Interventions for improving oral health in people after stroke.

BACKGROUND: For people with physical, sensory and cognitive limitations due to stroke, the routine practice of oral health care (OHC) may become a challenge. Evidence-based supported oral care intervention is essential for this patient group. OBJECTIVES: To compare the effectiveness of OHC interventions with usual care or other treatment options for ensuring oral health in people after a stroke. SEARCH METHODS: We searched the Cochrane Stroke Group and Cochrane Oral Health Group trials registers, CENTRAL, MEDLINE, Embase, and six other databases in February 2019. We scanned reference lists from relevant papers and contacted authors and researchers in the field. We handsearched the reference lists of relevant articles and contacted other researchers. There were no language restrictions. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that evaluated one or more interventions designed to improve the cleanliness and health of the mouth, tongue and teeth in people with a stroke who received assisted OHC led by healthcare staff. We included trials with a mixed population provided we could extract the stroke-specific data. The primary outcomes were dental plaque or denture plaque. Secondary outcomes included presence of oral disease, presence of related infection and oral opportunistic pathogens related to OHC and pneumonia, stroke survivor and providers' knowledge and attitudes to OHC, and patient satisfaction and quality of life. DATA COLLECTION AND ANALYSIS: Two review authors independently screened abstracts and full-text articles according to prespecified selection criteria, extracted data and assessed the methodological quality using the Cochrane 'Risk of bias' tool. We sought clarification from investigators when required. Where suitable statistical data were available, we combined the selected outcome data in pooled meta-analyses. We used GRADE to assess the quality of evidence for each outcome. MAIN RESULTS: Fifteen RCTs (22 randomised comparisons) involving 3631 participants with data for 1546 people with stroke met the selection criteria. OHC interventions compared with usual care Seven trials (2865 participants, with data for 903 participants with stroke, 1028 healthcare providers, 94 informal carers) investigated OHC interventions compared with usual care. Multi-component OHC interventions showed no evidence of a difference in the mean score (DMS) of dental plaque one month after the intervention was delivered (DMS -0.66, 95% CI -1.40 to 0.09; 2 trials, 83 participants; I2 = 83%; P = 0.08; very low-quality evidence). Stroke survivors had less plaque on their dentures when staff had access to the multi-component OHC intervention (DMS -1.31, 95% CI -1.96 to -0.66; 1 trial, 38 participants; P < 0.0001; low-quality evidence). There was no evidence of a difference in gingivitis (DMS -0.60, 95% CI -1.66 to 0.45; 2 trials, 83 participants; I2 = 93%; P = 0.26: very low-quality evidence) or denture-induced stomatitis (DMS -0.33, 95% CI -0.92 to 0.26; 1 trial, 38 participants; P = 0.69; low-quality evidence) among participants receiving the multi-component OHC protocol compared with usual care one month after the intervention. There was no difference in the incidence of pneumonia in participants receiving a multi-component OHC intervention (99 participants; 5 incidents of pneumonia) compared with those receiving usual care (105 participants; 1 incident of pneumonia) (OR 4.17, CI 95% 0.82 to 21.11; 1 trial, 204 participants; P = 0.08; low-quality evidence). OHC training for stroke survivors and healthcare providers significantly improved their OHC knowledge at one month after training (SMD 0.70, 95% CI 0.06 to 1.35; 3 trials, 728 participants; I2 = 94%; P = 0.03; very low-quality evidence). Pooled data one month after training also showed evidence of a difference between stroke survivor and providers' oral health attitudes (SMD 0.28, 95% CI 0.01 to 0.54; 3 trials, 728 participants; I2 = 65%; P = 0.06; very low-quality evidence). OHC interventions compared with placebo Three trials (394 participants, with data for 271 participants with stroke) compared an OHC intervention with placebo. There were no data for primary outcomes. There was no evidence of a difference in the incidence of pneumonia in participants receiving an OHC intervention compared with placebo (OR 0.39, CI 95% 0.14 to 1.09; 2 trials, 242 participants; I2 = 42%; P = 0.07; low-quality evidence). However, decontamination gel reduced the incidence of pneumonia among the intervention group compared with placebo gel group (OR 0.20, 95% CI 0.05 to 0.84; 1 trial, 203 participants; P = 0.028). There was no difference in the incidence of pneumonia in participants treated with povidone-iodine compared with a placebo (OR 0.81, 95% CI 0.18 to 3.51; 1 trial, 39 participants; P = 0.77). One OHC intervention compared with another OHC intervention Twelve trials (372 participants with stroke) compared one OHC intervention with another OHC intervention. There was no difference in dental plaque scores between those participants that received an enhanced multi-component OHC intervention compared with conventional OHC interventions at three months (MD -0.04, 95% CI -0.33 to 0.25; 1 trial, 61 participants; P = 0.78; low-quality evidence). There were no data for denture plaque. AUTHORS' CONCLUSIONS: We found low- to very low-quality evidence suggesting that OHC interventions can improve the cleanliness of patient's dentures and stroke survivor and providers' knowledge and attitudes. There is limited low-quality evidence that selective decontamination gel may be more beneficial than placebo at reducing the incidence of pneumonia. Improvements in the cleanliness of a patient's own teeth was limited. We judged the quality of the evidence included within meta-analyses to be low or very low quality, and this limits our confidence in the results. We still lack high-quality evidence of the optimal approach to providing OHC to people after stroke.

