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Dentures and the oral microbiome: Unraveling the hidden impact on edentulous and partially edentulous patients - a systematic review and meta-analysis

Evidence-Based Dentistry volume 26, page 150 (2025)Cite this article

Subjects

Abstract

Objective

This systematic review and meta-analysis evaluate the impact of edentulism and denture use on the oral microbiome, focusing on microbial diversity, colonization and biofilm formation in completely and partially edentulous patients.

Methods

A comprehensive search was conducted across five databases (PubMed-Medline, Scopus, Embase, Lilacs, and Google Scholar) until June 1, 2024. Randomized and non-randomized clinical trials, observational studies, and cohort studies were included. Data extraction and risk of bias assessment followed PRISMA guidelines. Meta-analysis was performed using STATA and R software with a random effects maximum likelihood model. Microbial co-occurrence networks, heatmaps, and longitudinal trends were analyzed, with heterogeneity assessed using Higgin’s I² (substantial heterogeneity defined as I² > 50%).

Results

Thirty-two studies met the inclusion criteria. The oral microbiome in edentulous patients differed significantly from dentate individuals, influenced by denture materials, design, and time. Veillonella abundance in acrylic complete dentures was 13.63% (95% CI = -0.04, 27.29), I² = 90.98%, compared to 49.10% (95% CI = -29.62, 115.81), I² = 99.47% in dentate patients. Candida albicans increased over time in acrylic dentures, from 63.13% (95% CI = 48.93, 77.33), I² = 99.84% after insertion to 344.72 CFU/ml × 10² (95% CI = 139.19, 550.24), I² = 98.30% at nine months. Streptococcus mutans in CAD/CAM dentures increased from 45.54 CFU/ml × 10² (95% CI = 33.82, 57.25), I² = 87.26% at three months to 125.22 CFU/ml × 10² (95% CI = 38.25, 212.18), I² = 97.89% at nine months. Co-occurrence networks revealed strong Candida albicans–Streptococcus mutans synergy, while Fusobacterium nucleatum showed antagonistic interactions. Heatmaps demonstrated microbial dysbiosis in denture stomatitis cases, with increased Porphyromonas gingivalis and Candida albicans and reduced commensals. Longitudinal analyses highlighted the progressive dominance of opportunistic pathogens, emphasizing the need for early and consistent hygiene interventions.

Conclusion

Denture wearers exhibit distinct microbial communities influenced by biofilm formation, denture materials, and hygiene practices. Findings highlight the importance of antimicrobial denture materials and effective cleaning protocols in managing microbial colonization. Given high heterogeneity, standardized methodologies are essential for future research. Frequent professional cleaning and individualized hygiene strategies are necessary to prevent denture-associated infections and maintain oral health.

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Fig. 1
Fig. 2: Forest plot for Streptococcus mutans (CFU/ml) in acrylic complete dentures.
Fig. 3: Forest plot for Candida albicans (CFU/ml) in acrylic complete dentures.
Fig. 4: Forest plot for Staphylococcus aureus (CFU/ml) in acrylic complete dentures.

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Data availability

The data supporting this article can be made available by the corresponding author upon request.

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Acknowledgements

We would like to acknowledge and thank Dr. A. Selva Arockiam for his help in performing the quantitative analysis for the meta-analysis.

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Authors and Affiliations

  1. Department of Prosthodontics Sri Ramachandra Dental College and Hospital, SRIHER, Chennai, India

    Seenivasan Madhan Kumar, Shanmuganathan Natarajan & Parthasarathy Natarajan

  2. laboratory medicine, SRIHER, Chennai, India

    Sridharan KS

  3. Luminous Biopharma Private Limited, Chennai, India

    Senthil Kumar Sundarajan

  4. Department of orthodontics, Private practitioner, Virudhachalam, India

    A. Selva Arockiam

Authors
  1. Seenivasan Madhan Kumar
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  2. Shanmuganathan Natarajan
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  3. Sridharan KS
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  4. Senthil Kumar Sundarajan
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  5. Parthasarathy Natarajan
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  6. A. Selva Arockiam
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Contributions

Dr. Seenivasan Madhan Kumar: Data curation, Formal analysis, Methodology, Validation, Visualization, Writing- original draft, Writing- review & editing; Dr. Shanmuganathan Natarajan: Data curation, Formal analysis, Methodology, Validation, Visualization, Writing- original draft, Writing- review & editing; Dr. K.S. Sridharan: Conceptualization, Funding acquisition, Project administration, Supervision, Formal analysis, Investigation, Resources, Writing- original draft, Writing- review & editing, Dr. Senthil Kumar Sundarajan: Conceptualization, Funding acquisition, Project administration, Supervision, Formal analysis, Investigation, Resources, Writing- original draft, Writing- review & editing, Dr. Parthasarathy Natarajan: Conceptualization, Funding acquisition, Project administration, Supervision, Formal analysis, Investigation, Resources, Writing- original draft, Writing- review & editing. Selva Arockiam: Data curation, Methodology, Formal analysis, Investigation, Writing- original draft, Writing- review & editing.

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Correspondence to Seenivasan Madhan Kumar.

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Madhan Kumar, S., Natarajan, S., KS, S. et al. Dentures and the oral microbiome: Unraveling the hidden impact on edentulous and partially edentulous patients - a systematic review and meta-analysis. Evid Based Dent 26, 150 (2025). https://doi.org/10.1038/s41432-025-01149-0

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