Denture stomatitis

What is denture stomatitis?

Denture-induced stomatitis is a common inflammatory reaction related to the wearing of dentures usually involving Candida (yeast) species. Less common forms of denture stomatitis may be due to mechanical trauma or an allergic contact reaction.

Stomatitis means a sore mouth.

Who gets denture stomatitis?

Denture-related stomatitis is very common, with over 50% of denture wearers affected in some populations. It is the most common clinically important condition developing in the mouth of denture wearers.

Factors that predispose to the development of denture stomatitis include:

• Complete upper (maxillary) denture – probably due to the large contact area between denture and oral mucosa
• Acrylic dentures – Candida species seem to have a particular binding affinity for acrylic resin
• Poor dental hygiene – Candida species and Lactobacillus bacteria stick to denture surfaces and should be removed chemically and/or mechanically at least daily
• Poorly fitting dentures – mechanical trauma damages the mucosa, making it more prone to infection
• Denture age – old dentures are commonly associated with denture stomatitis probably due to poor fitting and rough surface in which Candida can hide
• Continuous wearing of denture – failure to remove at night increases the risk
• Men – are twice as likely to develop denture stomatitis than women
• Diabetes mellitus – diabetics are more prone to developing yeast infections
• Dry mouth (xerostomia) – saliva normally helps flush the mouth and clean the denture surface

The elderly are the most likely population to wear dentures and are at particular risk of poor denture hygiene due to limited financial resources, poor vision, limited manual dexterity and lack of information. Poverty also influences the ability to visit a dentist regularly and replace ill-fitting dentures.

Clinical features of denture stomatitis

Denture stomatitis usually does not cause any symptoms. But on examination the mouth lining in contact with the denture will be red and swollen sometimes with small red dots (petechial haemorrhages).

How is denture stomatitis diagnosed?

Denture stomatitis is a clinical diagnosis based on the pattern of redness and swelling following the shape of the area of denture contact.

Microbiological swabs from the palate and/or denture surface will confirm the presence of yeasts – C. albicans is the most common followed by C. glabrata, C. tropicalis and others.

Examination of the denture may reveal some of the predisposing factors listed above.

Treatment of denture stomatitis

The most important treatment is removal of the dentures at night and thorough cleaning of the dentures.

Dentures should be removed and cleaned at least once daily. Cleaning options include:

Chemical cleaning

• soaking in sodium perborate, sodium hypochlorite (6 percent bleach diluted by mixing 10 parts water to one part bleach for 10 minutes), chlorhexidine digluconate, weak acids
• soaking in enzymes such as proteases and mutanases
• 10% vinegar overnight soak is an inexpensive option but not ideal. One study reported a reduced yeast count and clinical improvement, although not complete resolution

Mechanical cleaning

• brushing with neutral soap or dentrifice
• ultrasonic cleansing

For established denture stomatitis, topical antifungal applications to the denture-fitting surface and oral mucosa, for example 2% ketoconazole in Orabase. Miconazole oral gel should be avoided in patients taking warfarin as there have been reports of drug interactions.

Oral antifungal tablets should be avoided if possible as side effects are more common than with topical applications.

Oral mouth rinses such as hexetidine have also been shown to be helpful with few side effects.

A dental examination should be performed to assess the condition and fit of the denture. The denture may need relining, refitting or replacement.

Prevention is better and regular dental checks will note adequacy of denture hygiene and fit.