Clinical and antimicrobial efficacy of NitrAdine ™-based disinfecting cleaning tablets in complete denture wearers

Scientific evidence on the efficacy of effervescent tablets for cleaning removable prostheses. A systematic review and meta-analysis

STATEMENT OF PROBLEM

Scientific evidence to determine the optimal method of cleaning and disinfecting removable prostheses is lacking.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of effervescent tablets in the cleaning and sanitizing of removable prostheses compared with other chemical and physical methods by assessing the reduction of biofilm, microbial levels, and material stability.

MATERIAL AND METHODS

A systematic literature search and meta-analysis was conducted in August 2021 in the MEDLINE/PubMed, Cochrane, Embase, Scopus, and Web of Science databases. Randomized and nonrandomized controlled clinical trials published in English were included without publication year limits. A total of 23 studies were included in the systematic review and 6 in the meta-analysis, which had been registered in the international prospective register of systematic reviews (PROSPERO) database (CRD42021274019). The Cochrane Collaboration tool was used to assess the risk of bias of randomized clinical trials. The physiotherapy evidence database (PEDro) scale was used to analyze the internal validity of clinical trials by assessing the quality of the data obtained. The studies included in the meta-analysis were combined by using a random-effects model with the inverse variance method. Publication bias was analyzed by using the Duvall and Tweedie trim-and-fill method.

RESULTS

With regard to biofilm reduction, the standardized mean difference estimated with the 4 studies combined in the meta-analysis was P=.012: mean difference=-1.92; 95% confidence interval=-3.45 to -0.38, indicating a "large" effect of the combination of brushing and effervescent tablet versus brushing alone. To estimate the reduction in the total bacteria levels in the 3 combined studies, a "large" effect size was obtained for the combination of brushing and using an effervescent tablet versus brushing alone, P<.001: mean difference=-4.43; 95% confidence interval=-8.29 to -0.55. Finally, when the 3 studies were combined to assess the reduction of Candida or fungal infection, a "moderate" effect size was obtained for the combination of brushing combined with the use of an effervescent tablet, P<.001: mean difference=-0.78; 95% confidence interval=-1.19 to -0.37.

CONCLUSIONS

The combination of brushing and the use of effervescent tablets versus brushing alone had a significantly higher effect on reducing biofilm and bacterial counts and a moderate effect on reducing Candida. Regarding color and dimensional stability, few studies were found, with the results depending on the concentration of the product and the immersion time of the device.

Comparative effectiveness of interventions for the treatment of denture stomatitis: A systematic review with network meta-analysis

STATEMENT OF PROBLEM

Symptomatic denture stomatitis (DS) is a painful oral mucosal disorder that can impair quality of life in denture wearers. A complete cure of DS is difficult to achieve, and the most efficacious regimen to treat DS has not yet been conclusively established.

PURPOSE

The purpose of this network meta-analysis was to assess the comparative efficacy of interventions used for the treatment of DS.

MATERIAL AND METHODS

A search was conducted for trials published in Medline, Scopus, PubMed, and Cochrane Central Register of Controlled Trials from inception until February 2022 (PROSPERO Reg no: CRD42021271366). Network meta-analysis was performed on data from randomized controlled trials that assessed the comparative efficacy of any form of intervention for the treatment of DS in denture wearers. Agents were ranked according to their effectiveness in the treatment of DS based on outcomes using surface under the cumulative ranking (SUCRA).

