The Batson Byte
“a unit of dental insight for the curious practitioner”
Emily R. Batson DDS, MS – Prosthodontist
Spring Cleaning 2020
I know I am not alone when admitting over the past several weeks I have deep cleaned my office and house, and have aggressively sought out corners and baseboards I never knew existed in an attempt to disinfect my life. I have also forced my now online-schooled 13-year old to adopt the same behavior, despite moderate resistance. As I was scrubbing a countertop the other day pondering how dentistry will change during and after the COVID-19 pandemic I thought of all of my denture patients and how to reinforce to them that cleaning doesn’t end with handwashing. Cleanliness is equally as important for any type of dental prosthesis that might be in function. This edition of the Byte will focus on recommended protocols for denture cleaning and highlight some tips for your denture patients.
“Once I get dentures, I will never have to worry about my teeth again!”
How many times have we heard someone say this? We as dental practitioners know dentures are the beginning of an entirely different dental life cycle, and although dental decay may be eradicated, several other dental diseases are possible and likely. Probably the most common and important is denture stomatitis. It has been estimated that 67% of denture wearers may have stomatitis related to Candida albicans. That’s 2/3rd of our denture wearing population! The cause is multi-factorial but can frequently be
attributed to a contaminated denture that is repeatedly worn as well as an ill-fitting denture. Why is thisimportant? Especially in our elderly populations or anyone with a compromised immune system, reduction of oral biofilm is important to reduce the chances of other systemic disease, including aspirational pneumonia, respiratory tract infections, and endocardial infections.1 Just as we promote good oral health amongst our dentate patients, we should be doing the same for our edentulous patients. Note erythema and evidence of candidiasis in the photo related to a poor fitting denture.
Effective Cleaning Methods for Complete and Partial Dentures
Several studies have focused on mechanical and chemical methods for the cleaning of dentures. Studies are lacking in this area, as each country allows slightly different formulations of cleaners. There is one universal cleaner. BLEACH! Diluted sodium hypochlorite (2-5% solution) appears to be a gold standard in most studies, as it kills a majority of bacteria and viruses, as well as Candida albicans. Most of the over the counter denture cleaning tablets are somewhat effective in removing stain, but don’t possess a great deal of bactericidal properties. Thus, it is recommended that removable prostheses be soaked in a 2-5% bleach solution between 5-10 minutes. Studies are divided on cast metal partial dentures, but most show with soaking times less than 8 minutes the framework does not show deterioration. There is not a recommendation on how many times a week this should be done, so I prefer to make this patient specific. For anyone showing signs of erythema or denture stomatitis, daily disinfection with a bleach solution should be considered until symptoms resolve. Studies have shown breakdown of denture materials when soaking repeatedly for longer than 10 minutes. A recent study showed that a 6% solution of bleach significantly affected the retentive capacity of locator attachments.2 For patients with implant overdentures we must make it clear to them that cleaning of the prosthesis is important, and more frequent replacement of the nylon inserts may be a possibility.
What about denture creams and pastes? The recommendation is that a soft toothbrush with a non-abrasive denture cleanser should be used. Just as we have started moving away from whitening toothpastes because of their abrasiveness, the same is true for denture pastes. Anything abrasive will compromise the polished, or cameo, surface of a denture, and can lead to further microbial colonization of the denture. After the denture has soaked, it can then be rinsed and brushed with a soft toothbrush and mild paste, or baking soda. Mechanical and chemical cleaning are key to denture cleanliness.
The Importance of Treating the Tissues
This topic doesn’t get the attention it deserves. Irritated or affected tissues also need to be treated. For patients with obvious signs of candidiasis it is recommended to treat with normal anti-fungals, like fluconazole. However, we know Candida likes to hang out in dark folds and crevasses, so it is important that the oral tissues are mechanically cleaned with an ultrasoft toothbrush. By treating both the prosthesis and the tissue patients can effectively remove a large part of the biofilm that causes stomatitis. There are several projects in the works in terms of adding an anti-fungal agents to denture materials, but these have not yet been approved for use.
How Often Should Dentures Be Replaced?
This is another topic that new denture patients need to be made aware of. Nothing lasts forever. And for their health it is now recommended that dentures be replaced every 5-8 years. A position statement made by the American College of Prosthodontists in 2015 lists several reasons why patients should consider annual exams, and replacement of dentures every 5-8 years, with oral and systemic health being just one reason. I encourage you to read that position statement. (https://www.prosthodontics.org/about-acp/position-statement-the-frequency-of-denture-replacement/) Let patients know they are individual specimens, and should be evaluated annually to determine what treatment modalities are appropriate. Many times, we see the effects years later from an ill-fitting denture, and it compromises the outcome of any future treatment and makes for a very difficult denture fabrication.
I hope this Byte has been helpful for you and your denture patients. As always, I appreciate your referrals and am available to discuss any clinical scenarios you may have questions about. I can be reached by phone at 719-576-4247.
Dr. Emily Batson is a native of Colorado Springs, CO. She is a graduate of Indiana University School of Dentistry, and served in the United States Army Dental Corps. She completed her specialty training in Prosthodontics at the University of North Carolina at Chapel Hill. She maintains a full-time private practice limited to prosthodontics in Colorado Springs.
- Felton, D. et al. ”Evidence Based Guidelines for the Care and Maintenance of Complete Dentures: A Publication of the American College of Prosthodontists, J Prosthodontics 2011 (20).
Ayyildiz, S, et al. “Effect of Denture Cleansing Solutions on the Retention of Locator Attachments Over Time.” J Prosthodontics 2020 (29).