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Evidence-Based Guidelines for the Care and Maintenance of Complete dentures: A Publication of the American College of Prosthodontists

DAVID FELTON, DDS, MS, FACP,1 LYNDON COOPER, DDS, PHD, FACP,2 IBRAHIM DUQUM, BDS, MS,3 GLENN MINSLEY, DMD,4 ALBERT GUCKES, DDS, MS,4 STEVEN HAUG, DDS, MSD, FACP,5 PATRICIA MEREDITH, DDS, MS,6 CARYN SOLIE, RDH,7 DAVID AVERY, AAS, CDT,8AND NANCY DEAL CHANDLER,9 MA, RHIA, CAE9

1Professor, Department of Prosthodontics, School of Dentistry, University of North Carolina Chapel Hill, Chapel Hill, NC

2Stallings Distinguished Professor and the Chair, Department of Prosthodontics, School of Dentistry, University of North Carolina Chapel Hill, Chapel Hill, NC

3Clinical Assistant Professor, Department of Prosthodontics, School of Dentistry, University of North Carolina Chapel Hill, Chapel Hill, NC

44Associate Professor, Department of Prosthodontics, School of Dentistry, University of North Carolina Chapel Hill, Chapel Hill, NC

5Professor, Restorative Dentistry, School of Dentistry, Indiana University, Indianapolis, IN

6Clinical Associate Professor, Department of Oral Pathology, Radiology and Medicine, School of Dentistry, University of Iowa, Iowa City, IA

7Dental Hygienist, Spanish Springs Family Dental, Sparks, NV

8Director of Training and Education, Drake Precision Dental Laboratory, Charlotte, NC

9Executive Director, American College of Prosthodontists, Chicago, IL

Keywords

Dentures; edentulism; biofilm; adhesives; denture cleansers; denture relining; denture rebasing; denture repair; denture wear; stomatitis.

Correspondence

David Felton, Department of Prosthodontics, School of Dentistry, University of North Carolina Chapel Hill, 330 Brauer Hall, CB #7450, Chapel Hill, NC 27599-7450. E-mail: dave_felton@dentistry.unc.edu

Reproduced under agreement with the American College of Prosthodontists. The American College of Prosthodontists led the development of these evidence-based denture care guidelines in collaboration with the Academy of General Dentistry, the American Dental Association Council on Scientific Affairs, the American Dental Hygienists' Association, the National Association of Dental Laboratories, and GlaxoSmithKline Consumer Healthcare.

Funding for the guidelines development project and for this special supplement was provided by GlaxoSmithKline Consumer Healthcare.

Published in Journal of Prosthodontics 2011; Vol. 20, Suppl 1, pp. S1-S12

doi: 10.1111/j.1532-849X.2010.00683.x

Abstract

The current rates of edentulism have been estimated to be between 7% and 69% of the adult population internationally. In the United States, while the incidence of edentulism continues to decline, rapid population growth coupled with current economic conditions suggest that edentulism and conventional denture use will continue at current or higher numbers. Unfortunately, evidence-based guidelines for the care and maintenance of removable complete denture prostheses do not exist. In 2009, the American College of Prosthodontists (ACP) formed a task force to establish evidence-based guidelines for the care and maintenance of complete dentures. The task force comprised members of the ACP, the Academy of General Dentistry, American Dental Association (ADA) Council on Scientific Affairs, the American Dental Hygienists' Association, the National Association of Dental Laboratories, and representatives from GlaxoSmithKline Consumer Healthcare. The review process included the assessment of over 300 abstracts and selection of over 100 articles meeting inclusion criteria of this review. The task force reviewed synopses of the literature and formulated 15 evidence-based guidelines for denture care and maintenance. These guidelines were reviewed by clinical experts from the participating organizations and were published in February 2011 issue of The Journal of the American Dental Association for widespread distribution to the dental community. These guidelines reflect the views of the task force.

