| Exodontia.Info |
| Denture Sore Mouth (Denture-Related Stomatitis) |
Denture sore mouth is also known as sore mouth
under plates, chronic denture palatitis, stomatitis
prosthetica, denture-related candidiasis, denture-
induced stomatitis and denture stomatitis.
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.
Epidemiology
Denture stomatitis is a common condition: findings from
several studies suggest that it can affect as many as 35 -
50% of persons who wear complete dentures.
The prevalence of denture stomatitis among those wearing
partial dentures is markedly lower than among complete
denture wearers, whose rank goes from 10 - 70%
depending on the population studied.
No racial or sex predilection exists, although some authors
have described a higher prevalence among women.
under plates, chronic denture palatitis, stomatitis
prosthetica, denture-related candidiasis, denture-
induced stomatitis and denture stomatitis.
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.
Epidemiology
Denture stomatitis is a common condition: findings from
several studies suggest that it can affect as many as 35 -
50% of persons who wear complete dentures.
The prevalence of denture stomatitis among those wearing
partial dentures is markedly lower than among complete
denture wearers, whose rank goes from 10 - 70%
depending on the population studied.
No racial or sex predilection exists, although some authors
have described a higher prevalence among women.
| Photos of Denture Stomatitis |
| It predisposes to sores at the corners of the mouth (Angular Cheilitis). |
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Predisposing Factors for Oral Candidosis include:
1. Systemic factors
2. Local factors
Treatment
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.
1. Systemic factors
- 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)
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.
| Last Updated 9th February 2012 |
What are the Signs & Symptoms of Denture Stomatitis?
Denture stomatitis lesions may show different clinical patterns and are more
frequently found in the upper jaw, especially on the palate (roof of the mouth). The
absence of denture stomatitis in the lower jaw is probably due to the washing
action of saliva.
Despite the fact that denture stomatitis is frequently asymptomatic, patients may
complain of halitosis, slight bleeding and swelling in the involved area or a burning
sensation, xerostomia, or taste alterations (dysgeusia). These symptoms occur,
with variable intensity, in 20 - 70% of patients with denture stomatitis. In these
situations, the patient usually does not relate the use of a denture to the
experienced symptoms.
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:
Denture stomatitis lesions may show different clinical patterns and are more
frequently found in the upper jaw, especially on the palate (roof of the mouth). The
absence of denture stomatitis in the lower jaw is probably due to the washing
action of saliva.
Despite the fact that denture stomatitis is frequently asymptomatic, patients may
complain of halitosis, slight bleeding and swelling in the involved area or a burning
sensation, xerostomia, or taste alterations (dysgeusia). These symptoms occur,
with variable intensity, in 20 - 70% of patients with denture stomatitis. In these
situations, the patient usually does not relate the use of a denture to the
experienced symptoms.
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 hyperæmic 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)
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:
Useful Websites:
Emedine.com (Denture Stomatitis)
NHS Clinical Knowledge Summaries
NHS Choices
British Dental Health Foundation
New Zealand Dermatological Society
Useful Articles:
Australian Dental Journal 1998. Candida-associated Denture Stomatitis. Ætiology
and Management - A Review. Part 2. Oral Diseases caused by Candida species
Australian Dental Journal 1998. Candida-associated denture stomatitis. Aetiology
and management: A Review. Part 3. Treatment of oral candidosis
Dental Update 2000. Anti-mycotic Agents in Oral Candidosis. An Overview. 2.
Treatment of Oral Candidosis
Dental Update 2001. Oral Candidosis
Postgrad Med J 2002. Oral Candidiasis
BDJ 2005. Oral Medicine — Update for the dental practitioner. Oral white patches
Communicating Current Research and Educational Topics and Trends in Applied
Microbiology 2007. Non-Candida Albicans Candida Yeasts of the Oral Cavity
Cochrane Collaboration 2009. Interventions for preventing oral candidiasis for
patients with cancer receiving treatment (Review)
BDJ 2009. Bio-film microbial communities of denture stomatitis
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
Useful Websites:
Emedine.com (Denture Stomatitis)
NHS Clinical Knowledge Summaries
NHS Choices
British Dental Health Foundation
New Zealand Dermatological Society
Useful Articles:
Australian Dental Journal 1998. Candida-associated Denture Stomatitis. Ætiology
and Management - A Review. Part 2. Oral Diseases caused by Candida species
Australian Dental Journal 1998. Candida-associated denture stomatitis. Aetiology
and management: A Review. Part 3. Treatment of oral candidosis
Dental Update 2000. Anti-mycotic Agents in Oral Candidosis. An Overview. 2.
Treatment of Oral Candidosis
Dental Update 2001. Oral Candidosis
Postgrad Med J 2002. Oral Candidiasis
BDJ 2005. Oral Medicine — Update for the dental practitioner. Oral white patches
Communicating Current Research and Educational Topics and Trends in Applied
Microbiology 2007. Non-Candida Albicans Candida Yeasts of the Oral Cavity
Cochrane Collaboration 2009. Interventions for preventing oral candidiasis for
patients with cancer receiving treatment (Review)
BDJ 2009. Bio-film microbial communities of denture stomatitis