. Nano TiO₂ incorporated silicone cleaned with effervescent had fewer S aureus or C albicans biofilms.

CONCLUSIONS

The tested disinfectants and nano TiO₂ incorporation into silicone were effective against most of the microorganisms used in this study.

Infection Control in Dental Clinics: Prosthodontics Perspectives

AIM

The aim of this article is to discuss the infection control measures with focus on those related to prosthodontic work.

BACKGROUND

The risk of transmission of several infectious microorganisms during dental procedures and the increased awareness and knowledge of infectious diseases have led to an increased attention to the importance of infection control. Prosthodontists and dental personnel are exposed directly or indirectly to a significant risk of acquiring healthcare-associated infections.

REVIEW RESULTS

High standards of occupational safety and dental infection control must be applied by dental personnel for the safety of patients and dental healthcare workers. All reusable items (critical and semicritical instruments) that come in contact with the patient's saliva, blood, or mucous membranes must be heat-sterilized. Proper disinfectants should be used to disinfect nonsterilizable instruments (e.g., wax knifes, dental shade plastic mixing spatula, guides, fox bite plane, articulators, and facebows).

CONCLUSION

In prosthodontics, items potentially contaminated with patient's blood and saliva are transported between dental clinics and dental laboratories. Such fluids may contain microorganisms with high potential for transmission of several diseases. Therefore, sterilization and disinfection of all items used during prosthodontic work should be part of infection control protocol in dental care setting.

CLINICAL SIGNIFICANCE

In prosthodontic practice, a strict infection prevention plan should be implemented to minimalize the risk of infectious diseases transmission among prosthodontists, dental office, dental laboratory personnel, and patients.

The efficacy of commercial decontamination agents differs between standardised test settings and research laboratory usage for a variety of bacterial species

Decontamination of surfaces and items plays an important role in reducing the spread of infectious microorganisms in many settings including hospitals and research institutes. Regardless of the location, appropriate decontamination procedures are required for maintaining biosafety and biosecurity. For example, effective decontamination of microbial cultures is essential to ensure proper biocontainment and safety within microbiological laboratories. To this end, many commercial decontamination agents are available which have been tested to a prescribed standard to substantiate their efficacy. However, these standardised tests are unlikely to accurately reflect many conditions encountered in medical and biomedical research. Despite this, laboratory workers and other users of decontamination agents may assume that all decontamination agents will work in all situations. We tested commonly used commercial decontamination agents against a range of bacterial species to determine their efficacy under real-world research laboratory conditions. As each decontamination agent has a different recommended dilution for use, to compare their efficacy we calculated their 'effective ratio' which reflects the difference between the manufacturer-recommended dilution and the dilution needed to achieve decontamination under real-world research laboratory conditions. Effective ratios above one indicate that the agent was effective at a dilution more dilute than recommended whereas effective ratios lower than one indicate that the agent required a higher concentration than recommended. Our results show that the quaternary ammonium agents TriGene Advance and Chemgene HLD4L were the most effective out of the agents tested, with biocidal activity measured at up to 64 times the recommended dilution. In contrast, hypochlorite (bleach) and Prevail™ (stabilised hydrogen peroxide) had the lowest effective ratios amongst the tested agents. In conclusion, our data suggests that not all decontamination agents will work at the recommended dilutions under real-world research laboratory conditions. We recommend that the protocols for the use of decontamination agents are verified under the specific conditions required to ensure they are fit for purpose.

Dentistry and Intensive Care Unit: A Brief Report

OBJECTIVE

 The aim of this study is to verify whether removable dentures of patients admitted to an intensive care unit (ICU) are niches of microorganisms that can cause pathologies (Staphylococcus aureus, Candida spp., and enterobacteria).

MATERIALS AND METHODS

 Fifteen patients who were denture wearers (removable partial denture and complete denture) were included in this study. Patients must wear their dentures daily, and these dentures must have acrylic parts. Microbial biofilm was collected from the acrylic part of one denture of each patient. Then, the biofilm was seeded on different culture media: Sabouraud agar, blood agar, MacConkey agar, and mannitol salt agar. In this study, biochemical evaluations of microorganisms were performed.

STATISTICAL ANALYSIS

 The percentage of dentures with the microorganism identified by each culture medium was calculated.

RESULTS

 In total, 100% of the dentures were positive for Staphylococcus spp. (blood agar) and Candida spp. (Sabouraud agar); 33.3% of the dentures were positive for S. aureus (Mannitol salt agar); and 13.3% of the dentures were positive for Shigella spp. (MacConkey agar).

CONCLUSION

 Removable dentures of patients (removable partial dentures and complete dentures) admitted to an ICU are niches of microorganisms that can cause pathologies.

A randomised clinical trial on the effect of oral antimicrobial sprays in institutionalised elders

OBJECTIVE

To compare the effectiveness of chlorine dioxide, chlorhexidine and placebo sprays in improving oral hygiene among institutionalised elders.

