Denture Cream Research Articles

Une cause méconnue de myélopathie par carence en cuivre : l’utilisation de pâte adhésive dentaire

We report two patients with myelopathy associated with copper deficiency and pancytopenia. Excessive intake of zinc can lead to a severe deficiency of copper reducing the absorption of ingested copper. The patients had in common consumption of denture adhesive paste containing zinc. In both patients, laboratory tests showed a combination of copper deficiency, hyperzincemia and increased urinary zinc level. The use of a denture cream was stopped. Copper supplementation, initially subcutaneously then oral corrected the copper deficiency and pancytopenia. Clinically, the pain faded but the gait disturbance persisted. Copper deficiency associated with the use of denture cream rich in zinc is an unrecognized cause of myelopathy associated with pancytopenia which should be diagnosed early to establish appropriate therapeutic measures to minimize neurological complications.

Zinc Transmetallation and Gadolinium Retention after MR Imaging: Case Report

A patient with chronic zinc poisoning from denture cream retained gadolinium after a magnetic resonance imaging procedure, likely due to transmetallation. During chelation therapy, high levels of gadolinium in excreted urine (up to 89 μg/d, 29 days after gadolinium administration) were present, indicating that gadolinium had been retained. Almost 2½ years after gadolinium exposure, a 24-hour urine collection indicated that the gadolinium level remained in the elevated range (0.6 μg/d). This single case report suggests that patients with elevated zinc exposure may be at increased risk of gadolinium retention.

Copper Deficiency Induced Neuropathy: A Sticky Situation

Purpose: Acquired copper deficiency, which can manifest as peripheral neuropathy, can be precipitated by gastrointestinal surgery, malabsorption, and nutritional deficiencies. Rarely, zinc toxicity can also cause hypocupremia. We report a case of acquired copper deficiency secondary to zinc toxicity caused by chronic use of denture adhesives. Methods: A 72 year-old male presented to the emergency department with a chief complaint of difficulty walking. The patient described a six-month history of lower extremity weakness and decreased sensation bilaterally. The patient denied palpitations, slurred speech, or discordination. He also denied weight loss, floating or malodorous stools, skin pigment changes, abdominal distention, or past gastrointestinal surgery. On physical exam, the patient was noted to be wearing dentures. There was no spider angioma, palmour erythema, or jaundice noted. Rectal exam demonstrated normal brown stool, which was guaiac negative. Results: Electroencephalogram (EEG) and neurological Magnetic Resonating Imaging (MRI) of the brain and spinal cord were within normal limits. CSF analysis was negative for viral, fungal, and bacterial cultures. Initial electrolytes and mineral values were all within normal limits except for a ceruloplasmin level of 4 mg/dL (nml 20-60), and a copper level <10 ug/dL (nml >65). Subsequent gastrointestinal work up revealed normal liver enzymes and negative endosysial, gliadin, and transglutamanaise antibodies. Additional nutritional studies demonstrated a zinc level of 1.52 mcg/dL (0.6-1.1). The patient received two weeks of IV copper with complete resolution of symptoms. Conclusion: Copper deficiency is a known cause of peripheral neuropathy. Acquired copper deficiency can be caused by gastrointestinal surgery, malabsorption, and nutritional deficiency. Zinc toxicity can also lead to hypocupremia although the exact etiology remains unknown. In recent years, a correlation between denture adhesive cream and zinc toxicity has been reported. It is estimated that a tube of Fixodent® has from 17 to 34 mg of zinc, which exceeds the NIH's recommended daily allowance of 8 mg in adult females and 11 mg in adult males. Previous studies have demonstrated that extensive denture adhesive use (two or more tubes a week for several years) can result in neurological manifestations such as peripheral neuropathy. Copper deficiency secondary to zinc toxicity should be considered in the differential in patients with chronic denture use presenting with neuropathy.

Myelopolyneuropathy and pancytopenia due to copper deficiency and high zinc levels of unknown origin II. The denture cream is a primary source of excessive zinc

Neurodegeneration of the central and peripheral nervous system associated with hypocupremia and hyperzincinemia has been widely recognized but the origin of high zinc remained unknown. Denture cream has been recently suggested as one possible source of zinc, but the frequency with which denture fixative alone accounts for this syndrome is unknown. We analyzed the origin of excessive zinc in eleven patients with a progressive myelopolyneuropathy and unexplained hypocupremia with hyperzincinemia. These patients had a detailed clinical assessment, determination of zinc and copper levels, and analyzed use of denture cream with the estimates of daily zinc exposure. We identified denture cream as a source of excessive zinc in 100% patients in our cohort. They all had a history of ill-fitting dentures requiring large amounts of denture cream, resulting in significant zinc exposure. Their copper and zinc normalized after stopping denture cream, further confirming that this is the source of high zinc. Inappropriate use of denture cream appears to be the sole source of excessive zinc in these patients.

