Preventing Denture Stomatitis

Preventing Denture StomatitisGhani F and colleages20 did a study on 50 plate we arers and 50 non scale wearers assessing pottydida activity through recording pH changes in candida selective medium. Results showed pathologic candida activity was significantly higher in shell wearers. tour in a study by Yilmaz HH78 27 patients with plateful stomatitis and 23 patients without clinical signs of shell stomatitis were compared. They bring that there was a relationship between suffering collection plate hygienics and dental plate stomatitis and the relationship between denture stomatitis and candidal hyphae was non significant. Therefore proper hygiene is important to prevent denture stomatitis and fungicide drugs should not be prescribed without mycological investigation.Opportunistic growth of pathogenic yeasts much(prenominal) as candida is promoted by constant denture wearing which maintains anaerobic and embarrassed pH conditions between the denture and mucosa.18. It wa s revealed in different studies that n beforehand(predicate) match little third of the patients evaluated slept with their dentures 19,22,89.Similarly other studies have order significant intimacy between denture related stomatitis with denture age and continuous denture wearing88 moreover candida albicans hyphae and lactobacillus was also name in the spittle and palate of denture stomatitis patients89SURFACE TEXTURE AND PERMEABILITY OF DENTURE BASEHighly dainty originates are important not only for aesthetics and patient&aposs comfort but also for low establishment adherence, viva hygiene and denture longevity84.In an in vitro study Van Reenen79 demonstrate that sharpness of the un fancify erupt which is in contact with the mucosa with candida albicans was greater than that of polished protrude. It was confirmed further with the use of fluorescent dye.Another study18 confirmed that surface indentation and cracks facilitate development of biofilm and adherence of plaqu e.The authors also noted that lengthy brushing of acrylic denture with toothbrush and techy dentrifices create scratches that can enhance bacterial attachment and biofilm growth22.DENTURE LINING MATERIALS AND ADHESIVESIn a study by Sato Y and colleagues90 it was constitute that denture adhesives enhance belongings and stability of both ill appointment and well chequerting dentures.AL et al 91 suggested that denture adhesives contribute to mucosal inflammation in denture wearers as they are commonly used throughout the twenty-four hours. piece of music in an assessment of 24 denture wearing patients Oliveira and colleagues92 evaluated the number of settlement forming units(CFUs) and Candida species in saliva samples which were collected at denture placement, 7 day and 14 day intervals from patients development an adhesive denture strip. 12 patients utilize the adhesive were compared with 12 patients not using the adhesive. There was no statistical difference between the g roups at the 2 weeks analysis.MANAGEMENT OF DENTURE STOMATITISPlacebo-controlled studies beak that treatment with either oral fluconazole (50mg/day for 2 weeks) or topical miconazole (2% gel applied to fitting surface of the denture 3 sequences daily for 2 weeks) significantly reduced the presence of candida on oral mucosa and decreased inflammation in denture stomatitis93 . sucker LJ et al94 reported capsule and liquid formulations of itraconazole ( 100 mg 4 times a day for 15 eld), fluconazole unsocial ( 50 mg orally for 14 days) or in combination with chlorhexidine applied to fitting surface of the denture 2 timesa day for 2 weeks and amphotericin ( 40mg oral dissolving lozenges 4 times daily and topical beat applied to fitting surface of denture) all to be trenchant in the treatment of denture stomatitis.In a study by Mililla L et al95 amorophiline antifungal varnish was applied once or twice a week for 6 months in patients affected by nystatin distasteful denture stomat itis. Results showed significant decrease in candidal count and improvement in symptoms of denture stomatitis.In a study photodynamic therapy was found to be an legal regularity for resolving candida spp. on dentures96In a study by Webb et al97 nursing home patients with denture stomatitis were randomized to maintain their usual hygiene procedures or had their dentures cleaned daily with overnight soaking in atomic number 11 hypochlorite and littlewaving. congenator to control group both killing techniques showed 100% reduction in candida colonization and clinical improvement in denture stomatitis.In some other study 10% vinegar dissolvent was used for the immersion of dentures and was found to be effective in decreasing the quantity of candida spp in saliva and the presence of denture stomatitis 98 .Cryosurgery is the treatment of choice in patients with eccentric person III denture stomatitis along with prosthesis substitution34.POST INSERTION instruction manual