Inflammatory papillary hyperplasia: A systematic review.

INTRODUCTION: Inflammatory papillary hyperplasia (IPH) is a benign lesion of the palatal mucosa. It is usually found in denture-wearers but also has been reported in patients without a history of use of a maxillary prosthesis use. OBJECTIVES: The aim of this study is to review the literature to assess the prevalence of denture stomatitis and inflammatory papillary hyperplasia and the etiological factors associated. MATERIAL AND METHODS: A search was carried out in PubMed (January 2005 to October 2015) with the key words "inflammatory papillary hyperplasia", "denture stomatitis", "granular stomatitis" and "Newton's type III" The inclusion criteria were studies including at least a sample of 50 apparently healthy patients, articles published from 2005 to 2015 written in English. The exclusion criteria were reviews and non-human studies. RESULTS: Out of the 190 studies obtained initially from the search 16 articles were selected to be included in our systematic review. The prevalence of denture stomatitis was 29.56% and 4.44% for IPH. We found 5 cases of denture stomatitis among non-denture-wearer individuals. All IPH cases were associated with the use of prosthesis. Smoking and continued use of ill-fitting dentures turned out to be the most frequent risk factors for developing IPH. CONCLUSIONS: IPH is a rare oral lesion and its pathogenesis still remains unclear. Its presentation among non-denture-wearers is extremely unusual.

10-year survival rate and the incidence of peri-implant disease of 374 titanium dental implants with a SLA surface: a prospective cohort study in 177 fully and partially edentulous patients.

PURPOSE: This prospective cohort study evaluates the 10-year survival and incidence of peri-implant disease at implant and patient level of sandblasted, large grid, and acid-etched titanium dental implants (Straumann, soft tissue level, SLA surface) in fully and partially edentulous patients. MATERIAL AND METHODS: Patients who had dental implant surgery in the period between November 1997 and June 2001, with a follow-up of at least 10 years, were investigated for clinical and radiological examination. Among the 506 inserted dental implants in 250 patients, 10-year data regarding the outcome of implants were available for 374 dental implants in 177 patients. In the current study, peri-implantitis was defined as advanced bone loss (≧1.5 mm. postloading) in combination with bleeding on probing. RESULTS: At 10-year follow-up, only one implant was lost (0.3%) 2 months after implant surgery due to insufficient osseointegration. The average bone loss at 10 year postloading was 0.52 mm. Advanced bone loss at 10-year follow-up was present in 35 dental implants (9.8%). Seven percent of the observed dental implants showed bleeding on probing in combination with advanced bone loss and 4.2% when setting the threshold for advanced bone loss at 2.0 mm. Advanced bone loss without bleeding on probing was present in 2.8% of all implants. CONCLUSION: In this prospective study, the 10-year survival rate at implant and patient level was 99.7% and 99.4%, respectively. Peri-implantitis was present in 7% of the observed dental implants according to the above-mentioned definition of peri-implantitis. This study shows that SLA implants offer predictable long-term results as support in the treatment of fully and partially edentulous patients.

The Prevalence of Oral Inflammation Among Denture Wearing Patients with Chronic Obstructive Pulmonary Disease.