BACKGROUND

Available evidence suggests that oral sprays may be an effective alternative delivery method for plaque control; however, few studies have evaluated antimicrobial agents other than chlorhexidine.

MATERIALS AND METHODS

A total of 228 elders across 11 nursing homes in Hong Kong were recruited into the clinical trial. Participants were randomly allocated into one of the following groups: 0.1% pH-balanced chlorine dioxide spray, 0.2% chlorhexidine spray or sterile water spray (placebo control), once daily. Dental plaque, gingival bleeding and other clinical oral health outcomes were assessed at baseline, 3 and 6 months. Participant acceptability of the interventions was assessed at the end of the clinical trial.

RESULTS

Review assessments were conducted for 135 elders at 6 months. Significantly greater reductions in plaque index scores were observed with the chlorhexidine spray (0.4) and chlorine dioxide spray (0.3) than the placebo spray (0.1). While significant reductions in gingival bleeding scores were observed within the chlorhexidine (7.4), chlorine dioxide (7.5) and placebo (5.3) sprays after 6 months, change scores were not significantly different between groups. Significantly greater increases in the levels of staining were observed in the chlorhexidine spray group (-0.1) than the chlorine dioxide (0.0) and placebo spray (0.0) groups.

CONCLUSION

Antimicrobial sprays were shown to be effective among institutionalised elders. Chlorine dioxide spray showed equivalent effects on dental plaque and gingival bleeding relative to the chlorhexidine spray over a 6-month period.

Comparison of the disinfectant effects of Nanosil D2 and Korsolex extra solutions on thermoset acrylic resin contaminated with Streptococcus mutans and Bacillus subtilis

This study was conducted to compare the disinfectant effects of Nanosil D2 and Korsolex extra on thermoset acrylic resin contaminated with Streptococcus mutans and Bacillus subtilis. In this experimental study, 90 acrylic samples were made and sterilized. Two samples were cultured as a sterilization control in brain-heart infusion (BHI) and the rest of samples were divided into two groups. Samples of one group were placed in a bacterial suspension of S. mutans and the samples of another group were placed in a suspension containing B. subtilis. Each group was divided into two subgroups for immersion in Nanosil or Korsolex extra solutions. Seven samples were selected from each group at each of 30 min, 1 h, and 2 h and transferred to the BHI test tube, and their turbidity was evaluated after 24 h. SPSS 17 software was used to analyze the data, and the significance level of test was considered P < 0.05. At 1 h, Bacillus level of Nanosil D2 was significantly lower than that of Korsolex extra, and at all ½, 1, and 2 h, the level of Streptococcus in Nanosil D2 solution was significantly lower than that of Korsolex extra (P < 0.05). Bacillus and Streptococcus levels showed significant reduction in both solutions over time. The disinfecting power of Nanosil D2 is more than that of Korsolex extra.

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.

An In vitro Comparative Evaluation of Disinfectants on Standard and Clinical Microbial Strains on Heat Cure Resins

INTRODUCTION

Oral cavity is colonised by numerous micro-organisms that form a biofilm on the acrylic resin. Hence, routine hygiene is essential to prevent oral mucosal inflammation and lesions. Knowledge of appropriate disinfecting agents for acrylic resins is crucial in this context.

AIM

To compare and evaluate the effectiveness of four commercially available disinfectants on heat cure acrylic resin specimens contaminated with standard and clinical strains of two micro-organisms commonly inhabiting the oral microflora.

MATERIALS AND METHODS

Two hundred acrylic resin specimens (n=200), 10 in each group were contaminated in vitro with 1x10⁶ cells/ml suspensions of standard and clinical strains of micro-organisms (Candida albicans and Streptococcus mutans) and were immersed in four disinfectants (1% sodium hypochlorite, 2% chlorhexidine digluconate, 2% glutaraldehyde and 3.8% sodium perborate) for 10 minutes. The control group was not subjected to any disinfection process. For collection of clinical strains, oral swab was passed over the buccal mucosa and grown on blood agar culture media. Organism confirmation was done by growing them on selective culture media. Final counts of micro-organisms per ml were performed by plating method for evaluation of microbial level reduction. Results obtained were subjected to ANOVA and Tukey's test.

RESULTS

Standard strains of Candida albicans (C) and Streptoccocus mutans (S) subjected to various disinfectants showed varied mean Colony Forming Units per ml (CFU/ml) from <10,000 to 25,000 and <10000 to <50,000 respectively. Clinical strains and of Candida albicans (C) and Streptococcus mutans (S) subjected to various disinfectants showed varied mean CFU/ml from <10,000 to 50,000 and from 10,000 to 50,000 respectively. Control groups showed maximum mean CFU/ml (>10⁵). All intergroup comparisons were highly significant (p<0.001; HS) and intragroup comparisons were significant (p<0.05; S) except the comparison of clinical strains of Streptococcusmutans subjected to 2% chlorhexidine digluconate and 2% glutaraldehyde which was found to be non significant (p>0.05; NS).

