Denture Stomatitis – Types, Classification, Pictures, Differential Diagnosis, Causes, Definition

Denture stomatitis, also known as denture-induced stomatitis or denture-related stomatitis, is a common oral mucosal lesion that primarily affects denture wearers, characterized by inflammation of the palatal mucosa underneath the denture base. Often presenting as a sore mouth or redness of the mucosal surface, this condition is typically associated with poor oral hygiene measures, ill-fitting dentures, and the accumulation of microorganisms, particularly fungi-related (Candida species infection), on the denture-fitting surface.

Key Facts

• Denture stomatitis (also known as denture sore mouth) is a common condition characterized by inflammation of the oral mucosa beneath a denture
• It affects a significant number of denture wearers and can be caused by fungal infection, poor denture hygiene, or constant denture wear
• Symptoms include redness, swelling, and soreness under the denture are common symptoms
• Treatment include improved denture hygiene, antifungal medications, and periodic denture removal can help in treating this condition
• Prevention is regular cleaning of dentures and giving the mouth a break from wearing them can help in preventing denture stomatitis

What is Denture Stomatitis?

Denture stomatitis is an oral condition that affects the mucosal surfaces in contact with dentures. Denture stomatitis is characterized by mild inflammation and redness of the oral mucosa under a denture, primarily the upper denture. It is a common inflammatory reaction affecting both complete denture wearers and those with partial dentures. Although the inflammation is often mild and might not cause any discomfort, it is important to address this condition to avoid complications.

Who Does Denture Stomatitis Affect?

Denture stomatitis can affect anyone who wears dentures, but there are groups more prone to developing the condition:

• Elderly: Older adults are more likely to wear dentures and might not practice optimum denture hygiene.
• Immunocompromised Individuals: People with weakened immune systems are at higher risk.
• Night-time Denture Wearers: Those who wear their dentures continuously, including overnight.
• Dry Mouth Sufferers: People with a reduced saliva flow (xerostomia) have less natural antifungal properties in the mouth.
• Diabetic Patients: Diabetic individuals are more susceptible to infections including fungal infections in the mouth.

What Does Denture Stomatitis Look Like?

Denture stomatitis typically presents as areas of redness and mild swelling underneath the denture.
These are the common features:

• Redness: The affected mucosa beneath the denture appears redder than the surrounding tissue.
• Patchy Areas: It may present as diffuse redness or localized red patches.
• Swelling: Mild swelling or edema of the oral mucosa.
• Soreness or Burning: In some cases, there might be soreness, burning or discomfort, particularly when eating spicy or acidic foods.
• Fungal Infection: In many cases, there might be the presence of a fungal infection by Candida species, which can cause the formation of small red bumps or white patches.

How Common is Denture Stomatitis?

Denture stomatitis is a relatively common condition among denture wearers. Studies have shown that the prevalence of denture stomatitis ranges from 15% to over 70% among those who wear dentures. The variation in prevalence can be attributed to factors such as differences in oral hygiene practices, wearing habits of the dentures (such as wearing them during sleep), and the general health of the individual. It is more common in people who wear upper dentures and in those who have worn dentures for a long time.

What are the Symptoms of Denture Stomatitis?

The symptoms of denture stomatitis can range from mild to more noticeable and bothersome.
Common symptoms include:

• Redness and Inflammation: This is typically localized to the area under the denture.
• Soreness and Discomfort: The affected area may be tender or sore, particularly during eating or cleaning.
• Burning Sensation: Some people experience a burning sensation in the area affected.
• Foul Taste or Odor: There may be an unpleasant taste or odor due to the overgrowth of microorganisms.
• White Patches or Plaques: Sometimes, especially if a fungal infection is involved, white patches or plaques may be present.
• Cracking at the Corners of the Mouth: This can occur in association with denture stomatitis and is known as angular cheilitis.

What Causes Denture-Related Stomatitis?

Denture stomatitis can be caused by a variety of factors:

• Candida Fungal Infection: One of the most common causes is an overgrowth of yeast, particularly Candida. The denture provides a surface on which the fungus can adhere and grow.
  1. Candida Albicans: The most prevalent cause of denture stomatitis is a yeast infection by Candida albicans.
  2. Candida spp: Other Candida species can also contribute to the condition.
• Poor Denture Hygiene: Inadequate cleaning of denture surfaces can lead to the microbial accumulation and accumulation of food particles.
• Constant Wear of Dentures: Wearing dentures continuously, especially overnight, can predispose to denture stomatitis.
• Ill-Fitting Dentures: Poorly fitting dentures, particularly complete dentures, can cause mechanical trauma to the oral mucosa.
• Denture Age and Material: Older and acrylic dentures, especially those with rough denture surfaces, are more likely to harbor microorganisms.
• Reduced Saliva Production: Saliva has natural antimicrobial properties, and reduced saliva flow can predispose to infection.
• Dry Mouth: Decreased saliva production, commonly seen in elderly patients or cancer patients undergoing treatment.
• Systemic Diseases: Conditions such as diabetes, nutritional deficiencies, or a weakened immune system can predispose individuals to oral candidiasis and denture stomatitis.

Is Denture Stomatitis Contagious?

