Effectiveness of chlorine dioxide in disinfection on two soft denture liners

Effect of disinfectants on multispecies biofilm, the physical and mechanical properties of polymethyl methacrylate, and the corrosion of cobalt chromium alloy

STATEMENT OF PROBLEM

The optimal disinfection protocol that controls adverse effects and promotes effective antimicrobial action on removable prostheses is unclear.

PURPOSE

This in vitro study investigated the effect of disinfectant solutions on the biological, physical, mechanical, and chemical properties of removable prosthesis materials.

MATERIAL AND METHODS

Specimens of polymethyl methacrylate (PMMA) and cobalt chromium (Co-Cr) alloy were immersed in distilled water (PMMA) or artificial saliva (Co-Cr) as the control and in 0.25% sodium hypochlorite (NaOCl0.25%), 0.5% chloramine T (CT0.5%), and 0.15% Triclosan (TR0.15%). The antibiofilm activity was evaluated by microbial load and cell metabolisms of the mixed biofilm. Physical (color change, sorption, solubility, and surface roughness), mechanical (hardness, flexural, and impact strength), and chemical (corrosion) properties were analyzed before and after simulating a 5-year immersion. Laser confocal microscopy, scanning electron microscopy (SEM), and dispersive energy spectroscopy (EDS) complemented the analyses. The data were analyzed by using the Mann-Whitney U test, Kruskal-Wallis with Dunn posttests, 1-way ANOVA, and repeated measures ANOVA (α=.05).

RESULTS

All solutions were effective against bacteria, but only NaOCl0.25% eliminated Candida spp. TR0.15%, and CT0.5% increased cell metabolisms. For interaction (time and solution), there was a reduction in PMMA hardness in the control and TR0.15%. Color, sorption, solubility, and flexural strength did not change. CT0.5% and TR0.15% were similar for impact resistance. CT0.5% caused the lowest roughness. NaOCl0.25% showed the greatest corrosive potential. Dark spots were seen under SEM in Co-Cr stored with NaOCl0.25% and TR0.15%. EDS indicated different proportions of oxygen, cobalt, chromium, and molybdenum.

CONCLUSIONS

NaOCl0.25% had the best antimicrobial action. CT0.5% and TR0.15% have potential. Hardness and roughness changes were clinically acceptable, and the other properties remained unchanged. All the solutions caused color changes. NaOCl0.25% was unsatisfactory for use with Co-Cr, CT0.5% was intermediate, and TR0.15% was suitable.

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.

A comparison of the bleaching effectiveness of chlorine dioxide and hydrogen peroxide on dental composite

This study was carried out to verify if composites could be bleached using chlorine dioxide as compared with hydrogen peroxide. 3M ESPE Filtek Z350 Universal Restorative discs were prepared (n=40), with dimensions 5 mm diameter x 2 mm thickness. The discs were divided into 4 groups of 10 discs each. Color assessment was performed by CIEDE2000. The discs were stained with coffee, tea, wine and distilled water (control) solutions for 14 days, 5 hours daily. Color assessment was repeated on stained discs and followed by bleaching of 5 discs from each group using chlorine dioxide and hydrogen peroxide in-office systems. Finally, a last color assessment was performed and compared statistically. DE2000 after bleaching was very close to baseline for both the bleaching agents, although chlorine dioxide showed better results than hydrogen peroxide. After staining, there was a clinically significant discoloration (∆E2000≥3.43) for the tea, coffee and wine groups, and discoloration (∆E2000) was seen more in the wine group as compared to tea and coffee. Overall, the control group (distilled water) had the least color change in the three intervals. After bleaching, the color in all specimens returned close to the baseline. The color differences between bleaching and baseline were less than 3.43 for all groups. The obtained results show that chlorine dioxide is slightly superior to hydrogen peroxide in the bleaching of composites, while maintaining the shade of the composite close to the baseline.

In vitro antifungal evaluation of seven different disinfectants on acrylic resins

Objective. The aim of this study was to evaluate alternative methods for the disinfection of denture-based materials. Material and Methods. Two different denture-based materials were included in the study. Before microbial test, the surface roughness of the acrylic resins was evaluated. Then, the specimens were divided into 8 experimental groups (n = 10), according to microorganism considered and disinfection methods used. The specimens were contaminated in vitro by standardized suspensions of Candida albicans ATCC#90028 and Candida albicans oral isolate. The following test agents were tested: sodium hypochlorite (NaOCl 1%), microwave (MW) energy, ultraviolet (UV) light, mouthwash containing propolis (MCP), Corega Tabs, 50% and 100% white vinegar. After the disinfection procedure, the number of remaining microbial cells was evaluated in CFU/mL. Kruskal-Wallis, ANOVA, and Dunn's test were used for multiple comparisons. Mann Whitney U test was used to compare the surface roughness. Results. Statistically significant difference (P < 0.05) was found between autopolymerised and heat-cured acrylic resins. The autopolymerised acrylic resin surfaces were rougher than surfaces of heat-cured acrylic resin. The most effective disinfection method was 100% white vinegar for tested microorganisms and both acrylic resins. Conclusion. This study showed that white vinegar 100% was the most effective method for tested microorganisms. This agent is cost-effective and easy to access and thus may be appropriate for household use.

Prevention and treatment of Candida colonization on denture liners: a systematic review

STATEMENT OF PROBLEM

Denture liners are well known for their poor physical properties that favor the accumulation of plaque and colonization by Candida species, which can irritate the oral tissues and lead to denture stomatitis.

PURPOSE

A systematic review was conducted to determine the feasibility of a prevention protocol for Candida colonization in denture liners and an effective treatment after the fungi has colonized the material.

MATERIAL AND METHODS

Clinical and in vitro investigations that assessed the treatment and/or prevention of Candida colonization and biofilm formation in denture liners were selected according to the PRISMA statement. Seven electronic databases were searched from 1950 to April 2012 with the keywords "denture liner" OR "reline*" OR "tissue conditioner" AND "Candida" OR "denture stomatitis" OR "oral candidiasis" OR "antifungal agents" OR "denture clean*".

RESULTS

The incorporation of nystatin (in general, 500 000 units) into tissue conditioners to prevent the onset of the disease and immersion in sodium hypochlorite for disinfection were the methods most often described in this systematic review, and both methods were able to prevent or inhibit Candida colonization, depending on their concentrations. The 0.5% sodium hypochlorite concentration can disinfect tissue conditioners and denture liners. Microwave irradiation has also been described an alternative method of disinfection. Because of a lack of standardized results (especially with regard to the method used to perform microbial counts), a meta-analysis could not be performed.

CONCLUSIONS

The literature suggests that the use of 0.5% sodium hypochlorite can help disinfect denture liners and tissue conditioners. The incorporation of nystatin in those materials is also able to treat or prevent oral candidiasis. However, as most of the studies were in vitro, there is insufficient reliable evidence to truly provide recommendations regarding the ideal cleaning method or whether the addition of antifungal agents is worthwhile. Well-designed randomized controlled trials are needed to provide answers to these questions.

Resilient liners: a review

Resilient liners when used intelligently are an excellent adjunct in removable prosthodontics. However, currently they have to be best considered as temporary expedients because none of the advocated permanent liners have life expectancy comparable to resin denture base. This article reviews the literature regarding their composition, functions, gelation characteristics, bond strength and influence on denture bases. It also presents their drawbacks and attempts made to extend their longevity. A Medline search was completed for the period from 1986 to 2007, along with a manual search, to identify pertinent English peer-reviewed articles and textbooks.

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.

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.