DENTURE CREAM: AN UNUSUAL SOURCE OF EXCESS ZINC, LEADING TO HYPOCUPREMIA AND NEUROLOGIC DISEASE

We read with interest the article by Nations et al.1 describing four additional cases of copper deficiency myeloneuropathy in association with hyperzincemia and chronic use of denture creams containing zinc. We previously reported a patient with copper deficiency myeloneuropathy and zinc excess associated with over 15 years using a similar denture cream.2 The daily amount of zinc oxide applied with the adhesive was about 150 mg. Even though there are no data on zinc bioavailability from this source, we agree with Nations et al. that these findings prompt important safety concerns on the chronic use of denture creams …

When metals compete: a case of copper-deficiency myeloneuropathy and anemia

A 47-year-old woman with an otherwise unremarkable medical history was referred to the multiple sclerosis clinic by her primary neurologist for evaluation of a 2-3 year history of progressive knee and back pain, weakness, paresthesias, sensory loss, ataxia, and falls. During the same period, she had received blood transfusions for unexplained anemia and leukopenia. She had been wearing dentures for many years. Physical examination, neurological examinations (assessments of reflexes, gait, proprioception, and sensitivity to temperature, pinprick and vibration), neurophysiological studies (visual and brainstem somatosensory evoked potentials, nerve conduction studies and electromyography), T(2)-weighted MRI of the brain and spine, cerebrospinal fluid analysis and serum evaluations. Myeloneuropathy and anemia due to copper deficiency, secondary to zinc overload associated with long-term use of denture cream with a high zinc content. Change to a low-zinc denture cream and oral copper replacement.

Neurologic Disease Attributed to Denture Cream

These authors report on four patients with myeloneuropathy, hypocupremia, and hyperzincemia. All four reported use of large amounts of denture cream.

Denture cream

Chronic, excess zinc intake can result in copper deficiency and profound neurologic disease. However, when hyperzincemia is identified, the source often remains elusive. We identified four patients, one previously reported, with various neurologic abnormalities in the setting of hypocupremia and hyperzincemia. Each of these patients wore dentures and used very large amounts of denture cream chronically. To determine zinc concentration in the denture creams used by the patients as a possible source of excess zinc ingestion. Detailed clinical and laboratory data for each patient were compiled. Tubes of denture adhesives were analyzed for zinc content using dynamic reaction cell-inductively coupled plasma-mass spectrometry. Patients received copper supplementation. Copper and zinc levels were obtained post-treatment at varying intervals. Zinc concentrations ranging from about 17,000 to 34,000 mug/g were identified in Fixodent and Poli-Grip denture creams. Serum zinc levels improved in three patients following cessation of denture cream use. Copper supplementation resulted in mild neurologic improvement in two patients who stopped using denture cream. No alternative source of excess zinc ingestion or explanation for hypocupremia was identified. Denture cream contains zinc, and chronic excessive use may result in hypocupremia and serious neurologic disease.

THE EFFECT OF DENTURE ADHESIVE: ON MANDIBULAR MOVEMENT DURING CHEWING

The authors conducted a study to determine if reducing mandibular denture movement through the use of a denture adhesive improves chewing function in edentulous patients. The authors compared the mean chewing rates of 10 denture wearers who used and did not use a denture adhesive with that of a control group of 10 dentate people. The authors recorded mandibular movements using a multichannel magnetometer tracking system while the subjects chewed standardized pieces of dried apricots and fresh white bread. They made recordings for the test subjects without the use of denture adhesive and at zero, two and four hours after Fixodent denture adhesive cream (Procter & Gamble Co.) was applied to the mandibular denture. The mean chewing rate for the control group was significantly faster than that of the test group at baseline (P < .01). The authors found statistically significant increases in the mean chewing rates for the test group after the denture adhesive was applied at all time points for both foods. None of the after--adhesive-application rates were significantly different from the control group's rate (P > .05). Use of denture adhesive increased the mean chewing rate in test subjects immediately after and at two and four hours after denture adhesive was applied to a rate that approximated that observed in control subjects (P > .05). These findings show that using a denture adhesive promotes a faster and more natural rate of chewing.

LIPSTICK CHEILITIS

CHEILITIS is one of the most commonly seen dermatoses in clinical practice. Among the most frequent causes of this disease in women is the dye used to impart lasting qualities to indelible lipsticks. This dye is dibromfluorescein, tribromfluorescein or tetrabromfluorescein. Many other causative agents of cheilitis have been reported in the literature. Various authors have reported cases of cheilitis due to the following: actinic or chemically active rays of sunlight,1cold urticaria,2carmine and anilin dyes in liquid rouge,3trout,4lipstick,5methyl heptine carbonate in the perfume of lipstick,6dental plates (hecolite),7eosin dye in lipstick,8denture creams containing oil of anise,9lipstick in which local factors play a part,10mouth washes and cigaret holders,11derivatives of bromfluorescein (with photosensitization a factor to be considered), a husband's moustache wax, amalgam fillings for teeth, toothpaste and a preparation for gums