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Oral hygiene, dental visits and age of denture for prevalence of denture stomatitis
Abstract
A representative sample of Finnish denture wearers (n = 3875) aged 30 or over were examined clinically and interviewed about their oral hygiene habits, use of dental services and possible prosthetic treatment during last visit to a dentist. Of these denture wearers, over 80% brushed their dentures at least once a day, and 16% visited a dentist at least once in 2 yr. For denture stomatitis the age-standardized risk ratio decreased with brushing frequency in women and increased in men. For frequency of dental visits the prevalence of denture stomatitis increased in both men and women when visits were made over 2-yr intervals. The prevalence of denture stomatitis was higher in the group with dentures over 1 yr old. It seems that the oral hygiene measures as they are generally carried out and regular dental visits are not effective enough methods in preventing denture stomatitis.
... Many epidemiological surveys have suggested that DIS is multifactorial, and its incidence is high among elderly female denture wearers. 1,2,[16][17][18] The findings of the cur- rent study corroborate the foregoing fact pertaining to the etiology of DIS. For instance, 90% (n = 54) of the DIS group and 82% (n = 49) of the healthy group in our study sample were females with a mean age of 58 AE 10 and 62 AE 11 years, respectively. ...
... Two population-based studies conducted in Finland have revealed that higher percentage of females wear dentures, and the prevalence rate of DIS among females is also higher than that of males. 16,17 Possible causes for the high prevalence of DIS in middle-aged females could be attributed to hormonal changes and iron deficiency anemia that might emerge during middle age. However, further comparative studies involving more male denture wearers could be useful to confirm the gender susceptibility to DIS in Asian populations. ...
Aim:
The aim of the present study was to investigate factors associated with denture-induced stomatitis (DIS) among denture wearers and their oral and hand carriage of Candida.
Methods:
Sociodemographics and denture and oral hygiene practices were investigated using an interviewer-administered questionnaire in denture wearers with DIS (n = 60) and without DIS (n = 60) selected using a convenience sampling of patients attending the Department of Prosthetic Dentistry, University of Peradeniya, Sri Lanka. Denture and oral hygiene practices and denture quality were scored. DIS and denture hygiene were classified. Oral and hand carriage of Candida was assessed.
Results:
Middle-aged females were more prone to DIS. The most common DIS pattern was Newton type ΙΙ. The mean age of existing denture of DIS patients was significantly higher than the control. Denture hygiene practice was significantly low in DIS patients. Poor denture hygiene practice and sleep wear of dentures were significantly associated with DIS. The risk of Candida hand carriage in a DIS patient carrying oral Candida was significantly higher than the risk of Candida hand carriage in a healthy denture wearer who carried oral Candida.
Conclusion:
Old dentures, poor denture hygiene, and sleep wear of dentures might contribute to DIS. Oral Candida in denture wearers could lead to Candida hand carriage.
... 1,12 On the other hand, with an increase in the proportion of elderly persons in various communities, the identification of the specific aetiological factors of the condition is of utmost importance. 21 There are great discrepancies in the results of studies on the role of various aetiological agents in the pathogenesis of DS. [21][22][23] The research work carried out by Shulman in 2005 is the only study that deals with the role of vitamin A in the pathogenesis of DS. 7 Based on the evidence available, vitamin A deficiency makes individuals susceptible to infections. The previous studies showed that a higher percentage of neutrophils from vitamin A-deficient rats are hypersegmented and contain lower levels of cathepsin G than the neutrophils from control rats. ...
... The authors reported that the prevalence of denture stomatitis among the two studies was 35% and 48%, respectively. 12,13 The Finnish national-based survey indicated that around 44% of adults in Finland have denture stomatitis. Another nationalbased investigation was also conducted in Germany and reported different rates of denture stomatitis for different age groups. ...
Multiple factors are involved in the pathogenesis of denture stomatitis, which increases the risk of tissue infection and inflammation. These factors include poor oral hygiene, trauma secondary to poorly fitting prostheses, resin porosity, and bacterial plaque accumulation. Our present review discusses the epidemiology, etiology, and treatment of denture stomatitis based on data from current studies in the literature. The prevalence of denture stomatitis is significantly variable among the different studies, as previously discussed. However, the cumulative incidence of denture stomatitis among their participants ranged between 17-77%. These hugely variable rates have been attributed to the nature of data collection, diagnostic criteria, sample size, and patient demographics. Studies also show that the condition is more prevalent among elderly females. However, not many studies have reported this correlation, indicating the need for future studies. Candida albicans infection is the primary parameter in the etiology and pathogenesis of the condition. However, other factors related to the patient (like status of immunological response) and dentures (like hygiene) were also reported. Therefore, the management of denture stomatitis should be based on applying adequate interventions. Besides, using antifungal medications is also necessary to eradicate organism.
