Candida-associated denture stomatitis (CADS) is a common, recurring disease among denture wearers and can lead to other oral health problems, systemic infections, compromised quality of life, and even life threating conditions. Our elderly veteran denture wearers are more prone to develop CADS since many of them are medically and immunologically compromised due to systemic, physical, and mental diseases and their associated therapies (e.g., antibiotics, steroid therapies, and xerostomic drugs). Currently, there are no effective treatment strategies for controlling CADS and the reinfection rate is high, affecting up to 67% of denture wearers. This renewal application builds upon the results of our previous funding period in which we used a rechargeable ?click-on/click-off? anticandidal technology to develop long-term, infection-responsive denture base materials. The functional polymer grafts, including poly-N-vinyl-2-pyrrolidinone (PNVP), polymethacrylic acid (PMAA), and poly-2-hydroxyethyl methacrylate (PHEMA), were covalently bound onto denture discs using plasma as an energy source. These novel functionalized denture materials were capable of binding sufficient quantities of antifungal drugs, such as miconazole and chlorhexidine digluconate, and provide potent longlasting antifungal effects by release of the drugs into PBS or human saliva over the course of weeks to months. At the end of the experiment (or therapy for a patient), any remaining drug bound to the surface could be ?washed off? with a quenching solution. For clinical applications, the ?quenched? denture could be returned to the patient for regular use or, if the infection recurred or persisted, be recharged with the same or different class of antifungal agent. Our long-term goal is to develop this rechargeable, ?click-on/click-off? anticandidal technology to control CADS in clinical applications. Previous studies of denture discs have not addressed problems associated with the topology, bulk properties, physical/mechanical properties, dimensional stability, and drug loading/releasing properties from 3D complete dentures. The objective of this renewal is to further demonstrate proof of principle in this pre-translational stage regarding clinical utility of the new strategy.
The specific aims of the proposed research are to: (1) fabricate 3D dentures, using the ?click on/click off? anticandidal technology, for use in a rat model and evaluate their physical/mechanical properties and drug binding/releasing behaviors; (2) evaluate the new anticandidal rat 3D dentures for their biocompatibility and anticandidal activity under clinically simulated conditions; and (3) evaluate the new anticandidal 3D dentures in a rat denture stomatitis model. Further development of this new technology has the potential to significantly improve the quality of oral care delivered to our veterans by effectively managing CADS and its accompanying complications. If successful, this new denture material will be the first therapeutic denture, capable of delivering personalized treatment for long-term management of CADS, and benefit our aging veterans.
Candida-associated denture stomatitis (CADS) is a common, recurring disease that seriously affects patients? oral health and wellbeing. Management and prevention of CADS is a significant clinical challenge, particularly for our aging veterans. This project will develop new rechargeable anticandidal dentures by grafting functional groups (for binding antifungal drugs) onto conventional denture material for long-term protection against CADS based on a patient?s clinical infection status. The technology not only provides for personalized CADS treatment and prevention, but may also be used to develop the next generation of antimicrobial catheters, endotracheal tubes, and related devices to fight infection and create a safer healthcare environment.
