Denture Adhesives: Changing Attitudes

Click to edit Master subtitle style Joseph E. Grasso, D.D.S.,M.S.D.

JADA, Vol.127, January 1996

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About the article

q It traces the emergence and growth of denture adhesives q Mechanism of action q Review of myths and realities q Examination of data on their use q Clinical relevance of the findings

q AIM: To provide the dental professional with a better

understanding of modern adhesive products and their application to patient treatment

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Emergence And Growth Of Denture Adhesives

q Use began in the late 18th century q Dentists started using it in the 19th century*1 q First U.S. patent was issued in 1913* q 1939 Around 15million denture wearers and

numerous manufacturers of denture adhesive*

*1 Adisman IK. The use of denture adhesives as an aid to denture treatment. J Prosthet Dent 1989; 63;711-5 *2 Yankell SL. Overview of research and literature on denture adhesives. Compend Contin Educ Dent 1984;4(Supplement);518-21 *3 McKevitt FH. The measured vertical dimension and denture adhesive 4/28/12 powders. J Prosthet Dent 1951;1:393-401

Negative Attitude*
q To hold base plates while recording dental relations q In immediate denture construction until well-fitting

dentures were completed

q When the dentist is incompetent, or incapable, of

making a tight fitting denture.

*Young R, Weikel M. An appraisal of denture adhesive powders. Contact Point 1945; 23:247-9

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Mechanism of Action
q *Shay: the material swells 50 to 150 percent by

volume in the presence of water tissues

q Filling in spaces between the prosthesis and the q Anions in the adhesive are attracted to the cations of

the mucous membrane producing stickiness physical and chemical forces

q Current adhesives depend on a combination of

4/28/12 *Shay K. Denture adhesives: choosing the right powders and pastes, JADA

Physical Force
q Stefan. Physical force q Force required to pull two disks or plates apart is

directly proportional to the viscosity of the liquid between them

q Saliva

ses viscosity of the adhesive thereby sing the force required bioadhesive and cohesive forces

q Modern adhesives use materials that provide strong q Bioadhesion via carboxyl groups q Adhesive hydrates carboxyl groups form electrovalent

bonds that produce stickiness

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q Polymethyl vinyl ether-maleic anhydride (PVM-MA)

-synthetic copolymer- used widely because of its high level of carboxyl groups

q Sodium carboxymethylcellulose (CMC)- natural q CMC is more soluble than PVM-MA q CMC- stong initial hold q 1970s-combination of PVM-MA (calcium salts) amd CMC q Quick upfront hold (CMC) and a hold of longer duration

(PVM-MA)

q Highly cross-linked matrix

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q Late 1980s. PVM-MA zinc and calcium salts with

CMC

q Even greater cohesive strength q *Stronger, longer hold than calcium salts

*Mackay BJ, Jackson JJ, Vanalstine RL, Mas JC. Comparitive efficacy of powder denture adhesive (Abstract). J Dent Res 1993;72(Special Issue):376 *Mackay BJ, Jackson JJ, Vanalstine RL, Rajaiah J. Comparitive efficacy of cream denture adhesive (Abstract). J Dent Res 1993;72(Special Issue):376
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Patients Use of Denture Adhesives

q *1 Britons used about 88 tons of denture adhesives (1970)
q *2 Tautin Denture adhesives will be with us until we

eliminate the need for complete dentures.. The major problem with denture adhesives is not their effect on tissue nor the results of their long-term usage, nor even their effect on vertical dimension; it is that the dental profession knows so little about them.

*1 Stafford GD. Denture adhesives: a review of their uses and compositions. Dent Pract September 1970;21:17-9 *2 Tautin FS. Dental adhesives-a problem.Dent Survey 1978;54(8):24-6
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The role of denture adhesives with well-fitting dentures

q McKevitts opinions. 1950, 1951 & 1957. Early

criticism

q *He maintained the sinister role of denture adhesive

powders in prosthodontia prompts the query: has prosthodontia fallen into disrepute?