CONCLUSION

Almost 1% sodium hypochlorite was found to be the most effective disinfectant for both Candida albicans and Streptococcus mutans. The least effective disinfectant being: 3.8% sodium perborate.

Effect of comonomer of methacrylic acid on flexural strength and adhesion of Staphylococcus aureus to heat polymerized poly (methyl methacrylate) resin: An in vitro study

Aims and Objective:

The purpose of the present study was to evaluate and compare flexural strength and Staphylococcus aureus adhesion of heat-activated poly (methyl methacrylate [MMA]) resin modified with a comonomer of methacrylic acid (MAA) and MMA monomer.

Materials and Methods:

Comonomer preparation was done with the addition of varying concentration of MAA (0, 15, 20, and 25 wt %) to the MMA of conventional heat-activated denture base resin to prepare the specimens. Prepared specimens were stored in distilled water at 37°C for 1 day and 1 week before the evaluation of flexural strength and microbial adhesion. Flexural strength was measured using a universal testing machine at a crosshead speed for 2 mm/min (n = 10). Microbial adhesion (colony-forming unit [CFU]) was evaluated against S. aureus using a quadrant streaking method (n = 5). Data were subjected to one-way ANOVA, and the significant differences among the results were subjected to Tukey's HSD test. P < 0.05 was considered statistically significant.

Results:

Addition of MAA to the MMA monomer was found to significantly reduce the adhesion of S. aureus for all the groups. Reduction of CFU of S. aureus was found be more significant for Group 3 as compared to control, both at 1-day (P < 0.001) and 1-week (P < 0.002) storage in distilled water. However, no statistically significant changes in the flexural strength were observed with the addition of MAA at 1-day (P = 0.52) and 1-week (P = 0.88) time interval.

Conclusion:

Addition of MAA to conventional denture base resin reduced the microbial adhesion without significantly affecting the flexural strength.

Effect of chemical and microwave disinfection on the surface microhardness of acrylic resin denture teeth

PURPOSE

The purpose of this study was to evaluate the effect of simulated disinfections (2% glutaraldehyde, 1% sodium hypochlorite, and microwave energy) on the surface hardness of Trilux, Biocler, Biotone, New Ace, and Magister commercial artificial teeth.

MATERIALS AND METHODS

Specimens (n = 10) were made with the teeth included individually in circular blocks of acrylic resin, leaving the labial surface exposed. Cycles of simulated chemical disinfection were accomplished with the specimens immersed in the solutions at room temperature for 10 minutes, followed by tap water washing for 30 seconds and storage in distilled water at room temperature for 7 days until the next disinfection. Simulated disinfection by microwave energy was carried out in a domestic oven with 1300 W at a potency of 50% for 3 minutes with the specimens individually immersed in 150 ml of distilled water. Control (no disinfection) and the experimental groups (first and third disinfection cycles) were submitted to Knoop hardness measurements with indentations at the center of the labial tooth surface. Data were submitted to repeated measure two-way ANOVA and Tukey's test (α = 0.05).

RESULTS

Biocler, Magister, and Trilux showed lower surface microhardness when submitted to microwave. Lower microhardness for Biotone was promoted by hypochlorite, while no significant difference was shown for New Ace. The third disinfection cycle significantly decreased the tooth surface hardness only for microwave.

CONCLUSIONS

Different disinfection methods promoted different effects on the microhardness of different types of artificial teeth. Surface microhardness of the teeth was less affected by the simulated chemical disinfections when compared to microwaved specimens.

Effect of repeated immersion solution cycles on the color stability of denture tooth acrylic resins

Objective

Chemical solutions have been widely used for disinfection of dentures, but their effect on color stability of denture tooth acrylic resins after repeated procedures is still unclear. The aim of this in vitro study was to evaluate whether repeated cycles of chemical disinfectants affected the color stability of two denture tooth acrylic resins.

Material and Methods

Sixty disc-shaped specimens (40 mm x 3 mm) were fabricated from two different brands (Artiplus and Trilux) of denture tooth acrylic resin. The specimens from each brand (n=30) were randomly divided into 6 groups (n=5) and immersed in the following solutions: distilled water (control group) and 5 disinfecting solutions (1% sodium hypochlorite, 2% sodium hypochlorite, 5.25% sodium hypochlorite, 2% glutaraldehyde, and 4% chlorhexidine gluconate). Tooth color measurements were made by spectrophotometry. Before disinfection, the initial color of each tooth was recorded. Further color measurements were determined after subjecting the specimens to 7, 21, 30, 45, 60, and 90 immersion cycles in each tested solution. Color differences (ΔE*) were determined using the CIE L*a*b* color system. Data were analyzed using two-way repeated measures analysis of variance (ANOVA) followed by Tukey tests. The significance level was set at 5%.

