Denture Stomatitis (Denture Sore Mouth)

Definition:
- Denture-related stomatitis indicates an inflammatory process of the mucosa that bears a complete or partial removable dental appliance, typically a denture.
- It was known as: “chronic denture palatitis”, “stomatitis prothetica”, “denture related candidiasis” “denture-induced stomatitis” and “denture stomatitis”.
- The denture stomatitis occurs with patients of partial denture less than patients of complete denture.
- No racial or sex predilection exists.
- It can affect as many as 35-50% of persons who wear complete dentures.
- Denture sore mouth is common, but rarely sore.
- Caused mainly by a yeast (Candida) that is a normal inhabitant in the oral cavity, and it's not a transmitted disease.
- It can predispose to angular chelitis.
- It has no serious long-term consequences

Clinical Picture:
- Occurs in the maxilla more than the mandible, where the washing affect of salive is greater in the mandible.
- The Denture-induced stomatitis is assymptomatic, but patients may complain of halitosis, slight bleeding and swelling in the involved area, or a burning sensation, xerostomia, or taste alterations (dysgeusia).

Classification (Stages):
suggested by Newton in 1962, and states:
- Newton´s type I: pin-point hyperaemic 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)

Related disorders:
May be accompanied with other disorders of the same origin (Fungal), ex:
- Angular cheilitis
- Median rhomboid glossitis
- Candidal leukoplakia.

Aiteology:
The aetiology is best considered Multifactorial, but wearing the denture in the night is the major causitiva factor.
Other factors are:
1. Prosthetic factors:
- No denture stomatitis can exist without a prosthesis.
- Prosthetic traumatism is favoured by denture functional deficiencies

2. Infectious factors:
- The dentures can accumulate bacteria and yeasts, that cause the ecological changes:
- Bacteria proliferate: Staphylococcus species, Streptococcus species, Neisseria species, Fusobacterium species. or Bacteroides species has been identified in patients with denture stomatitis.
- Candida species, particularly Candida albicans, have been identified in most patients. Patients with denture stomatitis show higher intraoral concentrations of fungi than individuals without this disorder.

Predisposing factors:

1. Systemic factors
a. Physiological. (advanced age)
b. Endocrine dysfunctions.
c. Nutritional deficiencies.
d. Neoplasias.
e. Immunosuppression.
f. Ample spectrum antibiotics.

2. Local factors
a. Antimicrobials and topical or inhaled corticosteroids
b. Carbohydrate rich diet
c. Tobacco and alcohol consumption
d. Hyposalivation
e. Deficient oral hygiene
f. Wearing dentures (especially through the night)

Diagnosis:
- Clinical presentation of erythema and oedema on the palatal mucosa covered by the denture base (but not beyond) is a diagnostic finding.
- Take a smear of the palate to check for presence of Candida species, by staining with KOH, periodic acid-Schiff or by imprint cultures.
- Blood tests, microbiological studies or biopsy may be required.

Prevention:
• A routine basis inspection of the oral cavity for screening for this disorder, even when the lesions are asymptomatic.
• Properly denture sanitization and perform good oral hygiene
• Appropriate denture-wearing habits, instructing the patient to take his/her denture out of the mouth for 6-8 hours each day
• Patients with partial dentures should undergo periodic professional plaque control

Treatment:
• Good oral hygiene is mandatory.
• 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, chlorhexidine or in any solution suitable for sterilizing baby´s feeding bottles.
• Denture fitting and occlusal balance should be checked to avoid trauma. A new prosthesis should be made, if necessary.
• 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 before the denture is placed, and mild cases may respond to antifungal treatment.

• Antifungal medications are recommended when yeasts have been isolated, or when lesions do not resolve with hygiene instructions.

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