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.
Photos of Denture Stomatitis
It predisposes to sores at the corners of the mouth (Angular Cheilitis).
Predisposing Factors for Oral Candidosis include:

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:

  • 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:

  • 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