OVERVIEW

What is denture stomatitis?

Denture stomatitis (also known as denture sore mouth) is also called chronic erythematous (atrophic) oral candidiasis, a type of candidal stomatitis.

Candidiasis is a primary or secondary infection caused by certain pathogenic species of Candida, which can affect the skin, mucous membranes, and internal organs, presenting as acute, subacute, or chronic inflammation. Oral candidiasis is referred to as candidal stomatitis.

One type, where the lesions often occur on the palatal and gingival mucosa in contact with the upper denture (false teeth), is called denture stomatitis.

Note: Currently, denture stomatitis may also include traumatic denture stomatitis, but this article primarily focuses on Candida-associated denture stomatitis.

Is denture stomatitis common?

It is relatively common, particularly among middle-aged and elderly female denture wearers.

SYMPTOMS

What are the manifestations of denture stomatitis?

• Common symptoms: The mucosa appears bright red and edematous, with yellow-white striated or spotted pseudomembranes.

• Affected areas: Often occurs in the palatal and gingival mucosa in contact with the palatal side of the upper denture. Fungal stomatitis caused by lower dentures is very rare, while the mucosa in the bearing area of upper dentures is prone to denture stomatitis. This may be due to the strong negative pressure adsorption of upper dentures, which displaces antibodies from saliva in this area, and the broad and tight contact between the base and mucosa, allowing pathogenic fungi to accumulate.

• Associated symptoms:

  • Patients often experience dry mouth and a burning discomfort in the oral cavity.
  • Denture stomatitis is often accompanied by palatal papillary hyperplasia.
  • Among patients with candidal cheilitis or angular cheilitis, 80% have denture stomatitis. It can also occur alone without concurrent lip or angular lesions.

What conditions should denture stomatitis be differentiated from?

Since the lesions of denture stomatitis clearly match the shape of the palatal base of the upper denture, clinical differentiation is relatively straightforward. In cases with particularly atypical features, it should be distinguished from another condition characterized by pseudomembranous lesions—coccal stomatitis. In coccal stomatitis, the mucosa shows significant congestion and edema, with large patches of gray-yellow pseudomembranes that are smooth, dense, and easily wiped off, leaving an eroded surface with oozing blood.

CAUSES

What are the causes of denture stomatitis?

• Pathological factors: Studies have shown that fungi are the primary cause of denture stomatitis. Fungi attached to dentures are the main pathogenic factor. The surface roughness of dentures greatly affects the survival of Candida albicans. Candida albicans can adhere to various prosthetic surfaces, and the rough surface of the denture base provides more adhesion area and a favorable environment for biofilm formation. The attachment of Candida albicans to prostheses can lead to inflammation and pain in the underlying mucosal tissues.

• Personal factors: Although removable dentures appear smooth, they actually have many micropores that easily accumulate and adsorb fungi. Common situations include:

  • Inadequate denture cleaning: Causes bad odor, affects diet, reduces gastrointestinal function; breeds bacteria, leading to ulcers or other oral and systemic diseases.

  • Poor fit with oral tissues: Causes chewing pain, difficulty eating normally, friction-induced swelling, pain, and ulcers; leads to dental caries, periodontal disease, and denture stomatitis.

  • Improper denture cleaning methods: Soaking or rinsing with hot water or alcohol can cause damage, deformation, and reduce lifespan; toothbrushes may scratch dentures, creating grooves that harbor bacteria and infect the mouth.

• Iatrogenic factors: Flexible denture bases made of silicone rubber are more prone to retaining and adsorbing fungi, increasing the risk of denture stomatitis. Additionally, while soft lining materials are clinically used to restore injured mucosa, improper use can worsen mucosal inflammation, leading to denture stomatitis.

DIAGNOSIS

How is denture stomatitis diagnosed?

The diagnosis mainly relies on medical history, clinical features, and mycological examination. Since healthy individuals can be carriers, comprehensive evaluation is crucial.

What tests are needed for patients with denture stomatitis? Why are these tests performed?

