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Denture Stomatitis

Disease Details

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Description: Denture stomatitis is an inflammation of the oral mucosa beneath a dental prosthesis, often caused by Candida infection.
Type: Denture stomatitis is not a genetic condition. It is an inflammatory condition of the oral mucosa, primarily caused by wearing dentures, especially when they are not properly cleaned or taken care of. The condition is usually associated with a fungal infection, most commonly by Candida species.
Signs And Symptoms: Despite the alternative name for this condition, "denture sore mouth", it is usually painless and asymptomatic. The appearance of the involved mucosa is erythematous (red) and edematous (swollen), sometimes
with petechial hemorrhage (pin-points of bleeding). This usually occurs beneath an upper denture. Sometimes angular cheilitis can coexist, which is inflammation of the corners of the mouth, also often associated with Candida albicans. Stomatitis rarely develops under a lower denture. The affected mucosa is often sharply defined, in the shape of the covering denture.
Prognosis: Denture-related stomatitis is usually a harmless condition with no long term consequences. It usually resolves with simple measures such as improved denture hygiene or topical antifungal medication. In severely immunocompromised individuals (e.g. those with HIV), the infection may present a more serious threat.
Onset: Denture stomatitis is a condition often characterized by inflammation and redness of the oral mucous membrane beneath a denture. The onset of denture stomatitis can vary, but it commonly develops gradually over time due to factors such as poor oral hygiene, ill-fitting dentures, and constant wearing of dentures. Symptoms may not always be immediately noticeable but can include discomfort, erythema, and swelling under the denture area. It is important to maintain good oral hygiene and ensure proper fitting of dentures to prevent this condition.
Prevalence: The prevalence of denture stomatitis varies widely, but studies estimate it affects about 15-70% of denture wearers. This condition is more common among the elderly due to higher rates of denture use in this population.
Epidemiology: Denture-related stomatitis is common and occurs worldwide. Usually the people affected are middle aged or elderly, with females being affected slightly more commonly than males. Prevalences of up to 70% have been reported in elderly care home residents. It is by far the most common type of oral candidiasis.
Intractability: Denture stomatitis is generally not considered intractable. It can typically be managed and treated effectively with proper oral hygiene, adjustments to the dentures, and antifungal medications if there is a fungal infection involved. Regular dental check-ups and proper care of dentures are essential for prevention and management.
Disease Severity: Denture stomatitis is generally considered a mild condition. It causes inflammation of the oral mucosa underneath a denture. While it can be uncomfortable, it is usually not severe and can be managed with proper oral hygiene, antifungal treatments if necessary, and adjustments to the denture fit.
Healthcare Professionals: Disease Ontology ID - DOID:11875
Pathophysiology: Pathophysiology: Denture stomatitis, also known as denture-related stomatitis, is an inflammatory condition of the oral mucosa that underlies a denture. It is primarily associated with the overgrowth of yeast, particularly Candida species, but can also involve bacterial colonization and mechanical irritation. The pathogenesis involves several factors:

1. **Microbial Factors**: Candida albicans, the most common fungal species involved, adheres to the acrylic surface of dentures, forming biofilms that lead to infection and inflammation.
2. **Mechanical Factors**: Poorly fitting dentures can cause continuous trauma and irritation to the mucosal surface, exacerbating inflammation.
3. **Host Factors**: Impaired immune responses, reduced saliva production (xerostomia), and other systemic conditions like diabetes can increase susceptibility.
4. **Hygiene Factors**: Inadequate denture hygiene practices can promote microbial colonization and persistence, worsening the condition.

The condition often manifests as erythema, swelling, and discomfort of the mucosal tissue in contact with the denture, particularly the palate. It's important to address both the microbial load and mechanical causes to manage and prevent denture stomatitis effectively.
Carrier Status: Denture stomatitis is not typically associated with a carrier status. It is an inflammatory condition of the mouth caused by factors such as poor oral hygiene, ill-fitting dentures, or fungal infections like Candida.
Mechanism: Denture stomatitis is an inflammatory condition of the oral mucosa that occurs beneath a denture. The primary mechanisms involve mechanical irritation from the denture, poor oral hygiene, and microbial factors, particularly Candida species.

**Molecular Mechanisms:**
1. **Candida Overgrowth**: An overgrowth of Candida, particularly Candida albicans, releases enzymes and toxins that damage mucosal cells. Candida adheres to the mucosal surfaces and denture base using adhesins, promoting colonization.
2. **Immune Response**: The presence of Candida and other microbes triggers an immune response. Cytokines such as IL-1, IL-6, and TNF-α are upregulated, leading to inflammation.
3. **Biofilm Formation**: Microbial communities form biofilms on the denture surface. These biofilms protect the microbes from mechanical cleaning and immune defenses.
4. **Proteinases and Phospholipases**: Candida produces proteinases and phospholipases that degrade mucosal barriers and facilitate tissue invasion.
5. **Nitric Oxide Production**: Inflammatory responses can lead to increased levels of nitric oxide, contributing to tissue damage and inflammation.

