Laurie Moeller D.D.S.; Maureen Romer D.D.S., M.P.A.
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.
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.
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?
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journals were hand searched and contact was attempted of investigators of included studies for additional published and unpublished information.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.
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.
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:
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.