Denture-related Stomatitis Research Articles

Molecular typing of Candida albicans strains isolated from denture wearers by repetitive sequence-based PCR

Long-term use of prosthesis is the most important risk factor for the colonization of Candida species on the mucosal surfaces, which can lead to the development of denture-related stomatitis (DRS). Some individuals wearing prosthesis develop DRS and others do not. C. albicans strains isolated from both groups were genotypically compared. The purpose of this study was to determine whether the strain causing prosthesis stomatitis was different from the other strains genotypically. The study included 90 individuals wearing different prostheses and 20 control individuals with natural teeth. In the study 109 C. albicans strains were used which were isolated from the saliva samples and the mucosal surfaces of the tongues and palates of 51 individuals and then defined phenotypically. Phenotypic diagnosis of the isolates was genotypically verified by using species-specific PCR. For molecular typing, repetitive extragenic palindromic sequence polymerase chain reaction (REP-PCR) was employed. The results of the study revealed that REP-PCR had the capability to separate 109 C. albicans strains and six reference strains into 44 genotypes. Whereas C. albicans strains showed heterogenic distribution, C. albicans strains isolated from the individuals suffering from prosthesis stomatitis showed no specific genotypes. REP-PCR is a simple, fast and low-cost method and helped work on a great number of samples.

Assessment ofCandidaspecies colonization and denture-related stomatitis in complete denture wearers

Candida species are considered the primary causative agents of denture stomatitis, but their role in colonization and disease in denture wearers remains undefined. In this study, we investigated risk factors associated with progression to Candida-related denture stomatitis in patients using complete dentures, and we genetically identified Candida isolates associated with disease and colonization. We recruited 114 retirement home residents for this study, from whom oral mucosa samples were collected and cultured following oral cavity exams. Morphologic analysis was used to identify potential yeast-positive cultures, which were then characterized further by RFLP analysis. C. albicans was the most frequently recovered species (61; 41.5%), followed by C. glabrata (27; 18.4%), and C. tropicalis (19; 12.9%). In addition, 16 isolates (10.9%) of C. dubliniensis were recovered, which was the first identification of this species in clinical samples from Iran. This study demonstrated a significant association between the duration of denture wear and oral candidiasis. Furthermore, we noted a high prevalence of C. dubliniensis in complete denture wearers.

Determining Candida spp. Incidence in Denture Wearers

The aim of this study was to determine Candida spp. incidence in the oral cavity of denture wearers and characterize predisposing factors in denture-related stomatitis (DRS). Three groups of denture wearers and a control group were evaluated for DRS according to Newton's classification. The amount of yeast in saliva and the presence of yeast on mucosal surfaces were determined by phenotyping methods, and the impact of some risk factors on candidal carriage was evaluated. The development of DRS is most common in complete prosthesis users. When the count of yeast in saliva is >or=400 cfu/ml, the frequency of DRS is increased. In individuals who develop DRS, the most frequently encountered species that was identified as C. albicans. Prosthetic hygiene was related to the intensity of candidal growth and the development of DRS. C. albicans live as saprophyte in the oral cavity. But, it is capable of causing infection if there are predisposing conditions related to the host. Usage of removable prosthesis may cause these microorganisms to gain pathogenicity.

The prevalence of denture stomatitis and its predisposing conditions in an older Greek population

Pathology related to complete denture-wearing will remain an important issue because of an increase in the ageing population. To investigate the prevalence and the risk factors for denture-related stomatitis in the edentulous maxilla of older patients with a maxillary complete denture. One hundred and six patients treated in the Department of Prosthodontics of the Athens Dental School were interviewed and clinically examined. The results were analysed using chi-square tests and multiple logistic regression. Denture stomatitis was recorded in 39.6% of the sample (pinpoint hyperaemia: 17%, diffuse erythema: 16%, papillary hyperplasia: 6.6%). Chi-square tests recorded significant associations between denture stomatitis and the continuous use of dentures (particularly the diffuse erythema type), the increased duration of denture experience and the poor retention of the maxillary denture. Other significant associations were recorded between the increased age of the current denture and pinpoint hyperaemia, and the reduced frequency of denture cleaning and papillary hyperplasia. Multiple logistic analysis revealed that the most important risk factor for denture stomatitis was the continuous use of the denture. The prevalence of denture stomatitis was high in denture users. Although many predisposing conditions were recorded, the most important risk factor was the continuous use of the denture. Therefore, appropriate advice on denture maintenance should be provided.

