eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Denture Stomatitis

Author: James J Sciubba, DMD, PhD, Retired Professor and Director of Dental and Oral Medicine, Johns Hopkins University School of Medicine; Consulting Staff, Milton J Dance Head and Neck Center; Private Practice, Oral and Maxillofacial Pathology, Oral Medicine, Baltimore, MD
Contributor Information and Disclosures

Updated: Feb 18, 2009

Introduction

Background

Denture stomatitis is a common oral mucosal lesion in the United States and Western Europe. Prevalence rates of 2.5-18.3% in adults aged 35-44 years or 65-74 years are reported, with a predominance in the latter age group.1,2 Although patient age and denture quality alone do not predispose individuals this mucosal condition, the odds of developing stomatitis, denture-related hyperplasia, and angular cheilitis are increased almost 3-fold in denture wearers.3 Studies indicate that correlations may exist with the amount of tissue coverage by a maxillary denture, vitamin A levels, smoking of cigarettes, and not removing dentures.4

Pathophysiology

Mucosal factors have been implicated in the etiology of this condition, as have behavioral and manner-of-use factors in patients who wear complete dentures. In these patients, the nighttime wear of the prosthetic appliance is the most significant factor.5

Although the dominant etiologic factor now appears to be fungal infection, other factors must be considered; these include the prosthetic device itself and also local and systemic factors in patients who are aging and edentulous. The extent of inflammation has been correlated with the presence of yeast colonizing the denture surface.6 Trauma has been shown to have a role in the production of basement membrane alterations involving expression of type IV collagen and laminin (alpha 1), thus indicating a possible relationship between these elements and denture stomatitis.7 Regarding the prosthesis-related factor, an allergy in the form of contact mucositis is suggested. This reaction may be related to the presence of resin monomers, hydroquinone peroxide, dimethyl-p -toluidine, or methacrylate in the denture. Furthermore, contact sensitivities such as this one are more common with cold or autocured resins than with heat-cured denture-base materials.

Candida species have been identified in most patients8,9 or in all patients,10 with Candida albicans being the predominant species isolated in addition to many other candidal species.11 Whether the organism is merely commensal in this situation remains an issue because of the frequency of such organisms in the general population; the role of this organism as the sole etiologic factor in denture stomatitis is unclear; however, the presence of candidal organisms within the overall biofilm lends credence to its role in the development and maintenance of denture stomatitis.12 The etiology is best considered multifactorial, with the prosthesis considered the prime etiologic factor. The character of biofilm communities of denture wearers, however, has been shown to be distinctive when compared with healthy non – denture-wearing individuals.13

Related eMedicine articles include Noncandidal Fungal Infections of the Mouth and Candidiasis, Mucosal.

Frequency

United States

The exact prevalence of denture stomatitis is unknown, but it appears to be 2.5-18.3% among adults. The disease is common in elderly persons, especially those living in nursing home facilities. Findings from several studies suggest that denture stomatitis develops in as many as 35-50% of persons who wear complete dentures.14,15

International

Denture stomatitis is a common oral mucosal lesion in Western Europe, Thailand, and Turkey.16,17

Race

No racial predilection is recognized.

Sex

Sex-related frequencies differ among studies; therefore, no clear sex predilection is apparent.

Age

The disease is more common in elderly persons than in young persons because elderly persons are more likely to wear dentures and because their level of oral and denture hygiene is reduced. In addition, age-related chronic disease (eg, type 2 diabetes mellitus), iatrogenic drugs, and age-associated immunocompromise contribute to this risk level.

Clinical

History

  • Denture stomatitis usually occurs in a patient who wears a complete maxillary denture or a partial denture. The presence of deteriorating temporary soft denture lining material and an improperly matched cleanser (which generally is the case) is associated with an increased presence of candidal organisms within the biofilm.18
  • In almost all patients, the duration of the lesion is usually unknown because of its asymptomatic nature.
  • On rare occasions, patients may complain of slight bleeding and swelling in the involved area, as well as a burning sensation, a xerostomialike quality, or cacogeusia.19

Physical

  • Although symptoms are uncommon, the clinical presentation of erythema and edema in the part of the palatal mucosa covered by the denture base is a diagnostic finding. Intense erythema is the most common finding.
  • At times, an obvious fungal infection in the form of white surface colonies or plaques may be observed on the mucosal surface.
  • Variably intense erythema, which may also be associated with scattered petechiae, is distributed over the mucosa covered by the base of the denture but not beyond.
  • Palpation of the involved mucosa reveals no tenderness or tissue friability.
  • The severity of denture stomatitis can vary (see Staging).

Causes

See Pathophysiology.

More on Denture Stomatitis

Overview: Denture Stomatitis
Differential Diagnoses & Workup: Denture Stomatitis
Treatment & Medication: Denture Stomatitis
Follow-up: Denture Stomatitis
Multimedia: Denture Stomatitis
References
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References

  1. Reichart PA. Oral mucosal lesions in a representative cross-sectional study of aging Germans. Community Dent Oral Epidemiol. Oct 2000;28(5):390-8. [Medline].

  2. Shulman JD, Beach MM, Rivera-Hidalgo F. The prevalence of oral mucosal lesions in U.S. adults: data from the third national health and nutrition examination survey, 1988-1994. J Amer Dent Assoc. 2004;135:1279-1286. [Medline].

  3. MacEntee MI, Glick N, Stolar E. Age, gender, dentures and oral mucosal disorders. Oral Dis. Mar 1998;4(1):32-6. [Medline].

