d e n t a l m a t e r i a l s 2 6 ( 2 0 1 0 ) 76–82

available at www.sciencedirect.com

journal homepage: www.intl.elsevierhealth.com/journals/dema

Candida albicans adherence on silicone elastomers: Effect of

polymerisation duration and exposure to simulated saliva
and nasal secretion

Huseyin Kurtulmus b , Ovul Kumbuloglu b , Mutlu Özcan a,∗ , Guven Ozdemir c , Caner
Vural c
a University of Zurich, Dental Materials Unit, Center for Dental and Oral Medicine, Clinic for Fixed and Removable Prosthodontics and
Dental Materials Science, Zurich, Switzerland
b Ege University, Faculty of Dentistry, Department of Prosthodontics, Izmir, Turkey
c Ege University, Faculty of Science, Department of Biology, Microbiology Section, Izmir, Turkey

a r t i c l e i n f o a b s t r a c t

Article history: Objectives. The surfaces of maxillo-facial prostheses made of silicone elastomers exposed
Received 19 December 2008 to soft tissues may interact with saliva and nasal secretion. These body fluids may lead to
Received in revised form colonisation of microorganisms on their surfaces leading to their degradation or infection.
10 June 2009 This study investigated Candida albicans adhesion onto commercial maxillo-facial silicone
Accepted 4 September 2009 elastomers based on different polymerisation processes.
Methods. Room-temperature polymerised maxillo-facial silicone elastomers (N = 48)
(10 mm × 10 mm × 2 mm) processed at different durations [VerSilTal VST-30 (20 min), VST-
Keywords: 50 (12 h overnight), VST-50F (6 h)] were studied. C. albicans was chosen as a model organism
Bacterial adhesion for this study. The specimens were randomly divided into two subgroups and incubated in
Candida albicans either 1.5 ml simulated saliva or nasal secretion containing C. albicans (ATCC 60193, set to 0.5
Maxillo-facial prosthesis OD, 540 nm in advance) for 2 h. Candida assays and adherence assays were made by inocu-
Silicone elastomers lating C. albicans into Mueller Hinton Broth, Fluka® added 500 mmol sucrose overnight. After
fixation, specimens were stained by using sterilised Methylene Blue stain (Merck® ) and eval-
uated under optical microscope and SEM. For each material, on each specimen 15 different
areas (mm2 ) were counted. Data were analysed using one-way ANOVA, paired sample t-test
and Tukey’s HSD (˛ = 0.05).
Results. Material type (p < 0.05) and exposure media (p < 0.05) showed a significant influence
on the C. albicans adherence. VST-30 material showed the most C. albicans adherence in both
saliva and nasal secretion (mean rank: 99.84 and 53.47, respectively) (p < 0.05) and VST-50 had
the least colonisation in both media (10.35 and 5.57, respectively). Microscopic evaluation
showed clusters of blastospore cells of C. albicans being more spread out on VST-30 whereas
cells were more localised on VST-50 and VST-50F.
Significance. Among the tested materials, 12 h room-temperature polymerised silicone elas-
tomer resulted in less C. albicans adherence in both artificial saliva and nasal secretion.
© 2009 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