In vitro colonization of an experimental silicone by Candida albicans

Denture soft-lining materials are exposed to the oral cavity for long periods and are in continuous contact with saliva, subject to inhibition of liquid molecules, and susceptible to colonization by microorganisms. The opportunist yeast Candida albicans is of particular concern in this context, being associated with denture plaque and denture-related stomatitis. In this study, penetration of C. albicans into an experimental silicone elastomer soft-lining material was investigated under batch and continuous culture conditions. A model "denture plaque" microcosm was also used. Increasing the filler concentration within the elastomer decreased penetration under both batch and continuous culture conditions. In continuous culture, C. albicans penetration was significantly greater in pure culture than in the presence of bacteria after 72-h incubation (p < 0.05).

Oral mucosal lesions and temporomandibular joint impairment of elderly people in the South East Local Government Area of Ibadan

To determine the prevalence of oral mucosal lesions, temporomandibular joint (TMJ) impairment and oral health-related habits in the elderly people in South East Local Government Area (SELGA) in Ibadan. SELGA is one of the largest local government areas in Oyo State, Nigeria and has a population of 225,800. A cross-sectional survey. A randomly selected sample of 690 elderly people from 23 wards in SELGA were examined by two trained and calibrated examiners using mirror, probe and natural light. One hundred and fifty-five (22.46%) of the elderly examined had one or more oral pathology lesions, representing infection-related swelling, non-infection-related swelling, pre-malignant lesions, denture stomatitis, non-denture based ulcers, angular cheilitis, geographic tongue, scrotal tongue, lichen planus, hyper-pigmentation and TMJ impairment. Fifty-five (35.5%) of these pathologies were infection-related swellings. Six (3.9%) of the pathologies were denture-related stomatitis, 14(9.03%) were pre-malignant lesions, 14(9.03%) were non-infection-related swelling, while 27 (17.4%) were TMJ impairment. The rest of the lesions constituted the remaining 25.1%. Only 15.9% of the participants had tobacco-related habits, 10.7% drank alcohol, whilst 41.6% chewed kola nuts. Oral pathoses prevalence (22.46%) was similar to findings in developed countries (29.9%) but with a reversal of causal factors, infection-related swellings were more common, whereas pre-malignant lesions were less common. The infections were mostly complications from periodontal disease, which culminated in abscess formation. Tobacco-related habits were not highly prevalent among the elderly people in SELGA. However, oral pathoses resulting from nutritional deficiencies were the third most frequent lesions observed.

Denture stomatitis and its risk indicators in south Brazilian older adults

The purpose of this study was to evaluate if socio-demographic, behaviour and health variables are risk indicators for denture-related stomatitis in community-dwelling older adults from Carlos Barbosa, Brazil. In this cross-sectional study, 872 subjects aged 60 years or more were evaluated. Data collection included dental examinations and questionnaires to assess socio-demographic, behaviour, general and oral health data. All questionnaires and examinations were carried out during 2004. Associations between the independent variables and the outcomes 'prevalence of denture stomatitis' or 'prevalence of granular stomatitis' were adjusted by means of multivariate logistic regressions. Participants with denture stomatitis were significantly more likely to be females, to display increased amounts of plaque, and significantly less likely to visit the dentist for treatment. Participants with granular stomatitis were significantly more likely to be females and participants with granular stomatitis were significantly more likely to be females, aged 70 years or more and current smokers. In addition, participants with granular stomatitis displayed increased amounts of plaque. The data presented here confirms the central role of denture biofilm accumulation in denture stomatitis. It also indicates that smoking may increase susceptibility to infection in its most severe form.

