Keys to Dental Prosthesis Care

Maintaining healthy soft tissue, gingiva, and bone structure postdelivery of a fixed or removable prosthesis is paramount to the therapy’s long-term success. Toward this goal, clinicians can help patients maintain their dental prostheses by educating them about the many factors affecting oral health and appliance longevity. In providing such information, dentists must consider each patients’ oral health, general health and comorbidities. Fungal infections, for example, are not uncommon in denture wearers.¹ 

A plethora of chemicals and tools are indicated for the care of an intraoral prosthesis, and clinicians should help guide patients, as some of these products are contraindicated for use with specific prostheses, or for patients presenting with certain medical comorbidities. 

In addition, dentures are fabricated using multiple materials. Understanding which product works best for the denture being placed is paramount to achieving optimal long-term outcomes. This article will address appropriate care for various appliances.

CONVENTIONAL DENTURES

Because the need to treat edentulism is commensurate with an aging population, the demand for complete dentures is expected to continue.² Maintaining complete denture cleanliness is crucial to minimize the amount of harmful oral microflora that will adhere to dentures. Several measures need to be taken to ensure denture maintenance throughout the life of the prosthesis;³ for example, when the patient is not wearing the denture, it is recommended that it be placed in water to avoid distortion.¹ There are multiple ways described in the literature to clean dentures, including:

• Brushing⁴
• Soaking in either commercial tablets or sodium hypochlorite (NaOCL) for 10 minutes, before being moved to water⁵
• Ultrasonic cleaning⁶
• Microwave disinfection⁷

According to the American College of Prosthodontists’ guidelines, denture adhesives may be utilized for severely compromised ridges after the fit has been fabricated to the limitations of the remaining tissues. While adhesives should not be used to compensate for poorly made or ill-fitting dentures, the use of denture adhesives may improve masticatory function. These products are available in gels, powders and pads.

Applying gel adhesives should be done by adding three to four pea-size dots on the intaglio surface. Powder adhesives are used by lightly coating the intaglio surface after wetting the denture. Pad adhesives should be trimmed and placed within the confines of the intaglio surface. Excess amounts of all three types of adhesives should be removed.³

Following denture delivery, the patient should be examined after one to three days to evaluate and make appropriate adjustments to the occlusion and tissue-bearing areas. The patient is encouraged to maintain constant communication with the dentist if further adjustments are necessary. A yearly recare visit should be scheduled to examine the dentures, attachments and oral tissues.⁸ 

IMPLANT-RETAINED DENTURES 

Implant-retained overdentures differ from conventional dentures by virtue of the implant component that aids retention. Yet they are also similar, as the prosthesis is tissue supported and should be fully extended, as would a conventional denture. Maintaining implant-retained overdentures entails caring for the attachments and inserts, as well as the denture itself.

There are many attachment systems available, and three of the most common are locator attachments, O-ring attachments and Hader bars. Studies have looked at how different denture cleaners affect the retention of these components, and what that could mean in a clinical setting. A study by Ayyildiz et al⁹ compared retention loss values in blue, pink and clear locator attachment inserts after immersion in three commonly used denture cleaners at one, three and 12 months. The authors concluded that retention decreased in all three groups, with NaOCL having the greatest negative effect. 

Likewise, the same findings were noted in studies by Nguyen et al¹⁰ and You et al.¹¹ The Nguyen et al¹⁰ study reported that the studied mouthwash increased the retentive values of pink locator attachments, whereas other commercial cleaners did not statistically affect retention. In 2016, Kürkcüoğlu et al¹² reported locator attachment inserts (blue, pink and clear) were affected differently when soaked in commercial solutions. Blue inserts were significantly negatively affected by cleaners containing sodium bicarbonate (NaHCO₃) and NaOCL, while clear attachments were only affected by cleaners containing NaHCO₃.¹² Water temperature was found to have an effect on the retention loss of locator attachment inserts. A 2017 study found that immersing locator attachment inserts in water at 140° Fahrenheit resulted in significantly increased retention loss compared to 68.0°F and 98.6°F water.¹³

Similarly, O-rings were found to be affected when immersed in denture cleaners. Studies conducted by Felipucci et al¹⁴ and Derafshi et al¹⁵ concluded that O-ring attachments suffered retention loss when placed in denture cleaners compared to water. It was also reported that NaOCL caused the most retention loss.^14,15 

Studying Hader clips, Varghese et al¹⁶ reported that yellow Hader clips did not suffer significant retention loss when immersed in commercial dentures cleaners, as compared to water. In fact, the clips had increased retention values when immersed in NaOCL. However, the authors did not recommend the use of NaOCL, as this increase in retention may be the result of the Hader clips becoming more rigid.

IMPLANT-SUPPORTED FIXED COMPLETE DENTURES

It is recommended that full-arch fixed implant prostheses be evaluated every two to six months for follow-up. Radiographic assessment should be conducted every one to two years — or sooner if signs of peri-implantitis or peri-implant mucositis are present.^17,18 During the maintenance visit, the patient’s history should be updated and a clinical exam performed to assess the prosthesis and peri-implant tissue. Probing depths and bleeding on probing around the implants should be documented and compared to the baseline probing depths recorded during prosthesis placement.^18,19 Full-arch fixed implant prostheses need not be removed unless there is evidence of disease, a prosthetic complication, or a component misfit on the radiograph. If the prosthesis is removed, new screws should be used to reinsert the prosthesis.²⁰ In addition, clinicians should educate patients and caregivers on how to clean under fixed appliances. Prostheses are maintained by brushing and additional oral hygiene tools, such as any combination of the following:

• Floss
• Water flossers
• Interdental brushes¹⁷
• Occlusal devices

While numerous over-the-counter products are available to care for various prostheses, a thorough understanding of the chemical components is essential to the long-term sustainability of the denture and oral supporting structures. This again speaks to the need for patient education from the dental team.

