Denture-related stomatitis

Denture-related stomatitis is a symptomless red lesion under a dental appliance, most typically a maxillary denture

Candida and bacterial species are commonly causal

Candida proliferates in the dental plaque, dental appliance surface and on the mucosa

Candidiosis may also cause soreness at the commissures (angular cheilitis)

Treatment includes correcting the local ecological factors, and improving appliance hygiene, together with antifungal medication

INTRODUCTION

Denture-related stomatitis (denture sore mouth; chronic atrophic candidosis) consists of mild inflammation and erythema of the mucosa beneath a dental appliance, usually a complete upper denture.

INCIDENCE

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.

PREDISPOSING FACTORS

Dental appliance wearing (mainly maxillary dentures), especially when worn throughout the night, or with a dry mouth, is the major predisposing factor.

Smoking occasionally predisposes.

Diabetes or a high carbohydrate diet occasionally predispose.

Hyposalivation is a occasionally an underlying factor.

Haematinic deficiencies are a rare underlying factor.

HIV is a rare underlying factor.

Factors that are usually not significant include:

allergy to the dental material (if it were, denture-related stomatitis would affect mucosae other than just that beneath the appliance)

trauma; the condition is more common beneath maxillary dentures than mandibular dentures, yet trauma is more common under the latter

pharmacological agents.

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.

CLINICAL FEATURES

The characteristic presenting features of denture-related stomatitis are:

An absence of symptoms. The former term ‘denture sore mouth’ was a misnomer.

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).

Fig. 40.2 Denture-related stomatitis (denture in situ; same patient as in **Fig. 40.1**)

Uncommon complications, which include:

angular stomatitis, and rarely

papillary hyperplasia in the vault of the palate (idiopathic papillary epithelial hyperplasia (IPEH), which usually needs to be surgically removed before the appliance is replaced or relined).

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/> Only gold members can continue reading. Log In or Register to continue

Type

Definition

Comment

Localized simple inflammation or a pinpoint hyperaemia

Early lesion usually

Erythematous or generalized simple type presenting as more diffuse erythema involving a part of, or the entire, den/>

Only gold members can continue reading. Log In or Register to continue

Stay updated, free dental videos. Join our Telegram channel

Tags: Oral and Maxillofacial Medicine The Basis of Diagnosis and Treatment 3e

Jan 9, 2015 | Posted by mrzezo in Oral and Maxillofacial Pathology | Comments Off

Pocket Dentistry

Fastest Clinical Dentistry Insight Engine

40: Denture-related stomatitis

Denture-related stomatitis

INTRODUCTION

INCIDENCE

AGE

GENDER

GEOGRAPHIC

PREDISPOSING FACTORS

AETIOLOGY AND PATHOGENESIS

CLINICAL FEATURES

CLASSIFICATION

Related

Stay updated, free dental videos. Join our Telegram channel

VIDEdental - Online dental courses

Fastest Clinical Dentistry Insight Engine

40: Denture-related stomatitis

Share this:

Related

Related posts:

Stay updated, free dental videos. Join our Telegram channel

VIDEdental - Online dental courses