DENTURE CLEANSER & DENTURE ADHESIVE

BY, R.VENKATESHWARAN

Contents:
Introduction Requirements Classification Composition Mode of action Special scenario Denture maintenance Conclusion Reference

Introduction:
The purpose of using denture adhesives. Improved fit Comfort Improved chewing ability and confidence.

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 Less messy More readily available in shops Less expensive Better taste and fit

Classification:

Based on components: Natural gum - Karaya gum. Synthetic gum - Grantez polymer. Based on duration of action: Long acting - Poly vinyl methyl ether maleat Short acting carboxy methyl cellulose Based on forms: Paste. Powder.

Composition:
Components Action

Poly vinyl methyl ether maleate, Karaya gum, Methyl cellulose, Hydroxy methyl cellulose, Carboxy methyl cellulose sodium. Sodium borate, Sodium tetra borate, Hexa chlorophene.

Swell and are responsible for adhesive properties.

Antimicrobial agent

Propythy-hydroxy benzoate Sodium lauryl sulfate Magnesium oxide Silicon-di-oxide, calcium stearate Petrolatum, mineral oil, poly ethylene oxide Menthol, Pepper mint oil & oil of winter green

Preservative and anti fungal Wetting agent Filler To minimize clumping Binder Flavoring agent

Mode of action:
Swell to obliterate the space between the base of denture and the oral mucosa.
Influence: 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.

Viscous gel

Before applying adhesive

After applying adhesive

Indications:

Patients 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:
For the retention of improperly fabricated denture or poorly fitting prostheses

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

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
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:
Pleasant taste and are water soluble, permits easy cleaning Risk of adhesive contamination is reduced Cost is not a factor

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:

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:
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:

Two approaches to apply paste form:
Thin beads Small spots

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. On mandible: Apply three small lines into the into impression surface of denture.

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:
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.

 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 formulation Paste formulation

Degree of hold is less. Duration of action is short. Can be used in smaller quantities. Easy to clean of denture and tissue. Initial hold is achieved soon.

Degree of hold is high Duration of action is long. Requires more material. Difficult to clean of denture and tissue. Initial hold is achieved comparatively late.

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:
Prosthodontic treatment for edentulous patients Zarb, bolender. Applied dental materials-John.F.McCabe Anusavice, Phillips science of dental materials Tenth edition Craig 12th edition restorative dental materials Dental materials properties and selection William j.obrein Clinical dental materials Michael bagby

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.

Laboratory evaluation of a new denture adhesive; Journal of Dental Materials; vol: 20; 419424; 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; 137140;2000.g

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

Contents:
Introduction Composition Types Denture debris Advances Conclusion

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
Every surface in the oral cavity, natural or synthetic, becomes covered within about 30 minutes with a 0.5-1.5 -thick precipitate of salivary glycoprotein and immunoglobulin that is termed "pellicle.

 Calculus is also readily stained by tobacco, tea, coffee, certain medications (particularly iron supplements), and numerous other ingested materials.

Composition
Alkaline perborate -compounds for oxidizing, Perborate and/or carbonate effervescing, Edta -chelating, Silicone polymer, Detergent, Color, and fragrance agents.

Types:
Mechanical method. Chemical method. Combination method. Ultrasonic cleanser.

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.

Place paper towel or wash cloth in sink to prevent breakage if dropped Clean under cool water to prevent warping Scrub all areas with denture brush

Denture Brushes
Should have pointed side Should be discarded or sterilized following illness or infection Replaced when frayed or dirty

Boxes
Cleaned weekly Sterilized following illness or infection or replace

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:
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:
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
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

Ingredient
2540% DuPont Oxone 1020% Sodiumperborate monohydrate (SPBMH) 1020% Sodium bicarbonate 1015% Sodium carbonate

Function
Primary bleaching agent, effective at room temperature and at pH 610. Secondary bleaching agent Buffer and carbonate source for effervescence Buffer and carbonate source for effervescence

1015% Citric acid Acid source for CO2 effervescence

13% Polyvinylpyrrolidone 1% Detergent 1% EDTA

Binder Emulsifier Chelant and detergency builder

12% Sodium benzoate

0.5% Flavor 0.10.3% Magnesium stearate 0.1% Sodium sulfate

Preservative
Fragrance Mold release agent Color Filler

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
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.

 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

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

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
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

Symptoms of an allergic reaction Irritation Tissue damage, Rash, Hives, Gum tenderness, Breathing problems, and Low blood pressure.

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

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
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
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:
Books: Anusavice-Phillips science of dental materials(tenth edition) Craig 12th edition-Restorative dental materials Michael bagby-Clinical dental materials William J. obrein-Dental materials properties and selection

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; 131134 2004

The Evaluation of Denture Retention and Ease of Removal from Oral Mucosa on a New GelType Denture Adhesive; J Jpn Prosthodont Soc 52175-182, 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

BY, R.VENKATESHWARAN

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
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

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..
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

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

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..
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
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..
In 1970s 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

In 1940-Bartels-Adhesive did not inhibit presence of micro organism. In 1950-Kellys-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..
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.

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..
Can also contribute to occurrence of candida
albicans causing candidiasis and denture stomatitis.

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

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

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.