Author: Dr Delwyn Dyall-Smith FACD, Dermatologist, 2010.
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.
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:
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.
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).
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.
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:
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.
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