RESULTS

A total of 25 articles were included in the quantitative analysis. Topical antifungal agents (risk ratio [RR]=4.37[95% confidence interval [CI]: 2.15,8.90), topical antimicrobial agents used along with systemic antifungal agents (RR=4.25[95% CI: 1.79,10.33]), systemic antifungal agents (RR=4.25[95% CI: 1.79,10.10]), photodynamic therapy (RR=4.25[95% CI: 1.75,8.98]), and topical plant products (RR=3.40[95% CI: 1.59,7.26]) were found to effectively improve DS. Microwave disinfection concurrently administered with topical antifungal agents (RR=7.38(95% CI: 2.75,19.81), microwave disinfection 7.38[95% CI: 2.75,19.81]), topical antifungal agents (RR=4.88[95% CI: 1.92,12.42]), topical plant products (RR=4.49[95% CI: 1.70,11.82]), systemic antifungal agents together with topical antimicrobial agents (RR=3.85[95% CI: 1.33,11.10]), topical antimicrobial agents (RR=3.39[95% CI: 1.17,9.81]), systemic antifungal agents (RR=3.37[95% CI: 1.21,9.34]), and photodynamic therapy or photochemotherapy (PDT) (RR=2.93[95% CI: 1.01,8.47]) were found to effectively resolve mycological DS. Topical antifungals ranked highest in the SUCRA ranking for clinical improvement, whereas microwave disinfection concurrently administered with topical antifungal agents ranked highest for mycological resolution. None of the agents demonstrated significant side effects except for topical antimicrobial agents which demonstrated altered taste and staining of oral structures.

CONCLUSIONS

Available evidence suggests that topical antifungals, microwave, and systemic antifungals are effective in the treatment of DS, but confidence in these findings is low because of the limited number of studies and a high risk of bias. Additional clinical trials are needed on photodynamic therapy, topical plant products, and topical antimicrobials.

Is the Number of Appointments for Complete Denture Fabrication Reduced with CAD-CAM? A Literature Review

One of the key arguments in favor of digitally produced complete dentures (CDs) is the requirement for less patient visits in comparison to the conventional workflow. However, it is not yet clear if this argument is accurate; nor, if indeed the insertion of the complete dentures is achieved in fewer appointments, how many are required. The purpose of this literature review was to investigate the reported number of required patient visits for the production of digitally fabricated CDs. An electronic search was performed in PubMed/MEDLINE using three groups of keywords: “complete dentures”, “CAD/CAM”, and “Appointments” with their alternative forms. Out of the initial 157 results, 36 articles were automatically selected utilizing exclusion keywords. After consensus between the two examiners, eight articles were finally analyzed and presented in a table. The majority (75%) of the reports came from institutions, and the average number of appointments up to complete denture insertion was 4.1, not always including try-in dentures. In this study, it can be concluded that, with a digital workflow, the insertion appointment is reached in fewer visits than the conventional five-visit procedure which is commonly taught in dental schools.

Randomized Trial of Feasibility and Preliminary Effectiveness of PerioTabs® on Periodontal Diseases

This double-blinded and split-mouth design, randomized feasibility study aimed to assess the efficacy of prophylactic and therapeutic use of a new age NitrAdineTM-based brushing solution (PerioTabs®) on the clinical parameters before and after periodontal therapy. Four subjects were randomly assigned to two treatment groups according to periodontal infection: PerioTabs® and placebo. At the first appointment, a split-mouth scaling was performed in all participants. All oral care instructions concerning the use of effervescent tablets were explained to the participants in detail. The morning after the tablets were finished, a full-mouth scaling was completed in all participants. All parameters were recorded at 0, 11, and 40 days. According to the results, both the therapeutic and prophylactic interventions showed similar impacts on the gingival index and probing depth compared to the placebo in all patients. The bleeding on probing was further reduced at the PerioTabs® site at baseline until day 40 compared to the placebo in the gingivitis patients with both interventions; at both 11 and 40 days in the periodontitis patients receiving the therapeutic intervention; and at baseline to day 40 in the periodontitis group receiving the prophylactic intervention., While the preliminary results of this new-age brushing solution appear to be a promising approach for a future therapy of periodontal diseases, further research on a larger sample size is needed to draw firm conclusions.

Antimicrobial effects of a new brushing solution concept on a multispecies in vitro biofilm model growing on titanium surfaces

OBJECTIVES

To evaluate the antibiofilm and antibacterial effects of a new brushing solution concept, in a validated peri-implant biofilm model.