... This was in agreement with other studies. 1,15,16 The results of the current study indicate that denture wearers who did not wash their hands after denture handling or who handled their dentures frequently per day had a relatively higher proportion of fingertip Candidal isolation than those who washed their hands and handled their dentures less frequently. However, the difference was not statistically significant. ...
Wearing a dental prosthesis is known to increase oral candidal colonization and predispose the wearer to oral candidosis. Denture wearers frequently use fingers to take the prosthesis out of their mouth. Oral Candida, if present may contaminate wearer's finger. The objective of this study was to investigate the simultaneous candidal colonization of oral cavity and fingertips of complete denture wearers.
A total of 25 apparently healthy male subjects who had worn complete dentures for at least 1 year were selected. Information about each patient's denture age, denture hygiene, handling, and wearing habits, and hand washing habits after denture handling were be obtained. Intraoral examination of all the patients was done. For microbiological examination samples were collected from the fingertip and oral rinse of each patient. Candida species were identified with use of germ tube test and commercially available yeast identification system. Data was statistically analyzed. Significance was set at p < 0.05.
It was found that frequency of hand washing, denture handling and denture stomatitis with respect to fingertip candidal isolation was not statistically significant. But poor denture hygiene and denture stomatitis with respect to oral candidal colonization was statistically significant.
Denture wearers with oral Candida had a higher prevalence of Candida contamination on their fingers. Patients with removable prostheses should be informed about the importance of proper prosthesis and personal hygiene and the possibility of microbial contamination of the hands and other parts of the body.
... Risk factors for oral diseases are the four leading chronic diseases in elderly people: diabetes mellitus, chronic respiratory diseases, cardiovascular diseases and cancer [84][85][86][87][88]. In addition, nutrition (see below), an unhealthy diet, tobacco use, harmful alcohol use and poor oral hygiene are also risk factors for oral diseases [32,[89][90][91][92][93][94]. ...
... Risk factors for oral diseases are the four leading chronic diseases in elderly people: diabetes mellitus, chronic respiratory diseases, cardiovascular diseases and cancer [84][85][86][87][88]. In addition, nutrition (see below), an unhealthy diet, tobacco use, harmful alcohol use and poor oral hygiene are also risk factors for oral diseases [32,[89][90][91][92][93][94]. ...
Two important factors contribute to a higher chance of a deterioration of oral health status in frail and disabled elderly people. First, advances in oral health care and treatment have resulted in a reduced number of edentulous individuals and the proportion of adults who retain their teeth until late in life has increased substantially. Second, neglected self-care and/or professional care have led to reduced oral health care utilization. This review reports the consequences of having a poor oral health status and its impact on general health of frail elderly people and gives an overview of the important enabling and disabling factors regarding the provision of oral health care to frail older persons. Impaired cognitive and functional ability, medication-induced hyposalivation, reduced saliva buffer capacity and high saliva acidity, diabetes mellitus, the number of exposed root surfaces due to gingival recession, poor oral hygiene, high frequency of sugar consumption, and poor socio-economic conditions are the major predisposing conditions for the upsurge of caries in older population groups. Poor oral hygiene, tobacco smoking, and excessive alcohol consumption together with some systemic diseases, such as metabolic syndrome, rheumatoid arthritis, diabetes mellitus and post-menopausal osteoporosis are reported to be important risk factors for periodontal disease and later on peri-implantitis. Although during recent years increasing attention has been given to improving oral health care for frail old people, there is ample evidence showing that the oral health of elderly people, in particular of care home residents is (still) poor. The introduction of innovative care pathways to improve oral health care of elderly people by implementing new guidelines or health care models appears to be a complex process. Therefore, a poor oral health status might be regarded as a new geriatric giant in frail elderly people, which deserves urgent attention of scientists, health care providers and policymakers.
