Denture stomatitis

Preparation of the mouth

denture stomatitis

palatal inflammatory papillary hyperplasia

angular stomatitis (angular cheilitis)

Denture stomatitis = Denture sore mouth

Denture stomatitis (DS) – an erythematous lesion of the denture-covered maxillary mucosa associated with wearing of acrylic dentures

The prevalence of DS 40%-60% among denture wearers

DS occurs more frequently in females than in males (the ratio 4:1)

DS occurs more frequently in females than in males (the ratio 4:1)

endocrine disorders

iron deficiency anemia

higher oral carrier rate of Candida

greater inclination to wear dentures at night

DS occurs most commonly in the mucosa in the maxilla and DOES NOT extend beyond the borders

of the denture

Clinical symptoms of DS

bleeding

swelling

burning

pain

dryness

unpleasant taste

DS is frequently SYMPTOMLESS

Newton’s classification of DS

Type I

Type II

Type III

Type I – showing pin-point hyperemia, or localized simple type of inflammation

Type II – showing more diffuse erythema, confined to the mucosa in contact with the acrylic plate

Type III – showing granular inflammation, or inflammatory papillary hyperplasia, also called the granular type

Etiology of DS

denture trauma

infection

denture plaque

The significant causes of DS

denture trauma

infection

denture plaque

systemic predisposing factors (diabetes, immunosuppression, xerostomia)

continuous denture wearing

denture hygiene

Diabetes mellitus

Type 1

(insulin-dependent diabetes mellitus - IDDM)

Type 2

(non-insulin-dependent diabetes mellitus - NIDDM)

Denture stomatitis occurs more frequently and are more severe in patients with type 2 diabetes

The mean candidal density on the palatal mucosa was higher in the diabetic patients

The mean in vitro adherence of Candida albicans to palatal epithelial cells was greater in the diabetic patients

Candida-associated DS s considered as the most common form of oral candidiasis, affecting 34-60% of acrylic complete denture wearers.

C. albicans and related species play a major role in initiating, maintaining and aggravating this disease. The majority of manifestations of Candida-related denture stomatitis are associated with biofilm formation on the inert surface of acrylic denture .

Biofilm - the most common mode of microbial growth in nature, essential in the development of clinical infections, especially due to its high-level antibiotic resistance.

A biofilm - complex structured community of microorganisms enclosed in a self-produced protective and adhesive extracellular matrix.

C. albicans - the primary etiological agent of oral candidiasis

The other species that cause disease less commonly include:

C. glabrata,

C. tropicalis,

C. parapsilosis and

C. krusei

Morphology

Candida albicans, an opportunistic human pathogen, displays two modes of growth

Y form – blastospores

M form – mass of hyphae that forms colony

Etiology – behavioural factors

poor denture hygiene (denture plaque)

wearing the dentures at night

Etiology – denture trauma

loss of fit

occlusal imbalance

parafunctional activity (bruxism)

Etiology – local irritation

residual monomer – tissue damage

Etiology – systemic factors

immunological deficiencies

hormonal imbalance

deficiencies of vitamins and iron

Diagnosis

clinical appearance

identification of the aetiological factors

- the amount of denture plaque

- the degree of denture trauma

- night-wearing of dentures

- other local factors (medications, diet)

systemic factors

To establish a reliable diagnosis of infection it is necessary to make estimation of the outgrowth of yeasts on the mucosa and the fitting surface of the denture

- Oral swabs - Microscopic examination of oral smears- Pouring alginate impression with Sabouraud’s medium

Diagnosis

Denture plaque (the amount, quantity and distribution)

Denture trauma (occlusion, fit, parafunctional activity)

Night-wearing of dentures

Treatment

- Improve denture hygiene- Discourage the patient from wearing the dentures at night

Treatment

Correction of denture faults

(occlusal faults – an unbalanced occlusion should be corrected by occlusal adjustment,

impression surface faults - lack of fit of the denture)

Antifungal therapy

Denture hygiene instruction

brushing

rinsing

overnight immersion

0.5% hypochlorite solution

0.5% chlorhexidine gluconate