∗
Corresponding author. Tel.: +41 44 6345600; fax: +41 44 6344305.
E-mail address: mutluozcan@hotmail.com (M. Özcan).
0109-5641/$ – see front matter © 2009 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.dental.2009.09.001
 d e n t a l m a t e r i a l s 2 6 ( 2 0 1 0 ) 76–82
1. Introduction
Adhesion of microorganisms to a material surface initi-
ates with microbial colonisation on the surface [1]. Denture
resins, usually made of polymethylmethacrylates (PMMA),
applied in edentulous subjects may act as reservoir lead-
ing to infection [1]. Maxillo-facial prostheses made of various
elastomeric silicones on the other hand, are even more perme-
able and thereby more susceptible to microbial colonisation
[1–3]. Differences in surface topography [1,4–7], substratum
hydrophobicity, surface chemistry and processing methods
used for resins [8–10] may affect the adhesion of microorgan-
isms to that surface. Even after washing, higher number of
retained microorganisms on the surface could be expected
especially when substrate surface is rough [1].
Maxillo-facial prostheses are usually made of silicone elas-
tomers and they are often exposed to soft tissues that may
interact with either saliva and/or nasal secretion depend-
ing on their application and location. These body fluids
lead to colonisation of microorganisms on their surfaces
leading to their degradation and consequently possible infec-
tion [11]. Similar to the denture resins, surface irregularities
present on silicone elastomers could increase the likelihood
of microorganism colonisation on their surfaces [1–4]. For in
vivo applications, both PMMA and silicone elastomer prosthe-
ses are processed against dental stone. The resultant surface is
a kind of replica of the surface topography of the dental stone
and as such not particularly smooth. There have been many
studies in the dental literature on the Candida albicans adhe-
sion to denture base acrylic resin and silicone-based resilient
liner materials [12–18]. However, the substrates in these stud-
ies were processed against smooth and transparent surfaces.
This indicates that they were not representative of technical
processing of these materials for clinical applications since
typically they are manufactured against a dental stone sur-
face.
Surface roughness of heat-polymerised resilient liners
were found to be less than those of room-temperature
polymerised ones [11,13–16]. Correspondingly, C. albicans
adherence was reported to be significantly higher on the
room-temperature polymerised ones with various surface fin-
ish types [19–21,11,22–24]. The chemical composition of the
room-temperature polymerised resilient liners, the difference
in surface energies or higher hydrophilicity could be the rea-
sons for this condition [10]. Maxillo-facial silicone elastomers
are also processed at room temperature resulting in different
surface topographies [1]. It can be anticipated that long-term
polymerisation may lead to better polymerisation and thereby
less microbial colonisation. Although such materials cannot
be compared with those of denture resins, similar trends could
be expected with silicone elastomers. Unfortunately, previous
studies looking at this aspect [20,21,11,22–25] did not concen-
trate on the presence of saliva and nasal secretion, limiting the
significance of these studies. C. albicans is classified as an asex-
ual diploid fungus. The genus Candida is defined as a yeast,
as it is a fungus with a predominantly unicellular method of
growth and development. Plaque that contains high levels of
C. albicans typically becomes acidic as a result of microbial
metabolism which may subsequently produce inflammation
77
of adjacent mucosal surfaces or microbial colonisation on the
hard tissues [26]. Although controversial reports exist [26,27],
this is not always a pre-requisite for the yeasts to adhere to an
inert surface. In general as yeast cells tend to colonise more
in acidic conditions [22,27], it can be hypothesised that nasal
secretions, due to its low pH ranging between 4 and 6 [28,29],
would result in more microbial colonisation.
Dental literature contains many case reports on the con-
struction or application of maxillo-facial prosthesis made of
silicone elastomers but to the authors’ knowledge there is no
information on their maintenance. The objectives of this study
therefore were to investigate C. albicans adhesion onto three
commercial maxillo-facial silicone elastomers based on dif-
ferent polymerisation processes in the presence of artificial
saliva and nasal secretion and to evaluate the colonisation
microscopically. The tested null hypothesis were that nasal
secretion would result in more C. albicans colonisation than
artificial saliva and long-term room temperature processing
would result in less C. albicans adhesion.
2. Materials and methods
2.1. Specimen preparation
Room-temperature polymerised, additional cure maxillo-
facial silicone elastomers processed at different durations
were studied. The brand names, corresponding polymerisa-
tion modes, chemical compositions, shades, batch numbers
and manufacturers of the materials used in this study are
listed in Table 1.
Pink modeling wax (N = 48, n = 16 per group),
(10 mm × 10 mm × 2 mm) (DeTrey Dentsply, Colombes, France)
was placed in dental stone (Shera Medium, Shera GMBH & Co.,
Lemförde, Germany) in a two-part mold using a standard den-
tal flask. The molds were prepared in such a manner that both
parts of the molds were filled with vacuum mixed hard dental
stone. The wax was eliminated under running hot water and
plaster surfaces were sealed with four coats of sealant (Factor
2, NY, USA) using a clean brush each time. All materials
were mixed and processed according to the manufacturer’s
instructions where 5 ml of catalyst was added to 5 ml powder.
Mixing was performed in clean glass beakers. After mixing,
silicones were placed in the molds and polymerised following
the manufacturer’s recommendations. All specimens were
fabricated by one operator at 20–25 ◦ C room temperature.
Following polymerisation, silicone elastomer specimens were
gently removed from the molds and flashes were trimmed
away with sterile scissors. They were then randomly divided
into two subgroups (n = 8). Specimen surfaces were incubated
in simulated saliva or nasal secretions containing C. albicans.
Artificial saliva consisted of 0.220 g/l calcium chloride,
1.07 g/l sodium phosphate, 1.68 g/l of sodium bicarbonate, and
2 g/l sodium azide (0.2% NaN3 ) [30,31]. Nasal secretion, on
the other hand, was prepared using microdialysis procedure
as described elsewhere [29] that consisted 107 ± 4 mM Na+ ,
120 ± 6 mM Cl− and 8.7 ± 0.4 mM K+ . Specimens were incu-
bated in 1.5 ml simulated sterile saliva or nasal secretion at
37 ◦ C for 2 h.
78 d e n t a l m a t e r i a l s 2 6 ( 2 0 1 0 ) 76–82