Results

There were statistically significant differences in ΔE* among the 5 disinfectants and water during the 90 cycles of immersion for both denture tooth acrylic resins. Distilled water promoted the greatest color change in both denture tooth acrylic resins, nevertheless none of tested disinfectants promoted ΔE* values higher than 1.0 on these acrylic materials during the 90 cycles of disinfection.

Conclusions

Repeated immersion cycles in disinfecting solutions alter ∆E* values, however these values do not compromise the color of the tested denture tooth acrylic resins because they are imperceptible to the human eye.

Disinfecting the acrylic resin plate using electrolyzed acid water and 2% glutaraldehyde: a comparative microbiological study

Marked bactericidal activity of the electrolyzed acid water (EAW) and its less undesirable effects on biological tissues and the environment has been successfully utilized in dental practice. A review of literature reveals that not many studies have been performed to determine the disinfection effect of EAW on heat cured acrylic denture bases. The objective of the study is to determine the efficacy of EAW in disinfecting heat cured acrylic resin specimens as compared to the efficacy of disinfecting the specimens using 2% glutaraldehyde. Heat cured acrylic resin plates were immersed in Bacteria suspensions of Staphylococcus aureus and later disinfected using EAW which was produced using a custom made electrolyzing apparatus and 2% glutaraldehyde for different time intervals. The numbers of surviving bacteria were counted. As the control, the bacteria attached on the specimens were counted with out any disinfection treatment. The results obtained were statistically analyzed using ANOVA and post-hoc test. The disinfection potential of 2% glutaraldehyde was better than EAW when the specimens were disinfected for 1 and 3 min. Where as when the disinfection time was increased to 5 min there was no difference between EAW and 2% glutaraldehyde. However considering that the disinfecting time can be easily extended to 5 min, EAW can be effectively used for disinfecting the acrylic denture.

Evaluation of the efficacy of chemical disinfectants for disinfection of heat-polymerised acrylic resin

OBJECTIVE

This study evaluated the efficacy of disinfectants on the internal aspect of heat-polymerised acrylic resin contaminated with microbial strains.

BACKGROUND

Dentures absorb oral fluids and become contaminated by different microorganisms.

METHODS

Two hundred and fifty rectangular specimens were made of heat-polymerised acrylic resin, and then divided into five groups corresponding to the microbial strains (Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans, S. mutans and Enterococcus faecalis). After contamination, the specimens were immersed in 1 and 2% sodium hypochlorite and 2% glutaraldehyde for periods of 5, 10 and 15 min. The specimens were placed into tubes containing different broths and incubated at 35°C and then visually analysed. Turbidity in the medium indicated microbial growth. The Fisher's exact test was used in the analysis of the results.

RESULTS

The strain E. faecalis was the most resistant to the disinfectant solutions, and among them, glutaraldehyde was more effective than 2 and 1% hypochlorite for disinfection for 5 min; in the 10-min period there were no differences between the disinfectants. In 15 min of immersion, 1% hypochlorite and glutaraldehyde were more effective than 2% hypochlorite.

CONCLUSIONS

Disinfection for 10 min with 1% hypochlorite and glutaraldehyde is effective in disinfecting the internal aspect of heat-polymerised acrylic resin.

Effect of microwave treatment on the shear bond strength of different types of commercial teeth to acrylic resin

OBJECTIVE

The purpose of this study was to verify the effect of microwave treatment on the shear bond strength of commercial types of teeth to acrylic resin, when the glossy ridge laps were unmodified (groups 1 and 5), bur abraded (groups 2 and 6), bur grooved (groups 3 and 7) or etched by monomer (groups 4 and 8).

BACKGROUND

Controversial findings have shown that mechanical or chemical changes in ridge-lap surface of the tooth increase or decrease the bond strength between tooth and acrylic resin, and the microwave disinfection may cause different changes on this bond strength.

MATERIALS AND METHODS

Eighty specimens (n = 10) were made with the acrylic resin bonded to tooth glossy ridge lap, polymerised in water at 74 degrees C for 9 h, and deflasked after flask cooling. Specimens of the groups 5, 6, 7 and 8 were individually immersed in 150 ml of water and submitted to microwave treatment in an oven at 650 W for 3 min. Control specimens (groups 1, 2, 3 and 4) were not microwave treated. Shear bond strength test was performed in an Instron machine with a cross-speed of 1 mm/min. Collected data were submitted to anova and Tukey's test (alpha = 0.05).

RESULTS

Microwave treatment decreased the shear bond strength values of the tooth/resin bond. In the microwaved and non-microwaved procedures, mechanical retention improved the shear bond strength when compared with the control and monomer treatments.

CONCLUSION

Shear bond strength of the tooth/resin bond was influenced by the microwave treatment and different commercial teeth association, and was lower for the Biotone tooth.

