Journal of Dentistry, 13, Na 4, 1985, pp 2 7 l-2 76 Printed in Great Brirain

A gravimetric technique for measurement

of denture hygiene
A Taaffe, MRCPI, MRCP, MSc
Hull Royal ln firmary

J. M. Riggott BSc, PhD

Department of Zoology, University of Hull

ABSTRACT
A method for quantitative assessment of denture stomatitis which is easy to perform, produces reliable results,
has negligible costs and is not inconvenient to the patient is described.

INTRODUCTION
The aetiological factors of denture stomatitis are generally considered to be denture trauma,
candida infection and poor local hygiene (Cawson, 1978). Debate exists as to the relative
importance of these individual factors, but one of the most striking anomalies is the lack of
quantitative assessment of oral hygiene. The two methods available, using dye disclosure
(Hutchins and Parker, 1973) or spectrofluorometric protein assay (Altman et al., 1975), are
unsuitable for bedside use in large-scale clinical studies. A method which is easy to perform
and can produce reliable results is described

MATERIALS AND METHODS

A bacteriological swab (Medical Wire & Equipment Co. Ltd), used in routine hospital
practice, is shortened by division of the wooden shaft and reinsertion of the distal end of the
head of the swab handle. The outer polythene cylinder is also divided so that the shortened
device can be weighed on a balance pan, without contact with the pan’s suspending arms. One
end of the brand used is bevelled and this eliminates rolling during weighing. Sufficient of the
original label supplied by the manufacturer is retained, as it carries ink writing and can be used
for recording purposes. The device is as illustrated in Fig. 1 when complete. Batches of the
truncated swabs are pre-labelled and subjected to freeze drying in an Edwards model BSA
Machine.
The swab seals are opened during drying and closed as soon as the swabs are removed from
the chamber. The resealed swabs are weighed in a Mettler H20 five-figure balance
(Gallenkamp), which has a maximum capacity of 160 g. The internal atmosphere of the
balance is kept dehydrated with anhydrous calcium chloride crystals because of the critical
importance of the moisture in this technique.
A sequential collection routine is repeated for each of three collecting swabs. The truncated
swab is removed from its polythene container, the operator holding the denture ir, one hand.
The denture is cleaned by the swab with the outer hand moving in a backwards and forwards
272 Journal of Dentistry, Vol. 1 ~/NO. 4 (1985)

Fig. 1. Modification of bacteriological swabs for

collection of denture debris showing usual amount
of material collected after five seconds wiping in
this study (extreme right).

motion The manoeuvre is repeated for 15 s only, as pilot studies showed that after this period
the swab heads tend to become overladen and some of the material may be lost during transfer
of the swab back to its container. In this study, only half of the upper denture was examined for
debris measurement; the other half, separated by the ridge running posteriorly from the space
between the central incisors, was used for the microbial studies which will be reported
separately.
Simultaneously with the exposure of the movement of the collecting swabs, control swabs
were each exposed to the atmosphere for 15-20 s. All specimens and controls used in this
method were reweighed to calculate total gains caused by collection and/or exposure and, after
freeze drying, the third weighing was used to assess the amount of dry material and/or
atmospheric dust which the swabs had collected during the procedure.
Sixty age and sex-matched patients over 55 years were selected by ward sisters in
orthopaedic and cardiology wards from amongst their emergency admissions. The chief
criterion was willingness to have their denture studied by the above technique and, after it was
done, to have the palate examined for evidence of denture stomatitis. However, as the study
progressed the positive correlation between the amount of denture debris and the severity of
inflammation became predictable. Only those with totally inflamed palates were accepted as
cases and those with completely normal mucous membranes as normal volunteers.
Taaffe and Riggott: Measuring dental hygiene 273

w=wet weights
D=Drywei@ts

. .
Totals for controlsW 6 D
Il.30

Fig. 2. Graph of sequential wipes in volunteers and Fig 3. Graph of sequential wrpes in cases and their
their controls. controls.

Table /. Paired C tests (Student’s) of weight gains from different series of

swabs

t P

30 Volunteers examined
Total wet weight gain to that of control swabs 355158 < 0.005
Total dry weight gain to that of control swabs 5.5714376 < 0.001
Mean wet weight gain to that of control swabs 3.9578124 < 0.001
Mean dry weight gain to that of control swabs 3.905244 < 0.001

30 Cases examined
Total wet weight gain to that of control swabs 4.70285 < 0.001
Total dry weight gain to that of control swabs 4.30679 < 0,001
Mean wet weight gain to that of control swabs 3.2074396 < 0,005
Mean dry weight gain to that of control swabs 4.464 1 < 0,001

RESULTS
The results are expressed in Figs 2-5 and Tables I and II.
Fig 2 is a scattergram showing the difference between the amount of dry material (the weight
gained by the swabs) removed from the dentures of the volunteers, compared with that of the
simultaneously collected controls. The difference is statistically significant (Table I).
Fig 3 is a scattergram showing the difference between the amount of material removed from
274 Journal of Dentistry, Vol. 1 ~/NO. 4 (1985)

Graph cd canparison OI controls beans 6

standaId errors)for cases and wlunteef

groups.

