In vitro and in vivo removal of oral Candida from the denture base

Evaluation of candida albicans adherence to CAD-CAM milled, 3D-printed, and heat-cured PMMA resin and efficacy of different disinfection techniques: an in-vitro study

PURPOSE

Candida albicans has been regarded as the most predominant oral fungal pathogen and the main cause of denture stomatitis. This study aimed to investigate C. albicans adherence to three types of denture base polymers: heat-cured polymethylmethacrylate (PMMA), CAD-CAM milled and 3D-printed. The efficacy of four common disinfection techniques, glutaraldehyde, brushing, microwave irradiation, and Polident overnight tablets, were also examined.

MATERIAL AND METHODS

Sixty blocks of pink acrylic specimens were fabricated from each polymer group. To investigate the C. albicans adherence, as well as the efficacy of different disinfection techniques on removing the yeast from the different materials, specimens were cultured within the fungal culture overnight followed by disinfection. The adhered C. albicans on the materials were then obtained by vortexing in phosphate buffered saline (PBS), and the numbers of the yeast in the suspensions were evaluated by measuring the optical density and/or colony-forming units on agar plates. Data were expressed as mean ± SEM (standard error of the mean). Statistical differences were evaluated by one-way analysis of variance (ANOVA) followed by the post-hoc Tukey HSD tests.

RESULTS

Significant differences in C. albicans adherence to the three polymers were noted. CAD-CAM milled and heat-cured PMMA showed significantly less C. albicans adherence compared with 3D printed PMMA. No significant difference was noted between milled and heat-cured PMMA. In the disinfection test, microwave irradiation, mechanical brushing, and Polident tablets were found to be effective in removing fungal attachment on the different denture materials, while glutaraldehyde was found to be the least effective.

CONCLUSION

C. albicans adherence to the polymers varies greatly based on the types of PMMA. 3D-printed had the highest fungal biofilm attachment. Microwave irradiation, mechanical brushing, and Polident overnight tablets had comparable results in removing C. albicans from all types of PMMA, while glutaraldehyde was not as effective. This article is protected by copyright. All rights reserved.

Comparison of Methods for Cleaning Enteral Feeding Tube Junctions of the New International Standard (ISO 80369-3)

Introduction

International standards for enteral feeding involving the use of feeding tubes with junctions have been introduced. If these junctions are not properly cleaned, they can become contaminated, leading to microbial infections. We aimed to compare the ease and effectiveness of cleaning of four methods using the number of bacteria.

Methods

We compared enteral nutrition tube junctions cleaned using four methods such as water, toothbrush, cotton swab, and EnClean® brush with an uncleaned control. Once daily for 7 days, the tubes were injected with nutrients, cleaned, and incubated at 37°C. Samples for bacterial culture were collected before injections on days 7, 14, 21, and 28. The culture samples were incubated at 37°C for 48 h, and the number of colonies was counted.

Results

The number of residual bacteria on day 28 did not differ between the four cleaning methods and the control group. Moreover, no significant difference was observed in bacterial counts among the four wash methods. The number of washes did not differ among cleaning methods.

Conclusion

The bacterial count in the ISO-standardized tube junction increased, and none of the cleaning methods decreased the counts.

CLEANING OF REMOVABLE DENTAL PROSTHESES - A SYSTEMATIC REVIEW

Objectives The aim of this systematic review was to provide an overview of the scientific evidence available from prospective clinical studies regarding denture hygiene interventions. Therefore, investigations addressing the efficacy of removing microorganisms and biofilms formed on the surface of removable dental prostheses (RDPs) and denture base materials in situ and their impact on the properties of denture base materials, such as color stability, surface roughness, and dimensional stability, were included. Methods A systematic literature search was conducted from June 1975-May 2020 and included articles published in English that have been indexed in the digital archives of PubMed and Cochrane (including PubMed, Embase, ICTRP, CT.gov). A complementary manual search of the initially retrieved studies was conducted. Inclusion criteria comprised prospective clinical trials with a minimum of ten participants investigating (1) approaches and methods to remove biofilms formed on the surface of RDPs and denture base materials in situ and/or (2) the influence of these biofilms on denture base materials. A total of forty-four studies were included in this systematic review, which was registered in the PROSPERO database (CRD42020189649). Results and Conclusions Data gathered from the systematic review indicate that the combined use of chemical and mechanical denture hygiene interventions is significantly more effective than single cleaning approaches. Only limited evidence is available from clinical studies regarding the effect of denture hygiene interventions on the properties of denture base materials.

