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. Inflammatory 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. [25]
Another option for denture sanitization may be microwave disinfection. It was shown to be as effective as 0.2% chlorhexidine, 0.02% sodium hypochlorite, and topical nystatin in treating Candida-associated denture stomatitis. [26]
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 present before the development of type 2 diabetes mellitus is related to denture stomatitis. [27]
Other conditions that may need to be excluded include cellular immunodeficiency and humoral immunologic disorders, HIV infection, hypothyroidism, poor diet, and iatrogenic drug use. [28]
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. [29]
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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.
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When untreated and chronic, papillary epithelial hyperplasia may develop. This may need to be surgically removed before the denture is replaced or relined.
