Denture stomatitis is a common inflammatory condition affecting the tissues directly beneath a removable denture. It is characterized by redness and swelling of the oral mucosa, particularly on the hard palate under an upper denture. This is the most frequent type of inflammation experienced by denture wearers. It is often overlooked because it frequently causes little to no immediate discomfort, but recognizing this inflammation is key to effective management.
Understanding the Signs of Denture Stomatitis
Denture stomatitis is categorized into three main clinical types based on the severity of inflammation. The mildest form, Newton’s Type I, appears as pinpoint areas of redness and localized inflammation on the palate. This early stage often presents as small, distinct red spots, also called petechial hemorrhage, beneath the denture. Newton’s Type II is a more widespread presentation involving diffuse, generalized redness (erythema) that covers the entire area of tissue in contact with the denture. This is the most commonly seen form and is sharply outlined in the shape of the prosthetic.
The third and least common type, Newton’s Type III, is marked by a granular or “pebbly” surface, known as inflammatory papillary hyperplasia, usually involving the central hard palate. Although sometimes called “denture sore mouth,” the condition is often painless or causes only mild symptoms, allowing it to go unnoticed. Some individuals may experience a burning sensation, slight bleeding, or a change in taste, but many lesions remain asymptomatic. This lack of pain allows the inflammation to persist and become chronic before professional examination.
The Role of Candida and Other Contributing Factors
The primary cause of denture stomatitis is the overgrowth of the fungus Candida albicans, involved in nearly 90% of cases. While Candida naturally resides in the mouth, the presence of a denture creates a microenvironment for this yeast to become pathogenic. The acrylic material encourages the formation of a biofilm where Candida cells adhere and multiply. This microbial plaque, combined with the dark, warm, and moist space beneath the denture, facilitates fungal overgrowth. Continuous wearing, especially overnight, promotes this environment by limiting tissue exposure to saliva and oxygen, which normally control microbial populations.
Several other factors increase the risk of developing the condition. Poor denture hygiene is a major contributor, as inadequate cleaning fails to remove the fungal biofilm. Ill-fitting dentures cause micro-trauma, compromising the mucosal barrier and increasing susceptibility to infection. Systemic issues, such as diabetes, a weakened immune system, or the use of inhaled steroids or certain antibiotics, can also disrupt the oral environment and allow Candida to flourish.
Effective Treatment Strategies
Treatment requires a two-pronged strategy: addressing the infected oral tissue and decontaminating the dental prosthetic. For the oral mucosa, a dentist prescribes a topical antifungal medication, such as an oral gel or suspension, to eliminate the fungal infection. This medication is applied directly to the affected area or to the fitting surface of the denture before insertion.
In severe or persistent cases, a systemic antifungal medication (tablet) may be necessary. During active treatment, patients are advised to stop wearing the denture at night to allow inflamed tissues to rest. Simultaneously, the denture must be professionally cleaned and disinfected to remove the embedded Candida biofilm, which acts as a reservoir for reinfection.
The fit of the denture must also be evaluated, as improper fit causes friction or creates spaces favorable for microbial growth. The dentist may recommend a reline or adjustment to improve stability. If the denture is old or excessively porous, replacement may be necessary to prevent recurrence once the infection is cleared.
Daily Steps for Long-Term Prevention
Preventing recurrence relies on establishing a consistent daily hygiene routine. This involves mechanical cleaning using a soft-bristled brush and a non-abrasive cleanser formulated specifically for dentures. Regular toothpaste must be avoided because its abrasive properties scratch the acrylic surface, creating microscopic grooves where fungi and bacteria accumulate.
The primary component of prevention is the nightly removal of the denture for six to eight hours, preferably while sleeping. This practice allows the underlying palatal tissue to breathe, receive natural cleansing from saliva, and recover from continuous pressure.
Soaking the denture overnight in an appropriate chemical solution is also highly effective for disinfection. Suitable soaking agents include commercial denture cleansers or a diluted sodium hypochlorite (bleach) solution for dentures without metal components. This chemical action helps break down the fungal biofilm that brushing alone cannot entirely remove. Maintaining good overall oral hygiene, including gently brushing the gums, tongue, and palate, further reduces the microbial load and is a powerful defense against this common inflammatory condition.