MATERIALS AND METHODS

A multispecies in vitro biofilm model, including Streptococcus oralis, Actinomyces naeslundii, Veillonella parvula, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Fusobacterium nucleatum, was used. To evaluate the antibiofilm capacity, titanium discs (Ti-SLA) were immersed in 1 ml of the tested solution (one tablet dissolved in warm water) for 2 min, prior and every 24 h during a 3-day biofilm development. Negative (water) and positive (0.12% chlorhexidine/0.05% cetylpyridinium chloride mouth rinse) controls treated discs were run in parallel. To evaluate the antibacterial effects, planktonic cells and 72-h biofilms on sterile Ti-SLA discs were exposed (2 min) to the mentioned treatments. Biofilm structure was analysed by confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Bacterial load was measured by quantitative polymerase chain reaction and by culture in planktonic cells.

RESULTS

The tested product showed antibiofilm effects, impacting on the 48-h and 72-h biofilm thickness and significantly reducing viability of all bacterial species, except A. actinomycetemcomitans. Antibacterial effects were observed against the six bacterial species in planktonic state and in 72-h biofilms, especially for F. nucleatum and A. actinomycetemcomitans.

CONCLUSION

The tested brushing solution demonstrated antibacterial and antibiofilm properties, mainly against the peri-implant pathogens included in the validated in vitro biofilm model used.

The effectiveness of the information-motivation model and domestic brushing with a hypochlorite-based formula on peri-implant mucositis: A randomized clinical study

Objective

Management of mucositis is essential for the long‐term maintenance of dental implants. This study determined the efficacy, in terms of clinical parameters, of an adjunctive domiciliary agent paired with non‐surgical periodontal therapy (NSPT) for patients with peri‐implant mucositis.

Materials and methods

Patients involved in a periodontal maintenance program were randomly distributed to the domestic use of a chlorhexidine toothpaste and mouthwash (control) or a hypochlorite‐based formula brushing solution (test) after diagnosis of peri‐implant mucositis. A modified approach towards NSPTwas performed after 10 days of domestic use of the assigned maintenance product in both groups. Clinical and patient‐related outcomes were recorded during a 90‐day follow‐up period.

Results

Forty patients completed the three‐month study (20 patients per group). Both groups showed relevant clinical and patient outcome improvements after the NSPT (T2) and between T1 and T2 (p < 0 0.01), except for PPD. For the test group, the clinical improvement was significantly greater than that for the control group at the seventh‐day evaluation (T₁) in the gingival index (0–3) and FMBS (%). Favorable outcomes were maintained during the entire follow‐up period.

Conclusion

The present study showed that the modified NSPT paired with the domestic use of nitradine‐based formula helps resolve peri‐implant mucositis and that nitradine might represent an alternative to chlorhexidine in these cases.

Clinical relevance

The gold standard for nonsurgical maintenance is full‐mouth disinfection. A previous decontamination of the oral cavity with chlorhexidine or nitradine domiciliary for 10 days could reduce plaque and inflammation, resulting in a painless operative session. This protocol may help reduce airborne contamination and the risk of cross‐infection, and during the pandemic, the protocol is safer for clinicians. In the same clinical cases, nitradine may be more efficient than chlorhexidine, and the former has no side effects such as discolouration.

Effect of local hygiene protocols on denture-related stomatitis, biofilm, microbial load, and odor: A randomized controlled trial

STATEMENT OF PROBLEM

Denture stomatitis affects complete denture wearers and is frequently treated with antifungals drugs, as well as treating the denture with sodium hypochlorite. Whether the limitations of these treatments can be overcome with local hygiene protocols that do not damage the denture materials or adversely affect the patient is unclear.

PURPOSE

The purpose of this randomized controlled trial was to evaluate the effect of denture hygiene protocols on complete denture wearers with denture stomatitis.

