Dentures and Obturators

Intended Learning Outcomes

• Students should be able to describe different types of dentures and obturators by the end of this session.
• The importance of denture hygiene should be recognized.
• Assessing denture cleanliness, and the Denture Cleanliness Index should be discussed.
• Methods of cleaning dentures should be able to be identified.

Types of Dentures and Obturators

• Complete or full dentures replace all teeth in an arch.
• Obturators are prostheses used to close or block an opening, often in the palate.
• Partial dentures replace some teeth in an arch.

Importance of Denture Hygiene

• Lack of denture hygiene can lead to denture stomatitis.
• Candida Albicans can invade the surface of dentures.

Using the Denture Cleanliness Index (DCI)

• It is important to explain to patients that the denture will be checked to see if support in cleaning is needed.
• Obtain verbal consent and remain non-judgemental and reassuring.
• Fill the sink with water and gently wash the denture under cold water to remove loose debris.
• Apply plaque disclosing solution onto the fitting surface and rinse after 30 seconds to visually inspect.
• Assign a DCI score to both upper and lower dentures, and the worst score becomes the overall score.

The Denture Cleanliness Index Scoring

• A score of 0 means clean denture. No plaque is visibly seen, no staining, no plaque detectable.
• A score of 1 means that the denture is visibly clean with little staining (<25% fit surface stained).
• A score of 2 means denture has visible plaque and/or debris and moderate staining of the fit surface (25-50% fit surface stained).
• A score of 3 means denture has visible plaque and/or debris and severe staining of the fit surface (>50% fit surface stained).
• A score of 4 means denture has visible calculus deposit on any surface.
• The asterisk * symbol means visible defects in dentures, in addition to any of the above scores which are potentially plaque retentive or require repair or remake of denture.

Denture Hygiene Instructions According to DCI Score

• A score of 0 entails no intervention required, and reinforce current denture hygiene.
• A score of 1 entails denture hygiene reinforcement.
• A score of 2 entails denture hygiene reinforcement, and providing a patient information leaflet.
• A score of 3 entails denture hygiene reinforcement, a patient information leaflet, and a denture hygiene kit.
• A score of 4 entails denture hygiene reinforcement, a patient information leaflet, a denture hygiene kit and clinician intervention to clean dentures.
• An asterisk scoring entails considering denture reline or remake (depending on severity of defect), and refer to GDP.

Cleaning Dentures Manually

• Fill a sink or bowl with water.
• Use a denture brush/soft toothbrush with softer filaments to minimize scratching.
• Use denture cleansing adjuncts formulated specifically for dentures using denture toothpaste/gel/foam/powder.
• Clinicians can demonstrate cleaning all surfaces on half the denture, after which the patient can demonstrate back.

Chemical Cleaning for Dentures

• Bleach-based cleaners may contain sodium hypochlorite or sodium hydroxide.
• Effervescent cleaners may contain peroxide, bicarbonate, percarbonate, or persulphate.
• Other classes include mineral acid-based, enzyme-based, flexible denture cleaners and oral rinses.

Maintaining Optimum Oral Health for Denture Wearers

• Oral hygiene and denture hygiene coaching should be provided meticulously at appropriate intervals.
• Incorporate the Denture Cleansing Index into routine visits to assess denture hygiene.
• Make ensure the patient is cleaning the denture extra orally and over a filled sink/bowl.
• Cleaning with both mechanical (brushing) as well as the appropriate chemical cleanser offers the optimum plaque biofilm control.