REGARDIN G MAINTENANCE OF THE PROSTHESISTo decrease the levels of biofilm and harmful little organisms , patients who wear dentures mustiness do the followingDentures must be immersed and brushed with an effective and non abrasive denture cleanser everyday18.Denture cleanser must only be used to clean dentures outside the mouth62.Dentures must be rinsed thoroughly later(prenominal) immersion and brushing with denture cleansing solution before reinsertion in the oral cavity16.Dentures should be cleaned annually by a dentist using ultrasonic cleanser to minimize biofilm coverage overtime27.Dentures must never be placed in boiling water77.Dentures must never be moneyed in sodium hypochlorite bleaching agent for periods greater than 10 minutes because it whitethorn damage the dentures28.Dentures should be immersed in water after change, when not inserted in oral cavity to avoid warping16.MECHANICAL METHODS OF DENTURE CLEANING clash with tooth brush, denture brush and pastesScanning elect ron microscopic images and microbiologic essays have demonstrated that alter the dentures with water and tooth brushes is ineffective at removing microorganisms62.While in a study by Nishi Y and colleagues 25 it was found that the quantity of micro organisms was significantly reduced in the outpatients who used a denture brush for cleaning the prosthesis.Salles AES and Macedo LD99 found in a study that brushing with a denture paste(Corega Brite) was the most effective order of disinfecting dentures followed by brushing with neutral soap and brushing with water only was the least effective method.It was found by Lira AF et al100 that tooth brushing promoted higher levels of surface crudeness when compared to chemical disinfection while boiled resins were found to be more given over to surface primitiveness and biofilm accumulation than microwaved resins.Pisani MX and Bruhn JP et al101 analyzed surface indent and weight loss in acrylic caused by dentrifices. They found that the received dentrifice containing sodium bicarbonate produced greatest weight loss and surface roughness while dentrifices containing chloramine-T T and fluorosurfactant produced less weight loss and surface roughness.While in another study it was found that dentrifices containing 1% chloramine T and 0.01% fluorosurfactant decreased biofilm coverage but were ineffective against candida102.Ultrasonic cleaningUltrasonic devices are helpful in removing the plaque adhering to dentures by producing microscopic cavities that grow and burst creating voids that way out in localized areas of suction 16.Gwinnet et al103 showed in different ways effective disinfection of inoculated dentures using ultrasonic treatment in a water bath as well as in various baths of antiseptic and detergent agents.In another study it was found that ultrasonic cleaning when combined with immersion in a hydrogen peroxide based cleanser solution effectively reduces the quantity of micro organisms go on dentures25. Hence may be a suitable method for elderly who find brushing their dentures difficult.Studies have found that ultrasonic cleaning is not completely bactericidal but improves the killing of bacteria16.Chemical Methods alky in household solutionSodium hypochlorite diluted 110 in tap water is adequate for killing adherent micro organisms but is ineffective against calculus buildup and stains. Metallic elements in the denture subscribe a black stain after soaking in bleach for greater than 10 minutes daily62In a study through with(p) by Dr. Roshan Khan 5.25% sodium hypochlorite was more effective in disinfecting dentures as compared to 0.2% chlorhexidine at a 5 minute immersion period28.Surface roughness was evaluated by Paranhos HDO et al64 and they found that immersing the acrylic resin denture in 0.5% sodium hypochlorite solution every night for more than a class and a half resulted in increased surface roughness while no effect was noted regarding the flexural strength of the acr ylic.A major issue in immuno compromised and hospitalized patients is the emergence of methicillin resistant staphylococcus aureus(MRSA) which increases mortality rates significantly 16. downwind and colleagues104 showed that MRSA can be killed effectively with sodium hypochlorite.The use of vinegar (acetic acid) was evaluated by Basson et al105 and they found it effective at killing adherent micro organisms albeit less effective than sodium hypochlorite. Vinegar has an advantage over bleach and it is that inadequate rinsing after soaking in vinegar does not result in mucosal damage.In another study vinegar unsocial is found to be least effective at removing denture plaque but when used in combination with brushing its results were comparable with those of denture cleansers24Soaking in a commercial solutionImmersing the dentures in denture cleansers reduces the micro organisms and plaque and is found to be a suitable method for denture cleansing specially for