Denture Stomatitis 

  • Author: James J Sciubba, DMD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 17, 2012
 

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]

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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, 6]

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.[7] 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.[8] 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 patients[9, 10] or in all patients,[11] with Candida albicans being the predominant species isolated in addition to many other candidal species.[12] 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.[13] 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.[14]

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

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Epidemiology

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.[15, 16]

International

Denture stomatitis is a common oral mucosal lesion in Western Europe, Thailand, and Turkey.[17, 18]

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.

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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 Academy of Oral Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

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.

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.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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  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].

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  8. 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].

  9. 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].

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  11. 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].

  12. 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].

  13. 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].

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A variably intense erythema distributed over the part of the mucosa covered by the denture base is diagnostic of denture stomatitis.
When untreated and chronic, papillary epithelial hyperplasia may develop. This may need to be surgically removed before the denture is replaced or relined.
 
 
 
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