Original article

Effect of denture adhesive on the micro-organisms in vivo

Yasemin Kulak Ozkan1, Mert Uçankale1, Mutlu Özcan2 and Nurver Üner3
1
Department of Prosthodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey; 2Department of Dentistry and Dental Hygiene,
Clinical Dental Biomaterials, University Medical Center, Groningen, The Netherlands; 3Department of Microbiology, Faculty of Medicine,
Marmara University, Istanbul, Turkey

doi: 10.1111/j.1741-2358.2010.00381.x
Effect of denture adhesive on the micro-organisms in vivo
Background: Denture adhesives increase the retention and stability of dentures in edentulous patients,
especially in cases where salivary flow is impaired or in the management of traumatised oral mucosa.
Objectives: The effect of a denture adhesive on the oral flora at different time intervals.
Method: Thirty denture-wearing patients were involved in this study. While half of the group received a
denture adhesive, the other half did not. At baseline, 1 and 2 months after delivering the dentures, smear
samples were obtained from the saliva, palate and the dentures. Candida albicans, Candida krusei, Candida
glabrata, Candida spp., Staphylococcus aureus, Moraxella catarrhalis, a-haemolytic streptococci, b-haemolytic strep-
tococci, Pneumococcus aureus, S. anginosus, S. intermedius, S. constellatus, S. sanguis, S. gordonii, S. mitis, S. mutans,
S. salivarius, and yeasts were investigated. The data were statistically analysed using ANOVA and repeated
measures.
Results: Most types of the micro-organisms were not seen and could not be analysed statistically except a-
haemolytic streptococci and C. albicans. No statistically significant difference was found for a-haemolytic strep-
tococci and C. albicans in saliva, palate and the denture at all time intervals.
Conclusions: Prolonged use of the denture adhesive tested up to 2 months did not yield to increase in
micro-organisms of the oral flora.

Key word: Candida albicans, denture adhesive, denture micro-organisms.

Accepted 16 January 2010

complete denture4–6, improve chewing and masti-

Introduction
Improving denture retention and stability is of
considerable importance in prosthetic dentistry
when dealing with removable dentures. Funda-
mental rules such as appropriate impression taking
and extending the denture margins and consider-
ing the anatomical structures still hold for reliable
denture retention and stability. However, for
patients with Sjögren’s syndrome, those who are
under medication or radiotherapy that may lead to
xerostomia or bone resorption, denture retention
and stability may not be ideal or may require
frequent adjustments1,2.
Approaches to this problem over the years for
either conventional dentures or implant-supported
overdentures, have involved the use of denture
adhesives3. These are used by denture wearers in
order to increase the retention and stability of
cation ability7 and support the patient psychologi-
cally by making their use more acceptable8–10.
Many dentists hesitate to prescribe denture adhe-
sives, fearing that it indicates their failure to
provide an adequate denture. Although clinical
trials fail to show adverse effects of denture adhe-
sives on the oral soft tissues, dentists also fear that
denture adhesives cause increased alveolar ridge
resorption and soft tissue hyperplasia8,10,11,12.
Concern on the part of the profession and dental
educators about the misuse of denture adhesives
and the potential deleterious effects that they may
have on oral health is valid only with respect to ill-
fitting dentures. Certainly, patients who continue
to wear such dentures may misuse denture adhe-
sives6. There is however limited documentation
indicating that the use of these materials may be
harmful; however, the early literature is replete

