|Year : 2017 | Volume
| Issue : 2 | Page : 131-137
Effect of denture adhesive and its forms on microbial colonization in diabetic and nondiabetic complete denture wearers: An in vivo study
Ruta Jadhav1, Sounyala Rayannavar1, Raghunath Patil1, Vinuta Hiremath1, Sumati A Hogade2
1 Department of Prosthodontics, KLE VK Institute of Dental Sciences, Belagavi, Karnataka, India
2 Department of Microbiology, JNMC, Belagavi, Karnataka, India
|Date of Web Publication||30-May-2017|
Department of Prosthodontics and Crown and Bridge, KLE V. K. Institute of Dental Sciences, Belagavi, Karnataka
Source of Support: None, Conflict of Interest: None
Problem: Denture adhesives are known to enhance the retention and stability in denture wearers, especially in patients with resorbed ridges. However, dentists hesitate to prescribe them fearing denture adhesive-induced oral microbial infections or hyperplasia in the oral cavity.
Aim: The aim of this was to evaluate and compare the effect of denture adhesives and its forms on the microbial colonization of diabetic and nondiabetic edentulous patients using complete dentures.
Methodology: Forty subjects were included in the study (Group A: 20 diabetics and Group B: 20 nondiabetics). After 2 weeks of complete denture insertion, samples were collected from the hard palate and buccal shelf areas for baseline microbiological analysis. Colony forming unit (CFU) counts were calculated on blood agar after 48 h of incubation. Ten subjects per group were prescribed with denture adhesive powder form and other 10 subjects with paste form, which was used for 1 month. After 1 month, subjects were recalled and CFU were evaluated.
Results: The difference obtained between the CFU counts for T0 and T1 of both the groups; Group A and Group B showed no significant difference. As shown by the dependent t-test, there was a slight increase in the CFU counts of palatal area as compared to the buccal shelf area and increased counts for the paste form of denture adhesive as compared to the powder form of denture adhesive. However, these differences were statistically insignificant (P > 0.05).
Conclusions: Microbial colonization of diabetic patients was far more than the nondiabetic patients. Denture adhesives had no effect on the microbial colonization when used for 1 month for both the groups. Furthermore, the microbial colonies were found to be slightly increased for hard palate and for the paste form of denture adhesive, however, statistically not significant.
Keywords: Denture adhesive, diabetes, retention, microbial colonization
|How to cite this article:|
Jadhav R, Rayannavar S, Patil R, Hiremath V, Hogade SA. Effect of denture adhesive and its forms on microbial colonization in diabetic and nondiabetic complete denture wearers: An in vivo study. Indian J Health Sci Biomed Res 2017;10:131-7
|How to cite this URL:|
Jadhav R, Rayannavar S, Patil R, Hiremath V, Hogade SA. Effect of denture adhesive and its forms on microbial colonization in diabetic and nondiabetic complete denture wearers: An in vivo study. Indian J Health Sci Biomed Res [serial online] 2017 [cited 2022 Aug 13];10:131-7. Available from: https://www.ijournalhs.org/text.asp?2017/10/2/131/207261
| Introduction|| |
For prosthetic rehabilitation of patients using removable prosthesis, increased importance is given to improve the retention and stability of the dentures. The retention in complete denture is a matter of great satisfaction to the dentist and of utmost interest to the patient. It not only enhances its stability but also helps meet various psychologic problems encountered by the patient during reeducating period or learning. Therefore, retention supplementing stability will achieve a final denture which satisfies the physical, physiological, and psychological needs of the patients.
Moreover, in certain conditions, such as patients with diabetes mellitus and Sjogren's syndrome, those who are under medication or radiotherapy that may lead to xerostomia or bone resorption, and patients who are bedridden or with poor dexterity, denture retention, and stability may not be ideal and may require frequent adjustments. Denture adhesives are used by the patients to increase the retention and stability of complete denture, support the patient psychologically, and improve the chewing and masticatory ability by making their use more acceptable. Some of the other benefits of denture adhesives are (1) increased denture stability, (2) improved chewing ability, (3) improved comfort and confidence, (4) alleviation of denture sore spots, (5) reduced collection of food under dentures.
Many dentists hesitate to prescribe denture adhesives, thinking that it indicates their failure to provide an adequate denture to the patient. Furthermore, dentists fear that denture adhesives cause soft tissue hyperplasia and increased ridge resorption. Concerns about the denture adhesive misuse and the potential deleterious effects that they may have on oral health on the part of the professional and dental educators is valid only with respect to ill-fitting dentures. There is limited documentation indicating that the use of these materials may be deleterious or harmful and the early literature is replete with speculations and myths.
