Hong et al.

Int Chin J Dent 2010; 10: 41-45.

The effect of denture adhesive on bite force until denture
dislodgement using a gnathometer
Guang Hong, DDS, PhD,a Takeshi Maeda, DDS, PhD,b and Taizo Hamada, DDS, PhDa
aDepartment of Oral Health Care Promotion, Graduate School of Dentistry, Tohoku University, Sendai,band Department of Advanced Prosthodontics, Graduate School of Biomedical Sciences, Hiroshima
University, Hiroshima, Japan
Purpose: Denture adhesives are used to improve denture retention, stability and function. The purpose of thisstudy was to determine the effect of a cream-type denture adhesive on bite force until denture dislodgement(BFDD) using an improved gnathometer.
Materials and Methods: Twelve denture-wearing patients (six females and six males, mean age: 69 years) wereinvolved in the study. The maximum BFDD of two groups (“no biting pain” and “biting pain”) was measured
using a disposable gnathometer before and after denture adhesive application. The standard curve of thegnathometer measurements was produced using a constant load compression testing machine from 10 N to 80 N.
Results: A significant difference was found between the no biting pain group and the biting pain group before
the application of denture adhesive (p<0.0001). A notable improvement was observed in BFDD of the biting
pain patients after denture adhesive was applied (p<0.0001). No significant difference in BFDD was found in
the no biting pain subjects following the application of denture adhesive.
Conclusion: The following conclusions were drawn: 1) Denture adhesive is effective for improving the BFDDof complete denture wearers with biting pain; 2) The gnathometer is useful for measuring the BFDD of completedenture wearers. (Int Chin J Dent 2010; 10: 41-45.)
Key Words: bite force, complete denture, denture adhesive, gnathometer

Introduction
Denture adhesive has been extensively used by denture wearers with well-fitting and ill-fitting dentures as ameans to enhance denture retention, stability and function.1-6 The American Dental Association first reported theuse of denture adhesive in 1935.7 The first patent for denture adhesive was issued in 1913 in the US, with otherpatents following in the 1920s and 1930s.8 Clinical opinion about denture adhesive has been negative,9-12 anddentists have been slow to accept denture adhesive. Reported reasons for trying denture adhesive are to improve
fit, comfort, chewing ability, and also to improve patient confidence in wearing dentures.5,13 In the US in 1980,
15% of denture wearers used denture adhesives.14,15 Wilson et al.16 reported in 1990 that 30% of denture wearers
used, or had used, denture adhesive. However, Coates17 reported that a significant number of subjects in hisstudy did not know that denture adhesives existed. However, denture adhesives still hold a legitimate andindispensable place in prosthetic dental treatment.
The mechanical properties and cytotoxicity of denture adhesives have been widely investigated using a variety
of testing methods.18-22 Boos23 demonstrated the use of a gnathometer to measure intermaxillary biting force in1940. In 2004 and 2005, Psillakis et al.24 and Özcan et al.25 used a gnathometer to examine the effect of dentureadhesives on bite force until denture dislodgement (BFDD).
Patients using denture adhesive need to know how denture adhesive affects denture stability.

Thegnathometer is a useful tool to measure the BFDD of complete denture wearing patients. It is therefore
important that this device is easy for patients to use.
The purpose of this study was to examine the properties of the improved gnathometer using a calibration test.
In addition, the effect of denture adhesive on BFDD of complete denture wearing patients was examined using
the improved gnathometer.

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Materials and Methods
Twelve patients fitted with complete mandibular and maxillary dentures (six females and 6 males) wereinvolved in the study. Patients’ ages ranged from 52 to 82 years with a mean age of 69 years. The patients weredivided into the following two groups: those who did not experience pain in the alveolar mucosa on biting (theno biting pain group; seven patients: three females and four males); and those who experienced pain in thealveolar mucosa on biting (the biting pain group; five patients: three females and two males). All patients werein good health with no medical problems that would contraindicate their participation in the study. The patientswere informed about the aim of the study, and informed consent was supplied for the patients according to theEthical Commission of the University.

Fig. 1. Disposable gnathometer

Fig. 2. Denture adhesive application space

A baseline maximum BFDD was measured using a disposable gnathometer (GlaxoSmithKline K.K., Tokyo,Japan; Fig. 1) before denture adhesive application. Measurements were taken of the bite force a patient could
apply to the right first molar (R), central incisor (F) and left first molar (L) before dislodgement of the denture
occurred at the palatal seal. The denture was then removed, cleaned and dried. A cream-type denture adhesive(New Poligrip S, GlaxoSmithKline K.K.) was applied to the mandibular denture as 3x2 cm long strips, and to themaxillary denture as 4x2 cm long strips (Fig. 2). BFDD was measured 30 minutes following the application of
the denture adhesive.
We measured the correlation between the gnathometer scale and the load using a constant load compression
testing machine (A-001, Japan Mecc Co. Ltd., Tokyo, Japan) from 10 N to 80 N (10, 15, 20, 25, 30, 35, 40, 50,70, and 80 N), and produced a standard curve using regression analysis (SPSS 16.0, SPSS Co., Tokyo, Japan).
Three gnathometers were used for measurement, and each gnathometer was measured five times at each load.
The data were analyzed using ANOVA and Student’s t-test at a 0.05 level of significance (SPSS 16.0, SPSSCo.).