 2011 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: 9–16 9
10 Y. K. Ozkan et al.
with myths and speculations3. The regular use of
an appropriate adhesive is not associated with any
increased incidence in mucosal irritation in denture
wearers8 and, in fact, can reduce the likelihood of
the occurrence of tissue irritation and, at the same
time provide the denture wearer with physical and
psychological benefits8.
Denture adhesives often include antimicrobial
agents such as hexachlorophene, sodium tetra
borate, methyl salicylate and sodium borate.
However, the long-term use of adhesives may af-
fect the oral microflora by selectively supporting
the growth of some micro-organisms and inhibit
others13. Very little work has been published on
this aspect of denture adhesives14–16 and there is
little consensus as to whether the use of denture
adhesives has an effect on bacterial growth. Some
studies have shown that adhesives do not have an
inhibitory effect upon the oral flora14–16. whereas
others were claimed to promote Streptococcus mitis
and C. albicans growth16. However, Adisman17
stated that denture adhesives have a cushion effect
and thereby prevent the food bolus going under-
neath the denture and eventually inhibit C. albicans
growth. He et al.18 showed that Fixodent produced
an in vitro reduction of denture plaque micro-
organisms after 8 h and Kim et al.19 reported that
the denture adhesive tested did not significantly
alter the denture microbiota during the 14-day trial
period. However, longer duration of adhesive use
was not studied, but Neill and Roberts20 claimed
that if the general oral hygiene of a patient was
satisfactory, then denture adhesives did not cause
any bacterial growth. Also more recently, it has
been suggested that their use should be limited in
immunologically-compromised patients, as some
may contain bacterial and fungal contaminants
that could cause infection in such individuals21.
In the western world, denture adhesives are
widely used by complete denture wearers. Adis-
man17 reported that more than 5 million Ameri-
cans use these materials and approximately 75% of
the dentists prescribe them for their patients. In
Sweden $1.7 million is spent on denture adhe-
sives17. Unfortunately, there is little data as to
whether the long-term use of adhesives may affect
the oral microflora. Moreover, the existing
investigations are limited to a small number of
micro-organisms of the oral flora. Therefore, the
objectives of this study were to determine whether
denture adhesives sustain the in vivo presence or
growth of oral commensal micro-organisms at
different time intervals and to compare the results
with denture-wearing individuals who did not use
them. The null hypothesis tested was that the
 2011 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: 9–16
denture adhesive would increase the growth of oral
micro-organisms in denture-wearing individuals
and the longer use of it would add to the quantity
of micro-organisms.
Materials and methods
Subjects
Thirty subsequent healthy denture-wearers, (12
female, 18 male, mean age: 62 years) with healthy
oral tissues referred for construction of maxillary
and mandibular dentures, to Marmara University,
Dental School, Department of Prosthodontics were
involved in this study. The experimental protocol
was approved by the Marmara University Ethical
Review Committee. The patients received their
new conventional complete maxillary and man-
dibular dentures and the treatment followed a
standardised protocol including functional impres-
sions with individual trays, intraoral gothic arch
registration and establishment of lingualised
occlusion.
For baseline microbiological measurements,
during the delivery of these dentures to the
patients, smear samples were taken from the pal-
ate and the denture. The smear from the palate
and denture were taken from the incisive papilla
and the triangular region between the left and
right molars. In addition, saliva samples were
collected by means of sterile injections. After col-
lecting the samples at baseline, denture adhesive
(Kukident, Procter&Gamble Co., Geneva, Swit-
zerland) were applied to the dentures of 15 patients
and they were instructed to use the denture
adhesive for 2 months. The other 15 patients, who
did not receive the denture adhesive, were
considered as the control. Within this period, all
the patients were instructed to clean their den-
tures and their mouth in the same manner using a
normal toothbrush and soap. The patients were
further informed not to use any other denture-
cleansing agent. After the use of the adhesives for
1 and 2 months, the inner surfaces of the dentures
were evaluated microbiologically and samples
were collected again from the palate, denture and
saliva. The same procedures were repeated for the
control group.
Microbiological evaluation
All collected samples were immediately processed
for microbiological evaluation. In order to separate
micro-organisms from the denture and the saliva
and to achieve a homogeneous dispersion, each