Denture stomatitis has been mainly associated with Candida albicans. Denture stomatitis is also associated with denture trauma, which may be alleviated or reduced to some extent using a denture adhesive or a soft lining material. Certain denture adhesives are also known to be inhibitory to C. albicans, which may be attributed in part to the low pH of the denture adhesives.
There is high affinity of microbial species to adhere to, and subsequently colonize, denture acrylic resin material. Different forms of denture adhesives, for example, powder and paste, may affect the microbial adhesion on the denture surface and influence their colonization. Diabetics also have an increased predisposition to the occurrence of microbial infections and candidiasis, which is associated with poor glycemic control and therapeutic dentures. Diabetes mellitus is a chronic metabolic disease which causes several disorders. Colonization of microorganisms is more prevalent in people with diabetes mellitus. Studies have shown a higher prevalence of candidal colonization in the oral cavity of diabetics compared with nondiabetic patients. Hence, it is fairly evident that the combination of denture and diabetes in the patients can increase the microbial count in diabetic patients.,
Because of the high rates of diabetes mellitus in the elderly Indian population, many studies have been done to evaluate the prevalence of oral infections in these patients. However, there is an obvious lack of the studies done for the isolation of microbial species in the patients using powder and paste forms of denture adhesives. The present in vivo study was designed to evaluate and compare the effect of denture adhesives and its forms on the microbial count of diabetic and nondiabetic edentulous patients using complete dentures.
| Methodology|| |
Forty subjects were included in the study (Group A: 20 diabetics and Group B: 20 nondiabetics). The diabetic status of the patients was determined by the history of previous diagnosis of diabetes and the blood glucose levels were also determined using calorimetric method before the sample collection. The patients were assessed as nondiabetics and diabetics on the ground of fasting plasma glucose levels (normal = <110 mg/dl).
Both the groups were further divided into 4 subgroups:
- GROUP 1A: Diabetic patients who were given denture adhesive in powder form (n = 10)
- GROUP 1B: Diabetic patients who were given denture adhesive in paste form (n = 10)
- GROUP 2A: Nondiabetic patients who were given denture adhesive in powder form (n = 10)
- GROUP 2B: Nondiabetic patients who were given denture adhesive in paste form (n = 10).
The patients received their new conventional complete maxillary and mandibular dentures which were fabricated following a standardized protocol. After 2 weeks of complete denture insertion, samples were collected from the hard palate and buccal shelf areas for baseline microbiological analysis using sterile cotton swab [Figure 1] and [Figure 2]. The colony forming unit (CFU) counts were calculated on blood agar after 48 h of incubation at 37°C. Ten subjects per group were given denture adhesive powder form and ten subjects per group were given denture adhesive paste form to be used for 1 month. All the patients were instructed to clean their dentures using water and brush only. Only water, with no denture cleansers or antiseptic soap, was allowed during the study testing period. Patients were demonstrated about the correct method of application of denture adhesive powder (denture adhesive powder to be sprinkled 2 mm away from the borders of the wet denture evenly) and denture adhesive paste (three pea-sized drops of denture adhesive paste to be dispensed on to the intaglio surface of wet denture and to be spread out evenly using patient's finger and then to be inserted into the mouth) [Figure 3] and [Figure 4].
|Figure 1: Sample collected from the hard palate after 2 weeks of denture insertion|
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|Figure 2: Sample collected from the buccal shelf area after 2 weeks of denture insertion|
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|Figure 3: Correct use of denture adhesive powder form demonstrated to the patient|
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|Figure 4: Correct use of denture adhesive paste form demonstrated to the patient|
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After 1 month, subjects were recalled and samples were collected from the same areas; hard palate and buccal shelf area and CFU counts were evaluated in the same fashion and sent to the microbiological laboratory for evaluation.