Oral inflammation is an important contributor to the etiology of chronic obstructive pulmonary disease, which can impact patient's health status. Previous studies indicate that people with poor oral health are at higher risk for nosocomial pneumonia. Denture wearing is one promoting factor in the development of mucosal infections. Colonization of the denture plaque by Gram-negative bacteria, Candida spp., or other respiratory pathogens, occurring locally, may be aspirated to the lungs. The studies showed that chronic obstructive pulmonary disease (COPD) patients treated with combinations of medicines with corticosteroids more frequently suffer from Candida-associated denture stomatitis. Treatment of oral candidiasis in patients with COPD constitutes a therapeutic problem. Therefore, it is essential to pay attention to the condition of oral mucosal membrane and denture hygiene habits. The guidelines for care and maintenance of dentures for COPD patients are presented in this paper. The majority of patients required improvement of their prosthetic and oral hygiene. Standard oral hygiene procedures in relation to dentures, conducted for prophylaxis of stomatitis complicated by mucosal infection among immunocompromised patients, are essential to maintain healthy oral tissues. The elimination of traumatic denture action in dental office, compliance with oral and denture hygiene, proper use and storage of prosthetic appliances in a dry environment outside the oral cavity can reduce susceptibility to infection. Proper attention to hygiene, including brushing and rinsing the mouth, may also help prevent denture stomatitis in these patients.

Prevalence of oral mucosal lesions in an elderly population in the city of Valparaiso, Chile.

OBJECTIVE: Chilean population is ageing, which means an increase in the prevalence of multiple pathologies, including those located in the oral cavity. AIM: To measure the prevalence and distribution of oral mucosal lesions and to identify associated risk factors in elderly patients in the city of Valparaiso. MATERIAL AND METHODS: This study includes 126 patients over 60 years. The sample was calculated with a sampling error of 3.7% from a population size of 6000 file cards. Frequency and contingency tables were made together with odds ratios, with a confidence interval of 95%. Finally, we built a predictive model based on a binary logistic regression. RESULTS: From the whole sample, 85 patients (67.5%) had some oral mucosal lesion. The most frequent lesions were denture-induced stomatitis (37.1%). It was noted that there is a statistically significant association between the use of denture and the presence of oral candidiasis. The consumption of drugs and the use of denture increase the likelihood of having oral mucosal lesions. CONCLUSION: There is a high prevalence of oral lesions in the elderly patients of Valparaiso. The use of drugs and /or denture increases significantly the likelihood that a person over 60 years presents lesions in the oral mucosa.

Does the presence of anterior mandibular teeth increase the incidence of denture stomatitis?

PURPOSE: To compare the frequency of denture stomatitis (DS) under maxillary complete dentures (CDs) in patients with opposing mandibular distal extension removable partial dentures (RPDs) and CDs. MATERIALS AND METHODS: Participants included 365 maxillary CD wearers (241 women, mean age 70.5 ± 13.2 years; 124 men, mean age 71.5 ± 10.4 years) from 7 rest homes in Istanbul. A total of 268 had mandibular CDs; 97 had mandibular distal extension RPDs. Two independent, calibrated examiners performed oral examinations. Presence of maxillary denture-related stomatitis and the effect of risk factors on DS were evaluated and recorded. RESULTS: The frequency of palatal DS (Newton I-III) was 45.1% (n = 121) in the mandibular CD group and 49.5% (n = 48) in the mandibular distal extension RPD group, a statistically insignificant difference (p= 0.4). Factors significantly associated with palatal DS were maxillary denture age (p= 0.02), reduced occlusal vertical dimension (p= 0.04), and nocturnal denture wear (p= 0.03). CONCLUSION: In this study, DS beneath maxillary CDs did not differ between mandibular distal extension RPD and CD wearers. The presence of mandibular anterior teeth did not influence the occurrence of palatal DS.

Prevalence of oral mucosal lesions in a group of Iranian dependent elderly complete denture wearers.

