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Joseph E. Grasso, D.D.S.,M.S.D.

Denture Adhesives: Changing Attitudes

JADA, Vol.127, January 1996


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About the article

q It traces the emergence and growth of denture adhesives

q Mechanism of action

q Review of myths and realities

q Examination of data on their use

q Clinical relevance of the findings

q AIM: To provide the dental professional with a betterunderstanding of modern adhesive products and theirapplication to patient treatment


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Emergence And Growth Of DentureAdhesives

q Use began in the late 18th century

q Dentists started using it in the 19th century*1

q First U.S. patent was issued in 1913*

q 1939 Around 15million denture wearers andnumerous manufacturers of denture adhesive*

*1 Adisman IK. The use of denture adhesives as an aid to denture treatment. JProsthet Dent 1989; 63;711-5

*2 Yankell SL. Overview of research and literature on denture adhesives.Compend Contin Educ Dent 1984;4(Supplement);518-21

*3 McKevitt FH. The measured vertical dimension and denture adhesivepowders. J Prosthet Dent 1951;1:393-401


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Negative Attitude*

q To hold base plates while recording dental relations

q In immediate denture construction until well-fittingdentures were completed

qWhen the dentist is incompetent, or incapable, ofmaking a tight fitting denture.

*Young R, Weikel M. An appraisal of denture adhesive powders. Contact Point 1945;23:247-9


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Mechanism of Action

q *Shay: the material swells 50 to 150 percent byvolume in the presence of water

q Filling in spaces between the prosthesis and the

tissuesqAnions in the adhesive are attracted to the cations of

the mucous membrane producing stickiness

q

Current adhesives depend on a combination ofphysical and chemical forces

*Shay K. Denture adhesives: choosing the right powders and pastes, JADA


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Physical Force

q Stefan. Physical force

q Force required to pull two disks or plates apart isdirectly proportional to the viscosity of the liquid

between themq Saliva ses viscosity of the adhesive thereby sing the

force required

q

Modern adhesives use materials that provide strongbioadhesive and cohesive forces

q Bioadhesion via carboxyl groups

qAdhesive hydrates carboxyl groups form electrovalentbonds that produce stickiness


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q Polymethyl vinyl ether-maleic anhydride (PVM-MA)-synthetic copolymer- used widely because of its high levelof carboxyl groups

q Sodium carboxymethylcellulose (CMC)- natural

q CMC is more soluble than PVM-MA

q CMC- stong initial hold

q 1970s-combination of PVM-MA (calcium salts) amd CMC

q Quick upfront hold (CMC) and a hold of longer duration(PVM-MA)

q Highly cross-linked matrix


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q Late 1980s. PVM-MA zinc and calcium salts withCMC

q Even greater cohesive strength

q *Stronger, longer hold than calcium salts

*Mackay BJ, Jackson JJ, Vanalstine RL, Mas JC. Comparitive efficacy ofpowder denture adhesive (Abstract). J Dent Res 1993;72(SpecialIssue):376

*Mackay BJ, Jackson JJ, Vanalstine RL, Rajaiah J. Comparitive efficacy ofcream denture adhesive (Abstract). J Dent Res 1993;72(Special Issue):376


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Patients Use of Denture Adhesives

q *1 Britons used about 88 tons of denture adhesives (1970)

q *2 Tautin Denture adhesives will be with us until weeliminate the need for complete dentures.. The majorproblem with denture adhesives is not their effect on tissuenor the results of their long-term usage, nor even their effecton vertical dimension; it is that the dental profession knowsso little about them.

*1 Stafford GD. Denture adhesives: a review of their uses andcompositions. Dent Pract September 1970;21:17-9

*2 Tautin FS. Dental adhesives-a problem.Dent Survey 1978;54(8):24-6


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The role of denture adhesives with well-fittingdentures

q McKevitts opinions. 1950, 1951 & 1957. Earlycriticism

q *He maintained the sinister role of denture adhesive

powders in prosthodontia prompts the query: hasprosthodontia fallen into disrepute?