... 1,12 On the other hand, with an increase in the proportion of elderly persons in various communities, the identification of the specific aetiological factors of the condition is of utmost importance. 21 There are great discrepancies in the results of studies on the role of various aetiological agents in the pathogenesis of DS. [21][22][23] The research work carried out by Shulman in 2005 is the only study that deals with the role of vitamin A in the pathogenesis of DS. 7 Based on the evidence available, vitamin A deficiency makes individuals susceptible to infections. The previous studies showed that a higher percentage of neutrophils from vitamin A-deficient rats are hypersegmented and contain lower levels of cathepsin G than the neutrophils from control rats. ...
There is scant information regarding the multifactorial aetiology of denture stomatitis (DS) in the world and, despite its frequency, associated factors are not completely understood. The aim of this study was to investigate the risk factors that may be associated with this lesion.
A total of 70 edentulous patients, all wearing removable dentures, were divided into two groups. The test group comprised 43 patients with DS and the control group comprised 27 subjects with clinically healthy palatal mucosa. A thorough history-taking and physical examination were carried out; the subjects also answered a questionnaire. The serum level of vitamin A for each subject was assayed from a blood sample taken after the examination.
THIS STUDY SHOWED A SIGNIFICANT RELATIONSHIP BETWEEN THE INCIDENCE OF DS AND THREE MAJOR FACTORS: denture age (in terms of years), the practitioner manufacturing the dentures (general dental practitioner versus dental hygienist), and the night-long wearing of dentures. Also, the vitamin A serum level was low in 94.29% of all subjects (cases and controls).
Although many predisposing conditions were related to this situation, the most important risk factor was the continuous use of the dentures.
Objective
To assess the association between risk factors for developing denture stomatitis (DS) and oral health-related quality of life (OHRQoL) in complete denture wearers.
Methodology
Participants of both sexes, wearing complete dentures, were classified using the modified Newton classification for the absence or the severity of DS and allocated to groups Normal or zero, IA, IB, II, and III. Lifestyle, oral and denture history, and medication use were assessed using specific questionnaires; clinical parameters such as anatomical characteristics of support were evaluated with the Kapur classification; salivary flow (SF) was calculated by the volume of unstimulated saliva per minute; and microbial load was determined by counting colony forming units (CFU) of target microorganisms present in the biofilm collected from dentures and palate. OHIP-EDENT assessed the OHRQoL. Kendall's tau_b and Spearman tests were applied with a significance level of 5%.
Results
184 patients (143 female and 41 male) aged 65.5 ± 6.8 years were evaluated. Positive correlations were found for sex (women; p=0.013, r=0.16), individuals who started to consume alcoholic beverages as a young adult (18–27 years) (p=0.008, r=0.22), CFU of Candida spp. (p<0.001, r=0.27 denture; p<0.001, r=0.31 palate); Candida albicans (p=0.004, r=0.22 denture; p=0.003, r=0.25 palate), and Candida glabrata (p=0.004, r=0.22 denture; p=0.001, r=0.27 palate). Moreover, negative correlations with DS were found for CFU of Staphylococcus spp. (p=0.004, r=-0.20 palate) and enterobacteria (p=0.002, r=-0.24 palate), as well as a negative correlation between SF (p=0.009, r=-0.193) and DS. The CFU of Staphylococcus spp. and enterobacteria on the palate significantly correlated with OHRQoL.
Conclusion
Being female, consuming alcoholic beverages as a young adult, CFU of Candida spp., Candida albicans, Candida glabrata, and salivary flow may be the most significant risk factors for DS. The microbial load of Staphylococcus spp. and enterobacteria seems to influence the quality of life for complete denture wearers.
Dental examination and investigation of oral microbial flora in elderly people in two different institutions were performed and compared to each other in this study. Special attention was paid to the following : A) the number of Candida on the tongue and its correlation to denture wearing, and B) a comparison of Candida on the tongue of elderly people in both institutions versus that of elderly people living in their own homes* (*This study was a part of a project for the Ministry of Welfare investigating oral Candida in patients 70 and 80 years old). Subjects had been institutionalized in a nursing home in Kanagawa (n=50) and in a hospital for elderly people in Tokyo (n=29) and their mean age was 80.9 years old. Salivary flow rate, buffering capacity, the numbers of lactobacilli and mutans streptococci in saliva, and the numbers of Candida and staphylococci on the tongue were investigated after dental examinations were performed. When comparing the all results obtained from the nursing home and the hospital for elderly people, there were no differences. However, when comparing elderly people divided into denture-wearing and non-denture-wearing groups, the numbers of Candida and staphylococci on the tongues of those in the denture-wearing group were significantly higher than those of the non-denture-wearing group. The number of subjects who were classified in Grade IV (the number of Candida on the tongue was more than 101 CPU) was higher in the institutionalized elderly people than in the elderly people living in their own homes. These results suggested that the institutionalized elderly people had a higher number of Candida on the tongue, and denture wearing increased the number of Candida in the oral cavity because it acted as a reservoir for oral Candida.