MATERIAL AND METHODS

For this randomized, double-blind controlled clinical trial, 108 participants were assigned to parallel groups: 0.25% sodium hypochlorite (positive control) 0.15% Triclosan, denture cleaning tablets, or denture cleaning tablets plus gingival cleaning tablets. The participants were instructed to brush the dentures and the palate and immerse the denture in the solutions. The outcomes of denture stomatitis remission, biofilm removal, decrease of microbial load (colony-forming units), and odor level of the mouth and denture were measured at baseline and after 10 days. Descriptive analyses were used for sociodemographic characterization of the participants; the Pearson chi-square test was used to compare participant frequency with different degrees of denture stomatitis. The data were not normally distributed (Shapiro-Wilks test) or homogeneous (Levene test). So, the Kruskal-Wallis and Dunn post hoc tests and Wilcoxon test were used to compare the effects of solutions and time on the variables (α=.05).

RESULTS

The frequency of the highest to lowest denture stomatitis scores was significantly different for the 0.15% Triclosan and denture cleaning tablets groups. No significant difference was found among the groups in terms of denture stomatitis scores, biofilm, or colony-forming unit count of Candida spp. or C. albicans and S. mutans; a significant reduction was found in these parameters. The 0.25% sodium hypochlorite and 0.15% Triclosan treatments caused a significant reduction in Gram-negative microorganisms; these 2 protocols, and the denture cleaning tablets showed a significant reduction in Staphylococcus spp.; all protocols had similar effects. Only the S. mutans count of the palate decreased after 10 days. The odor level of the mouth and the denture was not significantly different (P=.778).

CONCLUSIONS

The evaluated protocols can be recommended for the hygiene of complete dentures, since they were effective for all the variables studied.

Antimicrobial activity of effervescent denture tablets on multispecies biofilms

PURPOSE

To investigate the impact of peroxide-based solutions in reducing viability and metabolic activity of multispecies biofilms on denture base acrylic resin surfaces and for removing them from these surfaces.

BACKGROUND

Denture cleansers are effective in reducing monospecies biofilm; however, studies evaluating their action on multispecies biofilms are scarce.

MATERIALS AND METHODS

Sixty-nine denture base acrylic resin specimens (Ø 15 × 3 mm) were sterilised then contaminated with Candida albicans, Staphylococcus aureus and Pseudomonas aeruginosa to form multispecies biofilms. Biofilms were grown for 24 hours; subsequently, specimens were immersed in three different cleansing solutions (n = 9): nitradine (NI), fixodent (FX) and phosphate-buffered saline (Control), according to the respective manufacturer's instructions. After applying the hygiene protocols, viability of microorganisms was evaluated by counting colony-forming units and assessing metabolic activity. Moreover, biofilm removal capacity was estimated based on extension of cell-covered areas visualised in fluorescent microscopy micrographics.

RESULTS

Microbial counts were solution-dependent; NI was effective against all microorganisms (P < .05). FX exhibited moderate antimicrobial action, reducing P aeruginosa (P < .05) and S aureus (P < .05) viability by approximately 2 logs. Both peroxide-based solutions reduced metabolic activity (P < .001) and biofilm-covered areas on specimen surfaces (P < .001).

CONCLUSION

Under the experimental conditions tested, these results demonstrated that peroxide-based solutions had favourable antimicrobial activity but promoted no broad elimination of aggregated multispecies biofilm. NI might be more suitable as complementary chemical agent for controlling multispecies denture biofilm.

Microbial Contamination and Disinfection of Sport Mouthguard: In Vitro Study

Mouthguards in Ethylene Vinyl Acetate (EVA) should be sanitized to prevent alteration of oral microbiota. The present study determined, in vitro and by SEM observation, the decontaminating effect of different substances on EVA mouthguards previously contaminated with saliva and broth culture of Enterococcus faecalis ATCC 29212 and Candida albicans CH 34 (clinically isolated). Subsequently, the mouthguards were subjected to the following treatments: (A) Untreated; (B) 5 min with sterilized distilled water (H₂O d); (C) 5 min with H₂O₂; (D) 5 min with a physiological solution; (E) toothbrush and fluoride toothpaste; (F) 5 min with 0.5% NaOCl; (G) 5 min with Oral Care Foam™; (H) 5 min with Bite Sept™. The highest efficacy against E. faecalis was demonstrated by H₂O₂ (84.19% bacterial load reduction). H₂O₂ and Oral Care Foam™ showed a greater reduction of salivary cell load. The highest efficacy against C. albicans was demonstrated by 0.5% NaOCl which caused a 92.95% reduction of cell load. In conclusion, hydrogen peroxide, 0.5% sodium hypochlorite and the solution Oral Care Foam™ allowed to obtain an optimum disinfection of the mouthguard. SEM observation showed that different substances demonstrated a decontaminating effect decreasing the microbial communities on the EVA surface.