A study on the effect on surface detail reproduction of alginate impressions disinfected with sodium hypochlorite and ultraviolet light - An In Vitro study

OBJECTIVES OF THE STUDY

To evaluate the surface detail reproduction of dental casts with impressions made using commercially available alginate impression materials after disinfecting with chemical disinfectant sodium hypochlorite and physical means of disinfection using ultraviolet radiation.

MATERIALS AND METHODS

A stainless steel die was used to make impression according to ADA/ANSI specification No. 18 having 25, 50 and 75 µm lines. Totally 70 impressions were made and divided in to 7 groups. The impressions in the first group were only rinsed with 250 ml of water. The 2nd, 3rd and 4th groups were disinfected by immersing in sodium hypochlorite for 1, 5 and 10 minutes, respectively. Fifth, 6th and 7th group samples were disinfected by placing them in ultraviolet chamber for 6, 12 and 18 minutes, respectively. All the impressions were poured immediately using type III gypsum. The casts were recovered and subjected for evaluation of the 75 µm lines using stereomicroscope.

RESULTS

There was no statistically significant change in the surface detail reproduction when disinfected with sodium hypochlorite or ultraviolet radiation.

CONCLUSION

Alginate impressions subjected to immersion disinfection using sodium hypochlorite for 1, 5 and 10 minutes and subjected to ultraviolet disinfection for 6, 12 and 18 minutes exhibited no statistically significant differences for surface detail reproduction compared to control groups.

Effect of repeated simulated disinfections by microwave energy on the complete denture base adaptation

This study evaluated the effect of repeated microwave disinfections on the adaptation of the maxillar denture base using 2 different flask closure methods. Twenty stone cast-wax base sets were prepared for flasking by traditional cramp or RS system methods. Five bases for each method were submitted to 5 repeated simulated disinfections in a microwave oven with 650W for 3 minutes. Control bases were not disinfected. Three transverse cuts were made through each stone cast-resin base set, corresponding to canine, first molar, and posterior region. Measurements were made using an optical micrometer at 5 points for each cut to determine base adaptation: left and right marginal limits of the flanges, left and right ridge crests, and midline. Results for base adaptation performed by the flask closure methods were: traditional cramp (non-disinfected = 0.21 ± 0.05mm and disinfected = 0.22 ± 0.05mm), and RS system (non-disinfected = 0.16 ± 0.05 and disinfected = 0.17 ± 0.04mm). Collected data were submitted to ANOVA and Tukey test (α=.05). Repeated simulated disinfections by microwave energy did not cause deleterious effect on the base adaptation, when the traditional cramp and RS system flask closure methods were compared.

Effect of the simulated disinfection by microwave energy on the impact strength of the tooth/acrylic resin adhesion

The objective of this study was to determine the effect of simulated microwave disinfection on the tooth/acrylic resin impact strength. Acrylic molar teeth with a wax stick attached to the ridge lap were included in brass flasks. Specimens were made with Classico thermopolymerized acrylic resin, according to the groups: 1 and 5 - tooth with no treatment (control); 2 and 6 - tooth bur abrasion; 3 and 7 - tooth bur retention; and 4 and 8 - tooth monomer etch. Eighty specimens (n=10) were polymerized in bath cycle at 74( masculine)C for 9 hours and deflasked after flask cooling. Specimen from groups 2, 4, 6 and 8 was submitted to simulated microwave disinfection in a microwave oven at 650W for 3 minutes. Impact strength test was performed with an Otto Wolpert-Werke machine (Charpy system) with an impact load of 40 kpcm. Fracture load value was transformed into impact strength as a function of the bond area (kfg/cm(2)). Collected data were submitted to ANOVA and Tukey's test (alpha=.05) and results indicate that the simulated microwave disinfection decreased the impact strength in all treatments.

Influence of simulated microwave disinfection on complete denture base adaptation using different flask closure methods

STATEMENT OF PROBLEM

Denture microwave disinfection may result in dimensional changes that may distort the acrylic resin base, causing discomfort to the patient.

PURPOSE

The purpose of this study was to determine the effect of simulated microwave disinfection on maxillary denture base adaptation using 2 different flask closure methods.

MATERIAL AND METHODS

Forty stone cast-wax base sets were prepared for flasking by the traditional flask closure (TFC) and Restriction System flask closure (RSFC) methods (n=20). The RSFC consists of 2 iron plates to hold the flask during definitive flask closure, maintaining the flask in a closed position after release of pressure. Acrylic resin (Classico) was prepared according to the manufacturer's instructions. After polymerization in water at 74 degrees C for 9 hours, the bases were removed following flask cooling and submitted to conventional finishing with abrasive stones and pumice slurry. Ten bases for each TFC or RSFC method (n=10) were submitted to simulated disinfection (SD) in 150 mL distilled water in a microwave oven at 650 W for 3 minutes; control bases for each TFC or RSFC method (n=10) were not disinfected (ND). Three transverse cuts were made through each stone cast-resin base set, corresponding to the distal of canines, mesial of first molars, and posterior palatal region. Measurements were made in the bases using an optical micrometer at 5 points for each cut to determine adaptation: left and right marginal limits of the flanges, left and right ridge crests, and midline. Collected data were submitted to 3-way ANOVA followed by the Tukey HSD test (alpha=.05).

