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Denture Stomatitis Treatment & Management

  • Author: James J Sciubba, DMD, PhD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Sep 02, 2015
 

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.[24]

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.[25]

Other conditions that may need to be excluded include cellular immunodeficiency and humoral immunologic disorders, HIV infection, hypothyroidism, poor diet, and iatrogenic drug use.[26]

A study evaluated the in vitro antifungal activity of apple cider vinegar on Candida spp. involved in denture stomatitis. The study concluded that apple cider vinegar showed antifungal properties against Candida spp., thus representing a possible therapeutic alternative for patients with denture stomatitis.[27]

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Surgical Care

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

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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 and Timonium, MD

James J Sciubba, DMD, PhD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Dental Association, International Academy of Oral Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, 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, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Acknowledgements

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.

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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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