DENTURE CLEANSER & DENTURE ADHESIVE : DENTURE CLEANSER & DENTURE ADHESIVE BY,
R.VENKATESHWARAN Contents: : Contents: Introduction
Mode of action
Reference Introduction: : Introduction: The purpose of using denture adhesives.
Improved chewing ability and confidence. Requirements: : Requirements: Neutral or slightly basic pH
Minimal toxicity to the oral mucosa
Adhesive bond strength for 12 to 16 hours
Easier to clean off oral tissues
Easier to clean off denture
More readily available in shops
Better taste and fit Classification: : Classification: Based on components:
Natural gum - Karaya gum.
Synthetic gum - Grantez polymer.
Based on duration of action:
Long acting - Poly vinyl methyl ether maleate
Short acting – carboxy methyl cellulose
Based on forms:
Powder. Composition: : Composition: Mode of action: : Mode of action: Swell to obliterate the space between the base of denture and the oral mucosa.
Increase the coefficient of surface tension of the fluid
Forms a viscous gel on contact with water
Increases cohesiveness of the film of saliva by increasing viscosity of the film. Slide 9: Before applying adhesive After applying adhesive Viscous gel Indications: : Indications: Patient’s perceived retention and stability expectations
Salivary dysfunction or neurological disorders
Xerostomia due to medication side effects
Head and neck irradiation
Systemic disease or disease of salivary gland
Cerebro-vascular accident (stroke) Contraindication: : Contraindication: For the retention of improperly fabricated denture or poorly fitting prostheses Toothpaste as denture adhesive: : Toothpaste as denture adhesive: Poor retention of complete denture trial bases can interfere with jaw relation record-making and clinical evaluation of tooth arrangement. ? Not a denture adhesive : ? Not a denture adhesive Difficult to remove from the bases and the patient's mouth,
Potentially spread infectious material or lead to contamination of dental casts, which may result in the adhesive being incorporated into the final denture base. ? To a tooth paste : ? To a tooth paste Toothpastes are similar in viscosity to denture adhesive pastes
Toothpaste placed in denture bases, as if it were an adhesive, forms a seal that will provide a temporary improvement in retention
Provide the opportunity to make inter-occlussal records or evaluate phonetics and esthetics of trial tooth arrangements Advantage: : Advantage: Pleasant taste and are water soluble, permits easy cleaning
Risk of adhesive contamination is reduced
Cost is not a factor Disadvantage : Disadvantage Mandibular dentures lined with toothpaste are not as retentive as maxillary dentures, so an adhesive might still be the material of choice. Direction for use: : Direction for use: Choice between cream and powder is largely subjective for individual
Least amount of material that is used should be 0.5-1.5g / denture unit (more for larger alveolar ridge, less for small ones)
Prosthesis should be moistened and then a thin adhesive sprayed onto denture surface Paste form: : Paste form: Comes in a tube and is squeezed onto the impression surface of the denture
Denture paste is probably the most preferred type of adhesive
Paste also comes in a variety of flavors and strengths Method to use paste form: : Method to use paste form: Two approaches to apply paste form:
Small spots Thin bead technique: On maxilla: : Thin bead technique: On maxilla: Beads of adhesive placed in the
Depth of dried denture in incisor region and molar regions.
An anteroposterior bead along mid palate.
Apply three small lines into the into impression surface of denture. Spot technique: : Spot technique: Small spots of cream are placed at 5-mm intervals throughout the fitting surface of dried denture uniformly in both maxilla and mandible. Powder form: : Powder form: Powders are sprinkled over the impression surface of denture.
The saliva in mouth, it activates the powder into sticky viscous gel holding denture in position. Slide 23: Inadequate or absent saliva, the denture should be slightly moistened with water before being inserted.
Easier to clean off the tissue surface after the dentures are removed. Powder form Vs Paste form : Powder form Vs Paste form Denture maintenance : Denture maintenance Daily removal of adhesive product from tissue surface
Prosthesis soaked in water over night, so readily rinsed off.
Running hot water over tissue surface of denture while scrubbing with a hard toothbrush.
Adhesive on ridge is removed by rinsing with warm or hot water and then firmly wiping the area with gauze or a washcloth saturated with hot water . References:Books: : References:Books: Prosthodontic treatment for edentulous patients Zarb, bolender.
