Denture Stomatitis: The Protocol for Prevention and Treatment

Denture stomatitis is a common but treatable infection. Our experts share their approach for preventing and treating the condition for their denture patients.

When you transition patients into conventional dentures, you need to have a conversation about stomatitis, also called Thrush. Stomatitis is a common condition for denture wearers caused by yeast or fungus (candida) usually in the palatal area. Communicating your expectations of what patients can do to prevent it is essential.  

However, if you do not handle a lot of conventional dentures transitions for your patients, you might not be prepared for this crucial conversation. We spoke to some experts to give you some guidelines for diagnosing, treating, and helping prevent denture stomatitis in your patient population.

Finding it Early and Often Is Key

Shirin Khoynezhad, DDS, is a prosthodontist and the Director of Second-Year Pre-Clinical Dentistry at the University of Alabama. She suggests a thorough exam on every patient visit to detect the early signs of stomatitis and more serious conditions, starting from minor irritation or inflammation up to initial cancerous lesions.

“For denture patients, stomatitis it is so common that we have to be more mindful of that and do a true exam on each visit,” Dr. Khoynezhad says. “Sometimes it's very hard to see the initial signs of stomatitis, so we have to be careful and do a good exam.”

Dr. Khoynezhad also urges clinicians to consider the patient’s overall health. The oral cavity biota can cause the disease on patients with specific conditions. When the body loses control over these microorganisms, it creates the conditions that are ideal for stomatitis to initiate.

Systemic issues make patients more prone to stomatitis. Dentists should consider these risk factors during the examinations:

• Patients who are taking medications that cause dry mouth have less saliva input

• Patients who are receiving long-term steroids or antibiotics

• Patients who are taking prescriptions for rheumatoid arthritis which tends to create immunosuppression in our bodies

• Patients with diabetes

Raymond Choi, DDS, a mini-implant dentist and educator for Glidewell Laboratories recommends having a patient-by-patient approach to addressing stomatitis when systemic conditions cause it. He explains to patients how their other health condition contributes to their susceptibility.

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“If you think about it, stomatitis is a fungal infection by and large. So, when our immune system goes down, then it gets active. So, some patients are more at risk,” Dr. Choi explains. “So, then I emphasize with these patients that because of their other condition, they need to take better care of their dentures and mouth.”

Patient education is essential also. You see your patients every six months in a best-case scenario. Therefore, patients must be able to recognize the signs and know what to look for in their mouth, Dr. Khoynezhad says.  By educating patients to notice early signs of Stomatitis, they can seek professional help right away if they spot them.

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“We have to educate our patient about this issue,” Dr. Khoynezhad says.

There are local causes of stomatitis as well. Sometimes patients do not realize how what they do that can cause the condition to present. Dr. Khoynezhad says one example of this is denture adhesive. When used in proper amounts and with appropriate cleaning afterward, denture adhesives are not a problem. However, if any excess adhesive remains in the mouth, it can attract bacterial and oral microorganisms.

“If they use adhesive and don't clean it properly or if they use too much of it, that's one of the risk factors for denture stomatitis,” Dr. Khoynezhad explains.

Cleaning the dentures is essential for all denture wearers. However, it is even more crucial for patients using an upper denture with the large area of the maxillary covered by the prosthesis.

“Foods can sit between the denture and palate and not get cleaned. So, oral hygiene, and proper care and cleaning are very important,” Dr. Khoynezhad says.

“If you have a young person with the same bad hygiene, they are going to get away with it,” Dr. Choi says. “But older people who are more compromised health-wise, they’re going to see more issues.”

Dentalhealth.org recommends the following patient instructions for treating and preventing stomatitis:¹

• Maintaining a good foundation of oral hygiene to keep the denture as clean as possible

• Rinsing mouth and denture after meals

• Stopping smoking because it encourages the microorganisms to grow

• Leaving dentures out of their mouth overnight

• Brushing and soaking dentures every day

• Cleaning with a non-abrasive denture cleaner rather than a toothpaste to avoid creating grooves in the surface that can collect bacteria within them

• Removing all the adhesive from the denture, including the surfaces that rest on the gingiva

• Following the manufacturers’ instructions for the cleaning solutions

• Avoiding bleach for dentures with metal parts

• Using Chlorhexidine once a week to disinfect the denture

Dr. Choi says another preventative measure for denture complications is to communicate with the lab fabricating the dentures about the materials and technique they use. For patients with allergies to resin monomers or methylmethacrylate, the reaction will present as one of the strains of denture stomatitis. Dr. Choi says materials that are self-curing, auto-curing, or cold curing tend to create more allergic responses than other materials.

If It’s Too Late for Prevention…

Once detected, there are multiple ways to address stomatitis. The systemic strain is localized, so Dr. Khoynezhad uses a type of swish that the patient can swallow after they use it. She also applies a topical antifungal medication to the affected area.

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“If it persists, we have to talk with their primary care physician to see if we can address the cause of the immunosuppression to cure that systemic issue,” Dr. Khoynezhad says.

You should always professionally clean the prosthesis at the dental office. Also, Dr. Khoynezhad emphasizes that you have to work on the proper denture hygiene care with your patients. She recommends also reviewing the everyday cleaning and disinfecting steps for the denture in detail with patients.

“Basically, you need to help with decreasing the load of microorganisms, bacteria, and fungal and also boosting the immune system to help the patients,” Dr. Khoynezhad says.

Dr. Choi says it can be challenging to get rid of a fungal infection. However, for the first line of treatment, you can use a variety of different medications and solutions that can treat the condition. He recommends Nystatin, an antifungal medication that comes in ointment or suspension. Using Nystatin, along with disinfection solutions, gets predictable results.

Sometimes, he combines the antifungal with cream-based Prednisone or Triamcinolone.

The patient applies the cream to the inside of the denture and then wears it after each meal. This way, the denture delivers the medication to the affected area during the day. After a couple of weeks, they will see improvement.

“At the same time, we tell the patient to soak the denture in a Nystatin suspension for at least an hour at nighttime. Some people use a .1-percent Clorox solution or a .25 percent Chlorhexidine,” Dr. Choi says. “You can use different things to disinfect the denture, but the denture needs to be disinfected.”

References

1. “Denture stomatitis.” Web. 8 August 2019. < https://www.dentalhealth.org/denture-stomatitis>.