Isolation of Candida dubliniensis from denture wearers

Candida albicans is considered the most important Candida species able to cause oral infections in denture wearers. In recent years, Candida dubliniensis has emerged as a pathogenic yeast in humans. The close phenotypic similarities of C. albicans and C. dubliniensis have led to the misidentification of these species. In this work, our aim was to verify through PCR the presence of C. dubliniensis in palate and maxillary denture samples from 112 denture wearers presenting with or without denture-related stomatitis (DRS). C. dubliniensis was isolated at low rates from both palate (5.3 % and 10.7 %) and maxillary denture (5.3 % and 8.9 %) samples from wearers regardless of the presence of the disease. However, when C. dubliniensis was detected in individuals with DRS, it was always associated with C. albicans. In addition, our results showed that C. albicans was the most commonly identified candidal species in maxillary denture and hard palate samples from DRS patients (78.5 % and 89.2 %, respectively) as well as from controls (31.2 % and 28.5 %, respectively). In conclusion, C. dubliniensis was detected in the oral environment of denture wearers. The association of C. dubliniensis with C. albicans occurred in approximately 10 % of the DRS cases.

The role of Candida albicans hyphae and Lactobacillus in denture-related stomatitis

Denture-related stomatitis (DRS) is still a dilemma in removable prosthodontics. The aim of this study was to investigate the relationship of DRS with the presence of Candida albicans hyphae and Lactobacillus. A total of 91 patients wearing maxillary and mandibular complete dentures were included in the present study and tested mycologically as well as bacteriologically. A statistically significant association of DRS was found with denture age (p = 0.003) and continuous denture wearing (p = 0.015). Presence of C. albicans hyphae was shown to be significantly higher in DRS cases (p < 0.01), and there was a statistically significant positive correlation between presence of hyphae and C. albicans (p < 0.01). Another interesting finding was that DRS patients showed higher Lactobacillus counts in their saliva (p = 0.04), as well as in the palate (p = 0.028). C. albicans is an important factor in the development of DRS. Hyphae seem to facilitate the rise of C. albicans counts and be related to the inflammatory response of the tissues. Lactobacillus seems to play an important role in the presence of DRS, as well. In agreement with many other studies, the results of this study confirm the importance of denture age and continuous denture wearing in the development of DRS.

Self-reported denture hygiene habits and oral tissue conditions of complete denture wearers

The aim of the study was to examine the influence of denture hygiene on the development and intensity of denture stomatitis and traumatic ulcers and their relationship to age, gender, educational level, smoking status, age of the denture, denture hygiene habits and denture-wearing behavior. The study population comprised 310 complete denture (CD) wearers (159 males and 151 females) aged 60–85 living in Kırıkkale, Turkey. Denture hygiene habits were assessed and recorded, and any relationships between denture hygiene habits and the condition of oral tissue were assessed. The majority (48.4%) of participants reported cleaning their dentures with a toothbrush and toothpaste and 45.2% with a toothbrush only. Less than half (44.8%) removed their dentures overnight. Stomatitis was observed in 35.8% and traumatic ulcers in 29% of patients. A positive relationship was observed between poor denture hygiene habits and the presence of denture-related stomatitis and traumatic ulcers. The degree of denture hygiene was significantly associated with age, sex, education, general health status, smoking status, self-perception of halitosis, overnight denture removal and denture immersion habits.

Correlation between enzyme production, germ tube formation and susceptibility to fluconazole in Candida species isolated from patients with denture‐related stomatitis and control individuals

Phospholipase and proteinase secretion in yeasts of the genus Candida has been described as a relevant virulence factor. Also, germ tube formation by Candida albicans is associated with its invasive capacity and is considered an important pathogenic mechanism. To link the production of hydrolytic enzymes with the capacity to produce infection, 232 clinical isolates of yeasts from the oral cavity of 140 individuals wearing removable maxillary protheses were studied. The sample was composed of 70 patients with denture-related stomatitis (DRS) and 70 individuals with normal palatal mucosa. For strains identified as C. albicans, the correlation between germ tube formation and their capacity to cause infection was studied and the presence of Candida dubliniensis was investigated. Susceptibility to fluconazole was evaluated. Candida albicans was the only species producing phospholipase and germ tube. We observed a higher level of production of phospholipase in cases of infection compared with commensals. Significant differences between the two groups of C. albicans isolates were observed as to germ tube production. Only, Candida glabrata showed lower susceptibility to fluconazole. The results reinforced the idea that C. albicans is the most frequent and can be the most pathogenic yeast in oral candidosis. However, the strains isolated from DRS patients and healthy individuals showed the same virulence factors. It seems that several virulence attributes are involved in the infective process but no single factor contributes to Candida virulence. Candida dubliniensis was absent in the oral cavity of individuals with and without DRS.

