ACP guidelines for the care and maintenance of complete dentures (2011): 15 rules on daily cleaning, adhesives, taking dentures out at night and a yearly check

What it says#

The document opens with the problem it is answering: between 7% and 69% of adult populations internationally are completely edentulous, 26% of the US population aged 65 to 74 has no teeth, and although the incidence of complete edentulism in the United States fell about 6% between 1988 and 2000, population growth means denture use will hold steady or rise, while few published guidelines exist on the daily and long-term care of the prostheses. In 2009 the American College of Prosthodontists formed a task force with representatives of the ACP, the ADA Council on Scientific Affairs, the Academy of General Dentistry, the American Dental Hygienists' Association, the National Association of Dental Laboratories and GlaxoSmithKline Consumer Healthcare, which also funded the project and the supplement. The members searched PubMed, EMBASE, prosthodontic references and CDC material on complete dentures and edentulism combined with biofilm, adhesives, cleansers, cleaning, relines, rebases, repairs, nocturnal or continuous wear, stomatitis and maintenance; reviewed over 300 abstracts; identified 150 manuscripts that met the inclusion criteria (clinical trials of more than 10 participants and more than 7 days, and crossover trials); included over 120; and met at the University of North Carolina Chapel Hill School of Dentistry in May 2010 to write the guidelines.

The 15 guidelines, in the document's order. One: careful daily removal of the bacterial biofilm in the mouth and on the dentures is of paramount importance to minimize denture stomatitis and to contribute to good oral and general health. Two: dentures should be cleaned daily by soaking and brushing with an effective, nonabrasive denture cleanser; cleansers should only be used outside the mouth; and dentures should be thoroughly rinsed after soaking and brushing before reinsertion, following the product instructions. Three: 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. Four: dentures should never be placed in boiling water. Five: dentures should not be soaked in sodium hypochlorite bleach, or in products containing it, for longer than 10 minutes, which may damage them. Six: dentures should be stored immersed in water after cleaning, when not in the mouth, to avoid warping.

Seven through thirteen cover adhesives. Properly used, adhesives can improve retention and stability and help seal out food particles beneath the denture, even a well-fitting one. In a quality-of-life study, patient ratings showed adhesives may improve perceived retention, stability and quality of life, but there is insufficient evidence that they improve masticatory function. Evidence on the effects of adhesives on the oral tissues beyond 6 months of use is lacking, so extended use should not be considered without periodic assessment of the denture and the supporting tissues by a dental professional. Improper use of zinc-containing adhesives may have adverse systemic effects, so as a precaution they should be avoided. Adhesive should be used only in sufficient quantity, three or four pea-sized dollops on each denture. It should be completely removed from the prosthesis and the mouth daily. And if increasing amounts are needed for the same retention, the patient should see a dentist to evaluate fit and stability.

Fourteen: while existing studies give conflicting results, it is not recommended that dentures be worn continuously, 24 hours a day, in an effort to reduce denture stomatitis. Fifteen: denture wearers should be checked annually by the dentist, prosthodontist or dental professional for maintenance of optimum fit and function, for evaluation for oral lesions and bone loss, and for assessment of oral health status.

The evidence sections behind the guidelines carry the numbers a practice will recognize. In a Brazilian clinic study of 236 complete-denture wearers, only 44% had sought treatment after delivery, and that at 10 years; 78% said they had received no instruction on cleaning, 92% had not been told to return for recall, and denture stomatitis was found in 42%, nearly 90% of whom had no symptoms. The document reports that there are no published clinical guidelines on how often to reline or rebase, and no studies of an appropriate recall interval for the edentulous patient, and it asks clinicians to evaluate every denture wearer periodically for ridge resorption, changes in vertical dimension, phonetics, base integrity and tooth wear, and for general health, soft tissue health, oral cancer screening and blood pressure.

Who it applies to#

Patients wearing conventional removable complete dentures, and the dental team that delivers and maintains them; the ADHA and the laboratory association sat on the task force because hygienists and technicians carry part of the work. The guidelines also reach caregivers of the dependent elderly, since the document's case for hygiene rests partly on the link between denture biofilm and aspiration pneumonia in that group.

It is a complete-denture document. Partial dentures and implant overdentures were not in the search terms, and nothing here speaks to them. It sets no reline, rebase or remake interval, because it found none in the literature. And it does not grade its own recommendations beyond flagging guideline 3 as weak evidence and guideline 14 as resting on conflicting studies; the task force says plainly that it did not categorize its references by strength of evidence and lists future research needs, including microwave cleaning, the impact of denture hygiene on general health, the inflammatory process in stomatitis, and adhesive effects beyond 6 months.

What changed#

First edition, and the abstract says why: evidence-based guidelines for the care and maintenance of complete dentures did not exist. Against common practice, four points bite. The cleanser goes on the denture outside the mouth, not in it. Bleach soaks stop at 10 minutes. The denture comes out for part of every day. And the patient comes back every year whether or not the denture hurts, which the Brazilian study shows most were never told to do.

Where the source is#

The document is Felton and colleagues, Evidence-Based Guidelines for the Care and Maintenance of Complete Dentures: A Publication of the American College of Prosthodontists, Journal of Prosthodontics 2011, volume 20, supplement 1, pages S1 to S12, doi 10.1111/j.1532-849X.2010.00683.x. The link under the title opens the ACP's own copy of the supplement, 12 pages, reproduced under agreement with the College; the Wiley journal page refused automated access when this entry was written, so the text was read from the ACP copy. The same guidelines were published in the February 2011 supplement of the Journal of the American Dental Association (142, Suppl 1, 1S-20S), which is behind the JADA paywall; both PubMed records are listed above. Funding for the project and the supplement came from GlaxoSmithKline Consumer Healthcare, and the authors declare no conflicts of interest.