Table 1 – The brand names, corresponding polymerisation modes, chemical compositions, shades, batch numbers and
manufacturers of the materials used in this study.
Brand name Polymerisation mode Chemical composition Shade Batch number Manufacturer
VerSilTal, Silicone Additional cure, Part A: Translucent 2130 Factor II, Lakeside,
Elastomer-VST-30 room-temperature polymethylvinylsiloxanes, AZ, USA
vulcanised. Cure time: polymethylhydrogensilicones,
20 min silica. Part B:
polymethylvinylsiloxanes,
platinum complex, silica.
Catalyst: stannous octoate
VerSilTal, Silicone Additional cure, Part A: Translucent 2150 Factor II, Lakeside,
Elastomer-VST-50 room-temperature polymethylvinylsiloxanes, AZ, USA
vulcanised. Cure time: polymethylhydrogensilicones,
8–12 h silica. Part B:
polymethylvinylsiloxanes,
platinum complex, silica.
Catalyst: stannous octoate
VerSilTal, Silicone Additional cure, Part A: Translucent 2150F Factor II, AZ, USA
Elastomer-VST-50F room-temperature polymethylvinylsiloxanes,
vulcanised. Cure time: polymethylhydrogensilicones,
4–6 h silica. Part B:
polymethylvinylsiloxanes,
platinum complex, silica.
Catalyst: stannous octoate

2.2. Candida assay
C. albicans strain ATCC 60193 was obtained as a stock cul-
ture (Basic and Industrial Microbiology Section, Department
of Biology, Ege University, Izmir, Turkey) and inoculated into
Mueller Hinton Broth, Fluka® with added 500 mM sucrose
medium and incubated for 24 h [19]. After incubation, the
culture was centrifuged (Hettich Rotina 35 R Zentrifugen, Ger-
many) at 1700 × g for 10 min. Supernatant was removed and
0.1 M phosphate-buffered saline (PBS) with 0.89% NaCl at pH
7.2 was added onto the collected cells [25,32]. The resultant cell
pellet was washed with phosphate-buffered saline (PBS) solu-
tion for three times by centrifugation at 1700 × g for 10 min.
The number of C. albicans cells was set to 0.5 OD at 540 nm in
advance. OD of cell suspension was previously determined in
either saliva or nasal secretion for the specimens to be inocu-
lated in saliva or nasal secretion, respectively [20].
2.3. Adherence assay
Specimens were sterilised in an autoclave (HiClaveTM HC-50L,
Hirayama, Japan) at 121 ◦ C for 20 min. Since the heat-
polymerised mode of these materials were suggested to
polymerise between 100 and 120 ◦ C according to the man-
ufacturer’s instructions, no adverse effect of heating during
sterilisation was expected on the properties of silicone. They
were then placed in separate sterile tubes and incubated with
either 1.5 ml simulated saliva (pH = 7) that contained C. albi-
cans cells (set to 0.5 OD, 540 nm, in advance) [20] or with 1.5 ml
simulated nasal secretion (pH = 4.8) at 37 ◦ C with orbital shak-
ing (100 rpm) for 2 h. After incubation, in order to remove the
unattached cells, specimens were gently removed from the
tubes and rinsed by dipping them into the PBS solution for
three times for approximately 75 s. Then, for fixation of the
attached cells, specimens were treated with 100% ethanol for
3 s and left to dry in sterile plates.
Specimens were stained using sterilised, fixated Methy-
lene Blue stain (Merck® ) for 1 min and subsequently evaluated
under optical light microscope (Olympus CH20, Olympus Sin-
gapore PTE Ltd., Singapore) at 40× magnification. On each
specimen, 15 different consecutive areas were counted. Visible
measurement field was calculated in mm2 and the obtained
data were expressed in cells/mm2 .
Complementary to the optical microscopy analysis, speci-
mens were also observed under scanning electron microscope
(SEM) (JEOL JSM-5200, Kyoto, Japan) after they were fixed with
2% gluteraldehyde, dehydrated with ethanol (at 25, 50, 75 and
100% for 5, 5, 5 and 10 min, respectively) and coated with Au–Pd
(750× to 3500× magnification).
2.4. Statistical analysis
The statistical analysis was performed with the SPSS soft-
ware package (version 11.5; SPSS, Chicago, IL, USA). Mean
ranks obtained from adherence assay were evaluated using
one-way analysis of variance (ANOVA) and paired sample
t-test. Since significant differences were found between or
within groups, Tukey’s HSD was used to determine the dif-
ferences. The results of normality and homogeneity test
(Kolmogorov–Smirnov) indicated that the residual values were
normally distributed when plotted against predicted values.
The uniformity and normality tests did not violate the statis-
tical assumptions. In all comparisons, statistical significance
was declared if the p-value was less than 0.05.
3. Results
3.1. C. albicans adherence
Material type (p < 0.05) and the exposure media (p < 0.05)
showed a significant influence on C. albicans adherence (one-
way ANOVA, paired sample t-test) (Table 2).
 d e n t a l m a t e r i a l s 2 6 ( 2 0 1 0 ) 76–82 79