Genotypic analysis of Candida albicans isolates obtained from removable prosthesis wearers

To assess of the genotypic diversity of Candida albicans isolated from removable prosthesis wearers, with and without denture-related stomatitis (DRS). The occurrence of different genotypes in pathological and control cases was investigated. One hundred and sixty-four isolates of C. albicans obtained from different oral cavity locations were compared by randomly amplified polymorphic DNA (RAPD). The coherence of this analysis was confirmed by genotyping a selected group of isolates with pulsed field gel electrophoresis (PFGE). Among the 164 isolates, 150 were grouped into seven groups on the basis of their RAPD patterns. Three of these groups (comprising 54 isolates) had significant (alpha < 0.10) predominance of clinical or control cases. For the other isolates, no significant differences were observed between control and DRS cases. Occasionally, more than one genotype was found in the same person. These findings were sustained by PFGE analysis. No relevant associations between the genotypic patterns and pathology level were found. This study evidenced that C. albicans with similar genotypes may be found in individuals with DRS and in control cases. This conclusion hints the involvement of other aetiological factors that alone or in association with C. albicans may trigger the emergence of DRS.

Development of an in vitro denture plaque biofilm to model denture malodour

This study aimed to develop an in vitro denture plaque biofilm to model denture malodour. No previous studies have attempted to characterize the malodour associated with dentures and the effect of Candida spp. (main aetiological agent of denture-related stomatitis) on malodour. Pooled denture plaque microcosms and ‘model’ denture plaque biofilms (pooled saliva supplemented with additional microbial species) with and without addition of candida were grown aerobically at 37 °C for up to 13 days in a constant depth film fermenter (CDFF) on denture acrylic discs. Sample discs were removed, rinsed in sterile water and placed in phosphate buffered saline (PBS). The discs were vortex mixed to remove the biofilms, diluted in PBS and plated in duplicate onto general and selective media. The composition and stability of the biofilms over time were assessed. CDFF-grown microcosms and ‘model’ denture plaque biofilms were relatively stable in composition, with streptococci remaining the dominant microbial group. Model denture plaque biofilms were comparable in composition to denture plaque microcosms. This model system has the potential for evaluation of agents that might affect these parameters such as denture cleansers and other oral hygiene treatments.

Denture‐related stomatitis: identification of aetiological and predisposing factors – a large cohort

The aim of this study was to identify and characterize aetiological and predisposing factors in denture-related stomatitis (DRS), by means of a case-control, transversal study, in a large cohort of 140 persons wearing removable maxillary polymethylamethacrylate prostheses. Data were obtained by (1) a questionnaire that included the identification of the subject, demographic and social data, medical history and behaviour; (2) intra-oral examination; (3) evaluation of the prosthesis; (4) microbiological examination; (5) yeast identification and analyses using Epi-info and the chi-square test. Results showed significant associations between DRS and yeasts, gender, age and alcohol consumption. We also found a significant relationship between the presence of yeasts and hyposalivation and decreased salivary pH. We found a highly significant difference between groups with and without DRS concerning the presence or absence of yeasts, regardless of the sample origin. Most cases of DRS showed the presence of Candida albicans. The results confirm a highly significant difference between groups with and without DRS concerning the presence or absence of yeasts.

Surface Roughness and Adherence of Candida Albicans on Soft Lining Materials as Influenced by Accelerated Aging

Candida albicans (C. albicans) has been widely associated with the etiology of denture-related stomatitis and has been found on soft denture lining materials. The aim of this study was to examine the surface roughness and adherence of C. albicans to saliva coated and non-coated soft lining materials by subjecting them to an in vitro accelerated aging test. Samples were prepared from three soft lining materials (Visco Gel, Ufi Gel P, Molloplast B). Surface roughness measurements and adhesion of C. albicans were examined before and after an aging process. The stimulated human whole saliva was used to assess its effect on adhesion. The aging process promotes the surface roughness of soft lining materials. The aging surface roughness of Visco Gel was significantly higher than Ufi Gel P and Molloplast B. No significant difference was observed between non-aged and uncoated materials, but aged and uncoated soft lining materials showed a greater adherence of C. albicans. No significant difference was observed between non-aged and saliva coated materials, but aged and saliva coated soft lining materials showed a greater adherence of C. albicans. Candidosis induced by C. albicans is the most common fungal infection. Awareness of susceptibility of soft lining materials to the adherence of C. albicans is an important factor in their selection. The use of soft lining materials with smooth surfaces minimizes the adherence of C. albicans.

