A clinical and microbiological evaluation of denture cleansers for geriatric patients in long-term care institutions.

BACKGROUND Many elderly patients in long-term care hospitals cannot adequately brush their dentures because of disease, dementia and poor dexterity. Such inadequate cleaning may allow for the multiplication of Candida spp. and bacteria, which could serve as reservoirs for disseminating infections. OBJECTIVE To assess the efficacy of 3 denture cleansers in reducing the number of microorganisms on dentures in a hospitalized geriatric population. METHODS Three brands of cleanser (Denture Brite, Polident and Efferdent) were compared; water was used as the control. Microbiological samples were obtained before and after 3 one-week periods of cleanser use; these samples were taken by a microbiologist blinded to the assigned treatment. In the statistical analysis, the ranks of the differences between the before-treatment and after-treatment scores of each regimen were compared by means of the general linear model. In addition, the efficacy of each cleanser in reducing accumulation of plaque, stain and food was assessed. RESULTS The rank of the differences in the number of colony-forming units (CFUs) of Candida spp. before and after one week of use of Denture Brite (p = 0.04) and Polident (p = 0.01), was significantly greater than that of the control group, but there was no difference between Efferdent use and control (p = 0.10). No significant differences in reduction of Streptococcus mutans were observed between Denture Brite (p = 0.13) or Polident (p = 0.12) and the control group, whereas dentures cleaned with Efferdent exhibited significantly greater reduction in Streptococcus mutans (p = 0.02) than dentures cleaned with water. Over all study periods, there were no significant differences among the cleansers in reduction of Candida spp. or Streptococcus mutans. Dentures cleaned with Denture Brite, Polident or Efferdent appeared to have similar reductions in the level of plaque, stain and food, and all had substantially greater reductions than dentures cleaned with water only. The significant difference in the rank of the reduction in Candida spp. CFUs (p = 0.005) was related to the variance between study periods (p = 0.01) and the variance between subjects (p = 0.008). CLINICAL SIGNIFICANCE The use of denture cleansers significantly reduced the number of microorganisms on dentures in a hospitalized geriatric population.