Raphael Freitas de Souza

The Impact of Edentulism on Oral and General Health

An adequate dentition is of importance for well-being and life quality. Despite advances in preventive dentistry, edentulism is still a major public health problem worldwide. In this narrative review, we provide a perspective on the pathways that link oral to general health. A better understanding of disease indicators is necessary for establishing a solid strategy through an organized oral health care system to prevent and treat this morbid chronic condition.

Effect of Three Methods for Cleaning Dentures on Biofilms Formed In Vitro on Acrylic Resin

PURPOSE The aim of this study was to evaluate the effect of three denture hygiene methods against different microbial biofilms formed on acrylic resin specimens. MATERIALS AND METHODS The set (sterile stainless steel basket and specimens) was contaminated (37 degrees C for 48 hours) by a microbial inoculum with 10(6) colony-forming units (CFU)/ml (standard strains: Staphylococcus aureus, Streptococcus mutans, Escherichia coli, Candida albicans, Pseudomonas aeruginosa, and Enterococcus faecalis; field strains: S. mutans, C. albicans, C. glabrata, and C. tropicalis). After inoculation, specimens were cleansed by the following methods: (1) chemical: immersion in an alkaline peroxide solution (Bonyplus tablets) for 5 minutes; (2) mechanical: brushing with a dentifrice for removable prostheses (Dentu Creme) for 20 seconds; and (3) a combination of chemical and mechanical methods. Specimens were applied onto a Petri plate with appropriate culture medium for 10 minutes. Afterward, the specimens were removed and the plates incubated at 37 degrees C for 48 hours. RESULTS Chemical, mechanical, and combination methods showed no significant difference in the reduction of CFU for S. aureus, S. mutans (ATCC and field strain), and P. aeruginosa. Mechanical and combination methods were similar and more effective than the chemical method for E. faecalis, C. albicans (ATCC and field strain), and C. glabrata. The combination method was better than the chemical method for E. coli and C. tropicalis, and the mechanical method showed intermediate results. CONCLUSION The three denture hygiene methods showed different effects depending on the type of microbial biofilms formed on acrylic base resin specimens.

Effect of denture cleansers on physical properties of heat-polymerized acrylic resin

PURPOSE This study aimed to measure the color change, surface roughness and flexural strength of heat-polymerized acrylic resin after its immersion in denture cleansers, simulating a 180-day use. METHODS Thirty disk-shaped (15mm x 4mm) and 30 rectangular samples (65mm x 10mm x 3.3mm) were prepared from heat-polymerized acrylic resin and immersed in Corega Tabs, Bony Plus, and distilled water. Color measurements (DeltaE) were determined by a portable colorimeter. A surface analyzer was used to measure the roughness before and after immersion (DeltaRa). The flexural strength (S) was measured using a 3-point bending test. The DeltaE values were submitted to statistical analysis by the Kruskal-Wallis test, followed by Dunns Multiple Comparisons test. The DeltaRa and S values were submitted to statistical analysis by ANOVA, followed by a Student-Newman-Keuls test (alpha=.05). RESULTS The color changes were significantly higher for the Corega Tabs than for the control group. The mean DeltaE values quantified by the National Bureau of Standards (NBS) were classified as Trace (0.0-0.5). The Bony Plus group had significantly higher surface roughness than the other groups. Corega Tabs and Bony Plus groups presented lower flexural strength than the control group. CONCLUSIONS Although the color changes after the immersion in denture cleansers were clinically insignificant, the Corega Tabs group showed higher color differences. The Bony Plus group showed significantly increased surface roughness. Both effervescent tablets Corega Tabs and Bony Plus significantly diminished the flexural strength of the acrylic resin.

Behaviors and hygiene habits of complete denture wearers

In this study, a questionnaire was applied to patients from Ribeirão Preto Dental School, University of São Paulo, Brazil, to evaluate the hygiene methods and habits concerning the use of complete dentures, the age of dentures, and whether patients have been instructed on how to clean their dentures. The mean age of patients was 63.35 years, and most of them were females (82.08%). The results showed that 62.26% of the respondents had been using the same maxillary complete denture for more than 5 years, and 49.06% used the same mandible complete denture for more than 5 years. Of the patients interviewed, 58.49% slept with the dentures. Mechanical brushing was the most used cleaning method by the patients (100%), using water, dentifrice and toothbrush (84.91%). Most patients (51.89%) reported never having been instructed by their dentists as to how to clean their dentures. Based on the limitations of this study, it was concluded that the patients interviewed had limited knowledge about prosthetic hygiene and oral care. The method more used by patients was the mechanical method of brushing, most patients used the same complete dentures for more than 5 years and slept with the dentures.

Effect of the physical properties of acrylic resin of overnight immersion in sodium hypochlorite solution.