During the past few decades, advances in oral health care
and treatment have reduced the number of edentulous
individuals and substantially increased the proportion of
adults who retain their teeth until late in life. In addition, a
still-increasing number of dentate older people have tooth
wear, oral implants, sophisticated tooth- and implantsupported
restorations and prostheses. As a result, older
people continue to need both preventive and curative
oral health care. The complexity of oral health status, oral
mucosal lesions, systemic diseases, and the general use
of multiple medications make (frail) older people more
vulnerable to oral problems than younger age groups,
even more so in those who are cognitively impaired. The
impression exists that many physicians, including elderly
care physicians, don’t examine the mouths of their patients
and have little knowledge of gerodontology and of
possible medical-dental interactions with some diseases.
This article describes the most important oral health (care)
related problems of (frail) older people, medical-dental interactions
of these oral health (care) related problems and
how oral health(care) for (frail) older people can be improved
through multidisciplinary cooperation.
Poor oral health, a potential new geriatric syndrome This article presents a brief introduction to the medical aspects of ageing and age-related diseases, and to some geriatric syndromes, followed by a discussion on their impact on general and oral healthcare provision to community-dwelling older people. Recent investigations suggest that inflammation constitutes a biological foundation of ageing and the onset of age-related diseases. Multimorbidity and polypharmacy, together with alterations in pharmacokinetics and pharmacodynamics, make older people at risk of adverse medication reactions. A side effect of several medications is causing xerostomia and hyposaliva-tion, and both the type and number of medications used are relevant. New options of general healthcare provision to community-dwelling older people are the use of mobility aids and assistive technology devices, domiciliary health care, respite care and telecare. Their oral health status may be jeopardised by frailty, disability, care dependency and limited access to professional oral health care. Recommendations for improvement are the following: better integrating oral health care into general health care, developing and implementing an oral healthcare guideline, providing customised oral hygiene care aids, domi-ciliary oral healthcare provision, visiting dental hygienists and/or nurses, oral hygiene telecare, easily and safely accessible dental offices, transforming dentistry into medical oral health care and upgrading dentists to oral physicians. In case oral healthcare providers do not take the responsibility of persuading society of the importance of adequate oral health, weakened oral health of community-dwelling older people will become a potential new geriatric syndrome.
The aim of this systematic review was to analyze the evidence on the occurrence of denture stomatitis (DS) and potential risk factors in patients wearing partial removable dental prostheses (RDPs).
MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews were searched and complemented by manual searching. Outcome measures were the presence of DS in patients wearing partial RDPs and an assessment of associated risk factors. All types of experimental and observational studies investigating an association between DS and the wearing of partial RDPs were included. Methodologic quality and level of evidence were assessed using valid scales. Two authors performed study selection, data extraction, and quality assessment independently.
A total of eight studies met the inclusion criteria. The prevalence of DS in partial RDP wearers ranged from 1.1% to 36.7%. Data on the potential risk factors were not consistent. Despite the heterogeneity and methodologic quality of included studies, an association between DS and the wearing of partial RDPs was found.
There is some evidence that the presence of DS is associated with the wearing of partial RDPs. However, because of methodologic limitations and cross-sectional designs of research studies, no cause-effect relationship could be inferred. Future research should provide higher levels of evidence to confirm the etiology of DS in partial RDP wearers.
Denture stomatitis, a common disorder affecting denture wearers, is characterized as inflammation and erythema of the oral mucosal areas covered by the denture. Despite its commonality, the etiology of denture stomatitis is not completely understood. A search of the literature was conducted in the PubMed electronic database (through November 2009) to identify relevant articles for inclusion in a review updating information on the epidemiology and etiology of denture stomatitis and the potential role of denture materials in this disorder. Epidemiological studies report prevalence of denture stomatitis among denture wearers to range from 15% to over 70%. Studies have been conducted among various population samples, and this appears to influence prevalence rates. In general, where reported, incidence of denture stomatitis is higher among elderly denture users and among women. Etiological factors include poor denture hygiene, continual and nighttime wearing of removable dentures, accumulation of denture plaque, and bacterial and yeast contamination of denture surface. In addition, poor-fitting dentures can increase mucosal trauma. All of these factors appear to increase the ability of Candida albicans to colonize both the denture and oral mucosal surfaces, where it acts as an opportunistic pathogen. Antifungal treatment can eradicate C. albicans contamination and relieve stomatitis symptoms, but unless dentures are decontaminated and their cleanliness maintained, stomatitis will recur when antifungal therapy is discontinued. New developments related to denture materials are focusing on means to reduce development of adherent biofilms. These may have value in reducing bacterial and yeast colonization, and could lead to reductions in denture stomatitis with appropriate denture hygiene.
