The importance of daily removal of the denture biofilm for oral and systemic diseases prevention

Inadequate cleaning of removable dentures Sromotes tKe accumulation and adKesion of bio¿lm, which is one of the main causes of failure of these Srostheses &omSlete denture bio¿lm is de¿ned as a dense layer of complex microbial communities embedded in a polymeric matrix, and it is known to contain more than 1011 microorganisms by gram in dry weight 13 7he composition of the denture bio¿lm microbial community is similar to that of dental bio¿lm with the exception of an increase in Candida spp 13. It has been widely reported that denture bio¿lm acts as a reservoir for opportunistic microorganisms that can cause local infections, especially Candida-related denture stomatitis, or even systemic diseases 1,3,8,15. Denture stomatitis is the most common form of oral candidal infection found on the palate of denture wearers (11 to 70%) 3,18. About 93% of individuals with clinical signs of denture stomatitis present fungal infection, being Candida albicans the most prevalent species, identified in 50 to 98% of all cases 2,18. Candida spp. interact with other microorganisms in the oral cavity, particularly Streptococcus spp. and Staphylococcus spp., thus resulting in a complex and mixed bio¿lm formation with organi]ed structure that is dif¿cult to remove 2,18. Moreover, bacteria in acrylic bio¿lms resulted in higher virulence and pathogenicity of Candida bio¿lms 4. Apart from local infections such as denture stomatitis, recent studies have recognized a relationship between denture bio¿lm and systemic diseases, mainly in elderly individuals 8,15. Kashiwabara, et al. 8 (2007) found high levels of Candida spp. and Staphylococcus spp. (including methicillin-resistant Staphylococcus aureus) from palatal tissue surface of maxillary dentures of geriatric inpatients and maxillary defective patients, respectively. It is know that respiratory pathogens preferentially colonize teeth or dentures, rather than soft tissue, being the pneumonia the leading cause of death attributable to infection in patients aged 65 years and older 5. According to O'Donnell, et al. 15 (2015), given a denture's close proximity to the respiratory tract, denture wearers are potentially at an increased risk of aspirating opportunistic pathogens from the denture into their lungs. These authors showed a high prevalence of putative respiratory pathogens on the dentures of ambulatory adults, a finding that could explain the source of infection in some cases of aspiration pneumonia 16. Besides aspiration pneumonia, oral pathogens have been implicated in bacterial endocarditis, gastrointestinal infection and chronic obstructive pulmonary disease, among others, and dentures offer a reservoir for microorganisms associated with these …