- Email: [email protected]
Denture adhesive and oral flora
Methods.—The 983 adults ranged in age from 18 to 80 years and were at high risk for developing caries, having 20 or more intact teeth and two or more lesions at initial screening. Four hundred ninety were randomized to receive 10% CHX coating of all teeth applied weekly for 4 weeks, then a coating applied 6 months later. The placebo group of 493 individuals received coatings of Sumatra benzoin 20% and alcohol at the same times. Methacrylate coatings were applied to protect the initial coating. The primary outcome was the change in tooth surface status between randomization and follow-up at 13 months. Secondary outcomes were the cumulative net change, the total crude change minus reversals in status, and the cumulative crude change minus reversals.
latter among the placebo group. Overall, no treatment effect was found. Discussion.—The trial of 10% CHX dental coating was unable to produce an anticaries effect in these adults. CHX was not effective in preventing coronal caries. Its role in the prevention of root caries requires further study in very high-risk patients.
Clinical Significance.—It is disappointing that CHX coating could not lower the incidence of coronal caries in adults. However, it may be that the 10% CHX coating is not efficacious in this setting. Also, this study focused on transitions to and from uncavitated lesions, which are harder to detect than cavitated lesions, especially when they occur interproximally just under the contact. Follow-up was also limited, so any anticaries effect may not have been given sufficient time to develop. The lack of radiographic evidence may also have reduced the accuracy of the findings. Further research is needed to clarify these issues.
Results.—Attendance at follow-up evaluations and treatment adherence were both excellent. The mean dose of CHX given over all applications in the ITT sample was 41 mg, with a total cumulative dose of 198.4 mg. Ninety-four percent of the teeth demonstrated no change between baseline and the final assessment. Mean number of cavitated, filled, or crowned tooth surfaces increased from 31.8 to 34.1 per patient, and mean number of surfaces with uncavitated lesions fell from 7.1 to 4.2 per patient. These were primarily coronal data, since 93% of the root surfaces were not exposed. In the ITT sample, no significant difference was noted in tooth surface status.
Papas AS, Vollmer WM, Gullion CM, et al: Efficacy of chlorhexidine varnish for the prevention of adult caries: a randomized trial. J Dent Res 9:150-155, 2012
Adverse events included pharmaceutical product complaints (such as unpleasant taste) and dyspepsia. The former was more common among the CHX group and the
Reprints available from WM Vollmer, Kaiser Permanente Ctr. for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA; e-mail: [email protected]
Removable Prosthodontics Denture adhesive and oral flora Background.—Reliable denture retention and stability depend on taking appropriate impressions, extending denture margins, and considering anatomic structures, but remain a problem for some patient groups. This includes patients with Sj€ ogren’s syndrome and those with xerostomia or bone resorption caused by medication or radiotherapy. These patients can have nonoptimal denture retention and stability or require frequent adjustments. Denture adhesives are also used to increase retention and stability for complete dentures, improve chewing and mastication ability, and support the patient’s psychologic health relative to denture use. However, dentists may hesitate to prescribe denture adhesives because such a measure reflects poorly on their ability to provide an adequate denture or for fear it will cause increased alveolar ridge resorption and soft
48
Dental Abstracts
tissue hyperplasia. Patients may also misuse denture adhesives by continuing to wear ill-fitting dentures with a liberal dose of adhesive when they should seek better-fitting dentures. Many denture adhesives include antimicrobial agents; the fear has also arisen that the long-term use of such adhesives will alter the oral microflora by selectively supporting the growth of some microorganisms and inhibiting the growth of others. The current data do not indicate whether this last fear is justified, so an investigation was undertaken to determine the effect of denture adhesive on the oral flora over various time intervals. Methods.—Half of the 30 participants were given a denture adhesive to use with their dentures and the other half were not. Smear samples were obtained from saliva, palate,
and dentures at baseline and after 1 and 2 months of use to determine what microorganisms were present and if the denture adhesive altered the oral flora. Results.—Most of the microorganisms the smear samples were tested for were not found and could not be analyzed statistically. A-hemolytic streptococci were present in 97.8% of the 45 salivary samples taken from the control group and Candida albicans was present in 6.6% of the samples. Salivary samples from the denture adhesive group showed a-hemolytic streptococci in 100% and C. albicans in 11.1%. The differences between groups were not statistically significant. Similar findings were noted for samples from the palate and from the dentures. Patients using denture adhesive had slight increases in the presence of a-hemolytic streptococci and C. albicans compared to control patients, but there was no significant difference found at any of the time periods. Discussion.—Most of the organisms that were sought did not occur in the samples obtained. Only a-hemolytic streptococci and C. albicans occurred in amounts sufficient
for analysis. These organisms did not occur significantly more often in patients who used denture adhesives than in patients in the control group.