Table 2 – Results of statistical analysis for the

experimental conditions (* p < 0.05).
Source DF MS F value p-Value*
Silicone elastomer material 2 90,935.021 9.049 0.100
Contamination medium 1 22,231.021 2.212 0.275
Interaction 2 10,048.896 59.645 0.000

Fig. 1 – Mean ranks of C. albicans adherence (mm2 )

according to the material and the exposure medium.

VST-30 material showed the highest C. albicans adherence

in both saliva and nasal secretion (mean rank: 99.84 and
53.47, respectively) (p < 0.05) and VST-50 had the least coloni-
sation in both media (10.35 and 5.57, respectively) (Fig. 1
and Table 3). While VST-50F silicone elastomer did not show
significantly different C. albicans colonisation in both media
(p > 0.05), VST-30 silicone elastomer demonstrated more C.
albicans colonisation in artificial saliva (p < 0.05). On the other
hand, VST-50 showed the least colonisation in both saliva and
nasal secretion than those of VST-50F and VST-30 (p < 0.05)
(Table 3).
Regardless of the material type, storage in simulated saliva
resulted in significantly higher C. albicans adherence than that
of simulated nasal secretion (p < 0.05, Tukey’s HSD).

3.2. Microscopical evaluations

In all materials, C. albicans adherence was observed in cluster
forms viewed in localised blastospore morphology (Fig. 2a–c).
VST-50 material showed individual cells that were observed
less in other materials. After ethanol fixation almost no C. albi-
cans colonisation was seen indicating that the loose cells were
washed away (Fig. 3a and b).
Fig. 2 – SEM micrograph of (a) VST-30 exposed to simulated
saliva with C. albicans. Note the rough surface and the C.
albicans adherence in clusters spread on the surface (3500×
original magnification). (b) VST-50 and (c) VST-50F exposed
to simulated saliva (2000×). Note the lower adherence of C.
albicans on both of these materials with cells more
localised when compared to VST-30.

