Denture stomatitis is characterized by an infection and inflammation of the mucosa under a denture.
Denture Stomatitis alters the denture bearing area due to the oedema and the infection is implicated in angular cheilitis.
The cause of denture stomatitis is multifactorial but important factors are prolonged wearing of dentures and poor denture hygiene.
Usually there are no symptoms at all and the patient is completely unaware until a dentist mentions this to them at a regular dental appointment.
The diagnosis is primarily the presence of erythema and oedema on the area that is covered by the denture. It is nearly always seen on an upper denture.
The treatment of choice for denture stomatitis consists of
1/ denture hygiene.
2/ application of a topical antifungal.
3/ making a new prosthesis.
4/ To avoid wearing the denture whilst sleeping.
In terms of the exact and specific antifungal agent, there are many available and they are all broadly effective.
As a way of a background,the microorganism implicated in the primary infection is candida albicans. Candida albicans is a fungus and is regarded as commensalism in the normal oral environment .However an imbalance will cause the proliferation of candida albicans.The imbalance is due to factors as discussed above such as wearing the dentures at night-time, and poor denture hygiene which causes an increase in the plaque biofilm.
In addition there may be other factors which promote and factors are xerostomia, immunosuppression, diabetes mellitus,endocrine and immune disorders including malignancy.
So how should a patient be instructed in maintaining the denture hygiene.
The Denture or prosthesis should be cleaned with a toothbrush using toothpaste under water. As well as using normal toothpaste, patients can also denture cleaners, sodium hypochlorite at 1.5 to 2% or baking soda.
Dentures can also be soaked overnight using a denture tablet or simply in mouthwash or even sodium hypochlorite.
It is important to stress in patients that it is not the type of cleaner which is important but it’s how well you use these methods.
Next all patients should be instructed to use an antifungal agent on the surface of the denture and then to place a denture back in over 4 to 6-weeks during daytime only.
Antifungals that can be used include miconazole gel, nystatin, fluconazole ,ketoconazole, clotrimazole and chlorhexidine.
Miconazole gel at 2% is the anti-fungal seems to be most successful in its application and is applied directly on the surface of the denture two to three times a day for 1/2 week. The patient should be then reviewed and for resistant cases, a patient can also be given oral antifungals but largely they are not required.
Relapse is common especially when a patient does not heed your advice with regard to denture wearing and denture hygiene. Chlorhexidine gluconate mouthwash at 0.12% was also effective in eliminating candida albicans from the surface of the denture on patients suffering from denture stomatitis. It’s method of action is to cause cellular alterations in the organism which makes it effective.
If there is associated angular cheilitis, this is also treated at the same time.
Newer methods of treating denture stomatitis include photodynamic therapy and the use of nanomaterials but results can be obtained by good denture hygiene, remaking the denture, denture wearing reduction and topical antifungal therapy.