Nigel Carter summarises the ‘long overdue’ publication of denture adhesive guidelines and why dentists should be encouraged to advise their use in their patients.
A set of global, science-based guidelines published by the Oral Health Foundation for denture adhesives hopes to correct the current lack of guidance for full denture wearers and combat the mindset that advising patients to use fixatives shows poor dental work.
A white paper, entitled Guidelines for the Use of Denture Adhesives and their benefits for Oral and General Health, was developed by a global task force of academic experts. The project reinforces the role denture adhesives play in having ‘best-fitting’ dentures, such as better retention and stability, improved confidence and comfort, and reduction or elimination of food debris beneath the denture.
Having undertaken a comprehensive review of existing guidance for best use of denture adhesives, the panel found only limited recommendations and guidance were available.
Key findings of the white paper
- Patient satisfaction has become a decisive factor for the overall success of prosthodontic treatment in full-denture wearers
- Denture adhesives can enhance the retention of, and reduce food accumulation beneath, well-fitting complete dentures
- Denture adhesives can be beneficial to the patient. They may enhance comfort, provide psychological satisfaction, increase confidence and thus wellbeing, while increasing retention and stability, and improving function
- The effectiveness of denture adhesives cannot compensate for significant denture deficiencies
- Dental professionals should provide guidance and instructions to the patient on the correct application and use of the adhesive, and on removing it and cleaning the denture
- The optimum time to advise on the use of an adhesive varies between patients. For well-fitting dentures it might occur at a review appointment, or for patients finding problems with compliance at the time of fitting or soon after.
Dr Nigel Carter OBE – chief executive of the Oral Health Foundation, which was part of the task force – spoke about the paper’s findings and what he hopes the guidelines will achieve.
He says: ‘The guidelines are long overdue. There were varied recommendations or no recommendations, or you shouldn’t be doing it, so all we wanted to come out with was a simple set of guidelines, and we came out with four things.
‘We’re quite capable to say these are science-based guidelines as opposed to evidence-based because the evidence out there is relatively low, but we take the best science that’s available and estimate. In terms of the long-term effects of fixatives there’s not a lot of work out there and that’s one of the areas we recommended for more research.
‘As a student when we were doing dentures we were told if you had to use an adhesive then you’d failed and the denture didn’t fit properly. The reality is far from that, but I think that is still being taught in many areas and the view of many dentists is they shouldn’t be recommending adhesives to their patients.
‘I think the best analogy to show fixatives have a place is you will be familiar with how uncomfortable it is to get a stone in your shoe when you’re trying to walk, that’s the equivalent to a denture patient trying to eat and getting a pip stuck underneath their denture. The fact that an adhesive can both give security in fixing the denture and stop food particles from getting in under the denture is really quite important.’
Denture adhesives guidelines
- Apply a small amount of denture adhesive cream to a clean and dry denture. One application a day should be sufficient
- After application, replace the denture in the mouth and firmly close the mouth for a couple of seconds. If the adhesive cream overflows, too much has been applied and the adhesive should be removed (rather than swallowed). Patients should not consume food or drink within the first five minutes of application
- Before sleep, the denture should be removed and the denture and oral cavity thoroughly cleaned to remove any remaining adhesive
- All patients who wear removable dentures should be enrolled into a regular recall and maintenance programme with their dental professional.
The guidelines have been sponsored by Glaxo Smith Kline Consumer Healthcare, which put forward the backing after recognising that recommendations were lacking, and were announced as part of the International Association for Dental Research 2019 meeting in Vancouver, Canada. The task force included experts from the Oral Health Foundation and King’s College London and representatives from the US, Greece, Japan and Switzerland.
The group formed to reflect the global need for advice for denture wearers in response to the ageing population around the world, as, by 2050, there is expected to be two billion people aged 60 years or older in the world.
Dr Carter said a key issue was changing the mindset, adding: ‘We’ve had a good response so far. I think there’s probably a psychological barrier because of how dental adhesives are being used. It’s going to take a little while and a push; a proportion of the profession are going to be thinking “oh, denture adhesives, I don’t want anything to do with those” and they need to read the guidelines to see they need to be engaged.
‘I remember as a student we had to wear a plastic appliance to give you an indication of what it’s like. Dentures have a far lower priority on the curriculum these days so I doubt that exercise even goes on in dental schools these days.
‘The next steps, we hope, is that they get widely adopted. We’ve got a whole programme of promotions through social media to increase the profile, and I’m sure like the other [guidelines] they will be translated into other languages.’
One of the next steps mentions giving advice to caregivers of elderly people, which is especially prescient in the wake of the Care Quality Commission’s report into the failings of oral health in care homes and the need for improvement.
Dr Carter said the guidelines were very relevant for the care home sector as it would help with awareness and make sure precautions are being taken to make sure dentures are looked after and labelled correctly.
He says: ‘The guidelines are intended primarily for oral health professionals, the chairside guide is equally targeting the care sector and we are looking at getting these guidelines out into the care sector. The guidelines will be suitable for care workers to use and carers in the homes, but that’s another big area that’s neglected.’
He also acknowledged the reduced need for dentures, as dental and oral health has improved over the years, but still saw their importance. He was also sceptical about the increasing number of younger dentists who are focusing more on implants.
Dr Carter concludes: ‘We’ve gone through a change where when I qualified more than 40 years ago 38% of those over 16 had got full dentures, by the time you got to 45/55 you’re running at 75%. The expectation was you got to middle age, you had full dentures, but I think the latest survey is now down to 11%.
‘But what’s happened is we’ve got more focused on our teeth so there’s more partial dentures out there. We’re now not losing teeth in the same way and a result of that my question to the young dentists today doing implants is: where are you going to put them? If they’re training to do implants in their 20s, in 20 years where is the patient going to be?’
Sponsorship for the development of these guidelines was provided by Glaxosmithkline Consumer Healthcare to the Oral Health Foundation. No editorial control, apart from ensuring compliance with legal and regulatory considerations/requirements, has been exercised by Glaxosmithkline Consumer Healthcare.
For more information, or to download the white paper Guidelines for the Use of Denture Adhesives and their benefits for Oral and General Health, visit www.dentalhealth.org/dentureadhesives.