Applied dental materials-John.F.McCabe
Anusavice, Phillip’s science of dental materials – Tenth edition
Craig 12th edition – restorative dental materials
Dental materials properties and selection – William j.o’brein
Clinical dental materials – Michael bagby Journals: : Journals: Denture adhesive: cyto-toxicity, microbial contamination and formaldehyde content; Journal of prosthetic dentistry; vol:69 issue :3; 314-317;1983.
Effect of denture adhesive on maxillary denture stability; Journal of prosthetic dentistry; vol:72; 399-405;1994.
A method of studying the effect of adhesives on denture retention. Journal of prosthetic dentistry; vol:50; issue :3;332-337;1983. Slide 28: Laboratory evaluation of a new denture adhesive; Journal of Dental Materials; vol: 20; 419–424; 2004.
Tooth paste used as short acting denture adhesive; Journal of prosthetic dentistry; vol:74; 119. 1995.
Usage of denture adhesives; Journal of Dentistry; vol:28; 137–140;2000.g Conclusion : Conclusion A useful adjunct in denture prosthesis services, with specific roles in both fabrication and post insertion phases.
They also indicated that the dual goals of maximizing the beneficial aspects of denture adhesive use while minimizing the misuse of denture adhesives be achieved. DENTURE CLEANSER : DENTURE CLEANSER Contents: : Contents: Introduction
Conclusion Introduction : Introduction Growth in the aging population has resulted in an increasing number of older persons requiring dentures.
Proper cleansing of dentures is an essential daily routine in order to ensure the safety and satisfaction of the edentulous patient.
To maintain an esthetic, odor-free appliance. Denture debris : Denture debris Every surface in the oral cavity, natural or synthetic, becomes covered within about 30 minutes with a 0.5-1.5 µ-thick precipitate of salivary glycoprotein and immunoglobulin that is termed "pellicle”. Slide 34: Calculus is also readily stained by tobacco, tea, coffee, certain medications (particularly iron supplements), and numerous other ingested materials. Composition : Composition Alkaline perborate -compounds for oxidizing,
Perborate and/or carbonate -effervescing,
Color, and fragrance agents. Types: : Types: Mechanical method.
Ultrasonic cleanser. Mechanical method : Mechanical method use of a brush in the presence of either hot or cold water
Toothbrushes and nailbrushes are also effective in removing gross material. Slide 38: Place paper towel or wash cloth in sink to prevent breakage if
Clean under cool water to prevent warping
Scrub all areas with denture brush Denture Brushes : Denture Brushes Should have pointed side
Should be discarded or sterilized following illness or infection
Replaced when frayed or dirty Boxes : Boxes Cleaned weekly
Sterilized following illness or infection or replace Disadvantage: : Disadvantage: Microbiologic assays and scanning electron microscopic images demonstrate that use of a denture brush with water is ineffective at removing an unacceptably large proportion of adherent microorganisms. Chemical methods: : Chemical methods: Most chemical means of disinfection is accomplished through exposure of the organisms to oxygen tension levels greater than oxygen tension levels in the mouth.
2H2O2 2H2O + 2[O]
(nascent oxygen) Advantage: : Advantage: Are potentially an effective for the control of common oral bacteria.
Significant reductions of microbial populations were achieved without the mechanical disruptive action of brushing in as little as 90 seconds.
Level of antimicrobial efficacy was comparable for a diverse range of microbes. Disadvantage : Disadvantage The color stability of denture base acrylic resins was influenced.
The presence of bleach is that metallic elements of removable partial dentures acquire a tenacious black stain after soaking in the bleach solution for more than 10 minutes daily. Effervescent cleansing tablet : Effervescent cleansing tablet Ultra sonic denture cleanser : Ultra sonic denture cleanser Sonic Denture Cleaner is an effective and simple way to clean dentures
The Sonic Denture Cleanser effectively removes discolouration caused by coffee, tea, red wine and tobacco.
It also removes lingering food odours, such as smells of onions and garlic. Mode of action : Mode of action The Sonic Denture Cleaner is integrated with UV sterilization and nano silver bacteriostasis.
It utilizes the latest electronic technology and does not require any consumables or special cleaning fluids.
The inner compartment becomes nano silver mixture holder as soon as you fill it with cold tap water. Slide 49: Sonic waves vibrate 8000 times per minute, removing tartar and food debris lodged between individual denture teeth and around the gum plates.