RESULTS

Dimension gap values (mm) for ND denture bases prepared by the RSFC method were significantly lower (0.16 +/- 0.05) when compared to the TFC method (0.21 +/- 0.05) (P<.027). Simulated disinfection statistically improved the base adaptation in bases prepared by the TFC method (0.17 +/- 0.03), compared to the ND bases (0.21 +/- 0.05) (P<.027). Simulated disinfection statistically significantly improved base adaptation (P<.0001) only in the distal of canines (ND=0.13 +/- 0.01; SD=0.11 +/- 0.03) and the posterior palatal region (ND=0.25 +/- 0.04; SD=0.21 +/- 0.01) when bases were prepared by the TFC method.

CONCLUSION

Simulated disinfection by microwave energy improved denture base adaptation when the TFC method was used, but did not statistically alter base adaptation for the RSFC method.

Effect of Disinfection Treatments on the Hardness of Soft Denture Liner Materials

PURPOSE

To evaluate the effects of disinfection treatments with chemical solutions (2% glutaraldehyde, 5% sodium hypochlorite, and 5% chlorhexidine) and microwave energy on the hardness of four long-term soft denture liners.

MATERIALS AND METHODS

Forty rectangular specimens of four soft lining materials (Molloplast-B, Ufi Gel P, Eversoft, and Mucopren soft) were made for each material. Ten samples of each material were immersed in different disinfectant solutions for 10 minutes or placed in a microwave oven for 3 minutes at 500 W. The hardness values were obtained with a Shore A durometer, before the first disinfection cycle (control), and also after two cycles of disinfection. Data were submitted to analysis of variance and Tukey's test (p < 0.01).

RESULTS

The highest value of hardness was obtained for Molloplast-B, independent of the disinfection technique. Mucopren soft demonstrated intermediate values and Ufi Gel P and Eversoft the lowest values of Shore A hardness. For Molloplast-B, the disinfection using glutaraldehyde demonstrated the highest value of hardness. The number of disinfections had no effect on the hardness values for all the materials studied and disinfection techniques.

CONCLUSIONS

The application of two disinfection cycles did not change the Shore A hardness values for all the materials. The glutaraldehyde solution demonstrated the highest values of Shore A hardness for the Molloplast-B, Mucopren soft, and Ufi Gel P materials, while Eversoft did not present any differences in hardness when submitted to different disinfection treatments.

Effect of chemical disinfectants and repair materials on the transverse strength of repaired heat-polymerized acrylic resin

PURPOSE

The purpose of this study was to evaluate both the effects of immersion in different chemical disinfectant solutions and the type of repair material on the transverse strength of repaired heat-polymerized acrylic resin.

MATERIALS AND METHODS

A total of 110 rectangular specimens (65 x 10 x 3 mm) of heat-polymerized acrylic resin (Triplex) were fabricated. After polymerization, the specimens were polished, then stored in distilled water at 37 degrees C for 1 week. The specimens were divided into 11 groups (n = 10) coded A to K. Specimens of Group A remained intact (control). The specimens of Groups C to F and Groups H to K were immersed in the following chemical disinfectant solutions (1%, 2.5%, and 5.25% sodium hypochlorite and 2% glutaraldehyde, respectively) for 10 minutes. The specimens of all groups except those of Group A were sectioned in the middle to create 10 mm gaps and repaired with the same resin (Groups B to F) and autopolymerizing acrylic resin (Groups G to K). The specimens of Groups C to F and Groups H to K were again immersed in the disinfectant solutions in the same sequence. The transverse strength (N/mm(2)) was tested for failure in a universal testing machine, at a crosshead speed of 5 mm/min. Two-way analysis of variance (ANOVA) was performed to evaluate the effects of both the disinfectant solutions and repair materials on the transverse strength of repaired specimens. All data were statistically analyzed using one-way analysis of variance followed by Tukey's test at 95% confidence level.

RESULTS

The repaired specimens treated with/without disinfectant solutions showed similar (p > 0.05) transverse strength values. No differences (p > 0.05) were detected among the repaired specimens either with heat-polymerized or autopolymerizing acrylic resins. The intact specimens showed transverse strength values (86.9 +/- 11.8) significantly higher (p < 0.05) than the values of the repaired specimens.

CONCLUSIONS

Among the repaired specimens, transverse strength was not affected after immersion in the disinfectants for the immersion period tested (10 min). The repair material, either heat-polymerized or autopolymerizing acrylic resin, had no effect on the transverse strength of the repaired acrylic resin specimens.