Denture stomatitis itself is not contagious, as it is an inflammatory reaction of the tissue under the denture. However, if denture stomatitis is associated with a fungal infection such as oral thrush (Candida), it is possible for the fungus to be spread through oral contact. It is important for individuals with denture stomatitis, particularly if it is associated with a fungal infection, to maintain good oral hygiene and to avoid sharing eating utensils or having oral contact with others until the condition is resolved.

How is Denture Stomatitis Diagnosed?

The diagnosis of denture stomatitis is typically based on a combination of patient history, clinical examination, and occasionally, laboratory tests. During a clinical examination, a dentist or oral health specialist will check for the common signs of denture stomatitis, which include inflammation and redness under the denture.
If there is suspicion of a fungal infection, such as candidiasis, a sample may be taken from the affected area and sent to a laboratory for a microscopic examination and culture. This can confirm the presence of a fungal infection and may help to identify the specific type of fungus, which can be useful in guiding treatment.

How do you Treat Denture Stomatitis?

The treatment of denture stomatitis involves both addressing the local factors and managing any underlying systemic conditions. For most patients, the management includes:

• Improving Oral and Denture Hygiene: This is an essential part of treatment. Implementing stringent oral hygiene measures for both the dentures and the oral cavity. This involves regular cleaning of the dentures using agents like sodium hypochlorite and ensuring their proper storage when not in use, removing them at night to allow the oral tissues to rest, and maintaining good oral hygiene to keep the mouth clean.
• Antifungal Treatment:The use of antifungal agents, such as topical nystatin, to eliminate fungal infections. If a fungal infection is present, topical antifungal medications may be prescribed. In severe cases, or if topical treatment is not effective, systemic antifungal medication may be necessary.
• Denture Adjustment or Replacement: Adjusting or replacing ill-fitting dentures to reduce irritation to the palatal mucosa. If the dentures are ill-fitting and causing friction or irritation, they may need to be adjusted or replaced.
• Use of Antimicrobial Mouthwash: To reduce the microbial load in the oral cavity. In some cases, an oral rinse with an anti-fungal or anti-inflammatory property may be prescribed to reduce the symptoms and treat the condition.
• Managing Systemic Factors: Treating any systemic health issues that might contribute to the condition, such as controlling blood sugar levels in diabetic patients.
• Denture Care: Regularly disinfecting the denture using methods like microwave disinfection can help eliminate pathogens from the denture surface.

How can I manage Denture Stomatitis Symptoms at Home?

There are several steps you can take at home to help manage the symptoms of denture stomatitis and prevent recurrences:

• Proper Denture Care: Clean your dentures daily and remove them at night to give your gums a rest.
• Good Oral Hygiene: Brush and floss your natural teeth regularly, and clean your tongue and gums gently with a soft toothbrush.
• Rinse with a Mild Saltwater Solution: Rinsing your mouth with a solution of warm water and a half-teaspoon of salt can help soothe inflamed oral tissues.

How soon after treatment will I feel better?

The duration of treatment and time to symptom resolution can vary depending on the severity of the stomatitis and the underlying cause. Generally, with proper treatment and improved denture hygiene, symptoms should begin to improve within a week. However, it’s important to continue the treatment as prescribed by your healthcare provider, even if symptoms have resolved, to ensure complete treatment of the condition. If symptoms persist despite treatment, or if they worsen, it is important to seek further medical attention.

How can I reduce my risk for Denture Stomatitis?

To reduce your risk of developing denture stomatitis, it is important to follow proper oral hygiene practices and care for your dentures.
Here are some steps you can take:

• Regular Denture Cleaning: Make sure to clean your dentures daily to remove food particles and plaque. Avoid using abrasive cleaners that can scratch the dentures.
• Remove Dentures at Night: Allowing your gums to rest and be exposed to the natural antimicrobial agents in your saliva can reduce the risk of infection.
• Maintain Oral Hygiene: Keep your mouth clean by brushing your gums, tongue, and palate daily with a soft-bristled toothbrush.
• Regular Dental Check-ups: See your dentist regularly for check-ups and to ensure your dentures are in good condition and fit well.
• Avoid Tobacco and Limit Sugar Intake: Smoking can contribute to oral infections, and consuming sugary foods can encourage the growth of yeast.

When should I see my Healthcare Provider?

You should see a healthcare provider if you notice any signs or symptoms of denture stomatitis, such as redness, swelling, or discomfort under your denture, or if you experience difficulty in wearing your dentures. Also, if you have been treating denture stomatitis but the symptoms are not improving or are worsening, it is important to seek professional advice.

Are there Alternatives to Traditional Dentures?

Yes, there are alternatives to traditional dentures for those who are looking for different options:

• Dental Implants: Dental implants are artificial tooth roots that are placed into your jawbone to support replacement teeth. They can be used to support a single tooth, several teeth, or a full arch of teeth.
• Implant-Supported Dentures: These are a type of over-denture that is supported by and attached to implants in the jaw. They are more stable than regular dentures.
• Partial Dentures or Bridges: For those missing only a few teeth, a partial denture or a fixed bridge can be an option.

Bottom Line

Denture stomatitis is a common condition that can cause discomfort and affect the health of your mouth. However, with proper care of your dentures and oral hygiene practices, it is often preventable. If you have dentures, it’s important to be aware of the signs and symptoms of denture stomatitis and to see your healthcare provider if you experience any issues. There are also alternatives to traditional dentures that can provide a more comfortable and stable solution for missing teeth.

This article is complete and was published on July 13, 2023, and last updated on December 29, 2023.