For evaluation of microbial colony count, serial 10-fold dilutions of the transport medium that contained the sample were prepared to 10-5 [Figure 5]. One hundred microliter of the diluted samples was inoculated on blood agar plates using micropippete [Figure 6]. These plates were incubated for 48 h at 37°C, with plate in aerobic condition into an incubator. The total number of the colony forming units was determined on the basis of serial dilution of 10-5 on the media. The number of colonies on each plate was counted after 48 h of incubation [Figure 7] and [Figure 8]. This process and colony counting were carried out by a same operator in the laboratory to exclude the examiners bias. The resultant data were subjected to the statistical analysis to draw conclusions from the experimental data.
|Figure 6: One hundred microliter of the diluted sample inoculated on the blood agar plates using micropipette|
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|Figure 7: Microbial colonies seen on the blood agar after 48 h of incubation without using denture adhesive (T0)|
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|Figure 8: Microbial colonies seen on the blood agar after 1 month of usage of denture adhesive (T1)|
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| Results|| |
The collected data were tabulated and subjected to statistical analysis using SPSS software version 20. To collectively compare the means of the study groups, two-way analysis of variance (ANOVA) tests were used (P < 0.05), pairwise comparison of the test group was done using Tukey's multiple post hoc (P < 0.05), and dependent t-test was used for comparison of CFU counts in palatal and buccal shelf areas at T0 and T1 of Group A and B for two denture adhesives (powder and paste).
Mean and standard deviation of CFU counts in the palatal area and buccal shelf area at T0 and T1 time points were calculated in each of the two groups (diabetic and nondiabetic) (n = 20) for powder and paste form of denture adhesive.
The mean values of palatal and buccal shelf area CFUs for nondiabetic patients (Group B) after using denture adhesive for 1 month were 34.50 (±1.08), 32.00 (±2.31) for powder form of denture adhesive and 35.30 (±0.95), 33.00 (±1.94) for paste form of denture adhesive, which were significantly less as compared to the mean values of CFUs in the palatal and buccal shelf area at T0 and T1 time points for diabetic patients (Group A) powder form of denture adhesive were 46.00 (±1.41) and 44.90 (±2.64) and paste form of denture adhesive were 48.10 (±2.51) and 45.00 (±2.11).
Two-way ANOVA for significance (P < 0.05) of two groups (diabetic and nondiabetic) and two adhesives (powder and paste) with CFU counts in buccal shelf area at changes from T0 toT1 time points (after 1 month) shows statistically insignificant difference between two groups and two adhesives. On two-way interaction also, there is a statistically insignificant difference present (F = 0.2923 and P = 0.5920) [Table 1].
|Table 1: Comparison of two groups (diabetic and nondiabetic) and two adhesives (powder and paste) with colony forming units counts in buccal shelf area at changes from T0 to T1 time points by two.way analysis of variance|
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Tukey's multiple post hoc procedures with respect to the effect seen in two groups (diabetic and nondiabetic) and two adhesives (powder and paste) with CFU counts in buccal shelf area at changes from T0 toT1 time points (after 1 month) show statistically insignificant difference between diabetic and nondiabetic groups and statistically insignificant difference between adhesive powder and paste groups (P > 0.05) [Table 2].
|Table 2: Pairwise comparisons of two groups (diabetic and nondiabetic) and two adhesives (powder and paste) with colony forming units counts in buccal shelf area at changes from T0 to T1 time points by Tukey's multiple post hoc procedures|
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Dependent t-test procedure with respect to comparison of T0 and T1 in two adhesives (Powder and paste) of diabetic group with CFU counts in palatal and buccal shelf area shows statistically insignificant difference between the subgroups powder and paste denture adhesives after a period of 1 month [Table 3].
|Table 3: Comparison of T0 and T1 in two adhesives (powder and paste) of diabetic group with colony forming units counts in palatal and buccal shelf area by dependent t-test|
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Dependent t-test procedure with respect to comparison of T0 and T1 in two adhesives (powder and paste) of nondiabetic group with CFU counts in palatal and buccal shelf area shows statistically insignificant difference between the subgroups powder and paste denture adhesives after a period of 1 month [Table 4].
|Table 4: Comparison of T0 and T1 in two adhesives (powder and paste) of nondiabetic group with colony forming units counts in palatal and buccal shelf area by dependent t-test|
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| Discussion|| |
The present study included forty new denture wearer diabetic and nondiabetic patients who were being prescribed either a denture adhesive powder or a denture adhesive paste, to evaluate the effect of these denture adhesives on the oral microbial colonization. New denture wearers between 40 and 70 years of age were included in the study. Patients on corticosteroid therapy, anti-fungal therapy, or patients suffering from any systemic disease other than noninsulin-dependent diabetes mellitus, compromising the immune system and which is known to predispose the patients to oral infections, were excluded from the study as it may alter the results of the study. Fixon ® was selected for the study as it is the most common, economical, and easily available denture adhesive brand in Indian markets.
