May 17, 2021
Dentures are an important prosthesis that help in retaining the functioning of the oral cavity. It enhances better chewing, speech and vertical height of the face in patients who have lost their natural teeth.
Denture wearing also asks for proper maintenance. This includes regular cleaning of the denture and removing them at night. When the maintenance of the denture is not done properly, it leads to an inflammatory reaction in the arch that bears the denture. This is called stomatitis. Stoma means the mouth and -itis indicates inflammation. Since this condition is triggered by factors associated with denture, it is called denture stomatitis. It is also called denture sore, chronic atrophic candidiasis or denture-associated erythematous. This condition was first described in 1962.
Denture stomatitis leads to reddish appearance of the areas that bear the denture. There can also be pinpoint reddish areas in the affected region. The soreness is triggered due to infection caused by a species of microbes called Candida. These microorganisms thrive best in the acidic environment. When dentures are unclean, do not fit properly, then the area covered by the denture does not receive saliva. Saliva has a protective role, as its flushing mechanism keeps the mouth clean. When the saliva does not reach the area, then the region below the denture becomes more acidic. This allows Candida and other microbes to predominate, causing soreness.
The inflammation can at times spread to the corner of the mouth, leading to angular cheilitis (inflammation of the corner of the mouth near the lips). Denture stomatitis is more often seen in the region of upper denture compared to lower denture. This condition can also occur due to the components of the denture, that can be made of acrylic, cobalt or chromium. Moreover, denture stomatitis can be facilitated by underlying conditions like xerostomia (dry mouth), diabetes, HIV, etc.
Dentures lie in close proximity to the respiratory tract. The microbes under the dentures that lead to stomatitis are thus also close to the respiratory system. These range of microorganisms can cause infection in the lungs and the cardiovascular system. Research has showed that bacterial species in the oral cavities are associated with diabetes and rheumatoid arthritis which are systemic conditions that compromise the immune system.
Denture hygiene maintenance includes some important points. Firstly, it needs to be cleaned by denture cleaning solutions and by using a small brush. It should also be disinfected using disinfectants. These disinfectants can be hypochlorites, benzoic acids, enzyme-based agents. The dentist can also help in microwave disinfection of the denture. Secondly, it needs to be removed at night and should not be wore constantly for prolonged periods. This helps in preventing the build-up of plaque under the denture. Dentists can also advise a change in the dietary pattern of the patient. Next, if the denture is not fitting properly, the patient should immediately tell the dentist. An ill-fitting denture can lead to more soreness. This can be corrected by procedures like relining and rebasing the denture with the adequate dental material.
Apart from dental hygiene, denture stomatitis treatment also includes targeting the inflammation or soreness in the mouth. This includes application of anti-fungal medications that are available in gel and cream forms. These medications can have nystatin, amphotericin, muconazole, fluconazole or other anti-fungal agents as the main components. Along with these antifungal medications, a chlorhexidine mouthwash can also help in curbing down the inflammation.
In severe cases of denture stomatitis, the tissues of the palate or the mucosa can result in the formation of a painful mass. This needs to be removed and is traditionally done by excising the tissue. However, with the advent of lasers, this minor surgical procedure has become more quick and efficient.
In most cases, denture stomatitis is asymptomatic. It presents with no pain unless the soreness intensifies. It usually has a favorable prognosis upon diagnosing. Even though severe forms of denture stomatitis take longer time to heal considering the age of the patient and the immune response, the inflammation eventually resolves with significant elimination of the causative organisms. People living with old-aged denture-wearers, should regularly monitor their oral hygiene and dental hygiene habits which can help in preventing denture stomatitis.