sample was immersed in a tube containing 1 ll
saline. 100 ll saliva was then added into 900 ll
saline. The samples were mixed on a vortex mixer
and 10-fold serial dilutions up to 10)5 were obtained
in saline. These were then inoculated on to Sabou-
raud Dextrose agar medium and blood agar plates
consisting of 5% sheep blood agar using quantita-
tive methods. All plates were incubated aerobically
for 48 h at 37C. They were then examined and
isolated colonies were evaluated according to their
morphology and pigment formation. Gram staining
characteristics and catalase and oxidase tests were
performed. The samples were examined for the
presence of Candida spp., S. aureus, Moraxella
catarrhalis, b-haemolytic streptococci, a-haemolytic
streptococci (S. pneomococcus, S. anginosus, S. interme-
dius, S. constellatus, S. sanguis, S. gordonii, S. mitis,
S. mutans, S. salivarius), Staphylococci, Enteric rods. S.
aureus was identified as being catalase and coagulase
positive. Enterobacteriaceae spp., yeasts and Strepto-
cocci were identified on a basis of API 20E, API 20
CAUX and API 20 Strep, respectively.
Statistical analysis
Statistical analysis was performed using SAS Sys-
tem for Windows, release 8.02/2001 (Cary, NC,
USA). The data obtained at baseline, 1 and
2 months after the use of denture adhesives as well
as the control group were analysed using analysis
of variance (ANOVA) and repeated measures. Log-
transformed values were used due to positively
skewed distribution. p values less than 0.05 were
considered to be statistically significant in all tests.
Results
The micro-organisms observed in saliva, palate and
denture at all time points in control and denture-
wearing patients who used denture adhesives are
presented in Tables 1 and 2, respectively. Most
types of the micro-organisms were not seen and
therefore could not be analysed statistically except
a-haemolytic streptococci and C. albicans (Fig.1 and
Fig. 2).
Forty-five samples were taken from the saliva of
the control group and in 44 (97.8%) of them
a-haemolytic streptococci, and in three (6.6%)
C. albicans were seen. The measurements after
using denture adhesive showed 100% presence of
a-haemolytic streptococci, whereas the percentage of
C. albicans was 11.1%, being in only five of the 45.
No statistically significant differences were detected
between groups in saliva samples for a-haemolytic
streptococci for the control (F = 3.22, p = 0.0835)
 2011 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: 9–16
Effect of denture adhesives on micro-organisms 11
and the adhesive using patients (F = 1.66,
p = 0.2078) (Tables 3 and 4).
In the control group data obtained from the
palate, 41 measurements showed a-haemolytic
streptococci (91.1%) whereas the C. albicans were
seen in only four (8.8%). After using denture
adhesive a-haemolytic streptococci were seen in 44
measurements (97.8%), while the C. albicans were
detected in seven (15.5%). No statistically signifi-
cant differences between groups in palate samples
of a-haemolytic streptococci were detected (F = 0.67,
p = 0.4198) (Tables 3 and 4).
In samples taken from the dentures of the control
group, a-haemolytic streptococci were seen in 42 of
the 45 measurements (93.3%) and C. albicans were
found in three of 45 (6.6%). In the patients who
used denture adhesive, while 43 measurements
involved a-haemolytic streptococci (95.5%), five
measurements involved C. albicans (11.1%). No
statistically significant differences between groups
in denture samples of a-haemolytic streptococci were
detected (F = 1.42, p = 0.2439).
Although there was some increase noted for both
a-haemolytic streptococci and C. albicans in the patients
using denture adhesive in palate, saliva and den-
ture, there was no statistical difference between the
control and the experimental group. No significant
differences were found at all time intervals.
Discussion
The earliest reports on the potential use of denture
adhesives were published a few decades
ago11,14,16,17. The American Dental Association
reported that denture adhesives could not be used
long-term except in some cases such as manage-
ment of traumatised oral mucosa3. After this report,
dentists hesitated in advising the use of denture
adhesives to their patients and refrained from
prescribing them or informing their patients. In
principle, when a denture is made, ideally there
should be no need for a denture adhesive. How-
ever, in order to compensate for technical failures
during denture processing, in situations where
anatomical structures are not favourable or in
patients where saliva flow is impaired due to
diseases or medication, the use of denture
adhesives has started to be seen as a potential aid to
improve denture retention and stability22,23. A
survey by Slaughter et al. using the Delphi Tech-
nique Survey Method was conducted using a panel
of 18 randomly selected prosthodontic programme
directors in the USA23. The panel concluded that
denture adhesives could be seen as a useful adjunct
in the denture prosthodontic service. While the
 12

Table 1 Micro-organisms found in saliva, palate and the denture base at baseline and 1 and 2 months in the control group.

