eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Denture Stomatitis: Treatment & Medication

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

Treatment

Medical Care

Mechanical plaque control and appropriate denture-wearing habits are the most important measures in preventing and treating the disease. Also, denture sanitization is an important element in the treatment of denture stomatitis.

Despite the absence of symptoms, patients with advanced, chronic, or previously untreated cases must be treated because of the risk of papillary epithelial hyperplasia. IPEH usually needs to be surgically removed before the denture is emplaced or relined. In mild cases of IPEH, antifungal treatment without surgery might be an alternative before the dentures are relined or replaced.

  • In the absence of papillary hyperplasia, verify denture-base adaptation to the alveolar and palatal mucosal surfaces and identify and correct occlusal disharmonies, vertical dimension, and centric position.
    • Scrupulous denture hygiene is mandatory, with daily thorough brushing. The dentures should be soaked overnight in an antiseptic solution such as chlorhexidine or dilute sodium hypochlorite (10 drops of household bleach in a denture cup or container filled with tap water). If the denture base contains metal, the patient should avoid using hypochlorite because it causes metal to tarnish.
    • Another benefit of the regimen of overnight denture soaking is that the patients must remove their dentures for a prolonged period. Removal of the denture minimizes additional irritation and is a cornerstone of treatment.
  • Initiate antifungal therapy if fungal organisms are identified or if the condition fails to resolve even with the regimen described above.
    • Topical therapy is the first-line treatment.
    • The use of clotrimazole or nystatin lozenges and/or pastilles, with the denture removed from the mouth, is recommended.
    • The application of antifungal agents (eg, nystatin powder or cream) on the tissue-contacting surface of the denture is also recommended.
    • Combine topical medical treatment with proper care of the denture, as described above.
  • In cases that fail to respond to the usual treatments, consider the role of systemic disease and its impact on oral function and homeostasis.
    • Chief among the systemic conditions that may affect denture stomatitis is type 2 diabetes mellitus. In patients with type 2 diabetes mellitus, the number of candidal organisms that adhere to the palatal epithelial cells is significantly increased; this finding supports the notion that this form of diabetes predisposes patients to Candida -associated denture stomatitis. However, a recent study group suggested that reduced resistance to candidal organisms preset before the development of type 2 diabetes mellitus is related to denture stomatitis.22
    • Other conditions that may need to be excluded include cellular immunodeficiency and humoral immunologic disorders, HIV infection, hypothyroidism, poor diet, and iatrogenic drug use.23

Surgical Care

IPEH should usually be surgically removed before the denture is relined.

Medication

The goals of pharmacotherapy are to eradicate the infection, reduce morbidity, and prevent complications.

Antifungal agents

Mechanism of action usually involves inhibiting pathways (enzymes, substrates, transport) necessary for sterol/cell membrane synthesis or altering the permeability of the cell membrane (polyenes) of the fungal cell. It may also involve an alteration of RNA and DNA metabolism or an intracellular accumulation of peroxide that is toxic to the fungal cell.


Clotrimazole (Mycelex Troches)

Broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing fungal cells to die.

Adult

Remove denture from mouth; dissolve 10-mg troche orally 5 times/d

Pediatric

<3 years: Not established
>3 years: Administer as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Not for treatment of systemic fungal infections; avoid contact with eyes; if irritation or sensitivity develops, discontinue and initiate appropriate therapy


Nystatin (Mycostatin Pastilles, Nystatin)

Fungicidal and fungistatic antibiotic obtained from Streptomyces noursei; effective against various yeasts and yeastlike fungi. Changes permeability of fungal cell membrane after binding to cell membrane sterols, causing cellular contents to leak. Treatment should continue until 48 h after symptoms disappear. Reevaluate after 14 days of treatment if no improvement. Drug is not significantly absorbed from GI tract.

Adult

Remove denture from mouth
Pastilles: Slowly dissolve 200,000-400,000 U (1-2 pastilles) 4-5 times/d
Oral susp: 400,000-600,000 U PO swish and swallow qid

Pediatric

Administer as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Patients should not chew or swallow pastilles whole; pastilles should be allowed to dissolve slowly in the mouth; if irritation or sensitivity develops, discontinue and initiate appropriate therapy

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

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  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].

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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].

  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].

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  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].

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  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].

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  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].

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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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