Systematic Review Compares Efficacy of Chemical and Non-Chemical Denture Cleansers Against Candida Species

Denture Cleansers: Balancing Antifungal Efficacy with Material Integrity and Patient Safety

Candida species, particularly Candida albicans, are significant contributors to denture-induced stomatitis due to their ability to form resilient biofilms on removable dental prostheses. While chemical cleansers are known for their effectiveness, concerns persist regarding their potential for material degradation and mucosal irritation. This review aimed to systematically compare the efficacy of chemical and non-chemical denture cleansers in reducing Candida species on removable dental prostheses.

Methodology

A systematic review was rigorously conducted following PRISMA 2020 guidelines. Comprehensive searches were performed across PubMed, Scopus, and Web of Science, covering the period from 2003 to 2025. These searches initially yielded 624 records. After thorough duplicate removal and meticulous screening, a total of 20 studies met the inclusion criteria. This final selection comprised 10 randomized controlled trials (RCTs) and 10 in vitro studies. The risk of bias for the included studies was carefully assessed using the Cochrane Risk of Bias 2.0 tool for RCTs and QUIN/SYRCLE tools for in vitro studies.

Key Findings

Chemical cleansers consistently demonstrated strong antifungal action. Agents such as sodium hypochlorite (ranging from 0.25–2.5%), chlorhexidine (0.2–2%), and effervescent peroxide tablets achieved an impressive 80–100% colony-forming unit reduction in the majority of studies. Some reports even indicated complete biofilm eradication.

Chemical agents demonstrated more consistent antifungal action, often achieving 80–100% reduction in Candida species.

However, the effectiveness of chemical cleansers came with trade-offs. Six of the ten studies reported that chemical cleansers caused increased surface roughness and discoloration of the denture materials.

In contrast, non-chemical agents exhibited a lower, but still significant, antifungal action, with a 40–85% colony-forming unit reduction rate.

A distinct advantage of non-chemical agents was their impact on material integrity. These cleansers consistently preserved material integrity and were frequently preferred by patients. This preference was often attributed to better taste profiles and greater ease of use compared to chemical alternatives.

The risk of bias was generally well-managed across the included studies. It was assessed as low to moderate in 80% of the RCTs and low in 10 of the 13 in vitro studies, indicating a reasonable level of methodological quality.

Conclusions

This systematic review underscores that both chemical and non-chemical denture cleansers are effective in reducing Candida species on removable dental prostheses. Chemical agents, while demonstrating more consistent antifungal action, pose challenges related to material compatibility.

Conversely, non-chemical agents, despite sometimes having slightly lower efficacy rates, offer significant benefits in preserving denture integrity, improving patient tolerance, and enhancing safety.

The findings support the use of adjunctive or alternative non-chemical agents, such as herbal and ozone-based cleansers, particularly for long-term use or in sensitive individuals.

Ultimately, clinicians face a crucial decision: they must balance the microbial efficacy of cleansers with the critical factors of denture material preservation and patient compliance. Future research efforts should prioritize the development of standardized protocols, investigate long-term clinical outcomes, and incorporate patient-reported measures to provide a more comprehensive understanding of denture cleanser effectiveness and patient satisfaction.