AIM: Oral mucosal lesions are frequently observed in institutionalized elderly patients more than other age groups. The aim of this study was to determine the prevalence of epulis fissuratum and denture stomatitis and their associated causes in dependent elderly complete denture wearers. MATERIALS AND METHODS: This study was conducted in dependent elderly complete denture's wearers living in four randomly selected nursing homes located in Tehran. Associated factors such as gender, age, use of medication, site of nursing home, denture quality and denture-wearing habit were studied. RESULTS: Overall, 674 patients were examined; 201 had complete denture. The prevalence of denture stomatitis was 36%. There was significant relationship among the prevalence of denture stomatitis with gender and denture wearing period (p < 0.05). The prevalence of epulis fissuratum was 16.4%. There was significant relationship among the prevalence of epulis fissuratum with gender, denture quality and denture wearing habit (p < 0.05). CONCLUSION: In this particular dependent age group, the prevalence of oral mucosal lesions is high and the mentioned associated factors should be noticed. CLINICAL SIGNIFICANCE: Dependent elderly complete denture wearers need more support and motivation for reducing the prevalence of these particular denture-associated oral mucosal lesions.

A study to evaluate the frequency and association of various mucosal conditions among geriatric patients.

UNLABELLED: Geriatric dentistry or gerodontics is the delivery of dental care to older adults involving the diagnosis, prevention and treatment of problems associated with normal aging and age-related diseases as part of an interdisciplinary team with other health care professionals. AIM: To evaluate the oral mucosal status in the elderly population of different age group and fnd out the association of age, gender and denture with oral mucosal disorders. MATERIALS AND METHODS: The study sample consisted of 570 geriatric persons concentrating mainly on the oral mucosal changes or lesions occurring in the geriatric population. Individuals those are aged above 60 years were selected, and all the examined geriatric persons were categorized into 3 age groups to fnd out the association of oral mucosal lesions in each group. Group I-60 to 65 years, Group II-66 to 70 years, Group III-71 and above years. RESULTS: The sample of 570 elderly patients included 279 (48.95%) men and 291 (51.05%) women in three age groups: 61 to 65 years (40.35%), 66 to 70 years (31.05%), and 71 years and older (28.60%). The sample included 254 (44.56%) dentate patients, 205 (35.96%) denture wearers (partial and complete denture wearers) and 111 (19.47%) edentulous persons who lacked dentures in both the jaws. Almost half of the patients examined (48%) had one or more oral mucosal lesions. The 48% of the patients who presented with oral mucosal lesions, twenty fve different oral mucosal conditions were identifed and the three most common fndings were lingual varices (13.68%), denture induced infammatory fbrous hyperplasia (4.21%), squamous cell carcinoma (4.21%). There was some differences in the distribution of oral mucosal condition among the sexes. Leukoplakia and dysplasia were signifcantly associated with men (p < 0.001) whereas the association of fbroma and lichen planus with women were signifcant (p < 0.001). CONCLUSION: In our study it was found that patients in groups II and III had more prevalence of oral mucosal disorders. Lingual varices, oral squamous cell carcinoma, fbroma and denture induced infammatory fbrous hyperplasia were more commonly associated with the geriatric patients. The oral lesions (fbroma and lichen planus) were strongly associated with women while leukoplakia was strongly associated with men. Ageing is an important factor that can infuence the occurrence of mucosal lesions and with age the oral mucosa becomes more permeable to noxious substances and more vulnerable to external carcinogens.

Management of Chronic Atrophic Candidiasis (Denture Stomatitis)-A Narrative Review.

One of the most common oral diseases affecting people wearing dentures is chronic atrophic candidiasis or denture stomatitis (DS). The aim of the paper is to provide an update on the pathogenesis, presentation, and management of DS in general dental practice settings. A comprehensive review of the literature published in the last ten years was undertaken using multiple databases, including PubMed via MEDLINE, EMBASE, and Scopus. The eligible articles were analyzed to identify evidence-based strategies for the management of DS. Despite its multifactorial nature, the leading cause of DS is the development of oral Candida albicans biofilm, which is facilitated by poor oral and denture hygiene, long-term denture wear, ill-fitting dentures, and the porosity of the acrylic resin in the dentures. DS affects between 17 and 75% of the population wearing dentures, with a slight predominance in elderly females. The mucosal denture surfaces and posterior tongue are the common sites of DS, and the affected areas exhibit erythema, the swelling of the palatal mucosa and edema. Oral and denture hygiene protocols, adjusting or re-fabricating poorly adapting dentures, smoking cessation, avoiding nocturnal denture wear, and the administration of topical or systemic antifungals are the mainstay of management. Alternate treatments such as microwave disinfection, phytomedicine, photodynamic therapy, and incorporation of antifungals and nanoparticles into denture resins are being evaluated for the treatment of DS but require further evidence before routine use in clinical practice. In summary, DS is the most common oral inflammatory lesion experienced by denture wearers. Most patients with DS can be managed in general dental practice settings. Effective management by general dental practitioners may be supported by a thorough understanding of the pathogenesis, the recognition of the clinical presentation, and an awareness of contemporary treatment strategies.

