Clinical and Histological Findings of Denture Stomatitis as Related to Intraoral Colonization Patterns of Candida albicans, Salivary Flow, and Dry Mouth

Abstract

Purpose Multifactorial etiological factors contribute to denture stomatitis (DS), a type of oral candidiasis; however, unlike other oral candidiasis, DS can occur in a healthy person wearing a denture. In this study, we therefore attempt to explore the association between candida, denture, and mucosal tissue using 1) exfoliative cytology, 2) the candidal levels present in saliva, on mucosal tissues and on denture surfaces, and 3) the salivary flow rate and xerostomic symptoms. Materials and Methods A cross-sectional study enrolled 32 edentulous participants, 17 without DS as controls and 15 with DS (Newton’s classification type II and III). Participants with systemic or other known oral conditions were excluded. Participants completed a xerostomia questionnaire, and salivary flow rates were measured. Samples of unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) were collected. UWS was used for fungal culturing. Periodic acid-Schiff (PAS) stain and quantitative exfoliative cytology were performed on samples from affected and unaffected mucosa from each participant. Levels of Candida species (albicans and non-albicans) were determined in salivary samples (expressed as colony-forming units, CFU), as well as from swab samples obtained from denture fitting surfaces, in addition to affected and unaffected mucosa. Results There were no significant differences in salivary flow rates, mucosal wetness, or frequency of reported dry mouth comparing participants with and without DS. Exfoliative cytology of mucosal smears demonstrated significantly higher (P = 0.02) inflammatory cell counts in DS patients, as compared with smears of healthy denture-wearers. C. albicans was significantly more prevalent in saliva (P = 0.03) and on denture surfaces (P = 0.002) of DS participants, whereas mucosal candidal counts and the presence of cytological hyphae did not show significant difference comparing DS to healthy participants. Conclusions In this investigation, we presented a unique group of healthy edentulous patients. This population may reflect the general DS population without systemic or other oral diseases. The prominent etiological factor for DS in this population is the presence of candida in denture and saliva. We found that other factors such as saliva flow/xerostomia, fitting of the denture, and the presence of candida in the mucosa, are less important in this population. Therefore, DS treatments in healthy patients should first focus on sanitization of an existing denture and/or fabrication of a new denture.

Candidíase oral em usuários de próteses dentárias removíveis: fatores associados

“…Altarawneh et al 11 concluem que o fator etiológico importante para estomatite protética na população de pacientes edêntulos é a presença de Candida em prótese e saliva. Verificou-se que outros fatores, tais como o fluxo salivar, xerostomia, adaptação da prótese e a presença de Candida na mucosa, são menos importantes nesta população.…”

Hareketli̇ Protez Kullanimi İle İli̇şki̇li̇ Oral Mukoza Lezyonlari Ve Ri̇sk Faktörleri̇

“…61 Altarawneh ve ark. 62 protezlerin candida türü organizmalar için rezervuar oluĢturduğunu, bu nedenle antifungal tedaviden çok mevcut protezlerin sanitizasyonu ya da yeni protezlerin yapılmasının yararlı olacağını vurgulamıĢlardır. Hareketli protez kullanan Tip 2 diabetes mellituslu hastalarda angular Ģelitise sağlıklı kontrol grubuna göre daha sık rastlanmıĢtır.…”

<i>In vivo</i> study of antifungal effects of low-molecular-weight chitosan against <i>Candida albicans </i>

“…Other members of the Candida species are C. guilliermondii, C. parapsilosis, C. krusei, and C. tropicalis; these are found in the oral cavity but rarely cause disease (1)(2)(3). C. albicans exists in a yeast form that is relatively safe and a hyphae form that is usually associated with invasion of host tissue (2)(3)(4). At least three factors determine the clinical existence of a fungal infection: the immune status of the host (1,2,5), the status of the oral cavity (1,2), and the fungal species involved (1,3).…”