OBJECTIVES This study evaluated colour stability, surface roughness and flexural strength of microwave-polymerised acrylic resin after overnight immersion in sodium hypochlorite, simulating 180 days use. MATERIALS AND METHODS Forty disc-shaped (15 mm x 4 mm) and 40 rectangular specimens (65 mm x 10 mm x 3 mm) were prepared from microwave-polymerised acrylic resin. The specimens were immersed in 0.5, 1% sodium hypochlorite, Clorox/Calgon and distilled water. Colour measurements (ΔE) were determined by a portable colorimeter. A surface analyser was used to measure roughness (μm). The flexural strength (MPa) was measured using a three-point bending test in a universal testing machine. Data were evaluated by one-way anova, followed by Student-Newman-Keuls test (α = 0.05). RESULTS Statistical analysis found significantly higher colour changes (SNK, p < 0.001) for the 1% sodium hypochlorite, but mean ΔE value quantified by National Bureau of Standards was classified as slight. When comparing the surface roughness, no statistical significance was found among the solutions (anova, p = 0.637). The 1% sodium hypochlorite presented significantly lower flexural strength compared with the control group (SNK, p = 0.034). CONCLUSION It was concluded that immersion in 1% sodium hypochlorite solutions for 8 h does influence the colour stability and flexural strength of microwave-polymerised acrylic resin, during the simulated period of 180 days.

Color Stability, Surface Roughness and Flexural Strength of an Acrylic Resin Submitted to Simulated Overnight Immersion in Denture Cleansers

This study evaluated color stability, surface roughness and flexural strength of acrylic resin specimens after immersion in alkaline peroxide and alkaline hypochlorite, simulating a period of one and a half year of use of overnight immersion. Sixty disc-shaped (16x4 mm) and 80 rectangular specimens (65x10x3.3 mm) were prepared from heat-polymerized acrylic resin (Lucitone 550) and distributed into 4 groups (n=20): C1: without immersion, C2: 8 h immersion in distilled water; AP: 8 h immersion in alkaline peroxide effervescent tablet; SH: 8 h immersion in 0.5% NaOCl solution. Properties were evaluated at baseline and after the immersion. Color data were also calculated according the National Bureau of Standards (NBS). Results were analyzed statistically by ANOVA and Tukeys HSD test (α=0.05). AP (2.34 ± 0.41) caused color alteration significantly higher than C2 (0.39 ± 0.30) and SH (1.73 ± 0.52). The mean ΔE values were classified as indicial for C2 (0.36 ± 0.29) and noticeable for AP (2.12 ± 0.39) and SH (1.59 ± 0.48). SH (0.0195 ± 0.0150) caused significantly higher ΔRa (p=0.000) than the C2 (0.0005 ± 0.0115) and PA (0.0005 ± 0.0157) groups. There was no statistically significant difference (p=0.063) among the solutions for flexural strength (C1: 105.43 ± 14.93, C2: 100.30 ± 12.43, PA: 97.61 ± 11.09, SH: 95.23 ± 10.18). In conclusion, overnight immersion in denture cleansing solutions simulating a year and a half of use did not alter the flexural strength of acrylic resin but caused noticeable color alterations, higher for alkaline peroxide. The 0.5% NaOCl solution caused increase in surface roughness.

In vitro and clinical evaluation of specific dentifrices for complete denture hygiene.

OBJECTIVES To study the physical properties of two experimental dentifrices for complete denture hygiene, their effect on denture biofilm removal and antimicrobial properties by means of a clinical trial. MATERIALS AND METHODS The experimental dentifrices comprised two compositions. One was based on the addition of 1% chloramine T (D1) and the other on the presence of 0.01% fluorosurfactant (D2). Measurements of density, pH, consistency, rheological features and abrasiveness were conducted. Sixty complete denture wearers were randomly assigned to three groups and were instructed to brush their dentures with a specific toothbrush: (1) Water (control); (2) D1; or (3) D2. Each method was used for 21 days. Denture biofilm was disclosed by a 1% neutral red solution and quantified by means of digital photos taken from the internal surface. Microbiological assessment was conducted to quantify Candida sp. and mutans streptococci. Data were evaluated by one-way anova and Tukey HSD, or Kruskal-Wallis (alpha = 0.05). RESULTS Both dentifrices decreased biofilm coverage when compared with the control group. D1 was the most efficacious treatment to reduce mutans streptococci, whereas D2 showed an intermediate outcome (ANOVA, p < 0.040). No treatment influenced Candida albicans or non-albicans species (Kruskal-Wallis, p = 0.163 and 0.746, respectively). CONCLUSION It can be concluded that brushing complete dentures with the experimental dentifrices tested could be effective for the removal of denture biofilm.

