Assessment of salivary PH and microbial growth in

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sample in the lingual vestibular region in the mandibular arch and was ... Results inferred a statistical significant difference between the Klebsiella, streptococcal,.
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Assessment of salivary PH and microbial growth in patients wearing complete denture Nirisha Sriram, Ashish R. Jain* ABSTRACT Background: Oral cavity supports the growth of various microorganisms due to the moist condition that it offers. Denture being a foreign substance aid in increasing the microbial growth, this, in turn, will decrease the overall health of the oral cavity. PH also indirectly affects the growth of these micro-organisms. Hence, there comes a need to assess the microbial growth for a healthy oral environment. Aim: The aim of the study was to assess the salivary PH and microbial growth in patients wearing complete dentures. Materials and Methods: A total of 20 completely edentulous patients desiring replacement with complete denture were enrolled in the study after obtaining informed consent. The swab was used to collect the microbial sample in the lingual vestibular region in the mandibular arch and was cultured for different bacteria, and salivary PH was estimated using PH indicator strip. Patients were given CD and oral hygiene instruction. The microbial samples were obtained after 2 weeks of denture wearing, and same salivary PH and microbial parameters were estimated and compared. The microbial growth was expressed in colony functioning units. Results: A dependent sample t-test was used to estimate statistically significant differences. Results inferred a statistical significant difference between the Klebsiella, streptococcal, and Lactobacillus species before and after denture insertion with no statistical significance in PH. Conclusion: Microbial colonization increased after wearing denture with no drastic change in PH. Hence, proper oral hygiene measures are to be followed to maintain a healthy oral cavity in denture wearers. KEY WORDS: Bacteria, Complete denture, Fungi, Microbes, Salivary PH

INTRODUCTION Oral cavity being a moist environment offers needed conditions for the growth of various microorganisms. The normal microbial flora of the oral cavity consists of a number of species of bacteria, fungi, mycoplasma, and protozoa.[1] The moist condition is mainly due to the presence of saliva. Any increase or decrease in this salivary flow rate will result in the alternation of the microbes present in the oral cavity. Complete dentures prosthesis that is offered to completely edentulous patients to re-establish their occlusion and aesthetics to a major extent. In most of the situations, complete dentures are offered to elderly individuals where age would already be an influencing factor in the salivary flow rate and the overall status of the tissues of the oral cavity.[2,3] When dentures are offered in such conditions, it will eventually result in the colonization of the bacteria on the tissue surface and teeth of the Access this article online Website: jprsolutions.info

ISSN: 0975-7619

dentures.[4] As the duration of usage of complete denture increases, the growth of micro-organisms increases exponentially as the duration of the usage of denture increases.[5] Another external enhancing factor that indirectly contributes to the rise in the growth of microbes in a removable prosthesis is due to the decrease in the ability to maintain the cleanliness of the prosthesis due to old age.[6] Studies have been conducted to determine the bacterial growth in the oral cavity, loss of teeth can eliminate the growth of certain microorganisms that require a hard surface for its adherence in the oral cavity.[7] However, several other bacteria along with Streptococcus mutants predominantly found in denture patients are found to be absent in edentulous patients.[8,9] The same perspectives can be used to relate the increase in fungal species in the oral cavity. The growth of candida albicans, an opportunistic fungi increases tremendously in denture wearers making the person susceptible to candidiasis.[10] Certain Gram-negative anaerobes are predominantly found in the edentulous space of the oral cavity irrefutable whether the person wears a denture or not.[11,12]

Department of Prosthodontics, Saveetha Dental College and Hospital Saveetha University, Chennai, Tamil Nadu, India *Corresponding author: Dr.  Ashish R. Jain, Department of Prosthodontics, Saveetha Dental College and Hospital, Saveetha University, Poonamalle High Road, Chennai -  600  127, Tamil Nadu, India. Phone: +91-9884233423. E-mail: [email protected] Received on: 24-01-2017; Revised on: 27-02-2018; Accepted on: 12-04-2018 488

Drug Invention Today | Vol 10 • Issue 4 • 2018

Nirisha Sriram and Ashish R. Jain

MATERIALS AND METHODS The study was carried out in Saveetha Dental College in the Department of Prosthodontics and Microbiology. The study consisted of 20 completely edentulous patients desiring replacement with complete denture were enrolled in the study after obtaining informed consent. The sample collected was saliva. The swab was used to collect the microbial sample in the lingual vestibular region in the mandibular arch and was cultured for different bacteria, and salivary PH was estimated using PH indicator strip [Figure 1]. The patients were given complete denture and oral hygiene instruction. The microbial samples were obtained after 2 weeks of denture wearing, and same salivary PH and microbial parameters were estimated and compared. The swabs were suspended in saline solution. The sample obtained from the patients was cultured in three different culture media, namely lactobacillus, Mitis Salivarius Agar base, and MHA medium. 67.15  g of lactobacillus powder was suspended in 1000 ml of distilled water to prepare lactobacillus medium. The media were then heated to dissolve the powder completely in water. The media were then autoclaved at 15lbd pressure for 15  min. Once the process of the autoclave was done, the suspension was mixed well and poured into sterile Petri plates. Mitts Salivarius Agar base was prepared by heating 3 scoops of agar for 15  min. The heated agar was then transferred to the plates after cooling it. The plates were then kept in an autoclave for 4 h and then kept in a hot air oven for 20  min. MullerHinton agar was prepared by suspending 38 g of the medium in 1 liter of distilled water. It is then heated with frequent agitation and boiled for 1 min to completely dissolve the medium. Autoclaving is then done at 121°C for 15 min and is then cooled at room temperature. The cooled Mueller Hinton Agar is then poured into sterile Petri dishes on a horizontal surface level, to give uniform depth and allow to cool at room temperature [Figure 2].

RESULTS The microbial growth was expressed in colony forming units. A dependent sample t-test was used to estimate statistically significant differences at 5% (α = 0.05). Results inferred a statistical significant difference between the klebsiella species (P = 0.02 0.05) before 1.6 × 106 CFU and after 1.8 × 106 CFU complete denture insertion. Streptococcal species (P = 0.01