It is estimated that between 7% and 69% of adult populations internationally are affected with complete edentulism, which is defined as the loss of all permanent teeth.1 Additionally, 26% of the U.S. population between the ages of 65 and 74 years are edentulous, and low income and education levels have the highest correlation with tooth loss.2-4 While the incidence of complete edentulism in the United States continues to decline (approximately 6% between 1988 and 2000,5 continued growth in the population strongly suggests that edentulism rates will remain constant or increase over the next few decades.6 However, with the increasing need and expected demand for complete denture services, there are few published guidelines on the daily and long-term care and maintenance of complete denture prostheses.

Methods

In 2009, the American College of Prosthodontists (ACP) formed a task force to develop contemporary, evidence-based guidelines for the care and maintenance of complete dentures. This task force comprised individuals representing the ACP, the Council on Scientific Affairs of the American Dental Association, the Academy of General Dentistry, the American Dental Hygienists' Association, the National Association of Dental Laboratories, and representatives from GlaxoSmithKline Consumer Healthcare.

A literature search was conducted by task force members using PubMed, EMBASE, known prosthodontic references and materials obtained from the U.S. Centers for Disease Control and Prevention. Search words and MEDLINE Medical Subject Headings for the search included the terms "complete dentures," "edentulism" and various combinations of those terms and the following: "biofilm," "adhesives," "cleansers," "cleaning," "relines," "rebases," "repairs," "nocturnal (or continuous) wear," "stomatitis," and "maintenance." Abstracts of the following types of articles were reviewed: Cochrane Reviews, systematic reviews, general literature reviews, meta-analyses, randomized controlled trials, prospective clinical trials, cross-sectional studies, retrospective cohort studies and any in vitro studies that introduced novel approaches to evaluation of the topic. Over 300 abstracts were reviewed, and set inclusion and exclusion criteria allowed the identification of 150 manuscripts, which were reviewed by members of the ACP. Inclusion criteria included:

• clinical trials involving more than 10 participants;
• clinical trials of more than 7 days' duration;
• crossover trials with or without a washout period.

The ACP task force members reviewed the abstracts and excluded from further assessment those studies that did not meet the inclusion criteria. The same task force members printed and reviewed full-text articles and collated all data from the manuscripts on manuscript review matrixes. The reviewers summarized data for discussion by the entire task force. Over 120 manuscripts were included in this review. After the reviewing task force members conducted a careful analysis of the manuscripts, they provided summaries to all task force members for review, and a meeting was held at the School of Dentistry, University of North Carolina Chapel Hill, in May 2010 to develop the guidelines. After the meeting and multiple conference calls, the document that follows was developed and agreed upon by the task force members.

This document provides the practicing clinician with the evidence-based guidelines for the care and maintenance of complete dentures. In the main portion of the document, the guidelines are reported in bold type followed immediately by the evidentiary documentation. This document has been distributed to the communities of interest for review and input, and subsequently this document has been developed for distribution.

Guidelines for the Care and Maintenance of Dentures

Based on the best available evidence, the following are guidelines for the care and maintenance of dentures:

1. Careful daily removal of the bacterial biofilm present in the oral cavity and on complete dentures is of paramount importance to minimize denture stomatitis and to help contribute to good oral and general health.
2. To reduce levels of biofilm and potentially harmful bacteria and fungi, patients who wear dentures should do the following:
   1. Dentures should be cleaned daily by soaking and brushing with an effective, nonabrasive denture cleanser.
   2. Denture cleansers should ONLY be used to clean dentures outside of the mouth.
   3. Dentures should always be thoroughly rinsed after soaking and brushing with denture-cleansing solutions prior to reinsertion into the oral cavity. Always follow the product usage instructions.
3. Although the evidence is weak, dentures should be cleaned annually by a dentist or dental professional using ultrasonic cleansers to minimize biofilm accumulation over time.
4. Dentures should never be placed in boiling water.
5. Dentures should not be soaked in sodium hypochlorite bleach, or in products containing sodium hypochlorite, for periods that exceed 10 minutes. Placement of dentures in sodium hypochlorite solutions for periods longer than 10 minutes may damage dentures.
6. Dentures should be stored immersed in water after...