The effectiveness of chemical denture cleansers and ultrasonic device in biofilm removal from complete dentures

Adequate denture hygiene can prevent and treat infection in edentulous patients. They are usually elderly and have difficulty for brushing their teeth. Objective This study evaluated the efficacy of complete denture biofilm removal using chemical (alkaline peroxide-effervescent tablets), mechanical (ultrasonic) and combined (association of the effervescent and ultrasonic) methods. Material and Methods Eighty complete denture wearers participated in the experiment for 21 days. They were distributed into 4 groups (n=20): (1) Brushing with water (Control); (2) Effervescent tablets (Corega Tabs); (3) Ultrasonic device (Ultrasonic Cleaner, model 2840 D); (4) Association of effervescent tablets and ultrasonic device. All groups brushed their dentures with a specific brush (Bitufo) and water, 3 times a day, before applying their treatments. Denture biofilm was collected at baseline and after 21 days. To quantify the biofilm, the internal surfaces of the maxillary complete dentures were stained and photographed at 45º. The photographs were processed and the areas (total internal surface stained with biofilm) quantified (Image Tool 2.02). The percentage of the biofilm was calculated by the ratio between the biofilm area multiplied by 100 and the total area of the internal surface of the maxillary complete denture. Results The Kruskal-Wallis test was used for comparison among groups followed by the Dunn multiple-comparison test. All tests were performed respecting a significance level of 0.05. Significant difference was found among the treatments (KW=21.18; P<0.001), the mean ranks for the treatments and results for Dunn multiple comparison test were: Control (60.9); Chemical (37.2); Mechanical (35.2) and Combined (29.1). Conclusion The experimental methods were equally effective regarding the ability to remove biofilm and were superior to the control method (brushing with water). Immersion in alkaline peroxide and ultrasonic vibration can be used as auxiliary agents for cleaning complete dentures.

Comparison of physical and mechanical properties of microwave-polymerized acrylic resin after disinfection in sodium hypochlorite solutions

This study evaluated the color stability, surface roughness and flexural strength of a microwave-polymerized acrylic resin after immersion in sodium hypochlorite (NaOCl), simulating 20 min of disinfection daily during 180 days. Forty disk-shaped (15 x 4 mm) and 40 rectangular (65 x 10 x 3 mm) specimens were prepared with a microwave-polymerized acrylic resin (Onda-Cryl). Specimens were immersed in either 0.5% NaOCl, 1% NaOCl, Clorox/Calgon and distilled water (control). Color measurements were determined by a portable colorimeter. Three parallel lines, separated by 1.0 mm, were registered on each specimen before and after immersion procedures to analyze the surface roughness. The flexural strength was measured using a 3-point bending test in a universal testing machine with a 50 kgf load cell and a crosshead speed of 1 mm/min. Data were analyzed statistically by ANOVA and Tukeys test (alpha=0.05). There was no statistically significant differences (p>0.05) among the solutions for color, surface roughness and flexural strength. It may be concluded that immersion in NaOCl solutions simulating short-term daily use during 180 days did not influence the color stability, surface roughness and flexural strength of a microwave-polymerized acrylic resin.

Effervescent tablets and ultrasonic devices against Candida and mutans streptococci in denture biofilm.

OBJECTIVE To evaluate the antimicrobial action of effervescent tablets and ultrasound on Candida spp. and mutans streptococci from denture biofilm. BACKGROUND It is not uncommon for edentulous patients to be elderly and find it difficult to brush their dentures. Hence, auxiliary methods are required for cleansing dentures as well as treating oral infections. MATERIALS AND METHODS Seventy-seven complete denture wearers were randomly assigned into four groups: (A) Brushing with water (control); (B) Effervescent tablets; (C) Ultrasonic device (Ultrasonic Cleaner, model 2840 D); (D) Effervescent tablets and ultrasonic device. All groups brushed their dentures with a specific brush and water, three times a day, before applying their treatments. Denture biofilm was collected at baseline and after 21 days. The samples were collected by brushing the dentures with saline and the detached microbial cells were quantified by plating. Counts [log (CFU+1) ml(-1) ] of total aerobes, Candida spp. and mutans streptococci were compared by one-way anova or Kruskal-Wallis test (α = 0.05). RESULTS No significant difference was found among the methods from C. albicans (p = 0.76), C. tropicalis (p = 0.94) and C. glabrata (p = 0.80). Lower counts were found for methods B and D when compared with the other methods against mutans streptococci (p < 0.001). Method B showed lower total aerobic counts than A, whereas C and D showed intermediate results (p = 0.011). CONCLUSION The effervescent tablets significantly reduced mutans streptococci and total aerobes from denture biofilm. However, they was not as effective against C. albicans. Ultrasonic cleansing presented a discrete antimicrobial effect and was less effective than the tablets for complete denture disinfection.