Denture-Related Oral Pathology

• Aetiology:

  • Trauma
  • Physical/chemical
  • Chronic/acute
  • Infection
  • Autoimmune
  • Neoplasia
• Traumatic ulcer:

  • Overextension of flange (the part that extends into the gingival sulcus) - rubs on the mucosa and causes irritation
  • Sequestration of bony spicule
  • Rough fitting surface
  • Foreign body beneath denture (fruit pip)
  • Varying size
  • Painful
  • Corresponds to trauma
  • May have proliferative inflammatory margin
  • Non-specific histology
  • Management:
  • Correction of underlying cause
  • Review
  • If no resolution consider referral
  • Be suspicious

  
• Inflammatory hyperplasia (denture granuloma):

  • Relieve affected area
  • Encourage pt to leave denture out
  • Surgery rarely indicated

  
• Extreme alveolar atrophy:

  • Flabby ridge
  • Retained mandibular anterior teeth only and the alveolar ridge is massively resorbed in the maxilla, leaving very flabby ridges

  
• Infective aetiology:

  • Candida Albicans
  • Acute pseudomembranous candidosis
  • 5% newborns, 10% elderly debilitated, AIDS (people whose immune systems don't work properly)
  • Acute atrophic candidosis
  • Prolonged steroid or  broad spectrum antibiotics (antibiotic sore mouth)
  • Chronic hyperplastic candidosis (can be a precursor to oral cancer)
  • Candida leukoplakia (white bits on tissues can't be wiped off)
• Chronic atrophic candidosis - Denture Induced Stomatitis (DIS):

  • 24-60% denture wearers
  • Palatal mucosa (area that's most covered by dentures really)
  • Females > males (females tend to want to wear their dentures more, so the tissues don't get a chance to clean themselves)
  • Frequently symptomless, but can involve mucosal bleeding, swelling, burning, halitosis, unpleasant taste, dryness
  • Angular cheilitis (occurs at corners of the mouth)
  • Other microorganisms may be present e.g. Staph. aureus

  
• Chronic atrophic candidosis - Denture Induced Stomatitis (DIS):

  • Type I - pin point hyperaemia and diffuse inflammation (limited area)

  
• Chronic atrophic candidosis - Denture Induced Stomatitis (DIS):

  • Type II (the one that's most commonly seen) - diffuse erythema of most of the denture bearing area

  
• Chronic atrophic candidosis - Denture Induced Stomatitis (DIS):

  • Type III - granular inflammation or inflammatory papillary hyperplasia

  
• Chronic atrophic candidosis - Denture Induced Stomatitis (DIS) aetiology:

  • Poor host defences
  • Xerostomia
  • Continuous denture wear
  • Denture trauma
  • Denture plaque
  • Candida albicans
  • Malnutrition - iron deficiency, excess carbohydrates
  • Oral antibiotics - in the presence of inflammation
  • Hormonal imbalance - tolerance of the oral tissues trauma decreased
• Management of denture-related oral pathology:

  • Denture hygiene advice
  • Leave dentures out at night
  • Tissue conditioners
  • Correction of denture faults
  • Diet advice
  • Microwave dentures
  • Antifungal agents
  • Type II/III - topical use best
  • Miconazole Oral Gel (DAKTARIN) - 2% gel, TDS, 14 days
  • Nystatin or amphotericin B
  • Fluconazole Capsules (DIFLUCAN) - 50mg/day, 7-14 days
  • Systemic anti-fungals
  • Fluconazole Capsules (DIFLUCAN) - 50mg/day, 7-14 days
  • Amphotericin B (side effects of nausea, vomiting, diarrhoea, plus renal, bone marrow, cardiovascular or neurological toxicity)
• Oral thrush - the disease of the diseased:

  • A sign that something else is wrong with the patient - their immune system is compromised in some way
  • Elderly
  • Frail
  • Prone to opportunistic infections
  • Social considerations

  
• Autoimmune denture-related oral pathologies:

  • Denture base allergy
  • Very rare
  • Similar symptoms to stomatitis
  • Positive patch test
  • Alternative materials eg Pro-flex (vinyl)
• Neoplasia denture-related oral pathologies:

  • Not directly related to denture wear
  • High suspicion
  • Any ulcer that doesn't resolve