Assessment of antimicrobial treatment of denture stomatitis using an in vivo replica model system: therapeutic efficacy of an oral rinse

Peel bond strength and antifungal activity of two soft denture lining materials incorporated with 1% chlorhexidine diacetate

Two soft denture lining materials (SC-Soft Confort and TS-Trusoft) were investigated with and without the addition of 1.0% of chlorhexidine diacetate (1.0% CHX). To assess peel bond strength, specimens (75×10×6 mm) were submitted to a peel test at 10 mm/min immediately and after 24 h. To evaluate Candida albicans growth inhibition, disc of specimens (10×3 mm) were immersed in a solution with 3×10⁶ CFU/mL of C. albicans, and spectral measurements were made following immersion in MTT solution for 2, 4, and 6 days. The agar diffusion test was performed by investigating the diameters of inhibition zones around the disc of specimens (10×3 mm)after 48 h. Data were submitted to statistical analysis (α=0.05) and the failure modes were visually classified. The incorporation of 1.0% CHX significantly decreased the peel bond strength for TS (p=0.001) and SC (p=0.005) for immediate test and for TS after 24 h (p=0.010), but not for SC. C. albicans growth was decreased for both materials over time (p<0.05). SC presented inhibition zones approximately 2.0 times larger than TS. The incorporation of 1.0% CHX inhibited fungal growth without impairment to the peel bond strength for SC after 24 h.

Antimicrobial and cytotoxic effects of denture base acrylic resin impregnated with cleaning agents after long-term immersion

The coadjutant method for denture cleansing most used by denture wearers is immersion in chemical agents, which are toxic when in direct contact with cells. However, clinically, the contact between these chemical agents and prosthetic tissues does not occur directly, but rather with what remained impregnated into acrylic bases, even after rinsing the disinfected dentures. This study evaluated the antimicrobial and cytotoxic effects of a denture acrylic resin after successive cycles of daily overnight immersion in 1% sodium hypochlorite (1%NaClO) and 2% chlorhexidine digluconate (2%CHX), simulating the periods of 9 months or 1.5 year. Microbiological and cytotoxic assays were performed, respectively, by broth microdilution method (Candida albicans or Staphylococcus aureus) and MTT assay. Chemical residues of 2%CHX impregnated into the denture acrylic resin had an antimicrobial effect on both immersion periods, which was not observed with those of 1%NaClO. However, residues of 2%CHX were severely cytotoxic to human gingival fibroblasts compared to those of 1%NaClO and acrylic resin (not submitted to the denture cleansers), which were slightly cytotoxic. Even at low concentrations recommended for overnight soaking of removable dentures, the chemical residues of CHX may result in some degree of toxicity to the denture-bearing mucosa after long-term daily immersion.

Effectiveness of Chemical and Microwave Disinfection on Denture Biofilm Fungi and the Influence of Disinfection on Denture Base Adaptation

The aims of this study were to evaluate the effectiveness of six disinfection methods and the influence of these methods on the adaptation of maxillary dentures. Acrylic resin specimens contaminated with fungi were exposed to the following disinfection treatments: 1. microwave oven (900 W) at full power for 5 min (with soaking the specimen in 250 ml water), 2. microwave oven at medium power for 5 min (with soaking the specimen in 250 ml water), 3. sodium hypochlorite 5.25 % for 5 min, 4. diluted sodium hypochlorite 1:420 for 5 h, 5. Chlorhexidine gluconate for 5 h, 6. effervescent tablets for 15 min, 7. soaking in 250 ml tap water for 15 min. Colony forming units (CFUs) of remaining cells were counted and compared with t test (p ≤ 0.05). Dimensional stability was evaluated using aluminum die simulating the maxillary edentulous arch. Posterior palatal gaps were measured. Data were analyzed using one-way ANOVA test and t test (p ≤ 0.05). Microwave irradiation (at full or medium power) and sodium hypochlorite 5.25 % for 5 min were able to reduce the CFUs of fungi by more than 4 log10 whereas diluted sodium hypochlorite, chlorhexidine gluconate, and effervescent tablets did not achieve a reduction of >2.8, 2.68 and 1.66, respectively. For dimensional stability test, t test revealed significant difference between control group and the microwave at full power group (p = 0.000). Within the limits of this study, microwave oven at medium power and sodium hypochlorite (5.25 %) are effective and safe methods of disinfecting removable dentures.

