Denture hygiene practices and candida-associated Denture stomatitis among complete denture Wearers at two clinics in Nairobi
Background: Studies have shown that one of the most common complications of complete denture wearing is denture stomatitis with a prevalence rate of 11%- 75%. Though the aetiology is multifactorial, denture hygiene practices and nocturnal denture wearing have been shown to contribute greatly to the condition. Objective: To determine denture hygiene practices and Candida-associated denture stomatitis among complete denture wearers at two clinics in Nairobi. Study design: This was a descriptive cross-sectional study; the study sample comprised of edentulous persons who had been treated at the UON School of Dental Sciences and Kenyatta National hospital and were contacted through telephone and/or post office mail and fulfilled the criteria. Materials and method: An interviewer administered questionnaire was filled with details on denture hygiene practices; denture cleanliness was assessed by soaking the dentures in 5% erythosine and plaque was graded using the Budtz- Jorgensen criteria of denture cleanliness; denture stomatitis was clinically diagnosed and graded using the modified Newton's criteria by Budtz-Jorgensen and swabs taken from the fitting surface of the denture and palatal mucosa were cultured to assess the Candida colony types. A data collection form was used to record the findings for denture cleanliness and Candida presence. Data analysis and presentation: The Statistical Package for Social Sciences (SPSS) 12.1 was used for data analysis. Descriptive analytical tests were carried out to determine the frequency of various variables. Pearson's Chi square and independent t-test was applied to test the hypothesis. The data was presented in form of figures and tables. Results: Data of 74 participants was included in the study. Duration of current denture the participants were wearing ranged from 8 months to 24 years with a mean denture age of 6.5 years. The main method of denture cleaning was brushing and soaking in water by 66.2% of the participants while 18.9% soaked in water only, 1.35% soaked in warm salty water and 13.5% brushed only. 51.4% cleaned their dentures once a day, 45.9% more than once while 2.7% cleaned occasionally. Denture cleanliness was excellent in 45.9%, fair in 44.6% and poor in 9.5%. Nocturnal denture wearers were 33.8% and majority cleaned once a day. Forty five (60.8%) participants had either local 33.8%, diffuse 24.3% or granular 2.7% denture stomatitis. In the cultured specimens, higher Candidal carriage occurred on the denture fitting surface than the palatal mucosa. The predominant species was G.albicans followed by C.krusei. C.tropicalis was co-cultured in two cases from the palatal mucosa. Positive mycological cultures were isolated in higher proportions in participants with the highest grades of inflammation. Conclusion: Within the limitations of this study, majority of the participants reported brushing and soaking their dentures in water and none reported chemical cleansing. Majority cleaned their dentures at least once a day. The level of cleanliness of the dentures was considered inadequate for half of the denture wearers. A third of the denture wearers reported nocturnal denture wear. Prevalence of DS in this population is 60.8% with only a half of those with DS had positive Candida cultures. G. albicans was the predominant species and statistically significant associations were observed between denture hygiene practices and positive Candida cultures. Significant association was observed between the denture hygiene practices and denture stomatitis. Recommendations: There is need to establish a health education program aimed at improving denture hygiene practices among complete denture wearers so as to reduce CDS. It is important for clinicians to advice denture wearers on chemical cleansing as mechanical cleansing alone has not been shown to control plaque accumulation on the denture surface. Clinicians should reinforce avoidance of nocturnal denture wearing since it has been significantly associated with positive Candida cultures and other studies need to investigate the other aetiologic factors of OS as only half of those with OS had positive Candida cultures.