Saliva Palate Denture

No of
patients Baseline 1 month 2 months Baseline 1 month 2 months Baseline 1 month 2 months
Y. K. Ozkan et al.

1 8 · 107 aHs 2.6 · 107 aHs 4 · 107 aHs 3.3 · 105 aHs 2 · 104aHs 3 · 105 aHs 2 · 107 aHs 1.2 · 105 aHs 2 · 106 aHs
1 · 103 C.a 2 · 104C.a 1.7 · 104 C.a 8 · 102 C.a 1 · 102 C.a
2 1.5 · 107 aHs 3.6 · 106 aHs 6 · 105 aHs 2 · 104 aHs – 1 · 102 aHs 2.3 · 106 aHs 2.4 · 103 aHs –
2 · 102 E.c
3 4 · 107 aHs 4.2 · 107 aHs 1.2 · 107 aHs 3 · 106 aHs 6 · 103 aHs 6 · 105 aHs 6 · 106 aHs 3 · 105 aHs 2 · 104 aHs
7 · 105 E.c 6 · 104 E.cl 1.2 · 105 E.cl 2.8 · 105 E.a 6 · 104 E.cl
3 · 104 P.a 1 · 104 P.a 2.4 · 105 P.a
4 2.1 · 107aHs 4 · 107aHs 1.3 · 107aHs 4 · 103aHs 6.6 · 107aHs 3 · 105aHs 1 · 106aHs 1.3 · 105aHs 2.4 · 105aHs
1 · 106S.a 4 · 106S.a 2.8 · 104C.a 4 · 104S.a 1.4 · 103C.a
2 · 102C.a 8.3 · 103 C.a 4 · 102 C.a
5 5 · 106aHs 1.5 · 107aHs 2 · 107aHs 4 · 102aHs 1 · 105aHs 3 · 104aHs 2 · 106aHs 5 · 105aHs 5 · 105aHs
2 · 105E.cl 1.2 · 103E.cl 2.8 · 105E.cl 1.5 · 105M.C
6 2.4 · 107aHs 2 · 107aHs 5 · 106aHs 1 · 104aHs 3.2 · 105aHs 2 · 106aHs 4 · 106aHs 5 · 105aHs 4 · 105aHs
7 5 · 105aHs 3.5 · 106aHs 4 · 106aHs 8 · 103aHs 1.1 · 106aHs 3 · 107aHs 1.7 · 104aHs 8.5 · 105aHs 9 · 105aHs
8 6 · 106aHs 1 · 107aHs 3 · 106aHs 1 · 106aHs 2.6 · 105aHs 4 · 105aHs 1.1 · 106aHs 5.4 · 105aHs 4 · 106aHs
4.6 · 104C.gl 7 · 103C.gl 1.2 · 105C.gl 5.2 · 105 C.gl 4.2 · 104C.gl 3.4 · 104C.gl
9 3.5 · 107aHs 1.6 · 108aHs 4 · 107aHs 1 · 105aHs 3 · 104aHs 4 · 106aHs 2.6 · 105aHs 2.8 · 106aHs 2.2 · 107aHs
1.1 · 103C.sp 1.1 · 103C.sp
10 1.7 · 106aHs 2 · 106aHs 3 · 106aHs – 1.7 · 103aHs 3 · 105aHs 3.5 · 105aHs 3 · 106aHs 6 · 104E.cl 3.5 · 107aHs
4 · 104E.cl 4 · 102E.cl
11 1.4 · 108aHs 1 · 104aHs 2 · 107aHs 1.5 · 104aHs 6 · 104aHs 9 · 105aHs 4 · 105aHs 6.2 · 105aHs 7 · 106aHs
6 · 103E.cl 4 · 105E.cl 3.4 · 106E.cl
3 · 103C.kr 8 · 103 C.kr
12 4 · 107aHs Ü.Y 6 · 107aHs 1.7 · 104aHs 1.4 · 104E.cl 1.1 · 104aHs 1.6 · 104aHs 2 · 104E.c 2.4 · 105aHs
13 5.4 · 107aHs 6 · 107aHs 8 · 107aHs 9 · 105aHs 1.5 · 105aHs 3 · 105aHs 4 · 105aHs 1.9 · 105aHs 3 · 104aHs
14 1 · 107aHs 8 · 107aHs 6 · 107aHs 4.2 · 106aHs 4 · 105aHs 6 · 106 aHs 3.5 · 105aHs 8 · 106aHs 9 · 106aHs

