by Clare Van Sant, RDH, BS
A thorough cleaning of their dentures may rate low on the priority list of some denture patients. For these patients, a quick brushing and occasional five-minute soak might be the extent of their denture care. Since in many cases poor oral hygiene is a contributing factor to their tooth loss in the first place, convincing these patients to adopt a more stringent daily cleaning routine may be an uphill battle.
Another major challenge with this population is motivating them to visit the dental office for routine recall appointments. One report indicates that only 19 percent of denture wearers remember their dentist’s instruction to come back for regular checkups.1 How can dental hygienists, who recognize the importance of daily disinfecting dentures and routine professional evaluations, help denture patients understand the importance of both regular office visits and everyday at-home care?
The answer may be as simple as sharing a few important facts. We know some patients are hard to motivate and may be resistant to change; however, sound clinical evidence can be a powerful influence for some people. Here are some lesser-known facts about dentures that any dental professional can use to help motivate patients to manage their dentures.
• Partial and full acrylic dentures have surface pores - To the eye, the acrylic surface of a denture appears solid and unbroken, but under a microscope, pockmarks are revealed.2 What does this mean to denture patients? A quick brushing every day may not be enough to thoroughly clean the denture. Even a very thorough brushing may not be sufficient to reach bacteria harbored in microscopic crevices. A denture brush and foaming toothpaste simply may not penetrate the many hiding places that microbes find in a denture surface.
Some might wonder if this is really a cause for concern. After all, everyone’s mouth is filled with germs, thus we get morning breath. But research has isolated Staphylococcus aureus, Streptococcus mutans, Klebsiella pneumoniae, Escherichia coli, and hundreds of other garden-variety germs in acrylic dentures.3,4 Keep in mind that while our mouths have the benefit of the body’s immune system, acrylic denture material has no such germ-fighting properties, so bacteria can easily reproduce within the denture.
From the dental hygienist’s point of view, one of the most important reasons patients should control denture bacteria is to help prevent unnecessary exposure to microbes that could cause oral and systemic disease. But denture bacteria can also have an effect on one of the biggest everyday problems patients are motivated by - bad breath. Eighty-seven percent of denture wearers report that malodor is a major concern.5 Because the body’s scent receptors become accustomed to a smell they are exposed to frequently, patients rightly fear that they may not be able to detect odor coming from their dentures.6 Dental hygienists can help patients manage their malodor and exposure to microbes by educating them on the effectiveness of overnight soaking in reducing odor-causing bacteria.
• Overnight soaking can kill 99.9 percent of denture germs -Pharmacy shelves are lined with denture cleaning options, from all-natural soaking solutions to high-end ultrasonic devices. It’s easy for denture wearers to think one cleaning option is as effective as the next, and therefore choose the fastest or least expensive one. But fast may not be best. By encouraging the use of an overnight soak such as Polident® (GlaxoSmithKline Consumer Healthcare), dental hygienists can empower patients to kill up to 99.9 percent of the bacteria that colonizes on their prostheses. This level of disinfection may not be reached with many quick-fix cleaning methods. Other good products on the market include Dentist On Call Denture Wipes (Majestic Drugs Company) or ProClean™.
Many patients who adopt overnight denture soaking find that the quick-soak method still has its place in their daytime routine. While a three- to five-minute soak may not achieve the 99.9 percent kill rate of an overnight soak, it can nevertheless be effective in reducing bacterial counts and helping patients freshen up quickly before a social event.
• For patients who suffer from dry mouth, contaminated dentures pose potential health risks -Dental professionals should be mindful of the prevalence of dry mouth in the aging population. The likelihood of xerostomia increases with the number of medications a person takes. Since people over 65 use an average of three prescriptions and two over-the-counter medications per day, they stand a good chance of suffering from dry mouth.7,8,9
In normal conditions, saliva provides a variety of protective functions and may be considered the mouth’s first line of defense against harmful bacteria. Denture wearers with reduced salivary flow should be particularly concerned about the cleanliness of their dentures. Dental professionals should make a point of inquiring about dry mouth with all patients, with special attention to dry mouth sufferers wearing dentures, and with emphasis on the importance of thorough daily cleaning to combat bacteria. To relieve ongoing symptoms of xerostomia, dental hygienists can recommend oral moisturizers that provide symptomatic relief and aid denture retention, which boosts patient confidence.
• Older patients - with or without dentures - have higher bacterial counts in their mouths - Researchers have discovered higher counts of lactobacilli and yeasts in the saliva of older people, particularly older denture wearers.10 This is due to several factors, including reduced salivary flow and diminished immune system protection. Unfortunately as people age, their mouths require more vigilant care, which can be an issue for patients experiencing declines in dexterity and self-sufficiency. Dental hygienists can review denture cleaning regimens and products with these patients to ensure that they make nightly soaking part of their routine. If manual dexterity is a problem, supplemental denture cleaning methods (e.g., denture wipes or stationary denture brushes) can be explored.