Oral candidiasis and angular cheilitis

Candidiasis, an often encountered oral disease, has been increasing in frequency. Most commonly caused by the overgrowth of Candida albicans, oral candidiasis can be divided into several categories including acute and chronic forms, and angular cheilitis. Risk factors for the development of oral candidiasis include immunosuppression, wearing of dentures, pharmacotherapeutics, smoking, infancy and old age, endocrine dysfunction, and decreased salivation. Oral candidiasis may be asymptomatic. More frequently, however, it is physically uncomfortable, and the patient may complain of burning mouth, dysgeusia, dysphagia, anorexia, and weight loss, leading to nutritional deficiency and impaired quality of life. A plethora of antifungal treatments are available. The overall prognosis of oral candidiasis is good, and rarely is the condition life threatening with invasive or recalcitrant disease.

Sensitivity of Candida albicans biofilm cells grown on denture acrylic to antifungal proteins and chlorhexidine

OBJECTIVES

Candida albicans cells form biofilms on polymeric surfaces of dentures and other prostheses introduced into the oral cavity. Many biofilm microorganisms exhibit resistance to antimicrobial agents; C. albicans cells may also develop resistance to naturally occurring antifungal peptides in human saliva including histatins (Hsts) and defensins (hBDs). Therefore, we evaluated Hst 5 activity on C. albicans biofilm cells compared to planktonic cells and measured whether surface treatment of denture acrylic with Hst 5, hBD-3, or chlorhexidine gluconate could inhibit in vitro biofilm development.

METHODS

Acrylic disks were preconditioned with 500 microl saliva for 30 min, and inoculated with C. albicans cells (10(6)cells/ml) for 1h, at 37 degrees C. Non-adherent cells were removed by washing and disks and were incubated in YPD growth medium for 24, 48, and 72 h at 37 degrees C. Candidacidal assays were performed on 48-h-biofilms and on planktonically grown cells using Hst 5 (15.5, 31.25, and 62 microM). Cell adhesion was compared on disks pre-coated with 0.12% chlorhexidine gluconate, 50 microM Hst 5, or 0.6 microM hBD-3 after 24, 48, and 72 h growth.

RESULTS

No significant difference was observed in sensitivity to Hst 5 of biofilm cells compared to planktonic cells (p>0.05). Pre-coating disks with hBD-3 did not inhibit biofilm development; however, Hst 5 significantly inhibited biofilm development at 72 h, while 0.12% chlorhexidine significantly inhibited biofilm development at all time intervals (p<0.05).

CONCLUSIONS

C. albicans biofilm cells grown on denture acrylic are sensitive to killing by Hst 5. Surface coating acrylic with chlorhexidine or Hst 5 effectively inhibits biofilm growth and has potential therapeutic application.

Effectiveness of different cleaning agents against the colonization of Candida spp and the in vitro detection of the adherence of these yeast cells to denture acrylic surfaces

PURPOSE

The aim of this study is to examine the effect Klorhex and Fittydent, which are used as cleaning agents on the adhesion of Candida on the surfaces of acrylic denture and palatal mucosa. In addition, ability of yeasts to adhere to acrylic strips was evaluated after applying these agents in vitro.

MATERIALS AND METHODS

Each group of 15 patients cleaned their dentures with either Klorhex or with Fittydent. The control group cleaned their dentures with water.

RESULTS

It was found that 62.2% of the patients had colonies of Candida species on their palatal mucosa which was reduced to 51.1% after using these cleaning agents. The colonization rate with Candida spp on their dentures was reduces from 82.2% to 68.8% using these cleaning agents. The mean adhesion value of the Candida strains isolated from the acrylic strips were found to be 75 cell/strip prior to applying the Klorhex and Fittydent and 37.5 cell/strip and 15 cell/strip after applying these agents, respectively.

CONCLUSION

These results showed that Klorhex and Fittydent have a certain preventive effect on the colonization rate of Candida spp on the surface of these dentures, the palatal mucosa, as well as on the acrylic strips in vitro.