15 3 · 108aHs 1.4 · 108aHs 1.1 · 106aHs 2.5 · 104aHs 8.2 · 104aHs 7 · 104 E.c 1.3 · 106aHs 1.5 · 106aHs 8 · 104E.cl
2.5 · 105E.cl 1.8 · 102 C.a
*aHs: a-haemolytic streptococcus, C.a.: C. albicans, E.cl.: Escherichia coli, C. spp: C. spores, C.kr: C. krusei, C.gl.: C. glabrata, P.a.: Pneumococcus aureus, S.a.: Staphylococcus aureus.

 2011 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: 9–16
 Table 2 Micro-organisms found in saliva, palate and the denture base at baseline and one and two months‘ of denture adhesive use.

Saliva Palate Denture

No of
patients Baseline 1 month 2 months Baseline 1 month 2 months Baseline 1 month 2 months

1 4.9 · 107aHs 4 · 107aHs 5.5 · 107aHs 4.5 · 104aHs 5.5 · 105aHs 5 · 105aHs 3 · 106aHs 3.2 · 106aHs 4.9 · 105aHs
1 · 106E.sp 5 · 103E.sp 2 · 104E.sp
2 1.1 · 108aHs 3.2 · 107aHs 9 · 107aHs 7.6 · 105aHs 5 · 104aHs 8 · 104aHs 1 · 105aHs 1.1 · 107aHs 1 · 106aHs
2 · 103C.a 2.6 · 104C.a
3 2.6 · 107aHs 5.6 · 107aHs 6.2 · 107aHs 2.2 · 105aHs 2 · 106aHs 3 · 106aHs 1.8 · 105aHs 2.7 · 107aHs 2.5 · 106aHs
2.9 · 104C.a 2.2 · 104C.a 6 · 103C.a 5 · 104C.a
4 1 · 107aHs 5 · 107aHs 1.1 · 107aHs 3.1 · 103aHs 2.8 · 105aHs 1.1 · 105aHs N.M 2 · 107aHs 6.4 · 105aHs
2.6 · 104C.sp 9.3 · 103C.sp 1.3 · 104C.sp
5 1.7 · 108aHs 6.4 · 107aHs 2.1 · 107aHs 1.4 · 103aHs 1.3 · 106aHs 1.3 · 105aHs 4 · 105aHs 8.8 · 106aHs 6 · 106aHs
6 8 · 106aHs 3 · 107aHs 4 · 107aHs 4.8 · 103aHs 3 · 106aHs 2 · 106aHs 2.7 · 104aHs 3.2 · 106aHs 2.8 · 105aHs
7 3.3 · 107aHs 1.9 · 107aHs 1.2 · 107aHs 6 · 104aHs 9 · 104aHs 8 · 105aHs 5 · 105aHs 4 · 106aHs 5.5 · 106aHs
8 2.9 · 107aHs 3.3 · 106aHs 4 · 106aHs 1.5 · 104aHs 5 · 102aHs 1.2 · 105aHs 1.6 · 104aHs 3.6 · 105aHs 2.5 · 104aHs
9 1.8 · 106aHs 6 · 107aHs 5 · 107aHs N.M 3.2 · 107aHs 2.4 · 106aHs N.M 4 · 107aHs 3.4 · 106aHs
10 1 · 106aHs 6 · 107aHs 4 · 107aHs 8.5 · 104aHs 7 · 105aHs 8.8 · 104aHs 1.8 · 105aHs 8 · 107aHs 1 · 106aHs
11 2 · 107aHs 1.6 · 107aHs 5.7 · 107aHs 2.2 · 104aHs 2.5 · 104aHs 7.5 · 105aHs 1.3 · 104aHs 1 · 107aHs 5.3 · 105aHs
5 · 105S.a 1 · 103S.a 1.2 · 104S.a
12 1.2 · 107aHs 3 · 107aHs 5.7 · 107aHs 8 · 106aHs 6.6 · 104aHs 9.6 · 103aHs 2.8 · 106aHs 8.6 · 104aHs 4.2 · 105aHs
1 · 104C.a 1.2 · 104C.a 1 · 103C.a 1 · 102C.a
13 1 · 107aHs 2.2 · 107aHs 3.2 · 107aHs 1.1 · 107aHs 5 · 103aHs 4 · 104aHs 1 · 106aHs 9 · 105aHs 8 · 105aHs

