ABSTRACT
The present study aimed to evaluate the effect of denture wearing on the occurrence of fungal isolates in the oral cavity before and after complete denture insertion. Fifty completely edentulous patients were selected. Swab samples were collected intraorally before the fabrication of complete dentures from the palatal mucosal surface and after complete denture fabrication (1 and 7 days after denture insertion). Further, these samples were inoculated and incubated. Results showed that in 48 patients, no isolate of fungus before denture insertion was found. In two subjects, results were false positive (contamination from the environment), and in six patients, there was an increase in growth, but not much significant increase of growth was seen (mild growth of fungus only after denture insertion). One of the major findings of this study was that the overall occurrence of fungal isolates (before and after denture insertion) in the oral cavity was not significant.
KEYWORDS: Candida, denture, denture stomatitis, fungal isolates, insertion
INTRODUCTION
Normal microbial flora of the oral cavity is complex and consists of a large number of species of bacteria, including mycoplasma, fungi, and protozoa. This is because of the fact that the mouth has many distinct habitats, including saliva and crevicular fluids, the surface of soft tissues such as lips, palate, cheek, tongue, gums, and hard surfaces of teeth.[1,2,3]
According to several studies, it has been stated that microbial flora varies qualitatively and quantitatively after tooth eruption, tooth extraction, artificial denture, dental treatments (scaling, polishing, filling), the frequency and type of food ingested, and antibiotic treatment.[4,5,6] Healthy individuals usually exhibit many fungal species, mainly Candida albicans, in the oral cavity, which is a prevalent opportunistic pathogen. Studies have shown a higher prevalence of Candida in diabetic patients when compared with nondiabetic individuals.[4,5,7]
Various chemical and mechanical methods were used for cleaning dentures, and they found that mechanical cleansing is an effective means of improving denture cleanliness and maintaining healthy mucosa beneath removable dentures.[6] Rare evidence was found regarding the occurrence of all the fungal isolates after denture insertion. So, considering all these facts, the present study was conducted to enlighten and evaluate the effect of denture-wearing on the occurrence of fungal isolates in the oral cavity.
MATERIALS AND METHODS
The present in-vivo study was conducted in the Department of Prosthodontics, including Crown and Bridge, and the Department of Microbiology, M. M. College Of Dental and Medical Sciences and Research, Mullana, Ambala.
Fifty patients who were completely edentulous, never worn complete dentures before were selected.
All the patients were divided into three major groups as follows:-
The patients were coded as groups A, B, and C, respectively, depending upon the time of collection of the swab.
Group A: swab samples before denture insertion.
Group B: swab samples one day after denture insertion.
Group C: swab samples seven days after denture insertion.
Each group consists of 50 patients.
Collection of Swab Sample
A swab sample was collected from the maxillary palatal mucosal surface before and after denture insertion.
After the collection of samples, microbial analysis was performed.
Microbial Analysis of the Samples
Swab samples collected from the patient were inoculated with inoculating loops directly on Sabourauds dextrose agar (SDA) culture media (HiMedia Pvt Limited, Mumbai, India). After 48 h of incubation, the growth of colonies was analyzed.
Gram staining was performed for the culture isolates and was observed under the microscope (Nikon Eclipse, America) for any fungal isolates. Further biometric analysis (germ tube test) was carried out. Formulation of results was performed based on statistical analysis.
RESULTS
Results showed no significant difference was observed between group A (before insertion of denture) and group B (1 day after denture insertion).
The fungal growth of group A (before insertion of the denture) does not differ significantly when compared to group C (7 days after insertion of the denture). The difference between groups B and C was also not significant when statistically analyzed [Table 1].
Table 1.
Group-wise comparison of growth of fungal isolates before denture insertion (Group A), 1 day after denture insertion (Group B), and 7 days after denture insertion (Group C)
| Characteristic | Growth | Count of funal isolates | Groups | ||
|---|---|---|---|---|---|
|
| |||||
| A | B | C | |||
| Growth | +ve growth (Candida albicans) | Count | 2 | 4 | 6 |
| % within group | 4.0% | 8.0% | 12.0% | ||
| No growth | Count | 48 | 46 | 44 | |
| % within group | 96.0% | 92.0% | 88.0% | ||
| Total | Count | 50 | 50 | 50 | |
| % within group | 100.0% | 100.0% | 100.0% | ||
DISCUSSION
In the present study, the data collected was based on the observation of fungal growth before and after insertion of complete denture from the palatal mucosal area in patients at varying time periods, viz. before denture insertion, 1 day, and 7 days after denture insertion.
Results showed that there was nonsignificant evidence of fungal growth before complete denture insertion and on the 1st day of insertion of the complete denture. Before the insertion of a complete denture, two patients out of 50 showed results for fungal isolates. Failure of isolation of fungus might be as a result of maintenance of proper oral hygiene of patient as well as good health of the patient (medically fit). It was found that mouth rinses appear to be well tolerated and are helpful in the treatment of oral candidiasis. Maintenance of good hygiene, as well as cleaning dentures on a regular basis, decreases the susceptibility of candidasis.[8] Regularly cleaning and keeping dentures dry overnight are efficient ways to control fungal colonization in denture wearers. According to one study, the efficacy of denture cleansers on Candida single- and dual-species biofilms formed on polyamide resin, and they found that the highest Candida species (spp.) biofilm growth was shown to occur on polyamide resin when compared with polymethyl methacrylate (PMMA).[9] One of the factors that may lead to less significant growth of fungal isolates was that the study was carried out for a short duration of time, that is, after 1 day as well as after 7 days, an increase in time duration might lead to an increase in fungal isolates. All these conditions attributed to the failure of isolation of fungal growth, as observed in this study.
According to studies, it has been seen that denture stomatitis is frequent among denture wearers and varies widely; reported prevalence ranges from 10–75%.[10,11] The etiology appears to be multiparametric; old age and the concomitant decline of the immune defenses, systemic diseases, smoking, wearing dentures at night, and poor oral hygiene resulting in the accumulation of plaque on the dentures have all been proposed as predisposing factors.[12,13]
Less than 20% of results showed there was an occurrence of fungal isolates (six out of 50 patients, i.e., four males and two females), but the growth of fungus isolated was not much significant, which was of prime concern in this study. Our results supported the literature that Candida isolates increase in the absence or negligence of the oral hygiene of the patient.[14] Other possible reason for the isolation of fungal colonies is that patient might have hidden or was unaware of his immune status. History reports an increase in fungal growth in immunocompromised patients. Stimulating local factors in the development of denture stomatitis. Poor denture hygiene favors colonization of Candida, which interacts as initiative local factors in the development of denture stomatitis.[15]
According to a study on Candida colonization on the dentures of diabetic and nondiabetic patients, it was found that diabetes mellitus can increase the colonization of Candida in dentures and mouth.[5]
CONCLUSION
By elimination of local and systemic factors in diabetic patients and improving their oral health care, Candida colonization and the risk of oral and systemic candidiasis will be decreased.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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