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Associated Topics

Interventions for cleaning dentures in adults

de Souza RF, de Freitas Oliveira Paranhos H, Lovato da Silva CH, Abu-Naba'a L, Fedorowicz Z, Gurgan CA . Cochrane Database of Systematic Reviews. 2009;(4):CD007395


BACKGROUND: Removing denture plaque may be essential for maintaining the oral health of edentulous people. Brushing and soaking in chemical products are two of the most commonly used methods of cleaning dentures. OBJECTIVES: To evaluate the effectiveness and safety of different methods for cleansing removable dentures. SEARCH STRATEGY: We searched the following databases: the Cochrane Oral Health Group Trials Register (to May 2009); CENTRAL (The Cochrane Library 2009, Issue 2); MEDLINE (1965 to May 2009); EMBASE (1980 to May 2009); LILACS (1980 to May 2009); and CINAHL (1997 to May 2009). There were no language restrictions. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing any mechanical method (e.g. brushing or ultrasound) or chemical (e.g. enzymes, sodium hypochlorite, oral rinses or peroxide solutions) in adults over the age of 18 wearing removable partial dentures or complete dentures.The primary outcomes considered were the health of denture bearing areas (soft tissues, periodontal tissues and teeth) and participants' satisfaction and preference. Secondary outcomes included denture plaque coverage area, indicators of halitosis and microbial counts on abutment teeth, soft tissues or denture base or saliva. DATA COLLECTION AND ANALYSIS: Two independent review authors screened and extracted information from, and independently assessed the risk of bias in the included trials. MAIN RESULTS: Although six RCTs were included in this review, the wide range of different interventions and outcome variables did not permit pooling of data in a meta-analysis. Isolated reports indicated that chemicals and brushing appear to be more effective than placebo in the reduction of plaque coverage and microbial counts of anaerobes and aerobes on complete denture bases. AUTHORS' CONCLUSIONS: There is a lack of evidence about the comparative effectiveness of the different denture cleaning methods considered in this review. Few well designed RCTs were found. Future research should focus on comparisons between mechanical and chemical methods; the assessment of the association of methods, primary variables and costs should also receive future attention. [References: 50]

Limited evidence suggests no difference in denture cleaning methods

Laurie Moeller D.D.S.; Maureen Romer D.D.S., M.P.A. .


Overview

Systematic Review Conclusion

There is no evidence that any denture cleaning method is more beneficial for the health of denture bearing areas or patients’ satisfaction/preference when compared with another.

Critical Summary Assessment

After a thorough search and evaluation of available studies this review found that no denture cleaning intervention is better than another based on health of denture bearing areas.

Evidence Quality Rating

Limited Evidence


Structured Abstract

Clinical Questions:

Is chemical, mechanical and/or an alternate method of denture cleaning preferred in adult patients? Are there differences in outcomes for these methods on the health of denture bearing areas?

Review Methods:

The authors searched six databases for studies published up to May 2009 with no language restrictions. Three additional journals were hand searched and contact was attempted of investigators of included studies for additional published and unpublished information. The inclusion criteria were limited to randomized clinical trials (RCTs) comparing any mechanical method or chemical in adults over age 18 wearing removable partial or complete dentures. Studies were excluded if participants had implant-retained prostheses or a history of corticosteroid or antimicrobial use within 3 months. Primary outcomes considered included health of denture bearing areas and patient satisfaction and preference. Secondary outcomes included denture plaque coverage area, indicators of halitosis and intraoral microbial counts.

Main Results:

The search strategy yielded 747 references to studies; duplicates were removed resulting in 266 potentially eligible studies. Of these, 27 were reviewed and six met criteria for inclusion for a total of 192 participants. Both institutionalized and non-institutionalized patients were included; some cleaning methods were performed by caregivers, others by patients; enzymatic and chemical cleaners, placebos, mechanical brushing with soap or dentifrice, or a combination of methods was analyzed. Assessment times varied with each study. Outcomes assessments included: caregivers opinion, visual plaque score, bacterial counts, and staining then computer imaging.

Conclusion:

The review provided some evidence of the effectiveness of several cleansing methods for complete dentures (CDs). However due to the substantial clinical heterogeneity of the studies, their results should be interpreted with caution. There is no evidence that one method of cleansing CDs is better than another.