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2 · 106S.a 2.6 · 104S.a 1 · 106S.a
14 8 · 107aHs 8.8 · 107aHs 8 · 107aHs 8 · 106aHs 1.2 · 107aHs 5.7 · 106aHs 1.2 · 107aHs 8 · 106aHs 7 · 105aHs
1.1 · 104C.a 1 · 103C.a 3.2 · 104C.a 9 · 103C.a 3.1 · 104C.a 7 · 103C.a 4 · 102C.a
15 1.6 · 108aHs 6 · 106aHs 2 · 107aHs 2.2 · 105aHs 6 · 104aHs 7.2 · 105aHs 4.8 · 106aHs 1.9 · 106aHs 3.2 · 105aHs
*aHs: a-haemolytic streptococcus, C.a.: C. albicans, E.cl.: Escherichia coli, C. spp: C. spores, C.kr: C. krusei, C.gl.: C. glabrata, P.a.: Pneumococcus aureus, S.a.: Staphylococcus aureus.
Effect of denture adhesives on micro-organisms
13
14 Y. K. Ozkan et al.

Table 3 Descriptive statistics per group and site for a-haemolytic streptococci.

Sample Group Observation n Mean Std Dev Median Minimum

Denture Denture adhesive 45 43 6210860.47 13928051.09 1000000.00 13000.00

Control 45 42 3330366.67 6888430.00 580000.00 2400.00
Palate Denture adhesive 45 44 2204781.82 5440292.12 175000.00 500.0000000
Control 45 41 3007321.95 11150159.65 260000.00 100.0000000
Saliva Denture adhesive 45 45 42824444.44 37614414.28 32000000.00 1000000.00
Control 45 44 39454772.73 55869665.63 20000000.00 10000.00

Table 4 Maximum values and skewness of the data per group.

Sample Group Observation Maximum Skewness

Denture Denture adhesive 45 80000000.00 4.1363446

Control 45 35000000.00 3.3338138
Palate Denture adhesive 45 32000000.00 4.2722820
Control 45 66000000.00 5.0982274
Saliva Denture adhesive 45 170000000 1.6530862
Control 45 300000000 2.9129620

indication for denture adhesives is not seen as a
danger in some countries, in others the use of such
adhesives is strictly avoided24. The major reason for
this reason is the microbiological concerns in the
case of uncontrolled prolonged use of the adhe-
sives. Since the existing studies provide informa-
tion on their use for no longer than 2 weeks, this
study was undertaken to highlight the possible
accumulation of oral flora in extended use of such
aids16,19,21. Although in this study the longest
microbiological information was derived from
2 months of denture adhesive use, compared to the
previous studies, it could still be considered a
worst-case scenario. Furthermore, this study could
be considered as the first one that considered a
wide spectrum of micro-organisms found in the
oral flora. Since neither the location nor prolonged

Figure 1 Mean values and SD for Candids albicans found Figure 2 Mean values and SD for a-haemolytic streptococci
in the control (n = 15) and the denture adhesive used found in the control (n = 15) and the denture adhesive
group (n = 15) at all time intervals. used group (n = 15) at all time intervals.