*McKevitt FH. The measured vertical dimension and denture adhesive powders. J Prosthet Dent 1951;1:393-401 *McKevitt FH. Denture adhesive powders. J Calif Dent Assoc Nevada State Dent Soc 1957;33:469-72
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Kapurs study
q Kapur objective approach q *A method for scoring denture retention and stability (ill,

fair and well-fitting prostheses)

q Published in 1967 q Conclusion: denture adhesives unequivocally increased

denture retention, thereby improving denture wearers incisive ability denture adhesives

q Advised dentists to "keep an open mind on the subject of q Patients have an increased sense of security, added comfort

and a subsequent perception that masticatory performance is improved 4/28/12

Stafford and Russell

q Objective investigation of denture performance q *Measured changes in pressure at the denture base-mucosa

interface with and without adhesive

q Patient can apply greater force to the occlusal surfaces of a

prosthesis under controlled circumstances (HYPOTHETICALLY)

q Adhesives allowed greater occlusal pressure q More for patients with ill-fitting prostheses q Amount of time needed to chew didnt vary

*Stafford GD, Russell C. Efficiency of denture adhesives and their possible 4/28/12 influence on oral microorganisms. J Dent Res 1971;50:832-6

Tarbet and colleagues

q Role of adhesives in denture retention and stability q *By counting denture dislodgements in patients who were

eating standardised portions of food (celery, taffy apple, steak and hard roll sandwich) with and without a denture adhesive
q Patients had or were provided with well-fitting prostheses q Results: significant reduction in dislodgement when an

adhesive was used

q Included patient perspective

*Tarbet WJ, Boone M, Schmidt NF. Effect of a denture adhesive on complete denture dislodgement during mastication. J Prosthet Dent 4/28/12

Chew and colleagues

q Kinesiographic technique q *Aim: To determine the effectiveness of denture

adhesives in improving retention and stability of complete maxillary dentures in vivo

q Result: adhesives improved retention and stability of

both well-fitting and ill-fitting dentures but exerted their greatest effect with ill-fitting dentures

*Chew CL, Phillips RW, Boone ME, Swartz ML. Denture stabilization with adhesives: A kinesiographic study. Compend Contin Educ Dent 1984;4(Supplement): S32-8
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Tarbet and colleagues

q *Biting force of denture wearers (radiotelemetry and

gnathodynamometry)
q In patients whose tissues were judged to be unlikely for

good retention and stability

q Result: when adhesives were used, these patients

achieved biting forces similar to patients with more satisfactory support tissues
q Improvement in maxillary retention and stability

4/28/12 *Tarbet WJ, Silverman G, Schmidt NF. Maximum incisal biting

Contd
q *Conclusion: "A denture adhesive thus an be of

considerable benefit to many denture wearers, even those with good quality denture support tissues. Subjectively, the adhesive provides confidence; objectively, it allows the development of needed forces in the biting and chewing of foods.

* Tarbet WJ, Silverman G, Schmidt NF. Maximum incisal biting force in denture wearers as influenced by adequacy denture bearing tissues and the use of an adhesive. J Dent Res 1981;60(2):115-9

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Grasso and co-workers

q *1 Use of adhesives generate significantly greater levels of

incisal bite force up to eight hours after application

q Increase of upto 20N (35N baseline to 54N at eight hours) q *2 Functional bite forces of 40 to 50N are required to incise

foods such as hard pretzels, apples and carrots crosses the required threshold

q Thus the increased bite force due to the use of adhesives

*1 Grasso JE, Rendell J, Gay T. Effect of denture adhesive on the retention and stability of maxillary dentures. J Prosthet Dent 1994;72:399-405.22. *2 Gay T. Rendell J, Majourau A, Maloney F. 4/28/12 quantitative Use of