Clinical Significance.—Using denture adhesive for up to 2 months did not significantly increase the numbers or types of microorganisms found in oral flora. It appears that denture adhesives can be safely used for patients who require it to achieve better denture retention and stability.
€ Ozkan YK, Uc¸ankale M, Ozcan M, et al: Effect of denture adhesive on the micro-organisms in vivo. Gerodontology 29:9-16, 2012 Reprints available from YK Ozkan, Dept. of Prosthodontics, Faculty of Dentistry, Univ. of Marmara, G€ uzelbahc¸e B€ uy€ ukc¸ftlik sok, No: 6 80200 Nis¸antas¸ı, Istanbul, Turkey; fax: þ90 212 2465247; e-mail: [email protected]
Radio frequency identification of dentures Background.—Since World War II, radio frequency identification (RFID) has been used as a method of identification. The RFID system consists of a data carrier, a tag or transponder, and a reader. The tag is a microchip with a coiled antenna that stores identifying information. This technology may offer a simple, reliable, and affordable way to identify dentures for patients in long-term care facilities (LTCFs). The reliability of RFID for identifying dentures of LTCF residents was tested. Methods.—Thirty-five residents (mean age 88.7 years) of two LTCFs received tags that had been programed to contain the resident’s family name and first name. The tags were inserted into the residents’ dentures, and the information was read to ensure they worked. The function of the tags was rechecked after 3 and 6 months. Results.—A total of 65 tags were placed and determined to be functioning correctly. Most of the residents had complete dentures and had worn dentures for more than 5 years. After 3 months, one resident had died, one tag was unreadable, and 62 tags (98.2%) were operational. After 6 months, three residents had died, two refused to participate, and two had left their dentures at home. Of the remaining 50 tags, all were functional.
Discussion.—Over the 6-month period, RFID provided a reliable method of tracking and identifying dentures. Only one device failed at 3 months; the others were all operational after 6 months.
Clinical Significance.—RFID tags can be placed inside dentures and are not altered by various denture disinfection methods. The tags can be placed where they will not be seen during function. They have the capacity to store much more information than was tested in this investigation and could carry the history of maintenance of the dentures, the patient’s medical history, or other useful facts. However, RFID is more expensive than the methods now used for identification. Current estimates are about $17 for each tag, about $1075 for a reader and its software, and a minor cost for placement of the tag. The reader can serve the entire facility, and the tags should be readable indefinitely. A close proximity between the reader and the tag is needed to permit reading. However, the reader allows any person in close contact with the patient to read the information stored on the tag, which raises issues of patient confidentiality. This can be managed by
Volume 58
Issue 1
2013
49
latter among the placebo group. Overall, no treatment effect was found. Discussion.—The trial of 10% CHX dental coating was unable to produce an anticaries effect in these adults. CHX was not effective in preventing coronal caries. Its role in the prevention of root caries requires further study in very high-risk patients.
Clinical Significance.—It is disappointing that CHX coating could not lower the incidence of coronal caries in adults. However, it may be that the 10% CHX coating is not efficacious in this setting. Also, this study focused on transitions to and from uncavitated lesions, which are harder to detect than cavitated lesions, especially when they occur interproximally just under the contact. Follow-up was also limited, so any anticaries effect may not have been given sufficient time to develop. The lack of radiographic evidence may also have reduced the accuracy of the findings. Further research is needed to clarify these issues.
Results.—Attendance at follow-up evaluations and treatment adherence were both excellent. The mean dose of CHX given over all applications in the ITT sample was 41 mg, with a total cumulative dose of 198.4 mg. Ninety-four percent of the teeth demonstrated no change between baseline and the final assessment. Mean number of cavitated, filled, or crowned tooth surfaces increased from 31.8 to 34.1 per patient, and mean number of surfaces with uncavitated lesions fell from 7.1 to 4.2 per patient. These were primarily coronal data, since 93% of the root surfaces were not exposed. In the ITT sample, no significant difference was noted in tooth surface status.