Evaluation of Effectiveness of a Toothpaste Containing Tea Tree Oil and Ethanolic Extract of Propolis on the Improvement of Oral Health in Patients Using Removable Partial Dentures

The aim of this study was to evaluate the effect of toothpaste containing natural tea tree essential oil (TTO) and ethanolic extract of propolis (EEP), on microflora and selected indicators of oral health in patients using removable acrylic partial dentures. Fifty patients with varying conditions of hygiene were divided into two groups. The study group received the toothpaste with TTO and EEP, while the control group received the same toothpaste but without TTO and EEP. At the first visit, oral hygiene and hygiene of the prostheses were carried out. Control visits took place 7 and 28 days later and compared to baseline. Indexes like API (Approximal Plaque Index), mSBI (modified Sulcus Bleeding Index), OHI-s (simplified Oral Hygiene Index), and DPI (Denture Plaque Index) were assessed in three subsequent stages, and swabs were collected from floor of the mouth area to assess the microbiota. After 7 and 28 days of using the toothpaste with TTO and EEP, a statistically significant decrease of the examined indicator values were observed in the study group as compared to the values upon the initial visit. The number of isolated strains of microorganisms in the study group was decreased or maintained at the same level, whereas in the control group an increase in the number of isolated strains was observed. The observed stabilization of oral microbiota in patients from the study group confirms the beneficial activity of toothpaste containing EEP and TTO compared to the control group.

Efficacy of removing Candida albicans from orthodontic acrylic bases: an in vitro study

Background

This study evaluated the efficacy of four methods in removing Candida albicans from the acrylic base material used to fabricate removable orthodontic appliances.

Methods

Heat-processed bars of orthodontic acrylic were incubated in a suspension of C. albicans for 2 h at 37 °C. Samples were allocated into five groups (five bars per group) according to the cleaning method: (1) manual brushing using a toothbrush; (2) soaking in a commercial denture cleaning solution; (3) soaking in a commercial mouthwash solution; (4) using an ultrasonic cleaner; and (5) soaking in distilled water as a negative control. Yeast remaining attached to the bars after cleaning were removed by vortexing in growth medium and plated on Sabouraud dextrose agar. The reduction in yeast colony count after cleaning was calculated and expressed as the number of colony forming units per acrylic bar (CFU/bar). The experiment was carried out three times.

Results

All four cleaning methods resulted in a significant decrease in viable yeast cells associated with the acrylic bars compared to the control group. The mean percentage reduction in viable yeast cells affected by the cleaning methods was: brushing 89.9%; chlorhexidine 95.8%; ultrasonic cleaning 99.9%; and denture tablet 100%.

Conclusions

All four methods evaluated in this study were effective, to some extent, in removing C. albicans from orthodontic acrylic samples. The most effective, and readily available, cleaning method was the use of commercial denture sterilizing tablets.

Development of antibacterial denture cleaner for brushing containing tea tree and lemongrass essential oils

We evaluated effectiveness of tea tree oil (TO) and lemongrass oil (LO) for removal of Candida biofilm from denture base resin and their influence on that surface. Biofilm of C. albicans was formed on resins, and immersed in various concentrations of each oil and distilled water (DW). The biofilm removal effect was determined by incubating specimens in RPMI medium containing Alamar blue (AB) and measuring absorbance. Wear test was also conducted, and surface condition of resins was determined using laser scanning microscope and digital microscope. Specimens immersed in the TO and LO solutions tended to have a lower AB value at higher concentrations and longer soaking times. Use of these agents resulted in less surface roughness as compared to DW. Our results suggest that TO and LO were valid to remove biofilm attached to resin with lower levels of abrasion, and these are effective for use in denture cleaner.