 2011 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: 9–16

use affected the accumulation of the micro-organ-
isms studied, the hypothesis could be rejected.
Gram-positive cocci were reported to be the most
predominant bacterial isolates found on both the
palatal mucosa and the surface of the denture, with
a mean prevalence ranging from 60% to 70% of
the total plaque composition24. Specification of the
isolated micro-organisms reveals Streptococcal
species including S. milleri, S. mutans, S. salivarius, as
well as S. aureus constituting the gram-positive
facultative cocci. In this study, S. aureus were also
found to be the predominant micro-organism
isolated from the palatal mucosa, the surface of the
denture and saliva samples.
Although there has been no consensus as to
whether the use of denture adhesives has an effect
on bacterial growth13–18,20, several studies13,18–20
that investigated only C. albicans for a duration of
2 weeks demonstrated that no statistically signifi-
cant increase or decrease of micro-organisms in the
oral cavity was produced. The findings of this study
of up to 2 months were in accordance with these
previous investigations. It can therefore be stated
that the prolonged duration in the use of denture
adhesive has no significant consequences on
microflora.
Denture-induced stomatitis is an inflammatory
lesion of the denture bearing mucosa that affects
approximately 50% of patients wearing complete
maxillary dentures and has a multifactorial aetiol-
ogy. Poor denture hygiene is a risk factor for oral
and disseminated infections, as denture base resins
become colonised by several microbial species in
the oral cavity. In addition to Candida spp., other
pathogenic and opportunistic micro-organisms
have also been isolated from patient’s dentures
including Staphylococcus spp., Streptococcus spp. and
Pseudomonas spp. This suggests that these bacteria
promote the adhesion of yeasts to the oral epithe-
lium and acrylic surfaces by co-aggregation13,16,24.
No single case report exists in the dental litera-
ture to date on the hazardous effects on the soft
tissues or general health on their extended use. In
this study, in addition to the frequently studied
C. albicans, a-haemolytic streptococci was also detected
and based on these results, concentrating on only
C. albicans and Streptococcus spp. would then elimi-
nate expensive and time-consuming microbiologi-
cal investigations for other micro-organisms to be
studied in future research.
Common sense surely dictates the use of denture
adhesives for shorter durations. However, the re-
sults of this study indicated no adverse effects or
potential of increase in microflora even after
2 months of denture adhesive use.
 2011 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: 9–16
Effect of denture adhesives on micro-organisms 15
Conclusions
It could be concluded that:
1. Most types of micro-organisms were not seen
and therefore could not be analysed statistically
except for a-haemolytic streptococci and C. albicans.
2. Although a slight increase was noted compared
to the baseline measurements, no statistically
significant difference was found for a-haemolytic
streptococci and C. albicans in saliva, on the palate
and the denture at all time intervals.
3. The amount of accumulated micro-organisms in
denture-wearing subjects with denture adhesives
was not significantly different than those of the
denture-wearers without adhesive (control group).
4. Prolonged use of the denture adhesive tested for
up to 2 months did not yield an increase in micro-
organisms of the oral flora.
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Correspondence to:
Professor Yasemin Kulak Ozkan, Department of
Prosthodontics, Faculty of Dentistry, University of
Marmara, Güzelbahçe Büyükçiftlik sok., No.: 6
80200 Nişantaşı, Istanbul, Turkey.
Tel.: + 90 212 2319120
Fax: + 90 212 2465247
E-mail: ykozkan@marmara.edu.tr