A recent study found that the vast majority of patients assessed (84%) had very poor levels of denture hygiene[ii]. This was attributed to the lack of hygiene instructions given by dental professionals, as after clinician led patient education, denture cleanliness index (DCI) scores increased significantly2.
Currently there is no clearly defined or regularly used standard or scoring system for determining denture hygiene in the UK. Therefore, the researchers devised the DCI scoring system prior to the audit, which ranges from 0-4. Additional studies are required to refine, test and evaluate the classification, however it could help dental professionals in the future to determine denture hygiene status of patients and highlight any areas of concern2.
Compared to dental care, denture hygiene has received little attention, yet neglecting to look after prostheses can significantly increase an individual’s risk of developing oral infections and systemic diseases[iii],[iv].
Dentures offer a reservoir for microorganisms to thrive and it is well documented that patients wearing partial sets are at a higher risk of developing periodontal disease and dental decay of the teeth directly adjacent to the dentures[v].
Several studies have shown that plaque biofilm accumulates on the internal surface of dentures and certain pathogens may even preferentially colonise on prostheses over oral soft tissues3,[vi]. Acting as a reservoir for bacteria and fungal microorganisms, these pathogens are involved not only in the appearance of local infections like denture stomatitis, but also systemic diseases such as endocarditis, pneumonia and respiratory track infections3.
Problems can also arise if there are any surface defects or other flaws in the denture which are either inherent and due to the fabrication process or acquired due to general use. These can cause imperfections and roughness, which increases the surface area on which bacteria can adhere and potentially colonise[vii].
Furthermore, if the finish is rough it can make cleaning the prosthesis and mechanical removal of the microorganisms difficult, as well as causing discoloration of the denture base materials. The irregularities on the surface can provide niches in which microorganisms are protected from oral hygiene measures, thus allowing the entrapped microbial cells to attach irreversibly to the prosthesis7.
Working with a laboratory, such as Sparkle Dental Labs, that complies with all of the current standards and regulations, uses the very best materials and creates dentures that fit perfectly is essential. The renowned company are able to offer complete traceability on every item and all dentures are fitted to duplicate models to ensure ultimate precision and patient comfort.
In the future the DCI scoring system could be used to help practitioners to identify patients suffering from poor denture hygiene. However, in the mean time dental professionals are encouraged to continue to fit quality dentures and offer patients oral healthcare advice.
[i] Health & Social Care Information Centre. Adult Dental Health Survey. Published 24th March 2011. Available online: http://www.hscic.gov.uk/article/3894/Adult-Dental-Health-Survey [Accessed 23rd December 2014].
[ii] Mylonas, P., et al. (2014). A clinical audit of denture cleanliness in general dental practice undertaken in the west midlands. British Dental Journal, 217.
[iii] de Andrade, I. M., et al. (2014). Trial of an experimental caster oil solution for cleaning dentures. Brazilian Dental Journal, 25 (1).
[iv] Milward, P., et al. (2013). Knowledge of removable partial denture wearers on denture hygiene. British Dental Journal, 215 (10).
[v] Coulthwaite, L., & Verran, J. (2007). Potential pathogenic aspects of denture plaque. British Journal of Biomedical Science, 64 (4), 180-189.
[vi] Salerno, C., et al. (2011). Candida-associated denture stomatitis. Oral Medicine and Pathology, 16 (2), 139-143.
[vii] Govindswamy., et al. (2014). The influence of surface roughness on the retention of candida albicans to denture base acrylic resins – an in vitro study. Journal of Nepal Dentists Association, 14 (1), 1-9.