Impact of frequency of denture cleaning on microbial and clinical parameters - a bench to chairside approach

Gordon Ramage, Lindsay O'Donnell, Leighann Sherry, Shauna Culshaw, Jeremy Bagg, Marta Czesnikiewicz-Guzik, Clare Brown, Debbie McKenzie, Laura Cross, Andrew MacInnes, David Bradshaw, Roshan Varghese, Paola Gomez Pereira, Anto Jose, Susmita Sanyal, Douglas Robertson, Gordon Ramage, Lindsay O'Donnell, Leighann Sherry, Shauna Culshaw, Jeremy Bagg, Marta Czesnikiewicz-Guzik, Clare Brown, Debbie McKenzie, Laura Cross, Andrew MacInnes, David Bradshaw, Roshan Varghese, Paola Gomez Pereira, Anto Jose, Susmita Sanyal, Douglas Robertson

Abstract

Objective: Robust scientific and clinical evidence of how to appropriately manage denture plaque is lacking. This two-part study (i) developed an in vitro model of denture plaque removal, and (ii) assessed effectiveness of these approaches in a randomised clinical trial. Method: (i) a complex denture plaque model was developed using the dominant microbial genera from a recent microbiome analyses. Biofilms formed on polymethylmethacrylate were brushed daily with a wet toothbrush, then either treated daily for 5 days or only on Days 1 and 5 with Polident® denture cleanser tablets (3 min soaking). Quantitative and qualitative microbiological assessments were performed. (ii), an examiner-blind, randomised, crossover study of complete maxillary denture wearers was performed (n = 19). Either once-daily for 7 days or on Day 7 only, participants soaked dentures for 15 min using Corega® denture cleansing tables, then brushed. Denture plaque microbiological assessment used sterilized filter paper discs. Results: The in vitro model showed daily cleaning with denture cleanser plus brushing significantly reduced microbial numbers compared to intermittent denture cleaning with daily brushing (p < 0.001). The clinical component of the study showed a statistically significant reduction in denture plaque microbial numbers in favour of daily versus weekly treatment (aerobic bacteria p = 0.0144). Both in vitro and in vivo studies showed that denture plaque biofilm composition were affected by different treatment arms. Conclusions: This study demonstrated that daily denture cleansing regimens are superior to intermittent denture cleansing, and that cleansing regimens can induce denture plaque compositional changes. Clinicaltrials.gov registration: NCT02780661.

Keywords: Denture; antimicrobials; denture cleansing; microbiology; oral microbiome; plaque.

Figures

Figure 1.
Figure 1.
Sequential treatment of denture biofilm protocol.
Figure 2.
Figure 2.
Study flow.
Figure 3.
Figure 3.
Quadrants used for sampling.
Figure 4.
Figure 4.
Daily CFU/mL counts of A) aerobic bacteria, B) anaerobic bacteria and C) total yeast count (±standard deviation) post treatment.
Figure 5.
Figure 5.
Principal component analysis showing different in vitro treatment outcomes associated with total and viable cell populations.
Figure 6.
Figure 6.
Daily CFE counts of (a) total bacteria and (b) total yeasts post treatment (±standard deviation).
Figure 7.
Figure 7.
Microbial composition as assessed by qPCR from in vitro denture disc samples. (a) Untreated [UT], (b) Denture cleanser [DT], (c) Brushing [IT].
Figure 8.
Figure 8.
(a) Aerobic bacteria and (b) Anaerobic bacteria microbial count Log10 (CFU/disc) by visit and treatment from denture disc samples (±standard error) (ITT population).
Figure 9.
Figure 9.
Microbial composition as assessed by qPCR from denture disc samples (ITT population).
Figure 10.
Figure 10.
Raw means plaque score on (a) Denture teeth, (b) Tissue fitting surfaces and (c) Polished surfaces (±standard error) (ITT population).

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