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.
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.
The purpose of the study was to determine the prevalence of oral mucosal lesions among institutionalized elderly. The study population comprised 486 elderly from eight nursing homes, and 199 elderly from five hospital long-term care facilities in the eastern part of Denmark. Approximately half of the subjects exhibited one or more pathologic conditions of the oral mucosa. Denture related traumatic ulcerations were found in 3.9% of the nursing home residents, compared to 8.3% among the elderly in hospital long-term care. The most prevalent finding was denture stomatitis, which was manifest in about one third of the elderly. The prevalence was strongly influenced by the denture hygiene; 54% of the elderly with poor denture hygiene suffered from denture stomatitis, as compared to only 7% of those with clean dentures. The prevalence of denture stomatitis was also related to the usage of dentures at night and to the age of the dentures. The prevalence decreased significantly with increasing age, although the oldest age group did not have better denture hygiene, or more favorable wearing habits. It did not appear that sex, type of residency, degree of urbanization, denture conditions, or the use of anticholinergic drugs influenced the prevalence of denture stomatitis. The prevalence and severity of the disease can probably be reduced if the denture hygiene is improved and if the elderly only use their dentures during the daytime.(ABSTRACT TRUNCATED AT 250 WORDS)
This study describes the association of yeasts and denture stomatitis with behavioral and biologic factors.
Seven hundred eighty 55-year-old citizens of Oulu, Finland, were examined clinically; 452 of them had complete dentures. Salivary yeasts and lactobacillus counts were detected through the use of Oricult-N and Dentocult-LB dip-slide techniques. Lifestyle factors were measured by means of questions concerning physical activity, tobacco smoking, alcohol consumption, and dietary habits. Other background variables used in cross-tabulations and logistic regression analysis were unstimulated salivary secretion rate, retention of denture, oral hygiene, gender, and socioeconomic status.
The prevalence of denture stomatitis was greater among subjects with an unhealthy lifestyle, subjects with higher lactobacillus counts, and subjects with poor oral hygiene. Salivary secretion rate and smoking were associated with the presence of yeasts, but general lifestyle measures were not.
The presence of yeasts tended to be associated with biologic factors, but behavioral factors reflecting lifestyle may be more important in the development of denture stomatitis.
The purpose of this study was to investigate oral flora in independent persons aged over 80 years with more than 20 remaining teeth. The subjects were 22 participants of the 8020 campaign (6 males and 16 females) with a mean age of 81.3+/-1.6 years and an average of 24.7 teeth (Independent 8020 group). This group was compared with a group of 38 elderly people residing in nursing homes (10 males and 28 females) who had a mean age of 81.3+/-8.5 years and an average of 4.2 teeth (Nursing group with fewer teeth). Saliva samples were collected from the vestibular areas of the maxilla and mandible using cotton swabs. Cell numbers of microorganisms were expressed as colony forming units/ml (CFUs/ml) and compared between the two groups. The average number of Staphylococcus species was 65.2+/-74.4 CFUs/ml in the Independent 8020 group and 400.3+/-352.1 CFUs/ml in the group with fewer teeth (p<0.01); that of Candida albicans was 18.0+/-37.7 CFUs/ml in the Independent 8020 group and 152.9+/-211.9 CFUs/ml in the Nursing group with fewer teeth (p<0.05). Both species showed statistically significant differences between the two groups. This suggests that the Independent 8020 achiever group had better oral hygiene and that the presence of many teeth may be associated with an increased awareness of dental health.
