40: Denture-related stomatitis

Denture-related stomatitis

AETIOLOGY AND PATHOGENESIS

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.

Candida, however, are not the only microorganisms associated with denture-related stomatitis; occasionally bacterial infection is responsible, or mechanical irritation has a role.

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.

CLASSIFICATION

Denture-related stomatitis has been classified into three clinical types (Newton types), increasing in severity (Table 40.1).

Table 40.1

Newton classification of denture-related stomatitis

Type Definition Comment
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/>

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Jan 9, 2015 | Posted by in Oral and Maxillofacial Pathology | Comments Off on 40: Denture-related stomatitis
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