Sanitary and epidemiological features of dental prosthesis care

Introduction

Proper dental prosthesis care has become a crucial aspect of maintaining oral health and overall quality of life, particularly among elderly individuals. Adequate prosthesis hygiene plays a significant role in preventing various oral diseases that can adversely affect general health. Inadequate or irregular prosthesis care may contribute to the development or exacerbation of systemic conditions. Oral infections have been linked to an increased risk of cardiovascular diseases, gastrointestinal disorders, diabetes mellitus, and respiratory infections. Thus, prosthesis maintenance is directly associated with the prevention of systemic diseases.

The study was aimed at analyzing the sanitary and epidemiological characteristics of dental prosthesis care among the population, identifying correlations between prosthesis hygiene and systemic/oral diseases, and substantiating the need for improved public awareness, particularly among older adults, regarding the importance of proper dental prosthesis maintenance.

Materials and methods

For the preparation of this review, an analysis of scientific articles and original research from library databases (eLibrary, PubMed, ResearchGate, Web of Science, and Scopus) was conducted.

Results

With increasing life expectancy and improved healthcare services, the number of denture wearers continues to rise. In the Russian Federation, average life expectancy has surpassed 73 years¹. As stated in the President of the Russian Federation’s address to the Federal Assembly on February 29, 2024, the national goal is to achieve a life expectancy of at least 78 years by 2030, with further progression to 80+ years, supported by the national project “Long and Active Life”². Consequently, a growing number of patients will require dental prosthetic treatment.

Despite the widespread use of dental prostheses, optimal care and maintenance protocols remain understudied. Many patients lack sufficient knowledge about proper denture hygiene practices. Non-compliance leads to accelerated wear, microbial colonization, aesthetic deterioration, and ultimately additional financial burdens for replacement prostheses [1].

Proper and timely denture care not only preserves functional and aesthetic properties but also prevents oral pathologies such as stomatitis, periodontitis, and other infectious-inflammatory conditions that significantly impair patients’ quality of life [2]. Inadequate hygiene promotes pathogenic microorganism accumulation on prostheses, increasing risks of both local and systemic infections [3], which strains healthcare systems through increased treatment demands and costs.

Dental prostheses play a vital role in oral rehabilitation by restoring masticatory function. Scientific literature confirms their critical importance for maintaining life quality in elderly populations [4].

In the Russian Federation, approximately one million removable partial dentures are fabricated annually [5]. The prevalence of complete edentulism reaches 1.1% in individuals aged 41–50 years, 5.5% in those aged 51-60 years, and 25% in populations over 61 years³. The growing demand for dental prosthetics correlates with demographic aging trends. However, economic accessibility of such services remains limited due to fixed incomes among elderly patients and persistent inflation in dental service costs, collectively contributing to deteriorating oral health conditions [5]. Epidemiological data from 2015 estimated 8.7 million potential prosthetic treatment candidates, reflecting increased life expectancy [6][7]. Municipal dental facilities in Moscow produced approximately 57,000 removable partial dentures in 2021, with private clinics demonstrating equivalent production volumes [8]. Based on literature reviews and demographic projections, domestic analysts predict the population requiring prosthodontic rehabilitation due to complete edentulism will reach 15.6 million by 2025 and 16.3 million by 2030 [6][7][9].

Discussion

The challenges associated with removable denture prosthetics encompass a wide range of physical, psychological, and functional changes that collectively significantly impact daily life [10]. The loss of proper masticatory function rapidly deteriorates patients’ quality of life. Food intake becomes problematic, leading to substantial dietary restrictions, nutritional deficiencies, speech impairments, and overall physiological imbalances [11]. Beyond restoring basic physiological functions, dental prostheses are essential for proper socialization. A well-fabricated and balanced prosthesis ensures clear speech, coordinated neuromuscular function, and facilitates social and economic interactions, thereby improving quality of life. Moreover, societal perceptions of tooth loss can diminish self-confidence. Psychologically, tooth loss often induces anxiety and negatively affects self-esteem [12]. Chakaipa et al. note that individuals may isolate themselves, limit smiling, or avoid conversations due to embarrassment or shame [13]. Nevertheless, studies show that 64.7% of elderly patients report a good quality of life after prosthetic rehabilitation [14]. There is a weak correlation between patient satisfaction and factors such as denture quality and hygiene [15]. Satisfaction with prosthetic use is not solely dependent on its current condition—patients often delay replacement until the prosthesis becomes irreparably damaged [16].

