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