wet swabs n-30 and t-1.424993 nil signifii

hy swabs n.30 and tr27WSl3 :. p< 0.01

002

cases vols cases i&s

wet wet w BY

Fig. 4. Graph of comparison of controls. Fig. 5. Direct comparison of weight gained by cases
compared with volunteers.

the dentures of the patients compared with that of the simultaneously collected controls. Again
there is a statistically significant difference (Table I), which is greater for the cases/controls
than the volunteers/controls.
Fig. 4 is a scattergram showing a difference when the simultaneous controls (atmospheric
exposure of swabs) of the volunteer and cases groups are compared This difference, though
not significant in statistical terms, is probably the result of less meticulous closure of swab
cylinders during the later stages of the study, when more patients were examined.
Fig. 5 ignores the control swabs and shows direct comparison between the weight gained by
swabbing the plates of volunteers as compared with cases. Whether the values for wet or dry
swabs are considered, the difference between the cases and volunteer groups is nonetheless
significant (Table Z). This figure also demonstrates that the maximum weight gain is at the
collection of the first of the three swabs.
Table II shows that, although the total amount of material removed is small, a difference
exists between the cases and volunteer patients which is statistically significantly higher in the
cases group.
When the wet controls (from atmosphere) used for the 30 patients are compared (paired t
test) with those of the volunteers t = 4249923, but when these swabs were dried then
t = 2.7965 13 and KO.0 1, the higher values being in favour of the patient group (Fig. 4). With
increased expertise, more subjects were studied and this may have contributed to the
I
error.
Anomalies in resealing swabs after removal from the freeze dryer could have accounted for
this. Few of the control swabsregained their original weights after thesecond drying, due either
to damage to the seals or contamination of the swab loads with atmospheric dust.
Taaffe and Riggott: Measuring dental hygiene 275

Tab/e I,! Total dry weight gain cases compared with

volunteers

Total dry weight gain /g)

Cases Volunteers

1. 0.01246 0.0 1944

2. 0.02747 0.00352
3. 0.02434 0.01751
4. 0.0 1444 0.0208 1
5. 0.02067 0.00751
6. 0.02724 o-000 14
7. 0.0084 0.00288
8. 0.00822 0.0056
9. 0.0 1248 0.00724
10. 0.00089 0.00723
11. 0.01946 0.00626
12. 0.1 1535 0~00501
13. 0.02069 0.012441
14. 0.0 1644 0.00232
15. 0.01258 0~00166
16. 0.01607 0.0 1606
17. 0.01395 0.01395
18. 0.00309 0.00506
19. 0.00636 0.00827
20. 0.00449 0.00372
21. 0.02 109 0.00872
22. 0.00745 0.003 14
23. 0.01729 0.00152
24. 0.08845 0.0059
25. 0.0152 0.0070 1
26. 0.0088 1 0.00 1 79
27. 0.00721 0.00827
28. 0.01725 0.00943
29. 0~00305 0.00225
30. 0.00603 0.00328
Mean ; =0.0192306 x = 0.00684036

DISCUSSION
The disclosing agent usually used to demonstrate plaque and other surface accumulations on
dentures is 4 per cent methylene blue (Hutchins and Parker 1973). Although it does not
discolour the denture materials, a disadvantage of this technique is that in detail survey work
which requires accuracy measurements taken over a long peri@ photography is required.
Even this does not surmount difficulties caused by variations of absorption of the dye into
various constituents of the debris, and its colour intensity may be influenced by interactions
with residues of denture-cleansing agents.
The spectrofluorometric method (Altman et al., 1975) depends on the affinity of
fluorescanine for proteins and peptides. This method involves removal of the prepared debris
by a spatula and treatment of the dried material on glass slides with appropriate chemical
agents. The proponents of this method (Altman et al., 1975) mention assessment of plaque
weight of 11 samples from 4 dentures as part of their evaluation of the protein content of
denture plaque removed by spatula Their objection to weighing assays is that these depend on
small differences between large numbers and that the method of scraping with the spatula
276 Journal of Dentistry, Vol. 1 ~/NO. 4 (1985)

probably involves removal of small amounts of substrate (acrylic resin) which is difficult to dry
to a constant weight. In the method described here, however, the swabs rapidly moistened by
saliva have been found to remove surface material more efficiently than the wooden spatula,
and are unlikely to remove any resin substrate, an important consideration when elderly
patients insist that no damage of any kind will be inflicted on their dentures. The difficulty of
small variations between large numbers is overcome by the use of a five-figure balance. It is not
claimed that this swab-removal method would be suitable for all studies in which chemical
analysis of denture debris would be required, but the ascendancies of this method lie in ease of
performance, negligible cost and lack of inconvenience to the patient.

REFERENCES
Altman M., Yost K. and Pitts G. (1975) A spectrofluorometric protein assay of plaque on dentures
and of denture cleaning efficacy. J. Prosthet. Dent. 42,502.
Cawson R A. (1978) Stomatitis and related diseases. In Essentials of Dental Surgery and
Pathology, 3rd ed. Edinburgh, Churchill Livingstone, p. 280.
Hutchins D. W., and Parker W. A (1973) A clinical evaluation of the ability of denture cleaning
solutions to remove dental plaque from prosthetic devices. N Y: State Dent. J. 30, 363.