Common; in some studies of institutionalized older denture-wearing patients, figures as high as 70% have been found, but it is overall considerably less common in other people, particularly in normal healthy subjects.
Dentures and other appliances can produce a number of ecological changes, including accumulation of microbial plaque (bacteria and/or yeasts) on and in the fitting surface of the denture and the underlying mucosa. Histological examination of the soft tissue beneath dentures has shown proliferative or degenerative responses with reduced keratinization and thinner epithelium.
Fungi, such as Candida, are isolated in up to 90% of persons with denture-related stomatitis, and when Candida species are involved in denture-related stomatitis, the more common terms ‘Candida-associated denture stomatitis’, ‘denture-induced candidosis’ or ‘chronic atrophic candidosis’ are used. The most frequently isolated organism is Candida albicans. In some persons, the cause appears to be related to a non-specific plaque, which undergoes sequential development, and is finally colonized by Candida organisms. Although there is no increased aspartyl proteinase production from the Candida involved, the decreased salivary flow and a low pH under the denture probably result in a high Candida enzymatic activity, which can cause mucosal inflammation.
It not yet clear why only some denture-wearers develop denture stomatitis, since most patients with denture-related stomatitis appear otherwise healthy and they have no serious cell-mediated immune defects, but they may sometimes be deficient in migration-inhibition factor (MIF) and may have overactive suppressor T cells or other T lymphocyte or phagocyte defects.
Chronic erythema and oedema of the mucosa that contacts the fitting surface of the denture, usually a complete upper denture (the denture-bearing area); the mucosa below lower dentures is rarely involved (Figs 40.1 and 40.2).
|1||Localized simple inflammation or a pinpoint hyperaemia||Early lesion usually|
|2||Erythematous or generalized simple type presenting as more diffuse erythema involving a part of, or the entire, den/>|