Effect of chemical disinfectants on the transverse strength of heat-polymerized acrylic resins submitted to mechanical and chemical polishing

STATEMENT OF PROBLEM

Immersion in chemical solutions used for cleansing and disinfecting prostheses can decrease the strength of denture base resins, making them more prone to fracture during use.

PURPOSE

The purpose of this study was to assess the effect of immersion in different chemical disinfectants for varying time periods on the transverse strength of 3 mechanically or chemically polished heat-polymerized acrylic resins.

MATERIAL AND METHODS

A total of 630 rectangular specimens (65 x 10 x 3 mm), 210 per resin (Classico, Lucitone 550, and QC-20), were fabricated. One side of each specimen was not polished and the other was either mechanically (n=300) or chemically (n=300) polished, and immersed for 10, 20, 30, 45, or 60 minutes in either 1%, 2.5%, or 5.25% sodium hypochlorite or 2% glutaraldehyde. Mechanically polished (n=15) and chemically polished (n=15) control specimens were immersed only in distilled water. The transverse strength (N/mm 2 ) was tested for failure in a universal testing machine, at a crosshead speed of 5 mm/min. Data were statistically analyzed using 2-way ANOVA and Student t test. Multiple comparisons were performed using Tukey and Scheffe tests (alpha=.05).

RESULTS

There was significant difference (P < .01) between types of polishing, with chemical polishing resulting in lower transverse strength. ANOVA identified significant differences (P < .01) in strength between mechanically polished Lucitone 550 and QC-20, and among all 3 chemically polished resins. No significant differences were observed between resins submitted to both types of polishing or between different immersion periods (10 to 60 minutes), disinfectants, or interaction.

CONCLUSIONS

Lucitone 550 resin presented the greatest transverse strength values with both types of polishing. Among the mechanically and chemically polished specimens, transverse strength was not affected after immersion in the disinfectants for the immersion periods tested (10 to 60 minutes). Chemically polished control and experimental (immersed in all solutions) QC-20 specimens showed significant differences in transverse strength values.

Clinical and microbiological efficacy of chlorine dioxide in the management of chronic atrophic candidiasis: an open study

OBJECTIVE

To assess the clinical and microbiological efficacy of chlorine dioxide (ClO2) as a topical antiseptic for the treatment of chronic atrophic candidiasis in geriatric patients.

PARTICIPANTS

Thirty patients with chronic atrophic candidiasis.

METHODS

Patients were instructed to rinse the mouth with 0.8% ClO2 mouth rinse (DioxiDent) twice daily for one minute and to soak their dentures overnight in the ClO2 for 10 days. Patients were evaluated both clinically and microbiologically at baseline and after 10 days, and any significant side effects were recorded. The clinical appearance of the oral soft tissues was scored on a scale of 0-3 (0 indicating no clinical signs, 1 indicating involvement of < 25% of the palatal mucosa, 2 indicating involvement of 25-50% of the palatal mucosa, and 3 indicating marked erythema involving > 50% of the palatal mucosa). Microbiological testing was undertaken to determine the number of colony forming units (CFUs) of Candida albicans.

RESULTS

ClO2 significantly improved the clinical appearance and microbial count (p < 0.001) after treatment, without significant side effects. Results showed marked improvement in the clinical appearance of the tissues after 10 days, with total resolution in the majority of cases. The total CFU/ml ranged from 15,000-53,000 at baseline and was reduced to < or = 500 after 10 days of treatment (p < 0.001). The mean clinical score was 2.50 at baseline, and was reduced to 0.17 after 10 days of treatment (p < 0.001).

CONCLUSIONS

Within the limitations of this pilot study, the effectiveness of topical chlorine dioxide (0.8%) in the management of chronic atrophic candidiasis was demonstrated. ClO2 provided a safe and clinically effective option in the management of chronic atrophic candidiasis.

An infection control protocol: effectiveness of immersion solutions to reduce the microbial growth on dental prostheses

This investigation evaluated the effectiveness of an infection control protocol for cleansing and disinfecting removable dental prostheses. Sixty-four dentures were rubbed with sterile cotton swab immediately after they had been taken from patients' mouths. Samples were individually placed in the culture medium and immediately incubated at 37 +/- 2 degrees C. The dentures were scrubbed for 1 min with 4% chlorhexidine, rinsed for 1 min in sterile water and placed for 10 min in one of the following immersion solutions: 4% chlorhexidine gluconate, 1% sodium hypochlorite, Biocide (iodophors) and Amosan (alkaline peroxide). After the disinfection procedures, the dentures were immersed in sterile water for 3 min, reswabbed and the samples were incubated. All samples obtained in the initial culture were contaminated with micro-organisms. All the lower dentures immersed in Biocide showed positive growth, and the upper dentures were positive for growth in six of eight dentures. The 4% chlorhexidine gluconate, 1% sodium hypochlorite and Amosan solutions have been proved effective to reduce the growth of the micro-organisms in the 10 min immersion period. The protocol evaluated in this study seems to be a viable method to prevent cross-contamination between dental personnel and patients.