Effectiveness of microwave disinfection of complete dentures on the treatment of Candida-related denture stomatitis

The effectiveness of microwave disinfection of maxillary complete dentures on the treatment of Candida-related denture stomatitis was evaluated. Patients (n = 60) were randomly assigned to one of four treatment groups of 15 subjects each;

CONTROL GROUP

patients performed the routine denture care; Mw group: patients had their upper denture microwaved (650 W per 6 min) three times per week for 30 days; group MwMz: patients received the treatment of Mw group in conjunction with topical application of miconazole three times per day for 30 days; group Mz: patients received the antifungal therapy of group MwMz. Cytological smears and mycological cultures were taken from the dentures and the palates of all patients before treatment at day 15 and 30 of treatment and at follow-up (days 60 and 90). The effectiveness of the treatments was evaluated by Kruskal-Wallis and Mann-Whitney tests. Microbial and clinical analysis of the control group demonstrated no significant decrease in the candidal infection over the clinical trial. Smears and cultures of palates and dentures of the groups Mw and MwMz exhibited absence of Candida at day 15 and 30 of treatment. On day 60 and 90, few mycelial forms were observed on 11 denture smears (36.6%) from groups Mw and MwMz, but not on the palatal smears. Miconazole (group Mz) neither caused significant reduction of palatal inflammation nor eradicated Candida from the dentures and palates. Microwaving dentures was effective for the treatment of denture stomatitis. The recurrence of Candida on microwaved dentures at follow-up was dramatically reduced.

Oral candidal infections and antimycotics

The advent of the human immunodeficiency virus infection and the increasing prevalence of compromised individuals in the community due to modern therapeutic advances have resulted in a resurgence of opportunistic infections, including oral candidoses. One form of the latter presents classically as a white lesion of "thrush" and is usually easily diagnosed and cured. Nonetheless, a minority of these lesions appears in new guises such as erythematous candidosis, thereby confounding the unwary clinician and complicating its management. Despite the availability of several effective antimycotics for the treatment of oral candidoses, failure of therapy is not uncommon due to the unique environment of the oral cavity, where the flushing effect of saliva and the cleansing action of the oral musculature tend to reduce the drug concentration to sub-therapeutic levels. This problem has been partly circumvented by the introduction of the triazole agents, which initially appeared to be highly effective. However, an alarming increase of organisms resistant to the triazoles has been reported recently. In this review, an overview of clinical manifestations of oral candidoses and recent advances in antimycotic therapy is given, together with newer concepts, such as the post-antifungal effect (PAFE) and its possible therapeutic implications.

Survey of hospital doctors' attitudes and knowledge of oral conditions in older patients

The study was designed to assess the views and knowledge of hospital doctors in general and geriatric medicine on oral health in older people. Eighty two doctors in general and geriatric medicine at two hospitals were shown 12 colour slides of oral mucosal conditions and asked to give a diagnosis for each slide and complete a questionnaire. Completed questionnaires with the answers to the coloured slides were returned completed by 70 doctors. The majority of doctors (84%) felt it was important to examine older patients' mouths, however only 19% (chi(2) p=0.0001) routinely do so. If asked to prescribe nystatin by the nursing staff, 30% said they would do so without examining the mouth itself. Only 9% of doctors knew that wearing dentures was a specific risk factor for oral candidiasis (chi(2) p=0.001). Altogether 56% of doctors did not feel confident in examining the oral cavity and most (77%) did not think they had had sufficient training in this examination. Only two doctors correctly diagnosed all of the slides. An early squamous carcinoma was misdiagnosed by 80% of the doctors (chi(2) p=0.0001). Hospital doctors do not routinely inspect older patients' mouths. Even if shown slides of typical oral mucosal lesions many hospital doctors are unable to diagnose them. Issues on training need to be addressed. From the patients' point of view a public health campaign is required to educate older people on the need for a regular dental review and be aware that doctors may not be able to diagnose serious oral conditions.

Microwave disinfection of denture base materials colonized with Candida albicans

STATEMENT OF PROBLEM

Infection of denture materials with Candida albicans is common and contributes to denture stomatitis.

PURPOSE

This 3-phase investigation examined: (1) the efficacy of microwave irradiation against C albicans colonized on 3 soft denture liners and 1 heat-polymerized denture base resin, and (2) the effect of this irradiation on the hardness of the materials tested.

MATERIAL AND METHODS

In phase 1, an experimental protocol was developed. Sterilized specimens from 2 denture base soft liners and 1 heat-polymerized acrylic resin denture base material (n = 45 each) were inoculated with C albicans. Two thirds of the specimens were irradiated in a 60 Hz microwave oven for 5 minutes (dry). C albicans growth was then assessed with streaked blood agar plates and thioglycollate broth. One third of the specimens were not irradiated and served as controls. Pretest and posttest Shore A hardness values were obtained and compared. For phase 2, 15 specimens from each material group were subjected to irradiation (while immersed in water) for 5 minutes; and, 15 from each material were subjected to 10- and 15-minute irradiation (dry), with subsequent sterility and change in hardness assessments completed as described in phase 1. In phase 3, 15 specimens from each material group were subjected to repeated 5-minute irradiation cycles (while immersed in water), and changes in hardness were examined.