Currently, prostheses for partial and complete secondary edentulism are fabricated from various materials, including polymers, composites, ceramics, and metal alloys. These materials influence oral microbiota, alter natural mucosal self-cleaning processes, and affect epithelial resistance to external damage. Wear and food debris accumulation disrupt the natural balance, potentially promoting pathological processes [17]. Microbial colonization of dentures begins immediately after insertion, with colonization rates depending on the prosthetic material, surface polish quality, and degree of wear [18].

The oral microbiota exhibits substantial diversity, comprising approximately 700 microbial species that colonize the oral mucosa and structures. These microorganisms utilize proteins, carbohydrates, amino acids, and inorganic compounds from oral fluids and human metabolic byproducts for survival [17][19]. Among aerobes with clinical significance, streptococci such as S. mutans, S. sanguis, S. salivarius, and S. mitis dominate, representing 30–60% of oral flora [20]. Each species demonstrates site-specific colonization patterns: S. mutans and S. sanguis predominantly inhabit dental calculus and plaque, S. salivarius colonizes the tongue dorsum, while S. mitis preferentially adheres to buccal mucosa. Anaerobic microbiota includes Bacteroides species such as B. gingivalis, B. melaninogenicus, and B. fragilis, along with Actinomyces, Fusobacterium, Leptotrichia, and Propionibacterium. These pathogens adhere to and proliferate in periodontal pockets, contributing to periodontal ligament destruction and eventual secondary edentulism [21]. Gram-positive cocci (peptococci) in gingival sulci, when combined with spirochetes and fusobacteria, compromise host resistance and promote periodontal disease progression⁴. Klebsiella and Proteus species activate lipid peroxidation and induce dysbiosis, with microbial toxins exacerbating inflammatory processes and precipitating mucosal dystrophic changes [22]. Lactobacilli (L. acidophilus, L. fermentum) constitute normal flora components, maintaining ecological balance through protease, peptidase, and bacteriocin production that ensures colonization resistance [23]. Candida species are detected in 40–50% of healthy individuals, with colonization levels influenced by age, systemic health status, and comorbidities [24]. It is important to note that their presence does not always indicate the presence of oral diseases. While typically existing as commensals, immunosuppression, inflammatory conditions, or broad-spectrum antibiotic use can trigger pathogenic transformation, resulting in oral candidiasis [25].

Microbial colonization of dental prostheses occurs during active use, facilitated by the material’s thermostatic properties and progressive development of surface microporosity that promotes pathogenic microorganism accumulation. The porous surface of dentures enables deposition and retention of food particles, while oral microbiota facilitates microbial adhesion and proliferation both on the surface and within the internal structure of the prosthetic device. Studies demonstrate significant increases in E. coli (from 10% to 63%), Candida-like fungi (from 30% to 74%), pathogenic staphylococci (from 10% to 22%), and enterococci (up to 22%, normally absent) [26]. Most denture base materials undergo biodegradation, a process generating toxic compounds hazardous to human health through microbial action on prosthetic materials, while also inducing undesirable allergic reactions⁵ [27]. Pathogenic colonization by A. naeslundii, P. melaninogenica, K. nucleatum, and S. intermedius can disrupt microbial balance, trigger inflammatory processes in the prosthetic bearing mucosa, and increase the risk of denture stomatitis development. Potential complications of this infectious process include progressive periodontal destruction, alveolar bone resorption, and consequent impairment of masticatory function with possible temporomandibular joint disorders [28][29].