Effect of Denture Cleansers on Cobalt-Chromium Alloy Surface: A Simulated Period of 5 Years' Use

PURPOSE

To compare the effect of solutions of effervescent tablets (ET), cetylpyridinium chloride (CPC), and experimental solutions of Ricinus communis on the surface of cobalt-chromium (Co-Cr) alloys.

MATERIALS AND METHODS

Fifty-five specimens of Co-Cr were prepared by the lost-wax casting method using circular patterns (∅12 × 3 mm). The specimens were randomly divided into 5 groups: deionized water (control); 2% R. communis; 10% R. communis; ET, and CPC. The surface roughness of specimens (n = 10) was evaluated before immersion (baseline), and at simulated times of ½, 1, 2, 3, 4, and 5 years, by laser confocal microscope (Sa, μm) and profilometer (Ra, μm). The surface topography and chemical composition (n = 1) was qualitatively analyzed with scanning electron microscopy (SEM), and energy dispersive X-ray spectrometry (EDS). Data were subjected to Kruskal-Wallis followed by Dunn tests, and Friedman followed by Wilcoxon tests (α = 0.05).

RESULTS

For Sa, there was no difference for the solution factor. For the time factor a significant difference was found with 2% R. communis solution among baseline and ½, 2, 3, and 5 years (p < 0.001) and with 10% R. communis solution between 1 and 2 years (p = 0.007), with decreasing roughness over time. For Ra, cetylpyridinium chloride exhibited less roughness than 10% R. communis solution in ½ (p = 0.048) and 5 years (p = 0.013). In the SEM and EDS analysis the solutions did not present deleterious effects or changes in the chemical composition on the surfaces.

CONCLUSIONS

Although a significant difference was found for the roughness, the results, below 0.2 μm, are clinically acceptable. Thus, all solutions can be used safely in removable partial denture cleaning for a period of 5 years.

Clinical trial for evaluation of Ricinus communis and sodium hypochlorite as denture cleanser

Objective

This study evaluated Ricinus communis and sodium hypochlorite solutions in terms of biofilm removal ability, remission of candidiasis, antimicrobial activity, and participant satisfaction.

Material and Methods

It was conducted a controlled clinical trial, randomized, double-blind, and crossover. Sixty-four denture wearers with (n=24) and without candidiasis (n=40) were instructed to brush (3 times/day) and immerse their dentures (20 min/day) in different storage solutions (S1 / S2: 0.25% / 0.5% sodium hypochlorite; S3: 10% R. communis; S4: Saline).The trial period for each solution was seven days and a washout period of seven days was used before starting the use of another solution. The variables were analyzed at baseline and after each trial period. The biofilm of inner surfaces of maxillary dentures was disclosed, photographed, and total and dyed areas were measured (Image Tool software). The percentage of biofilm was calculated. Remission of candidiasis was assessed by visual scale and score were attributed. Antimicrobial activity was assessed by the DNA-Checkerboard hybridization method. Patient satisfaction was measured using a questionnaire.

Results

S1 (4.41±7.98%) and S2 (2.93±5.23%) were more effective then S3 (6.95±10.93%) in biofilm remotion(P<0.0001). All solutions were different from the control (11.07±11.99%). S3 was the most effective solution in remission of candidiasis (50%), followed by S1 (46%). Concerning antimicrobial action, S1/S2 were similar and resulted in the lowest microorganism mean count (P=0.04), followed by S3. No significant differences were found with patient's satisfaction.

