Managing Denture Stomatitis: Diagnosis, Treatment, and Prevention

K Bhagwandin

DENTURE STOMATITIS

INTRODUCTION
Chronic atrophic candidiasis (denture stomatitis) affects edentulous individuals who wear partial or complete dentures. It can also involve intraoral orthodontic appliances. It primarily affects the palate and is commonly observed in patients with acrylic dentures, particularly in older individuals.

PATHOGENESIS
Denture stomatitis is caused by Candida albicans infection and is associated with mucosal trauma induced by ill-fitting dentures, poor oral hygiene, wearing dentures at night, and xerostomia.

LOCAL RISK FACTORS

• Xerostomia
  
• Age of the denture
  
• Local trauma from ill-fitting or poorly fabricated dentures
  
• Poor oral hygiene
  
• Nocturnal denture wearing
  
• Smoking
  
• Carbohydrate-rich diet
  
• Acidic salivary pH
  
• Sensitivity to denture material
  

SYSTEMIC RISK FACTORS

• Age
  
• Poorly controlled diabetes
  
• Xerostomia
  
• Radiation therapy
  
• Nutritional deficiencies
  
• Immunocompromised states
  
• Prolonged use of antibiotics and corticosteroids
  
• Hematological disorders
  

CLASSIFICATION

• Type I: Localized mucosal inflammation induced by trauma
  
• Type II: Diffuse involvement of denture-bearing mucosa
  
• Type III: Inflammatory papillary hyperplasia; denture-bearing mucosa shows a granular appearance
  

COMMON SITES

• Palate
  
• Tonsillar areas
  
• Maxillary ridge
  
• Posterior tongue
  

---

SYSTEMIC APPROACH TO DIAGNOSING AND TREATING DENTURE STOMATITIS

A. Identify Risk Factors

• Nocturnal denture wear
  
• Poor oral/denture hygiene
  
• Xerostomia
  
• High carbohydrate diet
  
• Smoking
  
• Alcohol use
  
• Recent use of broad-spectrum antibiotics
  
• Immunosuppression
  
• Poorly controlled diabetes
  
• Use of corticosteroids or other immunosuppressants
  

B. Recognize Signs & Symptoms

• Mucosal erythema under the denture, mostly on the palate
  
• Involvement of the tongue and buccal mucosa
  
• Cracks and inflammation at the corners of the mouth
  
• Associated irritation, discomfort, or pain
  

C. Initial Management

1. Manage Local Risk Factors
   
   • Provide denture and oral hygiene instructions
     
   • Avoid wearing dentures at night
     
   • Improve denture fitting with relining, tissue conditioners, or remaking the denture
     
2. Manage Systemic Factors
   
   • Liaise with a general medical practitioner
     
   • Provide smoking cessation advice
     
   • Offer dietary advice
     
   • Recommend salivary substitutes
     

D. Definitive Management

• Prescribe topical or systemic antifungals
  
• Monitor lesions for resolution and consider referral if:
  
  • Lesions do not resolve
    
  • Diagnosis is unclear
    
  • Premalignant or malignant changes are suspected
    

---

ORAL HYGIENE/DENTURE ADVICE

• Brush the palate for 2 minutes, three times a day, using a soft brush and water.
  
• During the day, brush dentures for 2 minutes, three times a day, using a soft brush and non-abrasive liquid soap.
  
• At night, soak dentures in a denture solution for 10–20 minutes, then leave them in water overnight.
  

---

ANTIFUNGAL THERAPY

Topical antifungal medications like nystatin (available as a dry powder, lozenges, or suspension) are usually effective against Candida albicans.

---

REFERENCES

Abuhajar, E., Ali, K., Zulfiqar, G., et al. (2023). Management of chronic atrophic candidiasis (denture stomatitis): A narrative review. International Journal of Environmental Research and Public Health, 20(4), 3029. https://doi.org/10.3390/ijerph20043029