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DENTURE CLEANSER & DENTURE ADHESIVE
BY,R.VENKATESHWARAN
Contents:IntroductionRequirementsClassificationComposition Mode of actionSpecial scenarioDenture maintenanceConclusionReference
Introduction:
The purpose of using denture adhesives.
Improved fitComfort Improved chewing ability and confidence.
Requirements: Neutral or slightly basic pHMinimal toxicity to the oral mucosaAdhesive bond strength for 12 to 16 hoursEasier to clean off oral tissuesEasier to clean off dentureLess messyMore readily available in shopsLess expensiveBetter 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 maleate Short acting – carboxy methyl celluloseBased on forms: Paste. Powder.
Composition: Components Action
Poly vinyl methyl ether maleate,
Karaya gum, Methyl cellulose, Hydroxy methyl cellulose,Carboxy methyl cellulose
sodium.
Swell and are responsible for adhesive properties.
Sodium borate, Sodium tetra borate, Hexa chlorophene.
Antimicrobial agent
Propythy-hydroxy benzoate Preservative and anti fungal
Sodium lauryl sulfate Wetting agent
Magnesium oxide Filler
Silicon-di-oxide, calcium stearate
To minimize clumping
Petrolatum, mineral oil, poly ethylene oxide
Binder
Menthol, Pepper mint oil & oil of winter green
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 fluidForms a viscous gel on contact with waterIncreases cohesiveness of the film of saliva by increasing viscosity of the film.
Before applying adhesive After applying adhesive
Viscous gel
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:
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 dentureDenture 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 beadsSmall 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, 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: 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; 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
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 µ-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
droppedClean under cool water
to prevent warpingScrub 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 Function25–40% DuPont Oxone10–20% Sodiumperboratemonohydrate (SPBMH)
Primary bleaching agent, effective atroom temperature and at pH 6–10.
Secondary bleaching agent
10–20% Sodium bicarbonate
Buffer and carbonate source for effervescence
10–15% Sodium carbonate
Buffer and carbonate source for effervescence
10–15% Citric acid Acid source for CO2 effervescence
1–3% Polyvinylpyrrolidone
Binder
1% Detergent Emulsifier
1% EDTA Chelant and detergency builder
1–2% Sodium benzoate
Preservative
0.5% Flavor Fragrance
0.1–0.3% Magnesium stearate
Mold release agent
0.1% Color
Sodium sulfate 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-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: "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
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
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 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
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..
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.