Maintaining good oral hygiene and ensuring proper fit and regular cleaning of dentures are crucial in preventing and managing denture stomatitis.
Treatment: The most important aspect of treatment is improving denture hygiene, i.e. removing the denture at night, cleaning and disinfecting it, and storing it overnight in an antiseptic solution. This is important as the denture is usually infected with C. albicans which will cause re-infection if it is not removed. Substances which are used include solutions of alkaline peroxides, alkaline hypochlorites (e.g. hypochlorite, which may over time corrode metal components of dental appliances), acids (e.g. benzoic acid), yeast lytic enzymes and proteolytic enzymes (e.g. alcalase protease). The other aspect of treatment involves resolution of the mucosal infection, for which topical antifungal medications are used (e.g. nystatin amphotericin, miconazole, fluconazole or itraconazole). Often an antimicrobial mouthwash such as chlorhexidine is concurrently prescribed. Possible underlying disease (diabetes, HIV) should be treated where possible.
Compassionate Use Treatment: Compassionate use treatment for denture stomatitis often involves using antifungal medications that are typically reserved for other conditions. These might include topical antifungals like nystatin or clotrimazole.

Off-label or experimental treatments could include the use of systemic antifungals such as fluconazole or itraconazole, though these are not always specifically approved for denture stomatitis. Additionally, some research suggests that probiotics or antifungal mouth rinses may help to manage symptoms, but more studies are needed to confirm their effectiveness.
Lifestyle Recommendations: For denture stomatitis, lifestyle recommendations include:

1. **Maintain Oral Hygiene**: Clean your dentures daily with a brush and mild soap. Avoid using toothpaste, which can be abrasive. Soak dentures overnight in a disinfecting solution.

2. **Regular Dental Visits**: Schedule regular check-ups with your dentist to ensure proper fit and to monitor oral health.

3. **Remove Dentures Overnight**: Allow your gums to rest by removing your dentures while you sleep.

4. **Healthy Diet**: Consume a balanced diet rich in vitamins and minerals to support overall oral health.

5. **Avoid Smoking and Alcohol**: These can exacerbate irritation and inflammation.

6. **Stay Hydrated**: Drink plenty of water to maintain oral moisture and prevent dry mouth.

Implementing these lifestyle measures can help manage and reduce symptoms of denture stomatitis.
Medication: For denture stomatitis, treatment typically includes:

1. **Topical Antifungal Medications**: Such as nystatin or miconazole to control the Candida infection.
2. **Antiseptic Mouthwashes**: Chlorhexidine gluconate can be used to reduce microbial load.
3. **Proper Denture Hygiene**: Clean dentures daily and soak them in an antifungal solution.
4. **Dietary Adjustments**: Reduce sugar intake to limit yeast growth.
5. **Oral Rinses and Lozenges**: Sometimes antifungal lozenges or oral rinses are recommended.

Always follow your healthcare provider's advice for the best treatment approach.
Repurposable Drugs: For denture stomatitis, one of the repurposable drugs that may be considered is Fluconazole, an antifungal used to treat Candida infections, which are often associated with this condition. Another option could be Nystatin, another antifungal effective for oral candidiasis. These drugs help reduce fungal load and alleviate symptoms related to denture-induced stomatitis.
Metabolites: Denture stomatitis, also known as denture-related stomatitis, is primarily associated with Candida species, especially Candida albicans. It results in inflammation of the oral mucous membrane beneath a denture. Metabolites relevant to the condition include microbial metabolites produced by Candida, such as ethanol and other organic acids, that can contribute to mucosal irritation and inflammation.
Nutraceuticals: Nutraceuticals have shown potential in managing denture stomatitis through the use of natural compounds with antimicrobial and anti-inflammatory properties. Common nutraceuticals that might be beneficial include probiotics, which help maintain oral microbiota balance, and vitamin C and E, which support tissue repair and immune function. Additionally, the incorporation of cranberries, which have natural anti-adhesion properties, can help prevent the adhesion of Candida species, a common cause of denture stomatitis.

However, there is limited direct evidence specifically linking these nutraceuticals to the treatment of denture stomatitis, so their use should complement traditional treatments such as antifungal medications and proper oral hygiene practices rather than replace them.
Peptides: Denture stomatitis, also known as denture-related stomatitis, is an inflammation of the oral mucosa beneath a denture. Concerning peptides and nanoparticles (nan), these are areas of ongoing research for their potential therapeutic benefits.

**Peptides:** Antimicrobial peptides (AMPs) could be beneficial in managing denture stomatitis by reducing the microbial load, particularly Candida species, which are often implicated in this condition.

**Nanoparticles (nan):** Nanoparticles, such as silver nanoparticles or other antimicrobial nanomaterials, have shown promise in research for their ability to inhibit microbial growth and biofilm formation on denture surfaces, potentially reducing the incidence or severity of denture stomatitis.

Research in these areas is still evolving, and clinical usage would require further validation through extensive studies.