Results
Figure 3 shows the standard curve of the gnathometer measurements. The regression was y=5.0007x+5.6205.

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Int Chin J Dent 2010; 10: 41-45.

R2 is 0.9855 and high correlation was accepted. A significant difference was found between the no biting paingroup and the biting pain group before the application of the denture adhesive (p<0.0001) (Fig. 4). A notable
improvement from the baseline was observed in the BFDD of the biting pain group (p<0.0001) when dentureadhesive was used (R: 23.82 N, F: 26.12 N, L: 25.62 N). All patients in the biting pain group reported that painin the alveolar mucosa diminished with the use of denture adhesive. In the no biting pain group, BFDD wasobserved to rise from the baseline when denture adhesive was used (R: from 82.06 N to 86.71 N, F: from 93.14
N to 94.57 N, L: from 89.92 N to 93.85 N); however, no significant difference was found (p>0.05). No
significant differences were found among the three biting sites for all groups (p>0.05).

Fig. 3. Standard curve of gnathometer (left)
Fig. 4. Mean BFDD with standard deviation before and after denture adhesive application (right)
R: right first molar; F: central incisor; L: left first molar. *: BFDD of R between before and after denture adhesive
application for biting pain group (p<0.0001). *: BFDD of F between before and after denture adhesive application
for biting pain group (p<0.0001). ***: BFDD of L between before and after denture adhesive application for bitingpain group (p<0.0001). ****: BFDD of R between no biting pain group and biting pain group before dentureadhesive application (p<0.0001). *****: BFDD of F between no biting pain group and biting pain group beforedenture adhesive application (p<0.0001). ******: BFDD of L between no biting pain group and biting pain group
before denture adhesive application (p<0.0001).

Discussion
Denture cleansers are widely used by denture wearers to remove plaque, stain and calculus form the surface ofdentures.1-5 In the clinic, patients would benefit greatly from a dentist’s guidance in the use of denture cleansers.
This study was designed to survey the knowledge, understanding and level of education about denture cleansers
among Japanese, Chinese, and Indonesian dentists.
More than 76% of Chinese dentists and more than 62% of dentists in Indonesia said that they had heard only alittle about denture cleansers and that they knew only a little of the function of denture cleansers. Furthermore,
more than 76% of dentists in China and more than 61% of Indonesian dentists answered that they did not knowof any disadvantages of denture cleansers. It is important for dentists to be familiar with the disadvantages ofdenture cleansers; in particular, the risk of deterioration of the physical and mechanical properties of denturebase materials and oral mucosal injury caused by inappropriate use of denture cleansers.15

Professional

education about denture cleansers is therefore necessary. Almost none of the dentists in China and Indonesia
knew of any domestic brands of denture cleanser. In China and Indonesia, there are practically no domestic
manufacturers of denture cleansers, and denture cleansers are mainly imported. This may be why so many
dentists in China and Indonesia did not know of any domestic brands.
Over 61% of dentists in China and Indonesia responded that they had never been taught about denture43Hong et al.

Int Chin J Dent 2010; 10: 41-45.

cleansers, and between 80% and 100% of Chinese dentists had never encountered denture cleansers in books,
lecture meetings or on television. Information about denture cleansers often comes from textbooks and lectures,but dentists often encounter this information only in technical journals and specialty books. In China andIndonesia, there have been few reports about problems caused by denture cleansers. Therefore, problems arisingfrom the improper use of denture cleansers, such as deterioration of the physical and mechanical properties ofdenture base materials and oral mucosal injury, may be prevented by raising dental professionals’ awareness andknowledge of denture cleansers.

We suggest that it is particularly important to teach dentists about theadvantages and disadvantages of denture cleansers in professional continuing education and training.
Over 69% of the dentists in Chinese and over 54% of the Indonesian dentists stated that they had never seen
denture cleansers in the clinic. There are various environmental differences among the three countries. These
differences could affect dental treatment, and could affect the use of denture cleansers.
Some limitations can be identified in this study.

Firstly, indirect translation of the questionnaire fromJapanese to Chinese and Indonesian might have influenced the results. Secondly, the sample sizes were small.
Thirdly, there were significant differences in age among the three groups of subjects. It is unknown whether theresults can be generalized to other samples; therefore, it is necessary to conduct future research over morediverse samples. Although caution should be exercised in making generalizations based on the results of thisstudy, the questionnaire is a starting point for investigating the awareness and knowledge of dentists in Japan,
China, and Indonesia about denture cleansers. These methods may be useful for comparing awareness ofdenture cleansers among other groups, and may further contribute to the evaluation of denture cleansers.
Acknowledgment
This research was supported in part by a Grant-in-Aid (No. 21791899) for Scientific Research from the Ministry ofEducation, Culture, Sports, Science and Technology, Japan. We would like to thank the GlaxoSmithKline Company for theirsupport of this study.

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Correspondence to:
Dr. Guang Hong
Department of Oral Health Care Promotion, Graduate School of Dentistry, Tohoku University
4-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
Fax: +81-22-717-8345 E-mail: hong@m.tohoku.ac.jp
Accepted August 31, 2010.

Copyright ©2010 by the International Chinese Journal of Dentistry.

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