Ejvind Budtz-Jørgensen

Materials and methods for cleaning dentures.

Proper hygienic care of removable dentures is an important means of maintaining a healthy oral mucosa in denture wearers. Denture cleanliness is often poor due to improper mechanical cleansing and the relative inefficiency of most commercial products for chemical cleansing of dentures. Dentists and patients should realize that microbial plaque on dentures may be harmful to both the oral mucosa and the patients general health. It is the responsibility of the patient to maintain oral hygiene through a daily home care routine. It is the obligation of the dentist to motivate and instruct the patient and provide the means and methods for plaque control. Future research should be directed to developing solution cleansers which can maintain plaque-free dentures with a daily soaking period of 15 to 30 minutes and not affect the color and surface luster of the denture acrylic resin.

Etiology, pathogenesis, therapy, and prophylaxis of oral yeast infections.

Etiologic factors in oral candidosis are immature antimicrobial host defenses, acquired suppression of immune defense mechanisms (AIDS, immunosuppressive or radiation therapy), or changes of the environmental conditions of the oral cavity (antibiotics, dentures, epithelial changes). After colonization and adhesion of Candida to the epithelial surface the subsequent mucosal lesion is due to tissue destruction by potent proteolytic enzymes or toxins and an inflammatory response to Candida antigens. Topical antimycotic treatment with nystatin, amphotericin B, or miconazole is important especially to prevent spread of the infection. Chronic Candida infections require long-term antifungal therapy, and patient compliance may be difficult to obtain. In denture stomatitis colonization of the fitting denture surface by Candida should be controlled by, for example, using a chlorhexidine solution as a denture disinfectant. However, recurrences are frequent if the local or the systemic predisposing conditions are not...

PREDOMINANT CULTIVABLE MICROFLORA OF PLAQUE ON REMOVABLE DENTURES IN PATIENTS WITH HEALTHY ORAL MUCOSA

Plaque from the fitting surface of upper full dentures in eight patients with healthy palatal mucosa was studied. To characterize the predominant cultivable flora, 916 isolates (100-128 from each sample) were subcultured from anaerobic roll-tubes. Streptococci constituted 0-81 per cent (median, 41 per cent) of the isolates with varying proportions of Streptococcus milleri, Streptoccus mutans, Streptococcus salivarius, Streptococcus mitior and Streptococcus sanguis. Staphylococcus aureus made up 0-13 per cent (median, 6 per cent). Gram-positive rods constituted 1-74 per cent (median, 33 per cent). Among these, Actinomyces israelii, Actinomyces naeslundii, Actinomyces viscosus and Actinomyces odontolyticus were the most common species, whereas lactobacilli were isolated only from two samples, constituting 21 and 48 per cent. Among Gram-negative bacteria, only Veillonella parvula was common, constituting 3-20 per cent (median, 10 per cent). Gram-negative rods were isolated only from three samples in small proportions making up 0-6 per cent (median, 0 per cent) of the flora. Forty-seven isolates (5 per cent) were lost. Cultures for yeasts on Sabouraud agar were positive for five samples and the yeast counts corresponded to 0-0.45 per cent (median, 0.002 per cent) of the total viable counts. The microflora of denture plaque is highly variable and is to a large extent similar to that of some forms of dental plaque.

A 5-year longitudinal study of cantilevered fixed partial dentures compared with removable partial dentures in a geriatric population

Prosthesis function and dental conditions were observed for 5 years in 27 elderly patients treated with mandibular cantilevered fixed partial dentures (FPDs) and in 26 elderly patients treated with distal-extension removal partial dentures (RPDs). All patients were treated with a complete upper denture. The patients were assigned randomly into two treatment groups that had the same composition with regard to sex, age, and distribution of teeth. The patients were under supervised oral hygiene and prosthodontic care. Clinical examination of prostheses, masticatory system, periodontal status, and caries was carried out yearly. Oral hygiene was good, and the periodontal status was maintained in both groups. Caries was observed six times more frequently in the RPD group than in the group with fixed restorations, however. Occlusal and functional conditions deteriorated in the RPD group only. Eight of 42 fixed partial dentures (19%) failed; of these, six were recemented with composite resin. Generally the need for dental and prosthetic follow-up treatment was more pronounced in the RPD group than in the FPD group.

Histopathology, immunology, and serology of oral yeast infections: Diagnosis of oral candidosis

For diagnostic purposes it is normally not important to obtain a biopsy specimen, since an oral smear from the lesion will yield blastospores and pseudohyphae in abundance. However, in lesions that respond poorly to antimycotic treatment a biopsy should be carried out to detect possible malignant changes in the epithelium. Assessment of cell-mediated immunity against Candida albicans and other antigens may be important in patients with severe chronic candidosis to assess the degree of immunocompetence and prognosis. Usually, patients with oral candidosis show only moderately elevated antibody titers in serum and saliva against C. albicans, and serologic tests are normally not a diagnostic tool for oral candidosis. However, such tests may be a prognostic instrument in patients with severe oral candidosis who respond poorly to antimycotic therapy.