4. Discussion
Table 3 – Mean ranks of C. albicans adherence (number
of adhered cells/mm2 ) on the silicone elastomers when Oral diseases or inflammations such as stomatitis may occur
exposed to simulated saliva and nasal secretion (N = 48,
as a consequence of cell accumulation to polymeric mate-
n = 8 per group).
rials facilitated by London, van der Waals and electrostatic
Silicone elastomers Contamination medium forces [29,30]. When the free surface energy is increased, it
Artificial saliva Nasal secretion activates microbial adhesion and the number of adhered cells
also increases [30]. Other studies on the hand, disagree on
VST-30 99.84 53.47
VST-50 10.35 5.57 the effect of surface free energy [24] or found that it has no
VST-50F 54.78 46.51 effect on cell adhesion [25]. Moreover, hydrophobicity, pres-
ence and types of nutrients as well as other psychochemical
Total 164.97 104.55
aspects may all affect adhesion of microorganisms such as
80 d e n t a l m a t e r i a l s 2 6 ( 2 0 1 0 ) 76–82
Fig. 3 – (a) C. albicans adherence on VST-30 without ethanol
fixation (3500×). (b) VST-30 surface after ethanol fixation
(750×). Note the rough surface but no C. albicans
colonisation.
C. albicans on the surface [32]. The factors affecting micro-
bial colonisation are multiple but it can be stated that several
factors synergistically function on microbial colonisation. In
addition to all these factors, pH of the surface or the media
with which the microorganisms are interacting may also have
consequences on colonisation. Acid production by some oral
strains of C. albicans and Lactobassilli has been reported dur-
ing microbial colonisation as an outcome of their natural
metabolisms [27]. Consequently, the pH of aqueous medium to
which the materials are exposed also plays a significant role on
microbial colonisation [33,34]. This study was undertaken in
order to investigate C. albicans adherence levels to commercial
silicone elastomers when they were exposed to two different
human body secretions, namely saliva and nasal secretions
that were artificially created. Regardless of the polymerisa-
tion duration, increased C. albicans adherence was found in
artificial saliva (pH = 7). For standardisation purposes, pH of
artificial saliva was kept as 7. The pH of the saliva in patients
with dentures presenting C. albicans adherence was reported
to be 5.2 [30,35]. From the clinical perspective, although a trend
for acidic saliva may be expected, a generalisation cannot be
made. Therefore verification of the results of this study needs
to be clinically verified and correlated with pH in vivo.
In fact, human saliva is a complex fluid secreted by the
major and minor salivary glands and the secretion is under
the control of the autonomic nervous system. Saliva has
also antimicrobial action due to the presence of lactoferrins,
immunoglobulins, cystatin, histatin and thiocyanate ions.
Therefore its simulation with artificial saliva is complicated
but this can serve as a screening medium.
Exposure of the specimens to simulated nasal secretion
yielded significantly less C. albicans adherence compared to
artificial saliva. Therefore the hypothesis is rejected. The nasal
secretion prepared had a pH of 4.8. Less C. albicans adherence
in this medium could be attributed to the presence of NaNO3
in this medium which might have inhibited colonisation by
creating ionic bonds and thereby having a repellent effect.
Another reason could be due to the storage duration of the
specimens in this media (2 h) which may not be the critical
time point. Unfortunately, to the authors’ knowledge, there
exists no study in the dental literature using nasal secretion
as an exposure medium for maxillo-facial silicone elastomers
to make comparisons of the findings of this present study. Cur-
rently, in a case-controlled clinical trial, the effect of human
nasal secretion on C. albicans adherence on silicones is being
evaluated.
In this study, three room-temperature polymerised sili-
cone elastomers with different processing durations were
tested. In all the materials tested, some degree of C. albi-
cans adherence was noted being significantly less for VST-50
which was polymerised for 12 h at room temperature, con-
firming the hypothesis. Although manufacturer’s instructions
advised 8–12 h overnight polymerisation period, 12 h was
chosen to make sure that the polymerisation process was
complete. VST-30, polymerised in 20 min showed dramati-
cally higher C. albicans than those of other materials. It can
therefore be concluded that shortened processing durations
should be avoided. The SEM findings presented fairly rough
surfaces with VST-30 material compared to the other mate-
rials. It should also be noted that the processing of the
tested materials was accomplished against a dental stone
in order to make close approximation to the clinical situ-
ation. The in vitro studies where silicone processing was
performed against glass should be evaluated with caution
[1,4,19,35].
Larger cells such as yeasts are more easily dislodged from
smooth surfaces than the bacteria [1,9]. Hence, from the clin-
ical perspective, washing the maxillo-facial prosthesis may
surely contribute to better hygiene of these appliances. In
this study, no antimicrobial agents were used in the clean-
ing (washing) process of the specimens but it would be of
interest to compare the effectiveness of cleansing agents
against microorganisms immobilised on surfaces. Neverthe-
less, knowledge on the effect of cleaning regimens and
antimicrobial agents on maxillo-facial silicone elastomers are
currently limited [26,36,37].
In this study, the exposure of the specimens to either simu-
lated saliva or nasal secretion was 2 h due to technical reasons.