Conclusions

10% R. communis and 0.25% sodium hypochlorite were effective in biofilm removal, causing remission of candidiasis and reducing the formation of microbial colonies in denture surfaces. All solutions were approved by patients.

Effects of Denture Cleansers on Heat-Polymerized Acrylic Resin: A Five-Year-Simulated Period of Use

This study evaluated color stability, surface roughness and flexural strength of acrylic resin after immersion in alkaline peroxide and alkaline hypochlorite solutions, simulating a five-year-period of use. Sixty disc-shaped (16 x 4 mm) and 60 rectangular specimens (65 x 10 x 3.3 mm) were prepared from heat-polymerized acrylic resin (Lucitone 550) and assigned to 3 groups (n = 20) of immersion (20 min): C1: distilled water; AP: warm water and one alkaline peroxide tablet; SH: 0.5% NaOCl solution. Color data (∆E) were determined by a colorimeter and also quantified according to the National Bureau of Standards units. A rugosimeter was used to measure roughness (μm) and the flexural strength (MPa) was measured using a universal testing machine. Data were evaluated by Kruskal-Wallis followed by Dunn tests (color stability and surface roughness) and by one-way ANOVA and Bonferroni test (flexural strength). For all tests was considered α = 0.05. AP {0.79 (0.66;1.42)} caused color alteration significantly higher than C1 {0.45 (0.37;0.57)} and SH {0.34 (0.25;0.42)}. The mean ∆Ε values quantified by NBS were classified as "trace" for C1 (0.43) and SH (0.31) and "slight" for AP (0.96). SH {-0.015 (-0.023;0.003)} caused significantly higher ΔRa than the C1 {0.000 (-0.004;0.010)} and AP {0.000 (-0.009;0.008)} groups. There was no statistically significant difference among the solutions for flexural strength (C1: 84.62 ± 16.00, AP: 85.63 ± 12.99, SH: 84.22 ± 14.72). It was concluded that immersion in alkaline peroxide and NaOCl solutions simulating a five-year of 20 min daily soaking did not cause clinically significant adverse effects on the heat-polymerized acrylic resin.

Alkaline Peroxides Versus Sodium Hypochlorite for Removing Denture Biofilm: a Crossover Randomized Trial

This study evaluated the efficacy of cleanser solutions on denture biofilm removal by a crossover randomized clinical trial. Thirty two edentulous patients were instructed to brush their dentures (specific brush and liquid soap) three times a day (after breakfast, lunch and dinner) and to soak them (≥ 8 h) in: (C) control -water; (AP): alkaline peroxide; or (SH) 0.5% sodium hypochlorite. Each solution was used for 21 days (three cycles of 7 days). At the end of each cycle, the inner surfaces of maxillary dentures were disclosed (1% neutral red) and photographed (HX1 - Sony). Areas (total and stained biofilm) were measured (Image Tool software) and the percentage of biofilm calculated as the ratio between the area of the biofilm multiplied by 100 and total surface area of the internal base of the denture. Data were compared by means of generalized estimating equation (α=5%) and multiple comparisons (Bonferroni; α=1.67%). Immersion in SH reduced biofilm (%) (8.3 ± 13.3B) compared to C (18.2 ± 14.9A) and AP (18.2 ± 16.6A). The 0.5% sodium hypochlorite solution was the most efficacious for biofilm removal. Alkaline peroxides may not lead to further biofilm removal in patients with adequate denture maintenance habits.