  4. Shulman JD, Rivera-Hidalgo F, Beach MM. Risk factors associated with denture stomatitis in the United States. J Oral Pathol Med. 2005;34:340-346. [Medline].

  5. Fenlon MR, Sherriff M, Walter JD. Factors associated with the presence of denture related stomatitis in complete denture wearers: a preliminary investigation. Eur J Prosthodont Restor Dent. Dec 1998;6(4):145-7. [Medline].

  6. Barbeau J, Seguin J, Goulet JP, et al. Reassessing the presence of Candida albicans in denture-related stomatitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Jan 2003;95(1):51-9. [Medline].

  7. Le Bars P, Piloquet P, Daniel A, Giumelli B. Immunohistochemical localization of type IV collagen and laminin (alpha1) in denture stomatitis. J Oral Pathol Med. Feb 2001;30(2):98-103. [Medline].

  8. Schou L, Wight C, Cumming C. Oral hygiene habits, denture plaque, presence of yeasts and stomatitis in institutionalised elderly in Lothian, Scotland. Community Dent Oral Epidemiol. Apr 1987;15(2):85-9. [Medline].

  9. Budtz-Jorgensen E, Stenderup A, Grabowski M. An epidemiologic study of yeasts in elderly denture wearers. Community Dent Oral Epidemiol. May 1975;3(3):115-9. [Medline].

  10. Cardash HS, Helft M, Shani A, Marshak B. Prevalence of Candida albicans in denture wearers in an Israeli geriatric hospital. Gerodontology. Winter 1989;8(4):101-7. [Medline].

  11. Marcos-Arias C, Vicente JL, Sahand IH, et al. Isolation of Candida dubliniensis in denture stomatitis. Arch Oral Biol. Feb 2009;54(2):127-31. [Medline].

  12. Ramage G, Tomsett K, Wickes BL, Lopez-Ribot JL, Redding SW. Denture stomatitis: a role for Candida biofilms. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Jul 2004;98(1):53-9. [Medline].

  13. Campos MS, Marchini L, Bernardes LA, Paulino LC, Nobrega FG. Biofilm microbial communities of denture stomatitis. Oral Microbiol Immunol. Oct 2008;23(5):419-24. [Medline].

  14. Cumming CG, Wight C, Blackwell CL, Wray D. Denture stomatitis in the elderly. Oral Microbiol Immunol. Apr 1990;5(2):82-5. [Medline].

  15. Frenkel H, Harvey I, Newcombe RG. Oral health care among nursing home residents in Avon. Gerodontology. Jul 2000;17(1):33-8. [Medline].

  16. Jainkittivong A, Aneksuk V, Langlais RP. Oral mucosal conditions in elderly dental patients. Oral Dis. Jul 2002;8(4):218-23. [Medline].

  17. Kulak-Ozkan Y, Kazazoglu E, Arikan A. Oral hygiene habits, denture cleanliness, presence of yeasts and stomatitis in elderly people. J Oral Rehabil. Mar 2002;29(3):300-4. [Medline].

  18. Nikawa H, Jin C, Makihira S, Egusa H, Hamada T, Kumagai H. Biofilm formation of Candida albicans on the surfaces of deteriorated soft denture lining materials caused by denture cleansers in vitro. J Oral Rehabil. Mar 2003;30(3):243-50. [Medline].

  19. Dorocka-Bobkowska B, Budtz-Jorgensen E, Wloch S. Non-insulin-dependent diabetes mellitus as a risk factor for denture stomatitis. J Oral Pathol Med. Sep 1996;25(8):411-5. [Medline].

  20. Arendorf TM, Walker DM. Oral candidal populations in health and disease. Br Dent J. Nov 20 1979;147(10):267-72. [Medline].

  21. Newton AV. Denture sore mouth as possible etiology. Brit Dental J. 1962;112:357-60.

  22. Vitkov L, Weitgasser R, Lugstein A, Noack MJ, Fuchs K, Krautgartner WD. Glycaemic disorders in denture stomatitis. J Oral Pathol Med. Oct 1999;28(9):406-9. [Medline].

  23. Wilson J. The aetiology, diagnosis and management of denture stomatitis. Br Dent J. Oct 24 1998;185(8):380-4. [Medline].

  24. Matear DW. Demonstrating the need for oral health education in geriatric institutions. Probe. Mar-Apr 1999;33(2):66-71. [Medline].

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Further Reading

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Keywords

denture stomatitis, denture sore mouth, oral mucosal lesions, dentures, oral candidal infection, denture-related lesions, denture-related hyperplasia, angular cheilitis, contact mucositis, dentures, Candida

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Contributor Information and Disclosures

Author

James J Sciubba, DMD, PhD, Retired Professor and Director of Dental and Oral Medicine, Johns Hopkins University School of Medicine; Consulting Staff, Milton J Dance Head and Neck Center; Private Practice, Oral and Maxillofacial Pathology, Oral Medicine, Baltimore, MD
James J Sciubba, DMD, PhD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Dental Association, and International Association for Dental Research
Disclosure: Nothing to disclose.

Medical Editor

Peter Fritsch, MD, Chair, Department of Dermatology and Venereology, University of Innsbruck, Austria
Peter Fritsch, MD is a member of the following medical societies: American Dermatological Association, International Society of Pediatric Dermatology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Drore Eisen, MD, DDS, Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati
Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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