Antimicrobial action and long-term effect of overnight denture cleansers

To evaluate two denture cleansers for overnight soaking (0.5% sodium hypochlorite and peroxide alkaline) regarding efficacy against Candida spp. biofilms (randomized clinical trial) and their effects on the physical properties of a denture base acrylic resin simulating a period of 5 years of use (laboratory study). The Candida spp. were identified and their resistance to main antifungal agents was evaluated.

32 complete denture wearers were instructed to brush their dentures three times a day and to soak them (≥8 hours) in: control - water (C); alkaline peroxide (AP); or 0.5% sodium hypochlorite (SH). According to a randomized sequence, each solution was used for three alternate periods of 7 days. The antimicrobial action was performed by counting the colony forming units (CFU) of Candida spp. For collection of the biofilm, each upper complete denture was placed in a Petri dish, the internal surface was brushed (Tek brush) with saline solution for 2 minutes and the suspension was transferred to a test tube. After dilutions (10 0 to 10-3), aliquots of 50 µL were seeded inside Petri dishes containing Candida Chromagar. After incubation, the colonies were counted and the values of CFU/mL calculated. Data were transformed in log10 (CFU +1) and analyzed by the Friedman test (α= 0.05) followed by Wilcoxon and Bonferroni tests (α= 0.05). Each of the different species identified perfunctorily has been confirmed through the identification of yeasts kit. The resistance to antifungal agents (amphotericin B, nystatin, flucytosine, econazole, ketoconazole, miconazole and fluconazole) was also evaluated. Adverse effects were estimated on heat-polymerized resin specimens, simulating a 5-year period of overnight use. Acrylic resin specimens were randomly distributed into three groups: C: Control (distilled water); AP: alkaline peroxide; and SH: 0.5% sodium hypochlorite. Color change, surface roughness and flexural strength were evaluated at baseline and after immersion procedures. Data were compared by Kruskall-Wallis followed by Dunn's test (color change and surface roughness) and one-way ANOVA (flexural strength) (α= 0.05).

There was a reduction of Candida spp. counts after using both solutions (AP and SH). The Candida spp. most often isolated was C. albicans, followed by the C. glabrata. Only 24.7% of isolate strains were resistant to at least one of the tested antifungals, highlighting azole compounds. Immersion in AP [ 5.73 (5.45-5.91)] caused significantly higher color change, with lower ΔE values for C [1.12 (1.15-1.37) ] followed by SH [3.70 (3.51-3.98) ]. The NBS values were classified as "slight" for C (1.12) group and " considerable" for AP (5.27) and SH (3.40). No solution altered surface roughness significantly. Flexural strength (in MPa) was significantly lower for C (64.59), AP (63.96 ± 12.98) and SH (62.84 ± 8.62) when compared to a group without any immersion (109.12 ± 8.37).

Both solutions tested presented antimicrobial action against Candida spp. and may be useful for denture biofilm control, but should be used with caution as an overnight immersion solution since they may damage denture bases in the long-term. Candida was most frequently isolated at baseline and after using the products. Only 24.7% of isolate strains were resistant to at least one of the tested antifungals, especially with azole compounds.