Date: 3rd Oct., 2016
There is a common belief among dentists that – optimal outcome of complete denture treatment depends on the successful integration of the prosthesis with the patient’s oral functions along with patient’s psychological acceptance of the dentures. It has been proved in evidence-based dentistry that complete denture patients are treated better by the psychological skills of the dentist, instead of advanced prosthodontic tools.
Which is why satisfying a complete denture patient has always been a nightmare for many dentists. The current trend is to consult a prosthodontist for a complete denture patient in most of the clinics. The most common problem faced by a such a patient is inadequate retention of the denture. As a prosthodontist, if I had to enumerate factors affecting retention in a complete denture patient, I could write an essay over it. To make it simple, these factors can be classified as:
- Dentist related – These factors depend on how skillfully the borders are trimmed or moulded to adapt the tissues and the surrounding musculature.
- Patient related -These factors can be the type of edentulous ridges, type and quantity of saliva and neuromuscular control
I have classified these factors in the aforementioned categories as they aren’t important from a general reader or patient’s point of view. I feel the need to mention them to acknowledge the fact that many patients blindly assign the blame for non-retentive dentures on their dentists instead of thinking about any other factor that may have been the cause.
Denture adhesives are used by many denture wearers and prescribed by dentists. Yet, many prosthodontists have a negative attitude towards the use of denture adhesives as they assume that to advocate their use is a means to compensate for deficiencies in clinical and technical procedures.
The fact, however, is denture adhesives increases denture retention and thereby improve chewing ability, reduce denture wobble, increase comfort and confidence, and decrease the amount of food particles collected under the dentures. Moreover, adhesives undoubtedly provide the sense of security and satisfaction, but they should use them if prescribed by their dentist. Patients should also be instructed on proper use and cautioned against misuse of adhesives.
Even the right tool in a wrong hand can be deleterious. Medicines are meant to cure but self-prescription of a medicine can do more harm than good.
The use of denture adhesives, fixatives, adherents began about the same time as the age of modern dentistry. Adhesives or fixatives used in the 19th century were formulated by an apothecary who mixed vegetable gums. Earlier, adhesives were formulated by mixing vegetable gums, which absorbed moisture from saliva and swelled to form a mucilaginous substrate that adhered to the mucosa of the mouth and the denture. The earliest patent pertaining to denture adhesives was issued in 1913.
Following are some studies conducted on denture adhesives:
- In 1967, Kapur1 conducted a study on 26 denture wearers and devised a method for scoring denture retention and stability. He concluded that denture adhesives improve the denture retention, and thereby improves the incising ability of the patient.
- Stafford and Russell2found that denture adhesives help in uniform distribution of force on the ridge.
- Tarbet et al3 found that denture adhesives improve the chewing ability and overall comfort and confidence of the patient.
- Abdelmalek and Micheal4 suggested that denture adhesives act as cushion under the complete denture to prevent excessive force being transferred to the ridges.
Dentures adhesives can mainly be grouped in two groups:
The insoluble group comprises of pads and wafers which are not commonly used nowadays. They all include a laminated fabric with a water activated component impregnated within the fiber mesh. Adhesives ingredients included are sodium alginate or ethylene oxide polymer.
– Karaya gum
– Tragacanth acacia
– Hydroxyl methylcellulose
– Sodium carboxy-methyl cellulose
|– Polyethylene oxide|
– Acryl amides
– Acetic polyvinyl
– Sodium tetra borate
– Sodium borate
– Wintergreen oil
– Peppermint oil
– Methyl paraben
– Sodium borate or polyparaben
– Mineral oil
– Polyethylene oxide
Mechanism of Action
Denture adhesives augment the retentive mechanism of a denture by:
- Increasing the adhesive and cohesive properties, and the viscosity of the medium lying between the denture and its basal seat
- Eliminating voids between the denture base and the basal seat
They are basically available in two forms
Adherent powders might include a vegetable gum such as acacia, tragacanth, or karava. Upon addition of water, these materials swell up to more than their original volume and acquire viscous and retentive properties.
Cream adhesives might derive their retentive properties from polymers such as methyl cellulose, hvdroxvmethvl cellulose, or carboxvmethvl cellulose. The increase in viscosity of the cream layer, compared with that of the saliva, is a factor for the increased retention.
Dental adhesives are important and can help in denture retention. In this post, we talked about the history, types, composition and mechanism of action of dental adhesives.
To know the characteristics, indications, contraindications and application procedures of dental adhesives, check out Dental Adhesive – Complete Overview, Part 2 of this blog.