Denture wearing during sleep doubles the risk of pneumonia in the very elderly

Poor oral health and hygiene are increasingly recognized as major risk factors for pneumonia among the elderly. To identify modifiable oral health-related risk factors, we prospectively investigated associations between a constellation of oral health behaviors and incident pneumonia in the community-living very elderly (i.e., 85 years of age or older). At baseline, 524 randomly selected seniors (228 men and 296 women; mean age, 87.8 years) were examined for oral health status and oral hygiene behaviors as well as medical assessment, including blood chemistry analysis, and followed up annually until first hospitalization for or death from pneumonia. During a 3-year follow-up period, 48 events associated with pneumonia (20 deaths and 28 acute hospitalizations) were identified. Among 453 denture wearers, 186 (40.8%) who wore their dentures during sleep were at higher risk for pneumonia than those who removed their dentures at night (log rank P = 0.021). In a multivariate Cox model, both perceived swallowing difficulties and overnight denture wearing were independently associated with an approximately 2.3-fold higher risk of the incidence of pneumonia (for perceived swallowing difficulties, hazard ratio [HR], 2.31; and 95% confidence interval [CI], 1.11-4.82; and for denture wearing during sleep, HR, 2.38; and 95% CI, 1.25-4.56), which was comparable with the HR attributable to cognitive impairment (HR, 2.15; 95% CI, 1.06-4.34), history of stroke (HR, 2.46; 95% CI, 1.13-5.35), and respiratory disease (HR, 2.25; 95% CI, 1.20-4.23). In addition, those who wore dentures during sleep were more likely to have tongue and denture plaque, gum inflammation, positive culture for Candida albicans, and higher levels of circulating interleukin-6 as compared with their counterparts. This study provided empirical evidence that denture wearing during sleep is associated not only with oral inflammatory and microbial burden but also with incident pneumonia, suggesting potential implications of oral hygiene programs for pneumonia prevention in the community.

The effect of cleaning substances on the surface of denture base material

Bakcground

The aim of this study was to evaluate the effect of substances used for hygienic cleaning of dentures on the surface of the denture base material.

Material/Methods

Meliodent Heat Cure (Heraeus-Kulzer, Germany) heat-polymerized acrylic resin was used to produce plates with all the characteristics of removable denture bases (subsequently, “plates”). Oral-B Complete toothbrushes of various brush head types were fixed to a device that imitated tooth brushing movements; table salt and baking soda (frequently used by patients to improve tooth brushing results), toothpaste (“Colgate Total”), and water were also applied. Changes in plate surfaces were monitored by measuring surface reflection alterations on spectrometry. Measurements were conducted before the cleaning and at 2 and 6 hours after cleaning.

Results

No statistically significant differences were found between the 3 test series. All 3 plates used in the study underwent statistically significant (p<0.05changed) – the reflection became poorer. The plates were most affected by the medium-bristle toothbrush with baking soda – the total reflection reduction was 4.82±0.1%; among toothbrushes with toothpaste, the hard-type toothbrush had the greatest reflection-reducing effect – 4.6±0.05%, while the toothbrush with table salt inflicted the least damage (3.5 ± 0.16%) due to the presence of rounded crystals between the bristles and the resin surface. Toothbrushes with water had a uniform negative effect on the plate surface – 3.89±0.07%.

Conclusions

All substances used by the patients caused surface abrasion of the denture base material, which reduced the reflection; a hard toothbrush with toothpaste had the greatest abrasive effect, while soft toothbrushes inflicted the least damage.

Urban legends series: oral candidosis

Candida species (spp) are commensal yeast that can only instigate oral infection (oral candidosis - OC) when there is an underlying predisposing condition in the host. We investigated four controversial topics on OC: (i) How can a microbiological determination of OC be made as Candida spp. are commensal yeasts and not all of them form hyphae or pseudohyphae during infection? (ii) Is median rhomboid glossitis (MRG) a manifestation of candidal infection? (iii) Can candidal infection cause palate papillary hyperplasia (PPH)? (iv) What is the best therapeutic treatment for denture-associated erythematous stomatitis (DAES)? Results from extensive literature searches, including a systematic review, suggested the following: (i) the diagnosis of OC merely on the basis of the presence of yeasts is an oversimplification of a complex process. No convincing evidence of a single test or method better able to discriminate the transition from candidal saprophytism to pathogenicity has been reported in the literature; (ii-iii) conclusive evidence of a direct aetiopathogenic relationship between MRG and PPH and candidal infection has not been found; and (iv) only limited evidence is available for any DAES treatment, thus making it impossible to make strong therapeutic recommendations.