The sterilizing UV light and the bacteriostatic action of the nano-silver destroy bacteria. Stains are removed and your dentures are fresh, clean and bright again! Vinegar as an anti-microbial agent : Vinegar as an anti-microbial agent Candida albicans strains are associated with denture-induced stomatitis.
Dentures immersed in a 10% vinegar solution (pH less than 3) overnight.
A significant reduction was verified in counts of Candida after treatment.
Reduced amounts of Candida spp. in the saliva and the presence of denture stomatitis in the patients. Nystatin anti-fungal suspension : Nystatin anti-fungal suspension A useful adjunct in the management of denture stomatitis.
Banting and colleagues found that a 10% dilution of 1:100,000 suspension of nystatin was no more effective than distilled water in reducing organisms on the denture surface. Air drying : Air drying Not a widespread acceptance denture cleaning technique for two reasons.
Drying an unclean denture will make the adherent material stick ever more tightly even as it fails to remove microbial surface antigens and exotoxins.
Dentists have historically been told that air drying an acrylic denture will distort its contours. Danger in denture cleanser : Danger in denture cleanser Symptoms of an allergic reaction
Breathing problems, and
Low blood pressure. Misuse of denture cleansers : Misuse of denture cleansers Some cleansers may list mouthwash as an ingredient, but consumers should never chew, swallow, or gargle with denture cleansers.
Dentures should be thoroughly rinsed with water before they are placed in the mouth. Advances Silicone Polymer : Advances Silicone Polymer A component of commercial denture cleanser,silicone polymer to which oral bacteria are unable to adhere.
The component floats on the surface of the denture bath, and when the denture is removed from the solution, a thin layer (constituting 0.1-0.8 mg) of the material coats all surfaces of the prosthesis. Microwave radiation : Microwave radiation They found the method to be effective at significantly reducing the number of cultivable organisms on the dentures, but non-viable organisms and their by-products still present after exposure to the radiation will still able to elicit an unwanted host response. Conclusion : Conclusion Dental professionals must have a current knowledge of denture cleansing strategies in order to maximize the service offered to denture patients.
Care and cleaning of dentures is more than a strictly esthetic concern References: : References: Books:
Anusavice-Phillip’s science of dental materials(tenth edition)
Craig 12th edition-Restorative dental materials
Michael bagby-Clinical dental materials
William J. o’brein-Dental materials properties and selection Journals: : Journals: "Allergic Contact Cheilitis Due to Effervescent Dental Cleanser: Combined Responsibilities of the Allergen Persulfate and Prosthesis Porosity," Conracr Dennariris. 41(5):268-271, November 1999.
The attitude of complete denture wearers towards denture adhesives in Istanbul; Journal of Oral Rehabilitation vol 31; 131–134 2004 Slide 60: The Evaluation of Denture Retention and Ease of Removal from Oral Mucosa on a New Gel-Type Denture Adhesive; J Jpn Prosthodont Soc 52：175-182, 2008
Vinegar As An Antimicrobial Agent For Control Of Candida spp. in complete denture wearers; J Appl Oral Sci. 2008;16(6):385-90
A Clinical Study to Assess the Breath Protection Efficacy of Denture Adhesive The Journal of Contemporary Dental Practice, Volume 3, No. 4, November 15, 2002 DENTUR ADHESIVE Journal References : DENTUR ADHESIVE Journal References BY,
R.VENKATESHWARAN Effect of denture adhesive on the retention and stability of maxillary dentures. JPD 1994, Vol:74,Issue:4.Joseph.E.Grasso : Effect of denture adhesive on the retention and stability of maxillary dentures. JPD 1994, Vol:74,Issue:4.Joseph.E.Grasso This study to measure effectiveness of denture adhesive.It used qualitative method to measure the effects of a denture adhesive on retention and stability of maxillary denture.
Improvement of retention was greatest for vertical dimension because ridge serve as a physical boundary, limiting movement in anterior/posterior/lateral movements. Cont… : Cont… Maximum adhesive property was seen at 2-4hours after application.
Use of adhesive reduced minor denture movements to 0.9-1.3mm in vertical dimension and 0.2-0.5mm in anterior/posterior/lateral dimension for both type of dentures.
Increase in incisal bite force from 20-35N at base line to a maximum of 54N at 8 hours after application. Use of denture axdhesive as an aid to denture treatment.JPD 1994,Vol.62 : Use of denture axdhesive as an aid to denture treatment.JPD 1994,Vol.62 History of denture adhesive :
Began only in age of modern dentistry, no reference available in text till late 18th century.
