DENTURE INDUCED
STOMATITIS
Dr Hira Bashir
INTRODUCTION
■ Denture induced stomatitis is also known as;
■ Sore mouth under plates,
■ Chronic denture palatitis,
■ Stomatitis prosthetica,
■ Denture-related candidiasis,
■ Denture sore mouth and
■ Denture stomatitis.
DEFINITION
■ DENTURE INDUCED STOMATITIS is mild
inflammation and erythema of the mucosa beneath
a dental appliance, usually a complete upper
denture.
■ Nowadays, “denture stomatitis” stands for a mild
chronic
erythematous candidiasis, usually seen after
middle age
as erythema (redness) limited to the area
beneath an
upper denture with the presence of the denture
as the only
common aetiological factor to these situations.
It is not
caused by allergy to the denture material.
PREDISPOSING FACTORS
. Systemic factors
1
■ Physiological (Advanced age)
■ Endocrine dysfunctions
■ Nutritional deficiencies
■ Neoplasias
■ Immuno-suppression
■ Broad spectrum antibiotics
2. Local factors
Anti-microbials and topical / inhaled corticosteroids
Carbohydrate rich diet
Tobacco and alcohol consumption
Hypo-salivation
Deficient oral hygiene
Wearing dentures (especially through the night)
ETIOLOGY AND PATHOGENESIS
■ Dentures and other appliances can produce a number of
ecological changes, including accumulation of microbial
plaque (bacteria and yeasts) on and in the fitting surface of
the denture and underlying mucosa.
■ Histological examination of the soft tissue beneath denture
has shown proliferative or degenerative responses with
reduced keratinization and thinner epithelium.
CLINICAL FEATURES
■ Chronic erythema and oedema of the mucosa that contacts
the fitting surface of the denture, usually complete upper
denture bearing area. Mucosa beneath lower denture is rarely
involved.
■ Uncommon complications, which include;
1. Angular stomatitis, and rarely
2. Papillary hyperplasia in the vault of the palate, which needs to
be surgically removed before the appliance is replaced or
relined.
SYMPTOMS
■ Halitosis,
■ Slight bleeding
■ Swelling in the involved area
■ Burning sensation
■ Xerostomia
■ Taste alterations (dysgeusia)
Staging
Different classifications have been proposed, but the reference classification
for
denture stomatitis is the one suggested by Newton in 1962, based exclusively
on
clinical criteria:
■ Newton´s type I: pin-point hyperemic lesions (localized simple inflammation)
■ Newton´s type II: diffuse erythema confined to the mucosa contacting the
denture (generalized simple inflammation)
■ Newton´s type III: granular surface (inflamatory papillary hyperplasia)
TREATMENT
■ Good oral hygiene is mandatory. The mouth must be kept as clean as
possible and a thorough rinse after meals should be performed.
■ Local factors which promote growth of yeasts, such as smoking or wearing
the dentures throughout the night, must be discouraged.
■ Dentures should be removed for as long as possible and definitely overnight.
Dentures should be brushed in warm, soapy water and soaked overnight in an
antiseptic solution such as bleach (10 drops of household bleach in a denture
cup), chlorhexidine (not when the denture has metal components) or in any
solution suitable for sterilizing baby´s feeding bottles. Benzoic acid containing
products should be avoided as they induce changes in the composition of
acrylic materials.
■ Denture fitting and occlusal balance should be checked to avoid trauma. A
new denture should be made, if necessary. Tissue conditioning agents are
porous materials easier to colonize than acrylic, so they are not recommended
for these patients. If there is no other choice, an anti-fungal agent, like
nystatin, miconazole or ketoconazole may be incorporated to the agent.
Dentures must be adequately polished and glazed as pores increase denture
contamination by oral micro-organisms
■ Newton`s type I and II denture stomatitis have been successfully treated
with low energy lasers to reduce inflammation of the supporting mucosa.
Inflammatory papillary hyperplasia usually needs to be surgically removed (by
scalpel, cryosurgery, electro-surgery or with a laser beam) before the denture
is placed, although mild cases may respond to anti-fungal treatment.
■ Anti-fungal medications are recommended when yeasts have been isolated, or
when lesions do not resolve with hygiene instructions.
■ First choice treatment is the topical application of nystatin or miconazole.
Resistance to nystatin is rare; the drug is administered as an oral suspension, with
an unpleasant taste and can induce gastro-intestinal problems and hypersensitivity.
Miconazole is available as a gel, varnish, lacquer and chewing gum. It also
provokes gastro-intestinal alterations and hypersensitivity, but it tastes better.
Miconazole enhances warfarin effect.
Systemic anti-fungal drugs (i.e. fluconazole, itraconazole or ketoconazole) are
almost exclusively reserved for patients with systemic factors that condition the
development and persistence of candidosis, such as immuno-suppression or
diabetes.
Prevention
■ It is mandatory to include denture stomatitis prevention in oral health care
programmes. Dental professionals working with geriatric patients must promote
this preventive programmes among all health care workers, home caregivers,
members of the patient's family and, of course, the patients themselves.
A preventive programme should include:
A routine basis inspection of the oral cavity for screening for this disorder,
even when the lesions are asymptomatic.
■ Properly denture sanitisation and perform good oral hygiene.
■ Appropriate denture-wearing habits, instructing the patient to take their
denture out of the mouth for 6 - 8 hours each day.
■ Patients with partial dentures should undergo periodic professional plaque
control