Denture stomatitis is a fungal infection. In addition to medical history and routine oral examination, mycological tests are required for clinical confirmation. Generally, three methods are commonly used:

• Smear method: This is the most widely used clinical method. Samples such as pseudomembranes or exfoliated epithelium from the oral mucosa are placed on a slide for observation. The presence of abundant pseudohyphae indicates pathogenic Candida. However, smear tests can only detect fungi without identifying species and have lower sensitivity in patients with dry oral mucosa.

• Culture method: The collected specimens are inoculated into a culture medium and examined microscopically. Thick-walled spores confirm Candida albicans. Common sampling methods include swab, saliva culture, concentrated rinse, and paper disc techniques.

• Immunological method: Indirect immunofluorescence is used to measure anti-Candida fluorescent antibodies in serum and unstimulated mixed saliva. Due to strong cross-reactivity, this method has a high false-positive rate.

TREATMENT

Which department should I visit for denture stomatitis?

Dentistry.

Does denture stomatitis require hospitalization?

No.

How is denture stomatitis treated?

The treatment principle involves eliminating predisposing factors, actively managing underlying conditions, and providing supportive therapy when necessary. Treatment is divided into local and systemic approaches:

• Eliminating predisposing factors: During severe infection, it is advisable to temporarily discontinue denture use to allow infected mucosa to recover. Maintain oral hygiene and clean dentures regularly.

• Local medication:

  • 2%–4% sodium bicarbonate solution: Since Candida does not thrive in alkaline environments, rinsing with this solution can inhibit its growth.

  • Chlorhexidine: With antifungal properties, a 0.2% solution or 1% gel can be applied topically, used as a rinse, or combined with nystatin to form an ointment or cream, optionally with a small amount of triamcinolone acetonide.

  • Nystatin: A 50,000–100,000 units/ml aqueous suspension can be applied topically every 2–3 hours and swallowed afterward.

  • Miconazole.

• Systemic antifungal therapy:

  • Fluconazole: Taken once daily with mild side effects, primarily nausea and occasionally rash, which resolve after discontinuation.

  • Itraconazole: 100 mg daily, with possible side effects including mild headache, gastrointestinal symptoms, and hair loss.

DIET & LIFESTYLE

What should denture stomatitis patients pay attention to in their diet?

Maintain a healthy, regular, and balanced diet, consume more vitamin-rich foods, and minimize spicy, irritating, and overly sticky foods.

What should denture stomatitis patients pay attention to in daily life?

In clinical practice, the majority of denture stomatitis cases are caused by improper denture use and poor oral hygiene.

• Denture storage: To maintain oral hygiene and prevent gum damage, remove and clean dentures after meals. Before sleeping, take them out and store them in a denture case to protect oral mucosa from bacterial and fungal infections.

• Denture cleaning:

  • Clean dentures with denture cleaning tablets and water. Avoid hot water or alcohol to prevent aging or deformation. Soak them in denture cleaning solution for 3-4 hours before bedtime, or overnight for heavy tartar buildup.
  • Additional cleaning tips: Do not use regular toothpaste, as it can roughen dentures and promote plaque growth. Use mild dish soap instead. After soaking, gently brush dentures again for thorough cleaning.

• Denture retention: Use professional denture adhesives or pads to ensure a stable, pain-free fit, maintaining chewing efficiency and preventing bacterial/fungal entry. Seek dental check-ups if discomfort occurs.

PREVENTION

Can Denture Stomatitis Be Prevented?

First, during the initial denture restoration, if the patient feels that the denture is unstable or poorly retained, they should promptly inform the dentist. The dentist can then take measures to ensure the retention and stability of the denture base, as well as balanced force distribution in various jaw positions, minimizing trauma to the underlying tissues. Additionally, poorly fitting or long-used dentures should be replaced.

Oral hygiene must be maintained. Older adults generally have poorer oral health, with thinning, dry, atrophic, and less elastic oral mucosa due to aging. Reduced salivary gland function leads to decreased and thicker saliva, making food debris more likely to adhere between the oral mucosa and dentures or within denture crevices, hindering self-cleaning. Moreover, saliva shifts from acidic to alkaline—conditions that favor Candida proliferation and mucosal invasion. Therefore, denture wearers should prioritize oral hygiene and clean their dentures regularly and thoroughly.