In vitro susceptibility of Candida albicans to four disinfectants and their combinations

AIM

The aim of this study was to evaluate the susceptibility of seven strains of Candida albicans to four disinfectants: iodine potassium iodide, chlorhexidine acetate, sodium hypochlorite and calcium hydroxide. In addition, all possible pairs of the disinfectants were tested in order to compare the effect of the combination and its components.

METHODOLOGY

Filter paper discs were immersed in standardized yeast suspensions and then transferred to disinfectant solutions of different concentrations and incubated at 37 degrees C for 30 s, 5 min, 1 h and 24 h. After incubation the filter paper discs were transferred to vials with PBS and glass beads that were then vigorously shaken for dispersal of the yeast cells. PBS with resuspended yeasts was serially diluted 10-fold. Droplets of 25 microL from each dilution were inoculated on TSB agar plates and incubated in air at 37 degrees C for 24 h. The number of colony-forming units was then calculated from appropriate dilutions.

RESULTS

C. albicans cells were highly resistant to calcium hydroxide. Sodium hypochlorite (5% and 0.5%) and iodine (2%) potassium iodide (4%) killed all yeast cells within 30 s, whilst chlorhexidine acetate (0.5%) showed complete killing after 5 min. Combinations of disinfectants were equally or less effective than the more effective component. All C. albicans strains tested showed similar susceptibility to the medicaments tested.

CONCLUSIONS

This study indicates that sodium hypochlorite, iodine potassium iodide and chlorhexidine acetate are more effective than calcium hydroxide against C. albicans in vitro. However, combining calcium hydroxide with sodium hypochlorite or chlorhexidine may provide a wide-spectrum antimicrobial preparation with a long-lasting effect.

Uses of inorganic hypochlorite (bleach) in health-care facilities

Hypochlorite has been used as a disinfectant for more than 100 years. It has many of the properties of an ideal disinfectant, including a broad antimicrobial activity, rapid bactericidal action, reasonable persistence in treated potable water, ease of use, solubility in water, relative stability, relative nontoxicity at use concentrations, no poisonous residuals, no color, no staining, and low cost. The active species is undissociated hypochlorous acid (HOCl). Hypochlorites are lethal to most microbes, although viruses and vegetative bacteria are more susceptible than endospore-forming bacteria, fungi, and protozoa. Activity is reduced by the presence of heavy metal ions, a biofilm, organic material, low temperature, low pH, or UV radiation. Clinical uses in health-care facilities include hyperchlorination of potable water to prevent Legionella colonization, chlorination of water distribution systems used in hemodialysis centers, cleaning of environmental surfaces, disinfection of laundry, local use to decontaminate blood spills, disinfection of equipment, decontamination of medical waste prior to disposal, and dental therapy. Despite the increasing availability of other disinfectants, hypochlorites continue to find wide use in hospitals.

In-depth disinfection of acrylic resins

This study demonstrated that bacteria penetrate three kinds of dental acrylic resin after a short time period. Samples of acrylic resin were contaminated with a variety of bacteria and were then placed in three different disinfecting solutions as directed by the manufacturers. After the specific dilution and immersion time, cultures were made from the resin samples. The only effective disinfectant was a 0.525% solution of sodium hypochlorite at a 10-minute immersion. It disinfected not only the surfaces but also the bacteria that penetrated the surfaces to a depth of 3 mm.

Denture stomatitis--a review of the aetiology, diagnosis and management

Denture stomatitis is a common recurring problem of the denture wearers. The aetiology of the disease includes infection, trauma and probably a defect in the host defence mechanism. Current thinking suggests an interplay of most of these factors in the pathogenesis of the disease. The extent of interplay of these factors is still a controversy. Candida albicans has been implicated as the causative organism. However, in the light of recent research it is debatable if it is the only causative organism. Recently, cases resistant to antifungal therapy have been reported. In such cases other micro-organisms have been isolated. At the moment, comprehensive management includes meticulous denture hygiene together with anti-fungal or antibacterial therapy and correction of denture faults.

Control of microbial contamination with commercially available cleaning solutions

The elimination of cross-contamination from operatory to laboratory is required for effective infection control. This study determined whether microbial cross-contamination occurs during cleaning of dental prostheses with an ultrasonicator and examined ways to reduce or eliminate the contamination that might occur. The antimicrobial activities of a temporary cement remover and tartar and stain remover were compared with deionized water and a known strong antimicrobial agent. All solutions were assessed without and with ultrasonication. The microbicidal strains were cultured in brain-heart infusion broth, with and without acrylic resin slabs, and the organisms were killed either without or with sonication and without or with acrylic resin slabs. Further testing with natural plaque-contaminated denture materials is warranted.