Papas AS, Vollmer WM, Gullion CM, et al: Efficacy of chlorhexidine varnish for the prevention of adult caries: a randomized trial. J Dent Res 9:150-155, 2012
Adverse events included pharmaceutical product complaints (such as unpleasant taste) and dyspepsia. The former was more common among the CHX group and the
Reprints available from WM Vollmer, Kaiser Permanente Ctr. for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA; e-mail: [email protected]
Removable Prosthodontics Denture adhesive and oral flora Background.—Reliable denture retention and stability depend on taking appropriate impressions, extending denture margins, and considering anatomic structures, but remain a problem for some patient groups. This includes patients with Sj€ ogren’s syndrome and those with xerostomia or bone resorption caused by medication or radiotherapy. These patients can have nonoptimal denture retention and stability or require frequent adjustments. Denture adhesives are also used to increase retention and stability for complete dentures, improve chewing and mastication ability, and support the patient’s psychologic health relative to denture use. However, dentists may hesitate to prescribe denture adhesives because such a measure reflects poorly on their ability to provide an adequate denture or for fear it will cause increased alveolar ridge resorption and soft
48
Dental Abstracts
tissue hyperplasia. Patients may also misuse denture adhesives by continuing to wear ill-fitting dentures with a liberal dose of adhesive when they should seek better-fitting dentures. Many denture adhesives include antimicrobial agents; the fear has also arisen that the long-term use of such adhesives will alter the oral microflora by selectively supporting the growth of some microorganisms and inhibiting the growth of others. The current data do not indicate whether this last fear is justified, so an investigation was undertaken to determine the effect of denture adhesive on the oral flora over various time intervals. Methods.—Half of the 30 participants were given a denture adhesive to use with their dentures and the other half were not. Smear samples were obtained from saliva, palate,
and dentures at baseline and after 1 and 2 months of use to determine what microorganisms were present and if the denture adhesive altered the oral flora. Results.—Most of the microorganisms the smear samples were tested for were not found and could not be analyzed statistically. A-hemolytic streptococci were present in 97.8% of the 45 salivary samples taken from the control group and Candida albicans was present in 6.6% of the samples. Salivary samples from the denture adhesive group showed a-hemolytic streptococci in 100% and C. albicans in 11.1%. The differences between groups were not statistically significant. Similar findings were noted for samples from the palate and from the dentures. Patients using denture adhesive had slight increases in the presence of a-hemolytic streptococci and C. albicans compared to control patients, but there was no significant difference found at any of the time periods. Discussion.—Most of the organisms that were sought did not occur in the samples obtained. Only a-hemolytic streptococci and C. albicans occurred in amounts sufficient
for analysis. These organisms did not occur significantly more often in patients who used denture adhesives than in patients in the control group.
Clinical Significance.—Using denture adhesive for up to 2 months did not significantly increase the numbers or types of microorganisms found in oral flora. It appears that denture adhesives can be safely used for patients who require it to achieve better denture retention and stability.
€ Ozkan YK, Uc¸ankale M, Ozcan M, et al: Effect of denture adhesive on the micro-organisms in vivo. Gerodontology 29:9-16, 2012 Reprints available from YK Ozkan, Dept. of Prosthodontics, Faculty of Dentistry, Univ. of Marmara, G€ uzelbahc¸e B€ uy€ ukc¸ftlik sok, No: 6 80200 Nis¸antas¸ı, Istanbul, Turkey; fax: þ90 212 2465247; e-mail: [email protected]
Radio frequency identification of dentures Background.—Since World War II, radio frequency identification (RFID) has been used as a method of identification. The RFID system consists of a data carrier, a tag or transponder, and a reader. The tag is a microchip with a coiled antenna that stores identifying information. This technology may offer a simple, reliable, and affordable way to identify dentures for patients in long-term care facilities (LTCFs). The reliability of RFID for identifying dentures of LTCF residents was tested. Methods.—Thirty-five residents (mean age 88.7 years) of two LTCFs received tags that had been programed to contain the resident’s family name and first name. The tags were inserted into the residents’ dentures, and the information was read to ensure they worked. The function of the tags was rechecked after 3 and 6 months. Results.—A total of 65 tags were placed and determined to be functioning correctly. Most of the residents had complete dentures and had worn dentures for more than 5 years. After 3 months, one resident had died, one tag was unreadable, and 62 tags (98.2%) were operational. After 6 months, three residents had died, two refused to participate, and two had left their dentures at home. Of the remaining 50 tags, all were functional.
Discussion.—Over the 6-month period, RFID provided a reliable method of tracking and identifying dentures. Only one device failed at 3 months; the others were all operational after 6 months.
Clinical Significance.—RFID tags can be placed inside dentures and are not altered by various denture disinfection methods. The tags can be placed where they will not be seen during function. They have the capacity to store much more information than was tested in this investigation and could carry the history of maintenance of the dentures, the patient’s medical history, or other useful facts. However, RFID is more expensive than the methods now used for identification. Current estimates are about $17 for each tag, about $1075 for a reader and its software, and a minor cost for placement of the tag. The reader can serve the entire facility, and the tags should be readable indefinitely. A close proximity between the reader and the tag is needed to permit reading. However, the reader allows any person in close contact with the patient to read the information stored on the tag, which raises issues of patient confidentiality. This can be managed by
Volume 58
Issue 1
2013
49