Comparing denture cleansers for effectiveness against Candida biofilms

Background and objectives

Candida species, particularly Candida albicans, are major contributors to denture-induced stomatitis because of their ability to form biofilms on removable dental prostheses. Although chemical cleansers are effective, concerns regarding material degradation and mucosal irritation have spurred interest in non-chemical alternatives. This review aims to systematically compare the efficacy of chemical and non-chemical denture cleansers in reducing Candida spp. on removable dental prostheses.

Methods

A systematic review was conducted according to the PRISMA 2020 guidelines. Comprehensive searches of PubMed, Scopus, and Web of Science (2003–2025) yielded 624 records. After duplicate removal and screening, 20 studies (10 randomized controlled trials (RCTs) and 10 in vitro studies) were included. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 for RCTs and QUIN/SYRCLE tools for in vitro studies.

Results

Chemical cleansers such as sodium hypochlorite (0.25–2.5%), chlorhexidine (0.2–2%), and effervescent peroxide tablets achieved 80–100% colony-forming unit reduction in most studies, with some reporting complete biofilm eradication. In contrast, non-chemical agents showed a 40–85% colony-forming unit reduction rate. Chemical cleansers caused increased surface roughness and discoloration in six of the ten studies included. Non-chemical agents preserved material integrity and were preferred by patients for their taste and ease of use. The risk of bias was low to moderate in 80% of the RCTs and low in 10 of the 13 in vitro studies.

Conclusions

This systematic review shows that both chemical and non-chemical denture cleansers effectively reduce Candida species, with chemical agents demonstrating more consistent antifungal action. However, material compatibility, patient tolerance, and safety remain important factors in cleanser selection. 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. Clinicians should balance microbial efficacy with the preservation of denture integrity and patient compliance. Future research should focus on standardized protocols, long-term clinical outcomes, and patient-reported measures. This review contributes to the scientific literature by integrating current evidence, evaluating emerging cleansers, and guiding clinical decisions for maintaining denture hygiene and preventing prosthesis-related fungal infections.