Adhesive used in the beginning of 19th century.
First patent was issued in 1913.
First ADA reference came from accepted dental remedies in 1935.
Allwrith found first non water soluble adhesive Cont.. : Cont.. Initially adhesive were formulated by an apothecary who mixed vegetable gums to produce a material that absorbed moisture from saliva and swelled to mucilaginous substrate that adhered to mucosa and denture Denture adhesives and uses, JADA 1996, Vol:127 : Denture adhesives and uses, JADA 1996, Vol:127 In 1945 adhesive were used only to hold base plate while “recording dental relation”.
In immediate denture construction until well fitting denture were completed. Denture adhesive: Choosing the right powder, JADA 1991,Vol 122 : Denture adhesive: Choosing the right powder, JADA 1991,Vol 122 Shay described that the material swells 50%-150% by volume in presence of water filling in space between prosthesis and tissue. As water is absorbed by adhesive agent, the resulting anions are attracted to cations in mucous membrane protein producing stickiness. Cont.. : Cont.. The physical forces are based on a principle derived by Stefan over a century ago, which states force required to pull two discs or plates apart is directly proportional to viscosity of liquid between them.
Saliva increases viscosity there by increasing the force required to separate prosthesis from oral mucous.
Modern adhesive have increased adhesive property by increase bio adhesive and cohesive forces. Mechanism of action : Mechanism of action Most adhesive ingredient provide bio adhesion via carboxyl group.
As adhesive hydrates free carboxyl group from electrovalent bond that produce stickiness.
Poly methyl vinyl ether maleic anhydride is a co polymer synthetic compound widely used because of its high level of carboxyl group.
As most of oral cavity is of anionic charge it readily adheres with calcium cation formed by adhesive. Cont.. : Cont.. In 1970’s divalent salts of PVM-MA in addition with carboxyl methyl cellulose (CMC).
There is a quick upfront hold through CMC and long duration through PVM-MA divalent salt.
The presence of divalent salt reduced rate of dissolution.
Increased overall material by developing a highly cross linked matrix between CMC,PVM-MA copolymer and divalent calcium ion. Relation to oral prosthesis : Relation to oral prosthesis In 1940-Bartel’s-Adhesive did not inhibit presence of micro organism.
In 1950-Kelly’s-Did not support bacterial growth.
In 1970-Stafford and Russell-adhesive supported some microbial growth (candida abicans). But were unable to demonstrate that adhesive have inhibitory effect on oral mucosa. Cont.. : Cont.. Abdelmelak and Michael- Alter histology of oral mucosa during the period adhesive got adapted to adhesive. There was a marked decrease in surface keratin.
In 1980-Tarbet,Grossman-No incidence of mucosal irritation.
Shay quoted that “Misled by biased product information, misinformed by anecdotal reports or totally uninformed denture adhesive. Professional attitude towards denture adhesive, JPD,Vol:82,Issue:1. : Professional attitude towards denture adhesive, JPD,Vol:82,Issue:1. Many of dentist does not consider denture adhesive as an useful adjunct to complete denture.
Instead they considered use of denture adhesive as a stigma in their practice and it also had some physcological effects on patients that denture is ill fitting.
It was considered that denture adhesive can have negative influence on both denture and dentist by masking underlying denture problems, avoiding necessary dental visit. Cont.. : Cont.. Can also contribute to occurrence of candida albicans causing candidiasis and denture stomatitis. JPD 1989,Vol:69,Issue:3 : JPD 1989,Vol:69,Issue:3 Microbial contamination was more pronounced with use of natural gum raw materials.
Denture adhesive containing karaya gum may worsen any pre-disposition to caries. IJPD 2005, Volume:14, Issue:2 : IJPD 2005, Volume:14, Issue:2 Use of denture adhesive significantly increased the BFDD (maximum bite force until denture dislodgement) Adhesives for maxillo facial prosthesis, JPD 2002,Volume:88, Issue 5 : Adhesives for maxillo facial prosthesis, JPD 2002,Volume:88, Issue 5 Denture adhesive paste can also be used to retain an extra oral facial prosthesis wax pattern for trial placement.
Because holding pattern with hand may disrupt in assessing the angulations and placement and assessment of prosthetic success.
Is used for temporary retention of prosthesis.