Denture biofilm increases respiratory diseases in the elderly. A mini-review

Purpose: This mini-review discusses the clinical implication of respiratory pathogens in the biofilm on acrylic resin removable dentures in the elderly. Methods: A search was conducted using the keywords: "dentures", "acrylic resin", "biofilm", "pneumonia", "elderly", "respiratory pathogens", and "respiratory diseases" in databases PubMed/Medline, Lilacs, SciELO and textbooks between 1999 and 2024. Results: The elderly are more susceptible to chronic diseases and/or life-threatening infections because of senescence itself and functional and degenerative alterations. Respiratory tract diseases (such as pneumonia) are of greater concern in the elderly because they have been associated with the aspiration of food and oral pathogens and with reflux. This relationship is more aggravating in the presence of removable dentures, common in the elderly after the sixth decade of life, since denture biofilm is a reservoir of respiratory pathogens. Lack of manual dexterity and visual acuity negatively interfere with denture cleaning and favor pathogenic denture biofilm maturation. Reduced salivary flow, a more acidic pH, and a reduced cough reflex associated with poor denture cleaning increase the potential of denture biofilm infections and aspiration pneumonia, which is related to a high mortality rate in the elderly. To prevent respiratory diseases in this population, measures to control denture biofilm should be adopted, such as the superficial or intrinsic modification of the acrylic resin denture bases and the use of effective methods of denture cleaning. CLINICAL SIGNIFICANCE: Respiratory pathogens colonizing denture biofilm can be aspirated into the respiratory tract, increasing the risk of respiratory infections, especially in the elderly. The knowledge of health professionals on methods of biofilm control can prevent respiratory diseases in elderly denture wearers.