The average full-mouth denture in the United States is 17.6 years old -Does the dental office consistently recommend routine professional oral evaluations to denture patients? Does the denture patient understand that follow-up is essential, and should not be only when their dentures have loosened or become uncomfortable, or when an oral infection is causing complications? It has been reported that 57 percent of denture wearers seldom or never receive a routine checkup.11
Depending on denture retention and stability, dentures should be replaced every five to seven years - a recommendation that greatly conflicts with the average denture age stated above. Obviously, most patients do not consider replacement that often and hope to get many years of wear out of their dentures. While this is sometimes possible, patients need to be reminded that routine professional evaluations and keeping dentures clean may help prolong the life of both full and partial dentures.
By sharing these five little-known facts with their patients, dental hygienists can inspire even less-compliant denture wearers to consider the many benefits of well-maintained dentures. Since thorough daily cleaning and routine professional follow-up can prolong the life and comfort of dentures, encouragement by dental professionals is worth the effort. The denture wearer experiences greater confidence, satisfaction, and pleasure, and produces more smiles and a healthier, happier life with dentures.
References
1 Burton MA. Current trends in removable prosthodontics. J Am Dent Assoc 2000; 131:52S-56S.
2 Shay K. Denture hygiene: a review and update. J Contemp Dent Pract Feb. 2000; 2(1):28-41.
3 Marsh PD, Percival RS, Challacombe SJ. The influence of denture-wearing and age on the oral microflora. J Dent Res July 1992; 71(7):1374-1381.
4 Shay K. Denture hygiene: a review and update. J Contemp Dent Pract Feb. 2000; 2(1):28-41.
5 Data on file, GlaxoSmithKline Consumer Healthcare.
6 Shay K. Denture Hygiene: A review and Update. J Contemp Dent Pract Feb. 2000; 2(1):28-41.
7 Atkinson JC, Baum BJ. Salivary enhancement: current status and future therapies. J Dent Ed 2001; 65:1096-1101.
8 Helling KD, Lemke JH, Semla TP, et al. Medication use characteristics in the elderly: the Iowa 65+ rural health study. J Am Geriatric Soc 1987; 35:4-12.
9 Espino DV, et al. Correlates of prescription and over-the-counter medication usage among older Mexican Americans: the Hispanic EPESE study. J Am Geriatr Soc 1998; 46:1228-1234.
10 Marsh PD, Percival RS, Challacombe SJ. The influence of denture-wearing and age on the oral microflora. J Dent Res July 1992; 71(7):1374-1381.
11 Burton MA. Current trends in removable prosthodontics. J Am Dent Assoc 2000; 131:52S-56S.
Poorly Cared-for Dentures Can Lead to Larger Issues
As noted in the adjacent story, 57 percent of denture wearers seldom or never receive a routine checkup. When you estimate that there are 49 million patients with dentures,1 that 57 percent is equivalent to nearly 28 million people who are improperly caring for their mouths and dentures.
All dental professionals have a responsibility to encourage these denture wearers to visit their dentists’ offices for checkups. But routine checkups are not always feasible for denture patients. However, dental professionals can help by providing patients with information to deal with some of the more common issues that can accompany poorly cared-for dentures.
Mouth sores
When dentures are not fixed into place appropriately or do not fit properly due to a patient’s weight loss or a change in the oral environment, they can rub inside the mouth and cause mouth sores or canker sores. These sores can make it uncomfortable to eat, talk, or just wear the dentures. Taking care of these sores is something denture wearers can typically manage themselves by using hydrogen peroxide or a specifically formulated over-the-counter mouth sore product, such as Gly-Oxide Liquid Antiseptic Oral Cleanser (GlaxoSmithKline Consumer Healthcare), that cleans and soothes the wound and promotes natural healing. Another option is an adhesive patch, such as Canker Cover (Quantum, Inc.), that adheres to the sore and helps avoid additional irritation.
Angular cheilitis
This condition can be identified by the deep cracks or splits that can form at the corners of the mouth. For people with dentures, the cause is often an overclosure of the mouth due to not wearing their dentures regularly. Treatment for these people can often be as simple as wearing the dentures regularly. Obviously, if the dentures do not fit and that is the reason for not wearing them, getting them properly fitted will make a world of difference. In the short term, the pain and irritation from angular cheilitis can be eased by using lip lubrication.
Leukoplakia
Another problem caused by ill-fitting dentures, leukoplakia is recognized by thick, hard, white patches in the mouth that cannot be removed. This is commonly caused by chronic irritation of the mouth, as would be the case when poorly fitting dentures rub against soft oral tissue, or from smoking or using smokeless tobacco. To treat this issue, tobacco users are encouraged to stop smoking as the leukoplakia may clear up on its own. Patients who do not smoke and are irritated by the hard patches may need to see a dentist to have them removed. It is also wise to recommend having these spots tested for early indication of oral cancer.
By being able to provide answers to these common denture issues, dental professionals will hopefully encourage those who neglect their dentures to obtain dental care on a regular basis. This advice may also significantly improve a patient’s quality of life and create a more successful overall denture experience.
1 Data on file, GlaxoSmithKlineClare Van Sant, RDH, BS, received her BS in Dental Hygiene from the Medical College of Georgia in 1975 and has been providing onsite dental hygiene care in nursing home settings since 2002. Her professional experience includes working as a public health hygienist, clinical periodontal therapist and community oral health educator. She lives in Spartanburg, S.C. You may reach her at [email protected].