Although salivary proteins have been considered to serve
as a source of nutrients for microorganisms for growth and
reproduction requirements, as well as assisting in microbial
succession of dissimilar bacterial species in developing plaque
[9,17], prolonged period of exposure may lead to possible cell
death [29]. In a colonisation process, the lack of nutrient has
a significant role for cell death. In principle, the stages of
biofilm formation consists of initial attachment, then coloni-
sation and maturation and finally detachment. For initial
attachment, microorganisms can be attached to the material
 d e n t a l m a t e r i a l s 2 6 ( 2 0 1 0 ) 76–82
surface depending on physical and chemical interactions with
the material. After this process, microorganisms colonise but
depending on their metabolic requirements, when they can-
not find the nutrient source, they can die.
In fact, prolonged exposure of the silicone elastomers
to such media may have more implications in vivo regard-
ing the functional lifespan of silicones since contacting host
surfaces would be more heavily colonised with initial microor-
ganisms, when opportunist pathogens such as C. albicans
and Candida glabrata are present [19,38,39]. The synergistic
effect of microbial colonisation with low pH together with the
conditions of the exposure media may lead to material degra-
dation and eventually rougher surfaces. Rougher surfaces of
denture liners were reported to be more susceptible to accel-
erated deterioration and more retention colonisation [1,19]
but information related to roughness effect and colonisation
on maxillo-facial silicone elastomers is lacking. Conventional
evaluation of surface roughness through surface contact often
involves the use of a stylus that is drawn over the speci-
men to detect and record variations in surface irregularity. A
primary limitation of this technique is that the stylus must
be drawn perpendicular to the surface that could potentially
damage the surface. In this study, due to the less dense
nature of the silicones, no roughness measurements were
undertaken. However, recent non-destructive roughness mea-
surement methods [40,41] as well as in growth of C. albicans
into silicone elastomers could be considered in future stud-
ies. Microscopical analysis however has shown VST-30 with
rougher surfaces. On this material also C. albicans were dis-
tributed compared to the other materials where cell clusters
were localised. One explanation for this form of colonisation
in VST-30 could be due to the variations in surface roughness
[19,20,29,30] that was also noticed on the SEM images.
Defects in the silicone surfaces are most likely to have
been incorporated during fabrication. Such defects are already
present in the plaster mold before packing the silicone. The
pits observed on the surface of the silicone are in fact a replica
of the dental stone caused by the crystalline structure of the
dental stone surface. Such pits and fissures, incorporated dur-
ing mixing the plaster were present on the silicone leading to
clumping of the cells around and within surface defects. After
a short polymerisation duration while opening the two-part
mold of the flask, due to less polymerisation, VST-30 could
have replicated the plaster mold more than the long-term
processed ones.
Prior to the SEM analysis, specimens were incubated in
ethanol solutions. This procedure must have affected the
material composition at least at the surface or removed
loose cells from the surface since compared to the opti-
cal microscopy findings, less adherent microorganisms were
found. This indicates that when evaluating the C. albicans
adherence using SEM [32,33], caution should be exercised
since surface cleaning procedures with ethanol prior to SEM
evaluations may interfere with the surface properties of the
silicone elastomers or damage the cell walls.
From the clinical point of view, maxillo-facial prostheses
placed into patients should be frequently assessed by the
dentist. Prostheses exposed to the nasal area comprise appli-
ances for nasal, midfacial, large orbital defects, combined
facial prosthesis with defects in the maxilla and tracheal stent.
81
Based on the obtained data, maxillo-facial prostheses made
for the nasal area seems to collect less C. albicans than the ones
exposed to saliva. Nonetheless, smooth surfaces and long-
term polymerisation of such materials may delay microbial
colonisation. In this study, C. albicans was used as a model
microorganism. The obtained results may change with other
Candida species such as C. tropicalis, C. dubliniensis, C. glabrata,
C. parapsilosis, C. guilliermondii, or with other microorganisms
such as Staphylococcus aureus or Streptococcus mutans [5,17,25].
In a mixed culture, enhanced attachment of C. albicans could
be expected especially in the presence of pioneer Streptococ-
cal species [9]. If the media used in this study were not sterile
and artificial but had contained nutrients, the pioneer Strepto-
coccal species could have adhered on the surface, metabolise
or use the organic materials such as glucose, and produce acid.
As a consequence, the pH of the environment may decrease
and thereby increase the affinity of C. albicans adherence.
These aspects warrants further research with maxillo-facial
elastomers.
5. Conclusions
From this study, the following could be concluded:
(1) Among the tested materials, 12 h room-temperature poly-
merised silicone elastomer resulted in better surface
properties and less C. albicans adherence in both simulated
saliva and nasal secretion.
(2) Silicone elastomers yielded more C. albicans adherence in
simulated saliva than in nasal secretion regardless of the
polymerisation duration.
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