Lorin Berland, DDS, discusses hygiene for removable appliances, such as mouth guards, aligners, retainers, airway devices, and dentures.
Unfortunately, most people do not understand the importance of cleaning their removable oral appliances. Without proper appliance hygiene, patient compliance, as well as patient satisfaction, may decline. Clinical research consistently finds that the majority of oral appliances, and their owners, eventually become infected with pathogens such as Candida Albicans, Streptococcus, Staphylococcus and Actinomyces—the leading causes of oral thrush, denture stomatitis, pneumonia, and more. In addition, these pathogens are also linked to multiple systemic health issues. As a result, millions of people suffer from long-term chronic infections. Tragically, they gradually become accustomed to the symptoms—inflammation, discomfort, loss of taste, respiratory issues, and digestive problems—and these afflictions can become the “new normal.”
Problems associated with removable oral appliances are even greater for denture wearers. The likelihood of developing oral infections increases with age, tobacco use, alcohol intake, and chronic diseases like diabetes, lupus, and Sjögren’s. Medications exacerbate these problems by upsetting the normal balance of oral flora and disrupting saliva formulation. The resulting dry mouth also decreases denture retention. In these cases, a moisturizing denture adhesive (such as Adhesadent, which has the ADA Seal of Acceptance) can help dramatically.
Emphasize Healthy Habits
The best time to introduce proper appliance hygiene is right at the beginning. Waiting until a patient has an infection, and then treating with antibiotics and/or antifungals, can have negative consequences including, but not limited to, the removal of good bacteria and increasing the drug resistance of the pathogens. But these short-term treatments will not eliminate the cause of the infection, which is the dirty and infected oral appliance. Typically, if denture patients develop problems later, they tend to go to a drugstore, not a dentist. And, physicians rarely pay attention to oral health matters.
Although the number of people with oral appliances keeps growing, there is little practical information available for patients about the proper care of specific devices and the associated oral tissues. An online search can lead to a range of myths and do-it-yourself methods that can quite often be ineffective and may even make matters worse. It is the responsibility of dental professionals to ensure that their patients know how to take the best care of their oral appliances.
Help Patients Choose the Right Protocol
Most denture wearers soak their dentures with a tablet dissolved in water, but OTC denture soak cleansers only claim to “remove stains and odor-causing bacteria.” They are ineffective against the pathogens that actually cause disease. This is equally important for airway devices. The underlying causes of infection—the bacterial and fungal infested biofilm on the denture or other device—are left untreated, and infections can recur. The patient may even blame the dentist who made the denture or other oral appliance. Dentists should know and recommend the proper products that treat these issues. The best solution for oral infections is prevention, easily accomplished daily by disinfecting the oral appliance with an all-purpose antimicrobial soak (such as Cleanadent Liquid Crystals [Dr. B Dental Solutions] in an ultrasonic cleaner).
Many denture wearers and other oral appliance patients believe that toothpaste is an acceptable cleanser. However, toothpaste is made for teeth, not for oral appliances. Regular toothpaste (especially when used with an old-fashioned denture brush) can cause microscopic scratches, negatively impacting both the color and shine. This is particularly true for fixed-implant bridges. The scratches trap more stains and create the ideal environment for bacterial and fungal colonies to thrive, forming a biological sponge.
Oral Hygiene Education for the Patient
Even for patients who clean their dentures regularly, many focus only on the denture, neglecting the equally important need to clean the mouth. Educating your patients on cleaning the gums, particularly around implants for overdentures, is essential to overall health. In fact, the American Dental Association recently dedicated a special article, “Vital Information About Types of Dentures and Their Care,” advising “the mouth cavity, tongue, and the jaws should be well cleaned to remove all plaques, before putting on the clean denture.” Clinicians and their dental teams should instruct their patients to visit the ADA website mouthhealthy.org. This site will give them access to dental care information and help them choose products that have been thoroughly vetted and that carry the ADA Seal of Acceptance.
A Unique Product With the ADA Seal of Acceptance
There is currently only one ADA-accepted paste that is safe for both prosthetics and gums, Cleanadent Paste (Dr. B Dental Solutions), which also has Vitamins A, D, and E; aloe vera; coconut oil; and tea tree oil to help moisturize the gums. It is also great at removing denture adhesive from the denture as well as the mouth. In addition, dentists find it very useful to give the patient Cleanadent Paste, a soft toothbrush, and a warm water rinse to remove any debris prior to taking impressions.
Whichever the oral appliance, the right protocol can make a big difference in hygiene and overall health. Whether it’s a new appliance or an existing appliance, patients depend upon their dentists to help them make the right decisions about their oral health. With just a short conversation, we can ensure that our patients are adequately educated about the maintenance of their appliances, understand the risks involved, and how to use the appropriate and best products in their home care routines.
Dr. Berland, DDS, is one of the most published authors on clinical dentistry with more than 100 articles, best-selling books, and instructional videos. Dr. Berland was recognized by the AACD for “Outstanding Contributions to the Arts & Science of Cosmetic Dentistry.” He began his career as a denture technician, and after more than 40 years of listening to patients and running a multi-specialty practice, he founded Dr. B. Dental Solutions, a line of ADA-accepted products designed to improve the lives of people with oral appliances. He can be reached at (844) DRB-DENT (372-3368), via the website drbdentalsolutions.com, or via email at info@drbdentalsolutions.com.
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