- Email: [email protected]
Preventing candidiasis
chewing capacity, the patient’s degree of satisfaction is an essential component for a successful outcome. Poor correlation has been noted between objective and subjective measures in this area, however. General dentists, who supply the majority of complete dentures to patients, are taught many techniques for fabricating complete dentures while in dental school, but most resort to simpler techniques once they begin practice. Whether each step they have been taught is essential has been questioned previously, with no clear answers. A clinical trial was designed to compare patient satisfaction, functional usefulness, and quality of complete dentures made with four different techniques.
secondary outcome measures, with the control group having the lowest mean VAS score. Measures of chewing ability in general as well as specific food items showed no significant differences among the groups. In addition, the prosthodontists found no significant differences among the groups for the four domains of denture quality. The largest between-group difference was between Group 2, which had the highest score on denture extension, and the control group. A non-significant correlation was found between general patient satisfaction level and objectively assessed denture quality score after 12 weeks.
Methods.—The study began with 40 edentulous patients, but with further randomized recruitment, the final sample was 43 patients ranging in age from 35 to 78 years (mean age 58.1 years). For many patients, this was their first sets of complete dentures or they had been edentulous for more than 5 years. Subjects were randomly assigned to four different groups and received treatment with variations in laboratory steps. Their dentures would be provided free of charge, and, if they were unhappy with the dentures after treatment was complete and the dentures had been made according to one of the modified techniques under investigation, the dentures would be remade using the standard technique at no cost to them. The four techniques were as follows: Group 1, secondary casts obtained from impressions in border molded custom trays were eliminated; Group 2, secondary casts and face-bow articulator mounting were eliminated; Group 3, face-bow mounting was eliminated; and Group 4, no steps were omitted (control group). The clinical procedures were the same for each group and were done by senior dental students supervised by prosthodontists blinded to the patient’s treatment group. Patients rated overall satisfaction and functional factors using a visual analog scale (VAS) after 1, 4, and 12 weeks. Independent blinded prosthodontists rated four domains of denture quality 1 week after the patient received dentures. Results were compared among the groups.
Discussion.—Patient satisfaction and objective assessments of denture quality showed no significant differences among the four groups of patients. With no evidence supporting the superiority of using the traditional technique, the use of less complicated and shorter procedures may be an appropriate choice.
Results.—No statistically significant differences were noted among the groups with respect to patient satisfaction with the dentures. However, consistently large betweengroup differences were noted between the patients in Group 2 and those in the control group. These amounted to 15.4 mm at 1 week, 18.0 mm at 4 weeks, and 18.5 mm at 12 weeks. The same differences persisted for all
Omar R, Al-Tarakemah Y, Akbar J, et al: Influence of procedural variations during the laboratory phase of complete denture fabrication on patient satisfaction and denture quality. J Dent 41:852860, 2013
Clinical Significance.—Dental students should be taught how to do not only the complete traditional techniques but also abbreviated versions, since it is likely that they will discover them as they begin practicing after graduation. With instruction from qualified professionals, dentists will then achieve more proficiency and perhaps more predictability with these abbreviated techniques. Because the need for complete dentures is increasing and changing, dental professionals will need to be prepared to be flexible and yet clinically defensible in their delivery of care. The laboratory fabrication process for complete dentures may also need to be reconsidered.
Reprints available from R Omar, Faculty of Dentistry, Kuwait Univ, PO Box 24923, Safat 13110, Kuwait; fax: þ965 25326049; e-mail: [email protected]
Preventing candidiasis Background.—The adherence of microorganisms to the surface of denture materials is a necessary first step in initiating oral candidiasis in denture-related stomatitis.