Antifungal, optical, and mechanical properties of polymethylmethacrylate material incorporated with silanized zinc oxide nanoparticles

Background

Fungal infected denture, which is typically composed of polymethylmethacrylate (PMMA), is a common problem for a denture wearer, especially an elderly patient with limited manual dexterity. Therefore, increasing the antifungal effect of denture by incorporating surface modification nanoparticles into the PMMA, while retaining its mechanical properties, is of interest.

Aim of the study

This study aimed to evaluate antifungal, optical, and mechanical properties of heat-cured PMMA incorporated with different amounts of zinc oxide nanoparticles (ZnOnps) with or without methacryloxypropyltrimethoxysilane modification.

Materials and methods

Specimens made from heat-cured PMMA containing 1.25, 2.5, and 5% (w/w) nonsilanized (Nosi) or silanized (Si) ZnOnps were evaluated. Specimens without filler served as control. The fungal assay was performed placing a Candida albicans suspension on the PMMA surface for 2 h, then Sabouraud Dextrose Broth was added, and growth after 24 h was determined by counting colony forming units on agar plates. A spectrophotometer was used to measure the color in L* (brightness), a* (red-green), b* (yellow-blue) and opacity of the experimental groups. Flexural strength and flexural modulus were determined using a three-point bending test on universal testing machine after 37°C water storage for 48 h and 1 month.

Results

The antifungal, optical, and mechanical properties of the PMMA incorporated with ZnOnps changed depending on the amount. With the same amount of ZnOnps, the silanized groups demonstrated a greater reduction in C. albicans compared with the Nosi groups. The color difference (ΔE) and opacity of the Nosi groups were greater compared with the Si groups. The flexural strength of the Si groups, except for the 1.25% group, was significantly greater compared with the Nosi groups.

Conclusion

PMMA incorporated with Si ZnOnps, particularly with 2.5% Si ZnOnps, had a greater antifungal effect, less color differences, and opacity compared with Nosi ZnOnps, while retaining its mechanical properties.

Impact of Denture Cleaning Method and Overnight Storage Condition on Denture Biofilm Mass and Composition: A Cross-Over Randomized Clinical Trial

Background

Appropriate oral hygiene is required to maintain oral health in denture wearers. This study aims to compare the role of denture cleaning methods in combination with overnight storage conditions on biofilm mass and composition on acrylic removable dentures.

Methods

In a cross-over randomized controlled trial in 13 older people, 4 conditions with 2 different mechanical cleaning methods and 2 overnight storage conditions were considered: (i) brushing and immersion in water without a cleansing tablet, (ii) brushing and immersion in water with a cleansing tablet, (iii) ultrasonic cleaning and immersion in water without a cleansing tablet, and (iv) ultrasonic cleaning and immersion in water with a cleansing tablet. Each test condition was performed for 5 consecutive days, preceded by a 2-days wash-out period. Biofilm samples were taken at baseline (control) and at the end of each test period from a standardized region. Total and individual levels of selected oral bacteria (n = 20), and of Candida albicans were identified using the Polymerase Chain Reaction (PCR) technique. Denture biofilm coverage was scored using an analogue denture plaque score. Paired t-tests and Wilcoxon-signed rank tests were used to compare the test conditions. The level of significance was set at α< 5%.

Results

Overnight denture storage in water with a cleansing tablet significantly reduced the total bacterial count (p<0.01). The difference in total bacterial level between the two mechanical cleaning methods was not statistically significant. No significant effect was observed on the amount of Candida albicans nor on the analogue plaque scores.

Conclusions

The use of cleansing tablets during overnight denture storage in addition to mechanical denture cleaning did not affect Candida albicans count, but reduced the total bacterial count on acrylic removable dentures compared to overnight storage in water. This effect was more pronounced when combined with ultrasonic cleaning compared to brushing.

Trial Registration

ClinicalTrials.gov NCT02454413