Relation of the Denture Stomatits (DRS) with cardiovascular risk and the effect of denture disinfection compared to local treatment on DRS remission and cardiac risk: controlled, randomized, double-blind clinical trial

Abstract

The occurrence of edentulism is still significant, especially among the elderly with full dentures, being a widely used option in the rehabilitation of the stomatognathic system. These devices favor biofilm formation and the development of oral inflammatory lesions such as Denture Stomatitis-Related (DSR), as well as halitosis. Inadequate control of this condition can trigger systemic complications. Conservative protocols based on denture disinfection have been proposed for the prevention and/or treatment of DSR. However, studies are necessary to evaluate the effectiveness of these protocols on systemic diseases associated with DSR. This study aims to assess whether DSR increases the cardiovascular risk of elderly individuals using complete dentures and, once the increased cardiovascular riskis identified, to assess whether DSR treatment with a mechanical-chemical hygiene protocol for dentures, compared to mechanical hygiene protocol associated with topical medication reduces cardiac risk. Methods: initially, individuals with complete denture and with (n = 50) and without DSR (n = 50) will be evaluated and compared for the existence of blood pressure changes and heart rate variability [total variability (time domain), spectral analysis (frequency domain), symbolic analysis, sample entropy (SampEn) and risk factors and biomarkers of heart disease] between the groups. Then, the participants of the group with stomatitis will be randomly distributed into 2 groups according to the protocols for treating stomatitis: (1) brushing the denture and immersing the denture in 0.25% sodium hypochlorite solution (control); (2) brushing the denture and nystatin. Thevariables analyzed will be heart rate variability and blood pressure changes; evaluation of pro-inflammatory cytokines, C-reactive protein level - CRP; ERP remission; reduction of microbial load and expression of virulence genes of the Staphylococcus spp., Gram-negative bacteria, Candida spp. and Streptococcus mutans and removal ofthe biofilm. Data will be collected at the beginning of the study, after 15 days oftreatment and after 30 days after stopping the use of the antifungal. After stopping theantifungal treatment, the patients will be submitted to the evaluation of the cardiac function through echocardiography, as well as to the evaluation of the sympatheticactivity on the heart by using the [123 I] meta-iodobenzylguanidine (MIBG). Expected results: DSR increases cardiac risk and the local treatment of DSR through the mechanical-chemical protocol will be effective for all variables, with a consequent reduction in cardiac risk due to DSR remission, biofilm removal, reduction of microbial load (Staphylococcus spp., Gram-negative bacteria, Candida spp. and Streptococcus mutans). (AU)