CARE FOR CONVENTIONAL DENTURES

Conventional dentures are one of the most common prostheses for edentulous patients. An investigation by Sharma et al²¹ noted the importance of patient education and proper oral hygiene for denture wearers. A patient presenting with a denture that has not been properly cared for may suggest a lack of patient education and/​or a lack of interest on the dentist’s part to have the prosthesis last for many years.^21–24 At the same time, a patient may have the knowledge, yet lack the physical or mental ability to clean the prosthesis.²⁵ Harikrishnan et al²⁶ and Peracini et al²⁷ conducted studies with similar outcomes that assessed awareness of denture care results with five cleaning methods. They reported that patients used water, toothpaste, and/​or a toothbrush combination to clean their dentures on a daily basis by:^26,27

• Brushing with water
• Brushing with soap
• Brushing with toothpaste
• Soaking in mouthrinse
• Brushing and soaking in mouthrinse²⁸

Consumer products used to soak a denture typically list sodium bicarbonate as the key ingredient. In addition, products commonly used to brush a denture are formulated to provide effective cleaning, yet without abrasive levels sufficient to damage the appliance.

Proper brushing will reduce bacterial and fungal growth on the denture and oral tissues. Oral candidiasis is found in 60% of healthy denture wearers, so educating patients about the type of brush to use for denture care is important.^24,29 There is a difference in the coarseness of the bristles between a manual toothbrush and denture brush. The coarseness/​hardness of the bristles of a regular toothbrush will increase the risk of developing roughness in the acrylic prosthesis and, subsequently, raise the incidence of bacterial growth on the denture.^27,29,30 Along these same lines, brushing with vinegar, bleach or baking soda may roughen dentures. The design of an end-tufted toothbrush will ensure easier cleansability of any attachments on the denture and implants (if present). 

When a denture-wearing patient presents with candidiasis, both the oral cavity and denture should be treated to eliminate the fungal infection. In this scenario, the recommended treatment for candidiasis is seven to 10 days.³¹ Once the dentist has reviewed the patient’s medical history, the choice is made as to which drug is indicated to treat the oral fungus. The drug options are outlined in Table 1.

Educating patients about the importance of soaking the denture and not brushing the denture when Candida is present is also indicated. Dentures that are not treated raise the risk of patients developing mucosal lesions, inflamed mucosal tissues, and pneumonia.³² If the dentures have soft liners, they should be soaked in an enzyme plus neutral peroxide denture cleaning solution to minimize surface degradation.³³

MEDICAL CONSIDERATIONS

Oral and medical concerns that should be considered with all patients who wear dentures include: 

Allergies: Completing a through medical history on the patient will help decrease the possibility of adverse events. One of the ingredients in denture cleaners is persulfate. Patients who are allergic to sulfur should evaluate each denture product they are considering to ensure this ingredient is not incorporated. 

Toxicity: Denture cleaners can be toxic if swallowed. Stressing the importance of thorough rinsing after cleaning will help patients avoid toxicity issues. In addition, patients should be cautioned about using too much zinc-containing dental adhesive, as adverse events have been reported.

Breakage: Instructing the patient about proper denture cleaning technique can help minimize problems with broken dentures. Placing water or a towel in the sink will act as a cushion if the prosthesis is dropped, as it may become slippery during the cleaning process. 

Inhalation Pneumonia: Linuma et al³⁴ conducted an investigation with 524 subjects who wore their dentures while sleeping. The study revealed these patients contracted inhalation pneumonia at a rate two times the norm.

Chronic Obstructive Pulmonary Disease (COPD): Patients who do not exhibit good denture oral hygiene are at increased risk for COPD. In addition, the same was noted with patients presenting with nicotine stomatitis.³⁵ 

CONCLUSION

Caring for a dental prosthesis is an ongoing process for the patient and oral healthcare team. Educating the patient about proper maintenance protocols related to the prosthesis and attachments will support the health of the oral tissues, as well as appliance longevity. 

Considering that locators are the most common attachment used when designing an implant-retained denture, clinicians should provide information specific to this type of device to help patients maintain oral health and maximize the service life of the prosthesis. Implant-supported, fixed full-arch prostheses need not be removed unless the patient presents with just cause. If a patient presents with candidiasis, a full medical history should be reviewed and treatment customized in a manner that treats not only the oral tissues, but the prothesis as well. 

Ultimately, ensuring oral health and long-term prosthesis function requires a team effort that includes the dentist, dental hygienist, and an educated patient. 

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KEY TAKEAWAYS

• Oral healthcare teams can help patients maintain their dental prostheses by educating patients about the many factors affecting oral health and appliance longevity.
• Numerous chemicals and tools are indicated for the care of an intraoral prosthesis, and clinicians should help guide patients, as some of these products are contraindicated for use with specific prostheses or for patients with certain medical comorbidities.
• In addition, dentures are fabricated using multiple materials. Understanding which products work best for the denture being placed is paramount to achieving optimal long-term outcomes.
• Maintaining denture cleanliness will minimize the amount of harmful oral microflora that adheres to the appliance.
• Use of a proper cleaning brush is essential, as the bristle coarseness/hardness of a regular toothbrush increases the risk of developing roughness in an acrylic prosthesis, and thus raises the odds of bacterial growth and disease.^27,29,30
• Maintaining implant-retained overdentures entails caring for the attachments and inserts, as well as the denture itself.
• While various products are available to care for dental prostheses, a thorough understanding of the chemical components is essential to the long-term sustainability of the denture and oral supporting structures. 
• This again speaks to the need for patient education from the dental team.

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REFERENCES

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From Decisions in Dentistry. April 2022;8(4)14, 16-18.