In vitro antiseptic properties of an ammonium compound combined with denture base acrylic resin

Denture base acrylic resin is easily colonised by oral endogenous bacteria and Candida spp., and eventually by extra-oral species such as Staphylococcus spp., Pseudomonadaceae or members of Enterobacteriaceae. This microbial reservoir can be responsive for denture related stomatitis and aspiration pneumonia, a life-threatening infection especially in geriatric patients. However, the oral and denture hygiene of dependent elderly individuals is extremely poor. This in vitro study aimed to determine the per cent of a quaternary ammonium compound heat-polymerised in acrylic resin necessary to obtain denture base displaying antiseptic properties. Acrylic resin discs containing 2-50% ammonium polymer (Poly 202063A; 0% control) were soaked in artificial saliva for 4 weeks. Resin discs were incubated for 24 hours with Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa [37 degrees C, brain-heart infusion (BHI) broth and phosphate-buffered saline (PBS) buffer] and Candida albicans (30 degrees C, Schaedler broth), in 15 ml (168 discs) and 600 microl (168 discs) of inoculum. Microbial growth was verified at t 0 hours and t 24 hours. Data were recorded as the mean of three colony forming unit (CFU) numerations. The borderline of antimicrobial effect was determined at 0.1% viable cells. In 600 microl of PBS inoculum, resin specimens had a bactericidal effect (E. coli and S. aureus: 2%; P. aeruginosa: 10%) and a fungicidal effect (C. albicans: 50%). Long-term stability and toxicity in vivo studies are now required. A 2% quaternary ammonium compound polymerised with a denture acrylic resin displayed antiseptic properties after a 4-week soaking period in artificial saliva. Such antiseptic denture base could help geriatric patients to improve their oral health.

Self‐reported oral hygiene habits among institutionalised elderly and their relationship to the condition of oral tissues in Taubaté, Brazil

To record self-reported hygiene habits, examine the oral conditions of a sample group of institutionalised elderly, and examine possible relationships between these habits and conditions. Cross-sectional. All the institutions for the elderly in Taubaté, Brazil. The entire population of these institutionalised elderly people (n = 553). The subjects were interviewed and underwent an oral examination. Oral hygiene habits, oral conditions and statistical relationships between habits and oral conditions were recorded. The average age of the subjects who knew their age (n = 364) was 74.9 years (+/-12.9), and 64.7% of the sample group were females. Denture-related stomatitis was found in 19.5%, impaired manual dexterity in 40%, dry mouth sensation in 36.3%, difficulty in performing oral hygiene in 20%, no oral hygiene-related orientation in 54.1%, no periodic oral examinations in 59.5%, and no tongue cleaning in 68.3% was declared. Among dentate subjects, 73.3% had periodontal disease, 54.7% had caries, 26% reported no toothbrushing, and 7.3% reported flossing. Of the denture wearers, 7% did not brush their dentures. Denture-related stomatitis showed a statistical relationship with impaired manual dexterity (p = 0.012) and an inverse statistical relationship with denture brushing frequency (p = 0.006). Periodontal disease showed an inverse relationship to flossing (p < 0.001) and tongue cleaning (p = 0.0026). Caries showed an inverse relationship with tooth-brushing (p = 0.043), flossing (0.022), proper oral hygiene orientation (p = 0.041) and periodical check-ups (p = 0.007). Oral hygiene practices in this sample group were found to be inadequate, and statistically significant relationships were verified between the lack of good oral hygiene practices and the deleterious oral conditions.

