Everything You Should Know about Denture Stomatitis

Dentures are among the most popular tooth replacement options in dentistry, which are opted by the elderly population. Typically, dentures are made from a rigid acrylic material that takes support from the mouth’s underlying gums and jaw bone.

While dentures may be an excellent option for replacing all or multiple teeth in the mouth, there might be some discomfort that patients with dentures may experience while getting accustomed to dentures. One of the most common conditions seen in denture wearers is denture stomatitis.

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Denture stomatitis is a mild infection of the gums that occurs due to several reasons such as poor oral hygiene, nutritional deficiency, hyposalivation, and systemic malfunctions. It is an inflammatory condition that causes a burning sensation. Symptomatic treatment is best to heal denture stomatitis.

Today’s article will highlight the causes and symptoms of denture stomatitis. Furthermore, we will discuss the treatment of denture stomatitis.

What is denture stomatitis?

Denture stomatitis is an inflammatory dental condition that is closely associated with prolonged denture wearing. It usually occurs due to the development of yeast infections such as candidiasis on the gums that provide denture support. (1)

Some other forms of denture stomatitis usually occur due to mechanical trauma or allergy. Additionally, denture stomatitis is commonly seen in people with a maxillary denture. Moreover, males are more affected than females.

What causes denture stomatitis?

Some of the common causes which may lead to denture stomatitis include –

  • Dentures made from acrylic resin
  • Poor oral and denture hygiene leading to increased risk of bacterial and fungal infections in the mouth
  • Ill-fitting dentures such as loose dentures that may cause mechanical trauma to the underlying gums
  • Old dentures that do not fit properly due to change in the gums and underlying bone
  • Prolonged use of dentures in the mouth during the day especially in people who sleep with dentures in the night (2)
  • Patients with systemic illnesses such as diabetes are more prone to infections in the mouth.
  • People with dry mouth leading to poor oral hygiene

Signs and symptoms

Usually, denture stomatitis may occur in a wide range of clinical patterns. However, some of the typical signs and symptoms of denture stomatitis may include –

  • A frequent occurrence in the maxilla, especially on the palatal surface. the lower jaw is less prone to denture stomatitis because of continuous salivary flow, which keeps the area clean and moist as compared to the palatal region. (3)
  • Some people may experience only bad breath without any other symptoms of pain or discomfort.
  • Swelling and bleeding from the affected site
  • Burning sensation in the involved area of the mouth
  • Taste alteration and increased risk of dry mouth
  • Angular cheilitis (inflammation in the corners of the mouth) may be associated with denture stomatitis.

Diagnosis

Typically, the diagnosis of denture stomatitis is made after a thorough clinical and histological examination. Swab tests are performed to understand the type of lesion. Moreover, a tissue biopsy may be advised in cases that represent proliferative or degenerative forms.

Typically, the diagnosis of denture stomatitis can be categorized into three types –

  • Type 1 – commonly known as pinpoint hyperemia or localized inflammation
  • Type 2 – diffuse erythema – redness is usually noticed in all parts of the mucosa covered by the denture (4)
  • Type 3 – papillary hyperplasia which may show nodular growth especially on the mid-palatal region and alveolar ridge

What is the treatment?

Treatment usually depends on the type of condition that is diagnosed by the dentist. Some of the conventional treatment modalities for denture stomatitis include –

Generally, type 1 and 2 denture stomatitis can be successfully treated with low energy laser treatment. These procedures help to reduce the inflammation of the affected oral tissue.

Type 3 – Inflammatory papillary hyperplasia usually needs to be surgically removed with a scalpel, cryosurgery, electro-surgery, or laser therapy before the denture is placed. Mild cases generally respond to antifungal treatment such as topical application of nystatin or miconazole. (5)

Although the resistance to nystatin is rare, the drug can cause unpleasant taste and induce gastro-intestinal problems or hypersensitivity. Systemic antifungal drugs like fluconazole, itraconazole, or ketoconazole are used for patients with underlying systemic conditions such as immunosuppression or diabetes.

Additionally, the treatment routine may also include the following –

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  • Maintenance of Good oral hygiene – rinse the mouth and the denture after every meal. Moreover, clean your mouth and dentures regularly before using them in the morning. Also, brush dentures in warm, soapy water and soak it overnight in an antiseptic solution such as bleach or chlorhexidine.
  • Avoid activities that may promote yeast infection in the mouth such as, smoking or wearing the dentures during the night,
  • It is best to remove dentures for as long as possible, especially during the night.
  • Routine dental check-ups will ensure proper denture fitting and occlusal balance that will also avoid trauma. (6)
  • Tissue conditioning agents are usually avoided as they increase the risk of infection.
  • Dentures must be professionally polished and glazed as any roughness may increase denture contamination by oral micro-organisms.

Take away message

Denture stomatitis is a common oral condition that usually occurs in patients who are denture wearers. Some of the contributing factors for denture stomatitis include poor oral and denture hygiene, prolonged denture wear, old and ill-fitting dentures. Patients with diabetes and immunosuppression are also prone to experiencing denture stomatitis.

This dental condition is typically classified into three types depending on the severity and clinical presentation. Most cases are seen with redness and swelling of the involved oral tissue. Treatment of denture stomatitis typically involves a symptomatic approach using antifungal medications. Oral hygiene and denture care are crucial to allow proper healing of this dental condition.

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