Denture plague and adherence of Candida albicans to denture-base materialsin vivo and in vitro

The aim of this paper is to review our understanding of the mechanisms and clinical significance of adhesion of C. albicans to denture-base materials in relation to denture plaque and denture-related stomatitis. Earlier repor ts in the literature of a 65% prevalence level of denture-related stomatiti s seem to be exaggerated. More recent studies indicate that denture-related stomatitis is considerably less common, particularly in normal healthy sub jects. The etiology of the condition is discussed in this review, and altho ugh much of the literature supports the view that the condition is strongly associated with C. albicans, this is not always so. In some subjects, the cause appears to be related to a non-specific plaque. This review also cons iders the role of denture plaque in the pathogenesis of denture-related sto matitis, the sequential development of denture plaque, and its colonization by Candida organisms. Designing controlled in vivo studies is difficult, a nd as a consequence, many investigators have had to resort to in vitro stud ies. The majority of these studies have attempted to investigate the hydrop hobicity of C. albicans, relating the surface free-energy of denture-base m aterials, particularly acrylic resin, to that of the organism Surprisingly little work has been directed at surface roughness and how it affects reten tion of organisms. Further, no attention has been paid to the properties an d character of the surface, other than average surface roughness, as it aff ects adhesion. A comparison of results from in vitro studies on the effect on adhesion of pre-coating the surfaces of denture-base materials with sali va has produced equivocal conclusions. This is largely due to little standa rdization of experimental protocols between studies, particularly in the co llection and handling of the saliva used. In conclusion, the review strongl y supports the suggestion that adherence of C. albicans to denture-base mat erials in vitro is related to the hydrophobicity of the organism. The clini cal significance of the observation and the mechanisms for the development and maturation of denture plaque are yet to be understood. There is a clear need for further investigation of other factors that may moderate the adhe sion of organisms and subsequent colonization of denture-base materials.