*McKevitt FH. The measured vertical dimension and denture

adhesive powders. J Prosthet Dent 1951;1:393-401

*McKevitt FH. Denture adhesive powders. J Calif Dent AssocNevada State Dent Soc 1957;33:469-72


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Kapurs study

q Kapur objective approach

q *A method for scoring denture retention and stability (ill,fair and well-fitting prostheses)

q Published in 1967q Conclusion: denture adhesives unequivocally increased

denture retention, thereby improving denture wearersincisive ability

q Advised dentists to "keep an open mind on the subject ofdenture adhesives

q Patients have an increased sense of security, added comfortand a subsequent perception that masticatory performance

is improved


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Stafford and Russell

q Objective investigation of denture performance

q *Measured changes in pressure at the denture base-mucosainterface with and without adhesive

q Patient can apply greater force to the occlusal surfaces of aprosthesis under controlled circumstances(HYPOTHETICALLY)

q Adhesives allowed greater occlusal pressure

q More for patients with ill-fitting prostheses

q Amount of time needed to chew didnt vary

*Stafford GD, Russell C. Efficiency of denture adhesives and their possibleinfluence on oral microorganisms. J Dent Res 1971;50:832-6


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Tarbet and colleagues

q Role of adhesives in denture retention and stability

q *By counting denture dislodgements in patients who wereeating standardised portions of food (celery, taffy apple,steak and hard roll sandwich) with and without a denture

adhesive

q Patients had or were provided with well-fitting prostheses

q Results: significant reduction in dislodgement when an

adhesive was usedq Included patient perspective

*Tarbet WJ, Boone M, Schmidt NF. Effect of a denture adhesive oncomplete denture dislodgement during mastication. J Prosthet Dent

-


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Chew and colleagues

q Kinesiographic technique

q *Aim: To determine the effectiveness of dentureadhesives in improving retention and stability of

complete maxillary dentures in vivoq Result: adhesives improved retention and stability of

both well-fitting and ill-fitting dentures but exertedtheir greatest effect with ill-fitting dentures

*Chew CL, Phillips RW, Boone ME, Swartz ML. Denturestabilization with adhesives: A kinesiographic study. CompendContin Educ Dent 1984;4(Supplement): S32-8


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Tarbet and colleagues

q *Biting force of denture wearers (radiotelemetry andgnathodynamometry)

q In patients whose tissues were judged to be unlikely for

good retention and stabilityq Result: when adhesives were used, these patients

achieved biting forces similar to patients with moresatisfactory support tissues

q Improvement in maxillary retention and stability

*Tarbet WJ, Silverman G, Schmidt NF. Maximum incisal biting


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Contd

q *Conclusion: "A denture adhesive thus an be ofconsiderable benefit to many denture wearers, eventhose with good quality denture support tissues.Subjectively, the adhesive provides confidence;

objectively, it allows the development of needed forcesin the biting and chewing of foods.

* Tarbet WJ, Silverman G, Schmidt NF. Maximum incisal biting force indenture wearers as influenced by adequacy denture bearing tissues andthe use of an adhesive. J Dent Res 1981;60(2):115-9


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Grasso and co-workers

q *1 Use of adhesives generate significantly greater levels ofincisal bite force up to eight hours after application

q Increase of upto 20N (35N baseline to 54N at eight hours)

q *2 Functional bite forces of 40 to 50N are required to incisefoods such as hard pretzels, apples and carrots

q Thus the increased bite force due to the use of adhesivescrosses the required threshold

*1 Grasso JE, Rendell J, Gay T. Effect of denture adhesive on theretention and stability of maxillary dentures. J Prosthet Dent1994;72:399-405.22.