In principle, there should be no need for denture adhesives to be used with complete dentures. However, in certain situations where anatomical structures are not favorable or in patients where salivary flow is impaired due to systemic diseases or medications such as in diabetes mellitus, the use of denture adhesive is seen as a potential aid to improve the retention and stability of complete denture. Despite of these advantages, dentists hesitate to advise the use of denture adhesives and refrain from prescribing them to their patients, thinking that it indicates their failure to provide an adequate and retentive complete denture. Many authors have reported the advantages of using denture adhesives in their studies. A study done by Guillermo Pradíes et al. by means of a gnathometer and a dynamometer demonstrated an improvement in the stability and retention of well-fitting complete dentures with the adjunctive use of denture adhesives. A survey by Slaughter et al. using the Delphi technique survey method has concluded that denture adhesives could be a useful adjunct in the service of complete denture prosthesis.
There is a high prevalence of denture stomatitis among complete denture wearers (25%–65%) and microbial contamination of the dentures is regarded as the major cause for this problem. It is also seen that the microbial population, especially candidial colonization, is higher in the oral cavity of diabetic patients. The present study evaluated the microbial CFU counts on palatal and buccal shelf areas in diabetic and nondiabetic denture wearers and it was found that microbial CFU counts on blood agar were significantly higher for diabetic patients as compared to the nondiabetic control group and also the microbial counts were higher in palatal region as compared to the buccal shelf area. The results of the present study are consistent with those of Kumar et al. who showed that colonization and carriage of Candida were found to be higher in the oral cavity of diabetic subjects than in nondiabetic subjects. Furthermore, the study has shown slight increase in microbial CFU counts for maxillary palatal region as compared to the mandibular buccal shelf area though the difference is statistically insignificant. The possible reason behind this increased palatal colonization is the yeast and microbial proliferation in the space between the maxillary denture and the palatal mucosa which may give rise to denture stomatitis  and also the presence of increased number of mucosal glands in the hard palate which can harbor microorganisms.
Dentists also fear that these denture adhesives can cause increased alveolar ridge resorption, tissue irritation, and soft tissue hyperplasia. Available information in literature is insufficient to relate to the effects of different forms of denture adhesives on bacterial growth and the effects they might have on oral mucosa, especially in denture wearers. In the present study, no significant increase was observed in the microbial CFU counts after the usage of denture adhesives for 1 month. It indicates that the denture adhesives used in the study had no harmful or irritating effects on the oral mucosa. The present results are in agreement with those of Ozcan et al. who observed no significant difference after usage of denture adhesives for alpha hemolytic streptococci and C. albicans in saliva, on the palate and denture surface  and Al et al. who found that none of the tested denture adhesives in his study induced cytotoxicity which was evaluated by the HET-CAM method.,
The correlation between poor denture cleanliness and denture stomatitis among patients was found to be significant in the study by Kulak-Ozkan. These findings that the oral hygeine maintenance reduces the microbial counts in denture wearers is also supported by the findings of the studies by Schou et al. (1987) and Budtz-Jörgensen (1973). In this study, utmost care was taken about giving complete oral hygiene instructions to the patients and educating them about the importance of denture cleaning and hygiene maintenance. This can be one of the reasons for no significant increase in the microbial CFU counts before and after usage of denture adhesive and its forms.
The denture adhesive was used by the patients for 1 month and it yielded no significant difference in microbial CFU counts on blood agar. Several studies have been performed in the past that investigated microbial growth after denture adhesive usage for different periods of time and are in accordance with the results of the present study.,
Powder and paste forms of “Fixon ®” denture adhesive were used in the study to see the effect of these forms on oral microbiota. This study has shown a slight increase in microbial CFU counts for the paste form of denture adhesive as compared to the powder form though not statistically significant. These results have been attributed to the increased viscosity of the paste denture adhesives as opposed to the powder form  and it would also be dependent on differences in composition of denture adhesives and thus on their adhesive properties.
After the results were analyzed by applying various statistical tests as mentioned earlier, it was concluded that there was no significant difference between the CFU counts of diabetic and nondiabetic denture wearers after 1 month of usage of denture adhesives. However, a statistically significant difference difference was found between the microbial colonization of diabetic and nondiabetic patients. A slight increase was seen in the microbial colonization in the paste form of denture adhesive as compared to the powder form and for hard palate as compared to buccal shelf areas, hence rejecting the null hypothesis. It is now accepted that if the denture adhesives are properly used and the patient maintains a good oral hygiene, they can be an asset to a dentist's armamentarium.
| Conclusion|| |
If the denture adhesives are properly used and the patient maintains a good oral hygiene, they can be an asset to a dentist's armamentarium.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
[Table 1], [Table 2], [Table 3], [Table 4]