Review
q Lack of objective measurement tools q Objective methods can provide a authoritative

position on the role of denture adhesives

q Contemporary testing methods have provided a

broader base

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Tissue irritation and bone resorption

q* Definite pattern

of bone resorption in the edentulous mouth with or without dentures

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Boone
q *He commented that, "much of this information is

fact, but more of it is fallacy, especially as it relates to the causes of alveolar bone change. and function have been lumped together bone changes.

q Over-the-counter products for altering prostheses fit q "accused of destroying bone, or at least of causing q Products should be divided into insoluble (causatives)

and soluble (adhesives) agents

* Boone M. Analysis of soluble and insoluble denture adhesives 4/28/12

 Denture pads agents Soluble agents Dissipate Insoluble Softened toilet paper Flow under pressure Insoluble plastic denture Spread

adhesives Distribute denture load Frank ridge destruction evenly

Cushioning

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Contd
q *1 Boone remarked, "If the use of adhesives were to cause

bone resorption, the stresses involved would have to be transmitted through the oral mucosa, even with ill-fitting dentures. If these stresses were of sufficient magnitude or duration to cause bone changes, it would be reasonable to expect that soft tissue lesions would occur. hygiene

q *2 Such changes are not observed with adequate oral

*1 Boone M. Analysis of soluble and insoluble denture adhesives and their relationship to tissue irritation and bone resorption. Compend Cont Educ Dent 1984;4(Supplement): S22-5 *2 Abdelmelak RG, Michael CG. The effect of denture adhesives on the 4/28/12 palatal mucosa under complete dentures: a clinical and histological

Contribution to oral pathoses???

q *1 1940s Adhesives did not inhibit microorganisms q *2 1950s Adhesives did not support bacterial growth

*1 Bartels HA. Bacterial activity and tissue tolerance: their role in prosthodontia. J Dent Educ October 1944;9:57-72 *1 Bartels HA. Bacteriological appraisals of adhesive denture powders. J Dent Res 1945;24(1):15-6 *2 Kelly J, Kutscher AH, Tuoti F. Bacteriological studies with a new adhesive preparation for oral use. J Conn State Dent Assoc 1959;33(3):9-14 4/28/12

Stafford and Russell

q Supported some microorganisms q Candida albicans, Streptococcus mitis q *Unable to demonstarte inhibitory effect on the oral

flora
q Imbalance in the flora by selective inhibition and

support
q Denture trauma initiates and perpetuates stomatitis q Adhesives reduce potential trauma
4/28/12 *Stafford GD, Russell C. Efficiency of denture adhesives and

Tarbet and Grossman

q Six-month investigation q *111 denture wearers who regularly used denture adhesives q No increase in mucosal irritation q Irritation improved or was eliminated due to the adhesives q Conclusion: An appropriate adhesive can reduce the

likelihood of tissue irritation

*Tarbet WJ, Grossman E. Observation of denture supporting tissue during six months of denture adhesive wearing. JADA 1980;101:789-91 4/28/12

Clinical Implications
q Denture patients can benefit in a variety of clinical dimensions by using denture adhesives
q Denture adhesives have a place in the professional care

ofpatients; they can significantly enhance denture performance and patient confidence but should not be used to compensate for denture deficiencies
q *Continuous use of a denture adhesive in an ill-fitting

denture can mask an underlying stomatitis that can lead to further involvement

*Polyzois GL. An update on denture fixatives. Dent Update 1983;10:57983

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Contd
q *1 Adisman suggested that, patient instructions

regarding the use or non-use of denture adhesives should be an integral part of denture aftercare instructions.
q *2 Shay said that some patients may benefit from

denture adhesives and that, the "keys to their proper use lie in the special needs of each patient, the properties of the adhesives themselves and in the dentist's knowledge and willingness to help.
*1 Adisman IK. The use of denture adhesives as an aid to denture treatment. J Prosthet Dent 1989; 63;711-5
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Conclusions
q Contraindicated in ill-fitting dentures q Improved function q Greater retention and stability q Increased incisal bite force q Sense of comfort (physical and psychological) for the

patient

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