Self‐reported denture hygiene of a sample of edentulous attendees at a University dental clinic and the relationship to the condition of the oral tissues

This article aims to evaluate the habits of hygiene and usage of a sample group of Brazilian wearers of complete dentures. This study has a cross-sectional design. It was performed in the dental clinic of the University of Mogi das Cruzes. A sample group of 236 complete denture wearers was selected. The individuals were interviewed and clinically examined. Most commonly used hygiene habits were assessed and recorded. Possible relationships between habits and oral conditions were also assessed. Dental treatment was sought by 43.6 % 10 years after their last dental appointment, 77.5 % declared they had been given no instructions regarding the hygiene of their dentures, only 22.9% said they had been instructed about oral hygiene, and 91.9% stated they had not been told to return for periodical review visits. Denture stomatitis was found in 42.4%, although 89% of these patients presented with no symptoms; 98.7% of the group brushed their dentures; 27.1% regularly immersed their dentures in chemical products; 26.3% removed their dentures overnight. A positive relationship was observed between the lack of recommendations regarding oral and denture cleansing and the presence of denture-related stomatitis and hyperplasia. Family income and periodicity of visits to the dentist were also found to be related. Mechanical cleaning is the most prevalent method of hygiene. Self-reported lack of guidance to oral care was statistically related to inflammatory oral conditions. Future research is necessary to clarify possible causal role between these factors.

Oral health care among nursing home residents in Avon.

To assess personal oral health care standards among frail, elderly and infirm nursing home residents prior to developing and evaluating a health promotion intervention. Descriptive survey, interview and clinical data. 22 randomly selected nursing homes in the Bristol area. 412 residents with denture(s) and/or natural teeth, and giving informed consent to the study were interviewed about dental attendance and current dental problems. A clinical examination assessed levels of oral and denture hygiene, denture-related stomatitis, gingivitis, calculus and root caries. Less than half the subjects (mean age 84.5 years) were ambulant. Over 70% had not seen a dentist for over 5 years, and 22% reported a current dental problem. Among denture wearers, 82% were unable to clean their dentures; staff cleaned dentures for 64%. Denture-related stomatitis affected 33%, and unhygienic dentures were worn by 95% of subjects. Among dentate subjects (mean number of teeth 11.6), 75% were unable to clean their teeth yet none received regular assistance. On average, two-thirds of each tooth surface were covered in plaque. Gingivitis was moderately severe. Calculus was present in 82% of subjects and root caries in 63% of subjects. Most residents required help with oral health care but many did not receive it. Residents' levels of plaque and associated dental disease were high. Staff did not effectively perform oral health care appropriate to residents' needs. Further research to evaluate an oral health care training programme for care staff is planned.

Denture plaque and adherence of Candida albicans to denture-base materials in vivo and in vitro.

The aim of this paper is to review our understanding of the mechanisms and clinical significance of adhesion of C. albicans to denture-base materials in relation to denture plaque and denture-related stomatitis. Earlier reports in the literature of a 65% prevalence level of denture-related stomatitis seem to be exaggerated. More recent studies indicate that denture-related stomatitis is considerably less common, particularly in normal healthy subjects. The etiology of the condition is discussed in this review, and although much of the literature supports the view that the condition is strongly associated with C. albicans, this is not always so. In some subjects, the cause appears to be related to a non-specific plaque. This review also considers the role of denture plaque in the pathogenesis of denture-related stomatitis, the sequential development of denture plaque, and its colonization by Candida organisms. Designing controlled in vivo studies is difficult, and as a consequence, many investigators have had to resort to in vitro studies. The majority of these studies have attempted to investigate the hydrophobicity of C. albicans, relating the surface free-energy of denture-base materials, particularly acrylic resin, to that of the organism. Surprisingly little work has been directed at surface roughness and how it affects retention of organisms. Further, no attention has been paid to the properties and character of the surface, other than average surface roughness, as it affects adhesion. A comparison of results from in vitro studies on the effect on adhesion of pre-coating the surfaces of denture-base materials with saliva has produced equivocal conclusions. This is largely due to little standardization of experimental protocols between studies, particularly in the collection and handling of the saliva used. In conclusion, the review strongly supports the suggestion that adherence of C. albicans to denture-base materials in vitro is related to the hydrophobicity of the organism. The clinical significance of the observation and the mechanisms for the development and maturation of denture plaque are yet to be understood. There is a clear need for further investigation of other factors that may moderate the adhesion of organisms and subsequent colonization of denture-base materials.