Multiple factors influence the adhesion process. Among these factors is the soft liner, which deteriorates as it loses plasticizers, along with inefficient mechanical cleansing to
Volume 59
Issue 3
2014
163
avoid brushing damaging the surface. From 15% to over 70% of denture wearers have reportedly been affected by denture stomatitis. Preventing the onset of the disease has been difficult. The literature was reviewed to determine (1) if there is a strong evidence-based protocol to prevent the colonization of denture liners with Candida organisms and (2) whether there is an ideal protocol to treat patients who develop Candida colonies. Methods.—The literature review included all Englishlanguage articles published from 1950 to April 2012. Because the data regarding methodologies used to measure antimicrobial effect and the results varied widely, only a qualitative investigation was possible, along with comparisons between studies. The 38 articles chosen were divided into (1) those in which an antifungal agent was incorporated into denture liners and conditioners and (2) those in which tissue conditioners were used without incorporating antifungal agents. Results.—Forty percent of the 20 articles in the first category used nystatin as the antimicrobial agent incorporated into denture liners and conditioners. Twenty percent used silver-based antimicrobial agents, 15% used fluconazole, and 10% each used chlorhexidine, amphotericin B, and miconazole. One study explored the use of zinc peroxide, clotrimazole, itraconazole, ketonazole, Melaleuca alternifolia, human lactoferrin, magnesium oxide, and triazine. Nystatin was effective in inhibiting Candida growth when added to both liners and tissue conditioners. The higher the concentration of nystatin that was used, the greater was the effect achieved, but the optimal concentration was not identified. Generally, a 500,000-unit amount was used. The effect diminished or disappeared after 1 week, 15 days, or 1 month, depending on the concentration. Positive results were also obtained with silver-based antimicrobial agents, miconazole, ketonazole, fluconazole, M alternifolia, and magnesium oxide. Amphotericin B, zinc, peroxide, triazine, and triclosan increased the susceptibility to fungal growth. The different brands of denture liners differed in their effectiveness in various studies. The second category included 18 articles that evaluated protocols for cleaning, treating, preventing infection, or disinfecting denture liners without using an antifungal or antibacterial agent. Immersion of the liner into a sodium hypochlorite solution of varying concentrations was studied in 44.4% of the articles, microwave irradiation was evaluated in 27.8%, and the use of effervescent cleansing tablets for dentures was assessed in 33.3%. Sodium hypochlorite methods were more effective than microwave irradiation
164
Dental Abstracts
and cleansing tablet use, but the results of effervescent cleansing tablet studies were contradictory. Microwave irradiation results were more reliable, especially when dentures were immersed in water and irradiated at 650 W for 5 minutes. All concentrations of sodium hypochlorite achieved disinfection, but the lowest concentration (0.5%) was preferred because it is less destructive of the denture surface. Mechanical cleaning and varnish have also been used, but the varnish increases biofilm formation. When plasma bombardment was followed by silane treatment on a silicone surface in vivo, Candida adherence was significantly reduced. Chlorine dioxide may be used in an immersion or spraying technique, but it was ineffective for use as a denture liner disinfectant. As a mouth rinse, it was able to improve palatal inflammation. Chlorhexidine has also been used as an antifungal agent. Discussion.—Adding antifungal agents to denture liners and tissue conditioners may prevent Candida colonization for denture wearers. However, it remains unclear which concentration and which agents are the most effective and reliable without causing deleterious effects on the denture material. Further studies are needed to clarify which is the ideal cleaning method or which antifungal agent produces the best results.
Clinical Significance.—Both nystatin and 0.5% sodium hypochlorite appear to be useful in treating or preventing oral candidiasis. With many of the studies evaluated, results were obtained through in vitro methods, which may not be applicable in vivo. As a result, the current evidence is insufficient to recommend any agent or technique as the most reliable and effective candidiasis preventative. Randomized controlled trials that have been well-designed and conducted under in vivo conditions are needed to determine how to prevent and treat Candida colonization without harming dentures or oral structures.
Skupien JA, Valentini F, Boscato N, et al: Prevention and treatment of Candida colonization on denture liners: A systematic review. J Prosthet Dent 110:356-362, 2013 Reprints available from T Pereira-Cenci, Rua Gonc¸alves Chaves, 457, Pelotas, RS 96015-560, Brazil; fax: 55-53-3222-6690; e-mail: [email protected]
secondary outcome measures, with the control group having the lowest mean VAS score. Measures of chewing ability in general as well as specific food items showed no significant differences among the groups. In addition, the prosthodontists found no significant differences among the groups for the four domains of denture quality. The largest between-group difference was between Group 2, which had the highest score on denture extension, and the control group. A non-significant correlation was found between general patient satisfaction level and objectively assessed denture quality score after 12 weeks.
Methods.—The study began with 40 edentulous patients, but with further randomized recruitment, the final sample was 43 patients ranging in age from 35 to 78 years (mean age 58.1 years). For many patients, this was their first sets of complete dentures or they had been edentulous for more than 5 years. Subjects were randomly assigned to four different groups and received treatment with variations in laboratory steps. Their dentures would be provided free of charge, and, if they were unhappy with the dentures after treatment was complete and the dentures had been made according to one of the modified techniques under investigation, the dentures would be remade using the standard technique at no cost to them. The four techniques were as follows: Group 1, secondary casts obtained from impressions in border molded custom trays were eliminated; Group 2, secondary casts and face-bow articulator mounting were eliminated; Group 3, face-bow mounting was eliminated; and Group 4, no steps were omitted (control group). The clinical procedures were the same for each group and were done by senior dental students supervised by prosthodontists blinded to the patient’s treatment group. Patients rated overall satisfaction and functional factors using a visual analog scale (VAS) after 1, 4, and 12 weeks. Independent blinded prosthodontists rated four domains of denture quality 1 week after the patient received dentures. Results were compared among the groups.
Discussion.—Patient satisfaction and objective assessments of denture quality showed no significant differences among the four groups of patients. With no evidence supporting the superiority of using the traditional technique, the use of less complicated and shorter procedures may be an appropriate choice.
Results.—No statistically significant differences were noted among the groups with respect to patient satisfaction with the dentures. However, consistently large betweengroup differences were noted between the patients in Group 2 and those in the control group. These amounted to 15.4 mm at 1 week, 18.0 mm at 4 weeks, and 18.5 mm at 12 weeks. The same differences persisted for all
Omar R, Al-Tarakemah Y, Akbar J, et al: Influence of procedural variations during the laboratory phase of complete denture fabrication on patient satisfaction and denture quality. J Dent 41:852860, 2013
Clinical Significance.—Dental students should be taught how to do not only the complete traditional techniques but also abbreviated versions, since it is likely that they will discover them as they begin practicing after graduation. With instruction from qualified professionals, dentists will then achieve more proficiency and perhaps more predictability with these abbreviated techniques. Because the need for complete dentures is increasing and changing, dental professionals will need to be prepared to be flexible and yet clinically defensible in their delivery of care. The laboratory fabrication process for complete dentures may also need to be reconsidered.