The saliva of patients undergoing prosthetic treatment demonstrates increased trace element content, resulting in shifts of electrochemical potentials and hydrogen index (pH) toward acidic values. This alteration compromises the oral mucosal barrier function, modifies ionic exchange rates, and enhances pathogenic microorganism activity [30][31]. Precious metal alloys containing gold exhibit minimal oral microbiota composition changes, with pathogenic and opportunistic microorganism colonization not exceeding 1.32×10⁶ CFU/cm² [32]. Silver-containing alloys demonstrate oligodynamic, bactericidal, and immunomodulatory properties, displaying selective antimicrobial activity against pathogenic microorganisms due to their heightened sensitivity to silver ions [33]. Stainless steel prosthetics show increased coccal populations (staphylococci and streptococci), spirilla, and microbial density up to 9.8×10⁶ CFU/cm², accompanied by reduced lactobacilli counts. Denture usage correlates with elevated Escherichia, Klebsiella, and Staphylococcus aureus colonization, increasing total microbial load to 1.2×10⁷ CFU/cm², which is indicative of compromised local immunity [34]. Microbial adhesion to dentures occurs through surface attachment and interbacterial interactions, potentially reaching 2×10⁹ CFU/cm² [32–34]. Contamination depth may extend 2.0–2.5 mm into prosthetic materials, necessitating replacement every 3–5 years with strict adherence to dental follow-up protocols [35]. Limited patient awareness exists regarding microbial contamination levels during routine denture use. Few patients employ specialized disinfection methods [2]. Effective cleaning requires professional or ultrasonic methods due to micropore dimensions and plaque adhesion strength [27][36]. Inadequate maintenance reduces prosthetic longevity, promotes oral cavity contamination, and contributes to systemic and odontogenic disease development [32–35].

In the study by Fomina et al., it is recommended to perform thorough daily care of dental prostheses. After removal from the oral cavity, orthopedic constructions should be stored in a dry and clean container. Before insertion, the prosthesis should be moistened with a small amount of water, or specialized adhesive gels should be used. In order to maintain the cleanliness of the prosthesis, after each meal, the orthopedic construction should be removed from the oral cavity and thoroughly rinsed under running water using universal soft or medium-hardness toothbrushes for the most effective removal of food debris. In the morning and evening, cleaning should be performed with a specialized double-sided brush-dental pick using specialized hygiene products. Cleaning of the dental prosthesis should be performed for at least 20 minutes [37]. Care of the orthopedic construction should be provided over a clean sink to avoid mechanical damage in case of accidental dropping and to reduce the risk of additional contamination from other surfaces [2]. The use of cleaning tablets or solutions containing active oxygen is recommended. They effectively clean prostheses and eliminate unpleasant odors, while not subjecting them to additional mechanical impact and preventing the introduction of infection into the oral cavity [38]. For oral hygiene and orthopedic constructions, disinfectant solutions with silver ions are increasingly being used. These solutions have demonstrated their effectiveness and possess a broad spectrum of selective antimicrobial, antifungal, and antiviral activity⁶ [33]. The combination of various hygiene products becomes an important component in maintaining the health and durability of orthopedic constructions, which emphasizes the necessity of patient awareness on this matter.

Regular follow-up examinations for patients undergoing prosthetic treatment are critically important. These visits enable the dental practitioner to assess the patient’s level of awareness regarding proper hygiene protocols, the functional integrity of the dental prostheses, potential complications, and the need for treatment plan modifications. When indicated, professional prosthesis cleaning utilizing ultraviolet and ultrasonic technologies should be performed [37]. Such comprehensive monitoring ensures optimal prosthetic longevity, facilitates timely replacement, and mitigates risks of developing odontogenic and systemic comorbidities [39][40][3][35][41].

Conclusion

Adherence to proper dental prosthesis care protocols results in reduced risks of inflammatory diseases caused by odontogenic infections and the development of systemic conditions. Analysis of sanitary-epidemiological aspects of dental prosthesis maintenance has demonstrated high efficacy of various cleaning tablets, disinfectants, and care methods (hygiene recommendations) in decreasing oral pathogenic microorganisms, preventing odontogenic diseases, and extending the service life of dental prostheses. The development and implementation of comprehensive patient education programs regarding the importance of oral and prosthetic hygiene significantly lower the risk of associated disease development.