Source of Funding:

None reported


Commentary

Importance and Context:

Microorganisms found in denture plaque can lead to denture stomatitis, a burning sensation, bad breath and denture staining. Patient preference affects compliance and therefore oral health. The effectiveness and safety of denture cleansing methods to remove oral plaque has been assessed in multiple studies, but no one method proved to be best. A review by Gruvosin in 2008 addressed this issue in patients with implant-retained dentures. A careful review of all available studies should help patients and clinicians select the most appropriate method for denture cleaning.

Strengths and Weaknesses of the Systematic Review:

Strategies for study selection followed accepted methods. Furthermore the approach was appropriate and well described. Duplicate data extraction, lack of language limitations and extensive hand searching all add to the quality of this review. The inclusion criteria were well defined, as were the exclusion criteria. Detailed tables of included/excluded studies’ characteristics were included and a methodological quality review of included studies was provided. Table and graphs also illustrated an extensive discussion of bias. In addition, the authors acknowledge inadequacies in the quality of the studies reviewed including the lack of data on cost of proposed interventions.

Strengths and Weaknesses of the Evidence:

None of the included studies included participants with removable partial dentures. The settings and condition of patients varied greatly and only one study reported on patient based outcomes. More importantly, it should be noted that “patient satisfaction” in this study was reported by proxy. As a result it is still unclear what method of denture cleansing, if any, patients prefer. The age ranges of the patients and comorbidities varied widely and several of the included studies were commercially funded. No two studies in the review compared the same interventions and several combined interventions with the control groups receiving placebo or no intervention. Therefore, analyzing the efficacy of each intervention in a comparative manner was not truly possible. While several studies indicated some evidence for effectiveness of cleansing methods, the heterogeneity of the studies leaves much room for caution in their interpretation.

Implications for Dental Practice:

Many different products are marketed and little evidence is available for health care practitioners to recommend the best method of cleaning dentures. Furthermore, since no studies in this review actually queried patients regarding preference of denture cleaning methods, this issue still remains in question.


Critical Summary Publication Date:

11/7/2010

These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association © 2019

Studies unclear on best method for cleaning dentures

Laurie Moeller D.D.S.; Maureen Romer D.D.S., M.P.A.


Overview

Systematic Review Author(s)

de Souza RF, de Freitas Oliveira Paranhos H, Lovato da Silva CH, Abu-Naba'a L, Fedorowicz Z, Gurgan CA

Summary Title

Limited evidence suggests no difference in denture cleaning methods


Summary

Body:

Background

Key terms

Plaque: (pronounced plak) Plaque is a thin layer of bacteria that forms on your teeth all the time.

Dentures: Dentures are a set of artificial teeth. They can replace all of one's teeth (complete dentures) or a section of teeth (partial dentures).

Ultrasound: Ultrasound refers to high frequency sound waves. It can be used to create images, similar to radiographs, or clean devices used in dentistry.

Plaque can build up on dentures and cause oral problems like irritation to the gums, cheeks and/or roof of your mouth.  Plaque that is not regularly cleaned from dentures also can cause bad breath and can stain your dentures.  You can clean dentures in a number of ways.  They can be brushed with toothpaste or a cleaner specifically made for use with dentures.  Ultrasound devices also can be used, and there are a number of solutions in which you can soak your dentures.

The authors of this review wanted to see whether adults with dentures preferred one cleaning method over another.  They also looked to see if oral health was better depending on the method that was used. They found six studies that involved 192 adults who wore complete dentures.  

Authors' findings
None of the studies reported which method adults with complete dentures preferred for cleaning.  Each of the studies, however, looked at the health of the areas where the dentures were in contact with the mouth.  Unfortunately, these studies were all very different from one another, and the authors could not compare the results to determine which was the best method for cleaning dentures.    

Conclusions
Current research does not identify the best method for cleaning dentures. 

Additional note
If you are unsure of how to care for your dentures, talk with your dentist.


Questions:

Do adult denture wearers prefer one cleaning method over another: brushing, ultrasound, chemical solutions, or a combination of any of these?  Is there a difference in how the methods affect oral health in the areas that support the denture?

Answer:

There is no evidence that adult denture wearers prefer one method over another or that any one method is the best way to limit the effects of dentures on the mouth.