Abstract A representative sample (n= 8000) was drawn from the population aged 30 years and over, registered as living in Finland. Periodontal disease status was recorded according to the modified Periodontal Treatment Need System (PTNS). Plaque retentions were examined separately. Of the subjects with four or more teeth 3.4% had a healthy periodontal status, while 10.2% of the jaw quadrants were healthy Plaque retentions were found in 96.6% of the subjects and 90.9% of the jaw segments. Periodontal treatment need was calculated in three ways and was 195± 111 (S. D.) min when the calculation was based on WHO recommendations (1978). Number of teeth, age, sex, caries and filling scores, and education explained about 30% of the treatment need when tested by multiple linear regression analysis.
An investigation was undertaken of 77 denture wearers to study the incidence of yeasts in the angles of the mouth, denturebearing mucosa, denture base, the throat and the gastrointestinal tract. Fifty-one denture wearers exhibited denture stomatitis and 26 showed no clinical signs of inflammation of the palatal mucosa (controls). In addition the influence of oral local treatment with an antifungal agent (Mycostatin®) on the yeast flora in the same sites was studied in denture wearers with denture stomatitis. The findings suggest a higher rate of yeast colonization in the mouth (100% compared to 40%) and feces (71% compared to 35%) in denture wearers with denture stomatitis than in denture wearers without stomatitis. Similar species of yeasts, predominantly Candida albicans, C. tropicalis and Torulopsis glabrata were identified among the isolates from the oral sites, throat and feces in denture wearers with stomatitis. In denture wearers without stomatitis the yeast species isolated from the oral sites and feces differed. In these samples the saprophytic yeasts Saccaromyces and Rhodutorula together with T. glabrata were dominating. Fourteen days of local oral treatment with Mycostatin significantly reduced the number of positive cultures of yeasts from the oral sites and the stool samples. However, after cessation of treatment the mycotic flora was largely re-established in most subjects.
Biopsy materials from the palatal mucosa showed no invasive fungal elements. All persisting yeast isolates after fourteen days treatment were susceptibility-tested and found to be sensitive to nystatin.
A quantitative estimate of the titer of agglutinins to Candida albicans was made in the serum of 303 persons wearing complete dentures. Ninety-nine persons had a clinically normal palatal mucosa, whereas 204 persons showed inflammatory changes (48 with localized simple inflammation, 80 with generalized simple and 76 with granular inflammation). Candida, harboured on the palatal mucosa, was diagnosed both by culture and by smears. Mycelium was found almost exclusively in smears from patients with the generalized simple and the granular type of denture stomatitis, and these groups of patients showed significantly higher titers as compared with the controls and the patients with the trauma-induced localized simple inflammation. A relationship was established between the severity of the involvement and the level of the antibody titer. Zero-titers, however, occurred so frequently in infected persons that the agglutinin reaction must be considered as an invaluable aid in establishing evidence of palatal candidiasis. It is noteworthy that high agglutinin titers occurring in patients who respond poorly to topical antifungal therapy may indicate systemic candidiasis, a serious condition that requires immediate systemic antifungal therapy.
Candida induced denture stomatitis usually does not reflect any deep seated abnormality, the dentures being the primary predisposing condition. However, infection with C. albicans should be recognized as an extremely common complication to the wearing of complete or partial dentures. Most cases are easily treated, but recurrences are frequent, and the infection often spreads to involve other parts of the oral mucosa, such as the tongue and the angles of the mouth. Therefore, preventive measures should be taken against colonization by Candida species of the palatal mucosa and the dentures. Patients with denture stomatitis offer an outstanding opportunity to study host parasite relationships in candidiasis in otherwise healthy individuals. In addition, the experimental model for induction of superficial candidiasis in monkeys makes it possible to study development of immunologic competence under various conditions. Although mycelium is seen consistently in smears, most abundantly in denture smears, tissue invasion is not recognized either in acquired or in experimental palatal candidiasis. It is most likely that Candida species exert their pathogenic effects partly through an enzymatic breakdown of the epithelial surface and partly by eliciting a delayed hypersensitive response, Candida endotoxins may aggravate the lesions.
Of a representative sample of 8000 persons aged 30 and over living in Finland, 3875 users of removable dentures were examined. The condition of the oral mucosa was recorded during clinical examinations. The prevalence of oral mucosal lesions associated with removable dentures was analyzed according to age, sex, place of residence, geographical region of living, and type and location of prosthesis. Lesions were found in about 50% of the denture wearers. Women were affected more often than men. The prevalence of lesions decreased with age and differed slightly according to region of living and place of residence. Compared with the wearing of partial dentures, wearing complete dentures increased the risk of lesions. Only one of the 72 denture users who wore a denture with metallic base plate had oral mucosal lesions associated with wearing a denture.