*2 Gay T. Rendell J, Majourau A, Maloney F. Use of quantitative


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Review

q Lack of objective measurement tools

q Objective methods can provide a authoritativeposition on the role of denture adhesives

q Contemporary testing methods have provided abroader base


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Tissue irritation and bone resorption

q* Definite pattern

of bone resorptionin the edentulousmouth with or

without dentures


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Boone

q *He commented that, "much of this information isfact, but more of it is fallacy, especially as it relates tothe causes of alveolar bone change.

q Over-the-counter products for altering prostheses fitand function have been lumped together

q "accused of destroying bone, or at least of causingbone changes.

q Products should be divided into insoluble (causatives)and soluble (adhesives) agents

* Boone M. Analysis of soluble and insoluble denture adhesives


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Insoluble agentsSoluble agentsDenture pads

Softened toilet paper

Insoluble plastic denture

adhesivesFrank ridge destruction

Dissipate

Flow under pressure

Spread

Distribute denture loadevenly

Cushioning


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Contd

q *1 Boone remarked, "If the use of adhesives were to causebone resorption, the stresses involved would have to betransmitted through the oral mucosa, even with ill-fittingdentures. If these stresses were of sufficient magnitude or

duration to cause bone changes, it would be reasonable toexpect that soft tissue lesions would occur.

q *2 Such changes are not observed with adequate oralhygiene

*1 Boone M. Analysis of soluble and insoluble denture adhesives and theirrelationship to tissue irritation and bone resorption. Compend Cont EducDent 1984;4(Supplement): S22-5

*2 Abdelmelak RG, Michael CG. The effect of denture adhesives on thepalatal mucosa under complete dentures: a clinical and histological


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Contribution to oral pathoses???

q *1 1940s Adhesives did not inhibit microorganisms

q *2 1950s Adhesives did not support bacterial growth

*1 Bartels HA. Bacterial activity and tissue tolerance: their rolein prosthodontia. J Dent Educ October 1944;9:57-72

*1 Bartels HA. Bacteriological appraisals of adhesive denturepowders. J Dent Res 1945;24(1):15-6

*2 Kelly J, Kutscher AH, Tuoti F. Bacteriological studies with anew adhesive preparation for oral use. J Conn State Dent Assoc

1959;33(3):9-14


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Stafford and Russell

q Supported some microorganisms

q Candida albicans, Streptococcus mitis

q *Unable to demonstarte inhibitory effect on the oral

flora

q Imbalance in the flora by selective inhibition andsupport

q Denture trauma initiates and perpetuates stomatitis

qAdhesives reduce potential trauma

*Stafford GD, Russell C. Efficiency of denture adhesives and


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Tarbet and Grossman

q Six-month investigation

q *111 denture wearers who regularly used denture adhesives

q No increase in mucosal irritation

q Irritation improved or was eliminated due to the adhesives

q Conclusion: An appropriate adhesive can reduce thelikelihood of tissue irritation

*Tarbet WJ, Grossman E. Observation of denture supportingtissue during six months of denture adhesive wearing. JADA

1980;101:789-91


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Clinical Implications

q Denture patients can benefit in a variety of clinicaldimensions by using denture adhesives

q Denture adhesives have a place in the professional careofpatients; they can significantly enhance denture

performance and patient confidence but should not be usedto compensate for denture deficiencies

q *Continuous use of a denture adhesive in an ill-fittingdenture can mask an underlying stomatitis that can lead to

further involvement

*Polyzois GL. An update on denture fixatives. Dent Update 1983;10:579-83


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Contd

q *1Adisman suggested that, patient instructionsregarding the use or non-use of denture adhesivesshould be an integral part of denture aftercareinstructions.

q *2 Shay said that some patients may benefit fromdenture adhesives and that, the "keys to their proper uselie in the special needs of each patient, the properties ofthe adhesives themselves and in the dentist's knowledge

and willingness to help.

*1 Adisman IK. The use of denture adhesives as an aid to denture

treatment. J Prosthet Dent 1989; 63;711-5*


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Conclusions

q Contraindicated in ill-fitting dentures

q Improved function

q Greater retention and stability

q Increased incisal bite force

q Sense of comfort (physical and psychological) for thepatient

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