Denture Stomatitis IV. An Experimental Model in Monkeys

An experimental candida infection of the palatal mucosa of 6 Macaca irus was produced by inoculation of C. albicans under an acrylic plate. A diffuse erythema was seen involving the palatal mucosa in contact with the acrylic plate. Infection appeared to be associated with a transformation of the yeast form of C. albicans into the hyphal form. However, histological sections did not show intra-epithelial invasion by hyphae. The inflammatory lesion showed spontaneous healing 2-3 weeks after infection, clinically and histologically. Prolonged topical treatment with Demethylchlortetracycline resulted in a continuous proliferation of candida and a sustained inflammatory reaction, more intense than that caused by candida alone. After re-infection a more intense inflammation appeared as compared with the primary lesion, a fact that may indicate that the experimental candida infection is capable of stimulating delayed hypersensitive responses.

Chlorhexidine gel and Steradent@ employed in cleaning dentures

It was the purpose of the study to test the efficacy of brushing with a 1% chlorhexidine gel or a commercial solution cleanser (Steradent) in preventing formation of plaque on the fitting surface of new dentures. The study group consisted of 74 denture wearers with denture stomatitis who were assigned randomly to one of four treatment groups, testing either the chlorhexidine gel, a placebo gel, Steradent, or a placebo solution. The experiment was started immediately after denture treatment was completed. The experimental period was 1 month. The amount of denture plaque, the clinical condition of the palatal mucosa, and the concentration of yeasts in mucosal and denture smears were recorded while the patients used their original dentures and after the experimental period. Plaque had formed on all new dentures but to a smaller extent in the groups testing the chlorhexidine gel or the placebo gel. The study does not provide any obvious evidence of a chemical effect of chlorhexidine gel or Steradent as a means to prevent formation of microbial plaque on the mucosal surface of maxillary complete dentures.

Reduction of Formation of Denture Plaque by a Protease (Alcalase

The efficacy of a protease preparation (Alcalase, Novo, Denmark) in preventing accumulation of plaque on the fitting surface of complete upper dentures was examined in a double-blind study. Seventeen denture wearers with clinically healthy oral mucosae participated in the study. The protease was dispensed in dissolvent tablets containing 15, 30, 60, 100, 300, 500, or 1000 mg of the enzyme. Enzyme tablets or placebo tablets were dissolved in 150 ml water at 50 degrees C, and the dentures were soaked once daily for 15 min. Denture soaking was performed with or without brushing. The study consisted of 14 1-week periods. At the start of each period the dentures were cleaned by brushing until they showed no visible plaque after staining. At the end of each period plaque was stained and the dentures were photographed. The photographs were projected, and the percentage area of the fitting surface showing plaque deposits was scored with 10% intervals. Statistical analysis showed that there was a significant reduction of plaque scores with increasing enzyme concentration. The most marked reduction in plaque formation was seen when mechanical cleansing was combined with immersion in a 500-mg enzyme solution. At a concentration of 300 mg (or more) the enzyme immersion was as efficient as mechanical cleansing in preventing denture plaque accumulation.

Cantilevered fixed partial dentures in a geriatric population: Preliminary report

This study has shown that treatment with distally extending cantilever fixed partial dentures is a favorable alternative to treatment with removable partial dentures in elderly patients with reduced dentition. In patients with anterior teeth and one or two premolar teeth remaining in the mandible, sufficient occlusal stabilization for a maxillary complete denture was provided by a two- or three-unit cantilever fixed partial denture. A pronounced improvement in chewing function and stability of the maxillary denture was expressed, even by patients who were previously well adapted to wearing removable partial dentures.

The effect of controlled oral hygiene in overdenture wearers

The effect of controlled oral hygiene was studied in 40 patients treated with immediate complete overdentures in one or both jaws. Before prosthetic treatment conservative periodontal treatment was conducted with intensive instruction and motivation in oral hygiene care. Caries and periodontal status were recorded before and 2-4 weeks (day 0), 6 months, and 12 months after prosthetic treatment. However, the patients were seen more frequently for motivation and professional tooth cleaning. The material included 44 overdentures with a total of 92 abutments, with 1-4 abutments in each jaw. Before treatment the overall mean plaque index score was 1.43 +/- 0.68 and the overall mean gingival index score 1.57 +/- 0.53, and on day 0 and after 6 and 12 months the overall mean PlI score was 0.33-0.65 and the overall mean GI score 0.67-0.97. Adjacent to the abutments there was a significant reduction of the PlI and the GI scores from before treatment to day 0 and from day 0 to 6 months after prosthetic treatment (P less than 0.001). There was a significant reduction of pocket depth from day 0 to 6 months and from 6 to 12 months (P less than 0.01). The results of this study have shown that it is possible to maintain teeth as abutments for overdentures in patients with an initial poor dental status.