Denture stomatitis (DS) is a common inflammatory condition affecting the tissues beneath a dental prosthesis. Characterized by inflammation and redness of the oral mucosa directly covered by the denture, it is most often observed on the palate beneath an upper denture. While generally benign, DS requires prompt attention to prevent discomfort and further oral health complications.
Recognizing the Signs
The visual presentation of denture stomatitis is often the primary indicator, as the condition frequently develops without causing pain or tenderness. The affected area, usually the roof of the mouth, displays a distinct, uniform redness known as erythema. Because of this lack of initial discomfort, many people remain unaware they have the condition until a dental professional points it out during a routine examination.
The severity and appearance of the inflammation are often categorized using the Newton classification system. Type I presents as localized areas of pinpoint redness, while Type II involves a more diffuse and generalized redness covering a large portion of the mucosal area beneath the denture base. The affected tissue may also appear slightly swollen or puffy, conforming exactly to the outline of the denture’s fitting surface.
The condition rarely develops under a lower denture, which is protected by the cleansing action of saliva. In some cases, the inflammation may be accompanied by a burning sensation or a change in taste, although these symptoms occur in a minority of patients.
The Role of Candida and Denture Hygiene
Denture stomatitis is overwhelmingly caused by an overgrowth of the yeast Candida albicans, a fungus that is a normal part of the mouth’s microflora. This organism shifts from a harmless component to a pathogen when the oral environment becomes favorable for its proliferation. The denture itself acts as a perfect breeding ground for this fungal overgrowth because it creates an ideal micro-environment.
The acrylic surface of the prosthesis, particularly in any rough or porous areas, allows Candida to adhere strongly and form a complex, resilient structure called a biofilm. This biofilm shields the yeast from the natural defenses of saliva and makes it difficult to remove through simple rinsing or brushing. The presence of the denture also reduces the flow of oxygen and saliva to the underlying soft tissues.
This creates a localized acidic and anaerobic (low-oxygen) micro-environment directly beneath the appliance, which significantly favors the growth of Candida. Poor denture hygiene and continuous wear are the primary behavioral risk factors that facilitate this process. When dentures are left in the mouth constantly, especially overnight, the oral tissues are never allowed to rest or be exposed to the cleansing effects of saliva and air.
Inadequate cleaning allows food debris, plaque, and the Candida biofilm to accumulate and mature on the denture’s fitting surface. Ill-fitting dentures also contribute to the problem by causing mechanical trauma and localized irritation to the mucosa. This tissue damage makes the underlying skin more susceptible to colonization and invasion by the opportunistic yeast.
Professional Diagnosis and Treatment Options
A professional diagnosis of denture stomatitis begins with a thorough visual examination by a dentist or dental hygienist. The clinician inspects the mucosal tissues for the characteristic pattern of erythema and inflammation after the patient removes the prosthesis. Since the condition is frequently asymptomatic, this examination is often the first time the patient becomes aware of the problem.
If the condition is persistent or severe, the professional may take a swab or scraping of the affected area to send for laboratory testing. This confirms the presence and species of the Candida fungus, which helps guide the treatment approach. Management requires a two-pronged strategy: treating the tissue infection and decontaminating the denture itself.
The oral tissues are treated with prescription antifungal medications, which may be topical agents like nystatin or miconazole, often in the form of a cream, lozenge, or oral suspension. In cases where the infection is widespread or resistant to topical application, a systemic antifungal tablet, such as fluconazole, may be prescribed. The patient is usually instructed to apply the topical treatment directly to the affected mucosa and sometimes to the denture’s fitting surface.
Simultaneously, the denture must be thoroughly disinfected to eliminate the Candida biofilm, which is the constant source of re-infection. This is achieved by soaking the appliance in specialized chemical denture-cleansing solutions, such as those containing sodium hypochlorite or chlorhexidine. Finally, any underlying mechanical issues, such as a loose or poorly fitting denture, must be addressed through a reline, rebase, or replacement to prevent the condition from recurring.
Preventing Recurrence and Proper Denture Care
Preventing the recurrence of denture stomatitis depends on the consistent adoption of proper daily hygiene practices. The most effective measure is allowing the oral tissues to rest by removing the dentures for a continuous period of six to eight hours every day. Professionals recommend removing the dentures overnight to give the palate and mucosa time to recover and receive proper oxygenation.
Essential Hygiene Practices
- Daily mechanical cleaning is essential and involves brushing the denture with a soft-bristled brush and a non-abrasive denture cleanser. Regular toothpaste should be avoided as it can scratch the acrylic surface.
- Soaking the denture daily in a commercial or prescribed disinfecting solution provides a chemical breakdown of any remaining microbial biofilm.
- Gently brush the gums, tongue, and palate with a soft toothbrush every day to remove any residual yeast or bacteria before reinserting the appliance.
- Regular appointments with a dental professional are necessary to monitor the fit and condition of the denture, ensuring the appliance is not causing trauma and detecting early signs of inflammation.