title: Promise of Combining Antifungal Agents in Denture Adhesives to Fight Candida Species Infections.
abstract: OBJECTIVE
  Several complications may arise in patients wearing complete prosthetic appliances, including denture-associated infections and mucosal stomatitis due to Candida species. This study evaluated the activity of anti-Candida agents in denture adhesive and the cytotoxicities of these preparations for primary human gingival epithelial (GE) keratinocytes.
  
  
  METHODS
  The anti-Candida activities of antimicrobial peptides, antimicrobial lipids, and antifungal agents against C. albicans ATCC 64124 or HMV4C were assessed in microdilution assays containing water or 1% denture adhesive. The minimal inhibitory concentrations (MIC) and the minimal bactericidal concentrations (MBC) were determined. The cytotoxicities of denture adhesive compounded with these agents were assessed in 1.0 × 105primary GE keratinocytes in LGM-3 media with resazurin.
  
  
  RESULTS
  Lactoferricin B, SMAP28, sphingosine, dihydrosphingosine, and phytosphingosine in 1% denture adhesive lost antimicrobial activity for C. albicans (p < 0.05). Amphotericin B, chlorhexidine dihydrochloride, chlorhexidine gluconate, fluconazole, and nystatin in 1% denture adhesive or compounded directly into denture adhesive and then diluted to 1% adhesive, did not lose antimicrobial activity. Compounded formulations were not cytotoxic (LD50> 100.0 μg/ml) against primary human GE keratinocytes.
  
  
  CONCLUSIONS
  Antimicrobial peptides and antimicrobial lipids had diminished activities in 1% adhesive, suggesting that components in adhesives may inactivate local innate immune factors in the oral cavity, possibly predisposing denture wearers to Candida species infections. More importantly, antifungal agents retained their anti-C. albicans activities in denture adhesive, strongly suggesting that antifungal agents could be candidates for inclusion in adhesive formulations and used as prescribed topical treatments for individuals with denture stomatitis.
authors.affiliation: Department of Restorative Dentistry, School of Dentistry, Oregon Health and Science University, Portland, OR.
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Garaicoa
authors.affiliation: Iowa Institute for Oral Health Research, College of Dentistry, The University of Iowa, Iowa City, IA.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Fischer
authors.affiliation: Iowa Institute for Oral Health Research, College of Dentistry, The University of Iowa, Iowa City, IA.
authors.forename: Amber M
authors.initials: AM
authors.lastname: Bates
authors.affiliation: Department of Prosthodontics, College of Dentistry, The University of Iowa, Iowa City, IA.
authors.forename: Julie
authors.initials: J
authors.lastname: Holloway
authors.affiliation: Department of Periodontics, College of Dentistry, The University of Iowa, Iowa City, IA.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Avila-Ortiz
authors.affiliation: College of Dentistry, University of Nebraska Medical Center, Lincoln, NE.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Guthmiller
authors.affiliation: Department of Periodontics, College of Dentistry, The University of Iowa, Iowa City, IA.
authors.forename: Georgia K
authors.initials: GK
authors.lastname: Johnson
authors.affiliation: College of Dentistry, University of Illinois at Chicago, IL.
authors.forename: Clark
authors.initials: C
authors.lastname: Stanford
authors.affiliation: Department of Periodontics, College of Dentistry, The University of Iowa, Iowa City, IA.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Brogden
mesh_terms: D000269:Adhesives / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002176:Candida albicans / Q000187:drug effects; D002180:Candidiasis, Oral / Q000517:prevention & control*; D003781:Denture Retention / Q000379:methods*; D005881:Gingiva / Q000187:drug effects; D006801:Humans; D008826:Microbial Sensitivity Tests
chemical_list: D000269:Adhesives; D000935:Antifungal Agents
keywords: Antimicrobial peptides; Candida; antifungal agents; antimicrobial lipids; denture adhesive; denture prosthesis; keratinocyte; stomatitis