RESULTS

Only the 5-minute irradiated specimens immersed in water were effectively sterilized, as verified by the thioglycollate assay. The effect of repeated 5-minute irradiation cycles resulted in a significant change in hardness of the PermaSoft specimens.

CONCLUSIONS

Five-minute irradiation, while immersed in water, killed all C albicans present on the materials tested; and, repeated 5-minute irradiation significantly affected the hardness of only the PermaSoft material.

Candida-associated denture stomatitis. Aetiology and management: a review. Part 3. Treatment of oral candidosis

Treatment of oral candidosis with topical antifungal agents such as nystatin and amphotericin B is effective initially. However, medication can produce side effects in some patients and when therapy is stopped the condition can recur. Alternative treatment involving the use of antiseptics and disinfecting agents has been shown to play an important role in the control of dental plaque. The use of sodium hypochlorite as an overnight denture soak has been shown to eliminate denture plaque and recent investigations have demonstrated that microwave irradiation of dentures at a specified setting and exposure time is bactericidal and candidacidal.

Evaluation of an optical instrument for objective assessment of oral mucosal erythema

This study evaluated the sensitivity and reproducibility of an optical instrument, the Erythema Meter, for quantifying erythema of palatal mucosa. The instrument is based on the principle that haemoglobin in the vasculature selectively absorbs green light but has little effect on red light and allows derivation of an 'erythema index'. Non-clinical investigations were carried out by taking a series of Erythema Meter readings from each colour block on a red check-standard used by graphic artists for colour reproduction. For clinical assessment, 20 dentate patients with healthy palatal mucosa and 40 complete denture wearers (20 with denture stomatitis and 20 with healthy palatal mucosa) were enrolled, and palatal erythema determined both visually and using the Erythema Meter. Two weeks later the Erythema Meter readings for the 40 patients with healthy palatal mucosa were repeated, to allow assessment of the reproducibility of the Erythema Meter scores. The median erythema index was 12 (range 2-38) for dentate patients with healthy palatal mucosa and 5 (range 0-29) for denture wearers with healthy palatal mucosa. For denture stomatitis patients the median erythema index was 95 (range 36-117). The overall reproducibility coefficient was 88%. Visual scoring correlated poorly with the Erythema Meter scores for those with moderate degrees of erythema. The Erythema Meter provides an objective and reproducible means of measuring the degree of erythema of the palatal mucosa.

Oropharyngeal candidosis in the older patient

Colonization of the oral and pharyngeal regions by Candida spp., particularly C. albicans, is extremely common in humans, particularly in early and late life. A variety of local and systemic conditions predispose the transformation of the benign colonization to a pathological state, which may have severe local or serious systemic consequences. The finding of oropharyngeal candidosis in an older patient, therefore, merits investigation of the likely host factors responsible for the organism adopting its pathogenic behavior. This paper provides non-dental clinicians managing older patients a review of the clinical characteristics, risk factors, diagnosis, and management of oropharyngeal candidosis in older adults.

Candida and oral candidosis: a review

Candida species are the most common fungal pathogens isolated from the oral cavity. Their oral existence both as a commensal and an opportunist pathogen has intrigued clinicians and scientists for many decades, and recent investigations have revealed many attributes of this fungus contributing to its pathogenicity. In addition, the advent of the human immunodeficiency virus infection and AIDS has resulted in a resurgence of oral Candida infections. Clinicians are witnessing not only classic forms of the diseases but also newer clinical variants such as erythematous candidosis, rarely described hithertofore. Therefore, this review is an attempt at detailing the current knowledge on Candida and oral candidoses together with the newer therapeutic regimes employed in treating these mycoses.

Annual review of selected dental literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The annual review of selected dental literature this year cites 384 published papers and reports. This year's review contains more editorial comment than reviews of years passed. New data on the biological responses to materials is emphasized in several sections. Observations on new compounds able to prevent plaque formation are presented. Clinically relevant advances in knowledge concerning the etching of different tooth structures are reported along with the effect of etching procedures on the dental pulp. Evaluation of periodontal diseases in all age groups is a topic. Limitations of current diagnostic techniques in periodontal disease, temporomandibular disorders, and implant therapy are included. There are new views on the use of dental amalgam. The future use of dental mercury is predicted. Interest in new ceramic systems is indicated as the demand for esthetics continues. Clinical information is emphasized over scientific information throughout this year's review.