Reprints available from R Omar, Faculty of Dentistry, Kuwait Univ, PO Box 24923, Safat 13110, Kuwait; fax: þ965 25326049; e-mail: [email protected]
Preventing candidiasis Background.—The adherence of microorganisms to the surface of denture materials is a necessary first step in initiating oral candidiasis in denture-related stomatitis.
Multiple factors influence the adhesion process. Among these factors is the soft liner, which deteriorates as it loses plasticizers, along with inefficient mechanical cleansing to
Volume 59
Issue 3
2014
163
avoid brushing damaging the surface. From 15% to over 70% of denture wearers have reportedly been affected by denture stomatitis. Preventing the onset of the disease has been difficult. The literature was reviewed to determine (1) if there is a strong evidence-based protocol to prevent the colonization of denture liners with Candida organisms and (2) whether there is an ideal protocol to treat patients who develop Candida colonies. Methods.—The literature review included all Englishlanguage articles published from 1950 to April 2012. Because the data regarding methodologies used to measure antimicrobial effect and the results varied widely, only a qualitative investigation was possible, along with comparisons between studies. The 38 articles chosen were divided into (1) those in which an antifungal agent was incorporated into denture liners and conditioners and (2) those in which tissue conditioners were used without incorporating antifungal agents. Results.—Forty percent of the 20 articles in the first category used nystatin as the antimicrobial agent incorporated into denture liners and conditioners. Twenty percent used silver-based antimicrobial agents, 15% used fluconazole, and 10% each used chlorhexidine, amphotericin B, and miconazole. One study explored the use of zinc peroxide, clotrimazole, itraconazole, ketonazole, Melaleuca alternifolia, human lactoferrin, magnesium oxide, and triazine. Nystatin was effective in inhibiting Candida growth when added to both liners and tissue conditioners. The higher the concentration of nystatin that was used, the greater was the effect achieved, but the optimal concentration was not identified. Generally, a 500,000-unit amount was used. The effect diminished or disappeared after 1 week, 15 days, or 1 month, depending on the concentration. Positive results were also obtained with silver-based antimicrobial agents, miconazole, ketonazole, fluconazole, M alternifolia, and magnesium oxide. Amphotericin B, zinc, peroxide, triazine, and triclosan increased the susceptibility to fungal growth. The different brands of denture liners differed in their effectiveness in various studies. The second category included 18 articles that evaluated protocols for cleaning, treating, preventing infection, or disinfecting denture liners without using an antifungal or antibacterial agent. Immersion of the liner into a sodium hypochlorite solution of varying concentrations was studied in 44.4% of the articles, microwave irradiation was evaluated in 27.8%, and the use of effervescent cleansing tablets for dentures was assessed in 33.3%. Sodium hypochlorite methods were more effective than microwave irradiation
164
Dental Abstracts
and cleansing tablet use, but the results of effervescent cleansing tablet studies were contradictory. Microwave irradiation results were more reliable, especially when dentures were immersed in water and irradiated at 650 W for 5 minutes. All concentrations of sodium hypochlorite achieved disinfection, but the lowest concentration (0.5%) was preferred because it is less destructive of the denture surface. Mechanical cleaning and varnish have also been used, but the varnish increases biofilm formation. When plasma bombardment was followed by silane treatment on a silicone surface in vivo, Candida adherence was significantly reduced. Chlorine dioxide may be used in an immersion or spraying technique, but it was ineffective for use as a denture liner disinfectant. As a mouth rinse, it was able to improve palatal inflammation. Chlorhexidine has also been used as an antifungal agent. Discussion.—Adding antifungal agents to denture liners and tissue conditioners may prevent Candida colonization for denture wearers. However, it remains unclear which concentration and which agents are the most effective and reliable without causing deleterious effects on the denture material. Further studies are needed to clarify which is the ideal cleaning method or which antifungal agent produces the best results.
Clinical Significance.—Both nystatin and 0.5% sodium hypochlorite appear to be useful in treating or preventing oral candidiasis. With many of the studies evaluated, results were obtained through in vitro methods, which may not be applicable in vivo. As a result, the current evidence is insufficient to recommend any agent or technique as the most reliable and effective candidiasis preventative. Randomized controlled trials that have been well-designed and conducted under in vivo conditions are needed to determine how to prevent and treat Candida colonization without harming dentures or oral structures.
Skupien JA, Valentini F, Boscato N, et al: Prevention and treatment of Candida colonization on denture liners: A systematic review. J Prosthet Dent 110:356-362, 2013 Reprints available from T Pereira-Cenci, Rua Gonc¸alves Chaves, 457, Pelotas, RS 96015-560, Brazil; fax: 55-53-3222-6690; e-mail: [email protected]