geriatric patients106. It was found that soaking in alkalic peroxide every night for more than a year resulted in color alteration of the resin64.In a study it was found that the combination of brushing and peroxide cleansers was the most efficacious method to eliminate denture plaque24.It was found in a study by de Andrade IM and colleagues107 that the aglitter(p) tablets are effective in reducing streptococci mutans and total aerobes from denture biofilm. However, they were not as effective against C. albicansMc Cabe and colleagues108 reported that effects of alkaline peroxide solution were enhanced using water at a temperature of 50 centigrade.In a study done to investigate the relationship between the frequency of use of denture cleanser and the quantity of micro organisms adhering to dentures it was found that patients who used denture cleansers daily or 3-4 times a week had significantly lower amount of micro organisms than the patients who used the denture cleanser once or less per month25.While in a study by Jose A and colleagues23 it was conclude that denture cleansers were effective against Candida albicans activity both in terms of removal and disinfection but residual biofilm memory board that could lead to re growth and denture colonization was seen. Hence jump mechanical cleaning methods are required to enhance biofilm removal..New materials for denture immersion contain silicon polymer that provides a protective coating on denture as a final step in cleaning process. Coating helps to minimize adhesion of debris throughout the day until the adjacent cleaning27.MICROWAVE RADIATIONEffectiveness of microwaving depends on solution in which the dentures are immersed, the time of exposure, the level of power of microwave oven and the eccentric persons of micro organisms adhering the denture109.Senno P and colleagues110 found that putting the dentures in denture cleanser and then microwaving was efficient in disinfecting dentures with lower irradiation time and temper ature than the use of microwave irradiation alone therefore avoiding denture distortion. While in another study it was concluded that immersing the denture in a cup of water to transfer heating uniformly during microwave sterilization was more effective111.While Kaskin et al112 showed that independent of solution used irradiation for 15 minutes at 500 west achieved complete sterilization of acrylic resin base materials contaminated by Staphylococcus aureus, Escherichia coli, candida albicans and streptococcus mutans.It was concluded by Brondani MA et al109 that irradiation time above 15minutes and voltage greater than 850 wests may cause distortion and surface roughness of the denture while not affecting the hardness of the material.While in another study 50 seconds of exposure at 850 watt seemed to be sufficient to disinfect the acrylic denture without any obstinate effect on the material113.ALTERNATE DENTURE CLEANSING METHODSChlorhexidine destroys bacteria by breaking their memb ranes and inducing cytoplasmic precipitation114.In a study by de Andrade IM and colleagues 107 60 CD wearers participated in a trial for 21 days after getting brushing instructions. They found that the biofilm coverage area after treatment with immersion in 2% chlorhexidine for 5 minutes was the last-place when compared to immersion in water and in 0.12% chlorhexdine for 20 minutes.While in a study by Uludamar A and colleagues26 it was found that patients whose upper dentures were sprayed with mouthwashes on palatal surface showed decreased candida count when compared to patients who used effervescent type denture cleansers for soaking and cleaning. It can be concluded that mouthwashes can be used as effective denture disinfectants.Tissue cleansing and rub off is often neglected part of complete denture care. Brushing the natural language and residual ridges will improve the circulation and remove plaque and debris that may cause irritation of soft tissue and offensive odors 115. In a study by Marchini L116 it was found that 68% of the complete denture wearers didn&apost clean their tongue.PERIODIC RECALL FOR ORAL EXAMINATIONPatient bow out must be a tool to help prevention, allow early intervention and ensure long term dental health117. In a study by Peracini A 51% of the patients interviewed were not informed round their recall visits.118 An evidence based, patient centered approach taking into account multiple risk categories must be implemented in pattern recall visits.119The American College of Prosthodontists recommends that patients wearing complete dentures must be go over every year for assessment of oral health status, denture fit and function and for evaluation of bone loss as well as oral lesions such as denture stomatitis 16. This recommendation is based on the evidence regarding the relationship between proper complete denture oral hygiene and overall systemic health particularly in subordinate elderly45.