Candida-associated denture stomatitis: clinical, epidemiological, and microbiological features.

OBJECTIVE: The identification of Candida spp. in denture stomatitis, the clinical manifestations, and the antifungal susceptibility profile lead to a correct and individualized therapeutic management of the patients. This study is aimed at investigating the clinical manifestations and epidemiological and microbiological characteristics of Candida-associated denture stomatitis. DESIGN: The samples were obtained by swabbing the oral mucosa of the subjects and then seeded onto Sabouraud Dextrose Agar and onto CHROMagar® Candida plates. The identification at the species level was confirmed by Matrix Assisted Laser Desorption Time of Flight Mass Spectrometry. Clinical classification was performed according to the criteria proposed by Newton (1962): (i) pinpoint hyperemia, (ii) diffuse hyperemia, and (iii) granular hyperemia. For carrying out the antifungal susceptibility testing, we adopted the CLSI M27-S4 protocol. RESULTS: C. albicans was the most prevalent species in our study. Regarding non-albicans Candida species, C. glabrata was the most common species isolated from the oral mucosa (n = 4, 14.8%), while in the prosthesis, it was C. tropicalis (n = 4, 14.8%). The most prevalent clinical manifestation was pinpoint hyperemia and diffuse hyperemia. Candida albicans, C. glabrata, and C. parapsilosis were susceptible to all the tested antifungals. Concerning fluconazole and micafungin, only two strains showed dose-dependent sensitivity (minimum inhibitory concentration (MIC), 1 µg/mL) and intermediate sensitivity (MIC, 0.25 µg/mL). One C. tropicalis strain was resistant to voriconazole (MIC, 8 µg/mL). CONCLUSIONS: C. albicans was the most common species found in oral mucosa and prosthesis. The tested antifungal drugs showed great activity against most isolates. The most prevalent clinical manifestations were Newton's type I and type II.

Management of Denture Infection with Phytomedicine.

Natural teeth are an integral part of the masticatory system. Absence of dentition subjects the individual to compromised oral function, facial appearance and phonetics. Rehabilitation with dental prosthesis is imperative to restore form and masticatory activity. Currently, fabrication of removable and fixed prosthesis has become most predictable. Nonetheless, there is an increased prevalence of oral stomatitis observed over the years in edentulous individuals wearing removable dentures. Amongst the many pathogens that cause denture infections, Candida albicans is assumed to be the most virulent opportunistic agent. Different methods, such as mechanical, chemical, chemicmechanical, and pharmacological are tried to fight such infections. Regardless of various management strategies developed to treat denture stomatitis, the research continues to evolve the most optimal one. Improper oral and or denture hygiene maintenance, surface irregularities on denture, persistence of xerostomia and associated systemic illness pose risk for exaggeration of the disease. In extreme conditions, the development of aspiration pneumonia in geriatric patients is considered a threat to both dental and medical specialists. Therapeutic administration of synthetic anti-microbial drugs, along with meticulous oral hygiene maintenance are recommended protocols till date. However, limitations such as antibiotic resistance, side effects, counter drug reactions, cost of the medicaments predispose to origin of natural herbal products to treat denture stomatitis. Vast array of plant products are studied in previous literature, yet no definitive edge of one over the other is proven. This article intends to provide a mini-review on the different organic plant materials, also called as phytomedicines used for the treatment of candida associated denture stomatitis (CADS).

Oral health in institutionalised elderly people in Oslo, Norway and its relationship with dependence and cognitive impairment.

OBJECTIVE: Investigating oral health's relationship with dependency and cognitive state. BACKGROUND: Oral hygiene is poor in the institutionalised elderly. There are problems regarding the oral care of residents having poor mobility or cognitive impairment. MATERIAL AND METHODS: Cross-sectional study involving 135 participants (mean age 85.7, SD 8.8 years) in two categories: nurses doing tooth cleaning and residents doing tooth cleaning. Those cleaned by nurses were categorised as co-operative or unco-operative. The oral hygiene status, presence of caries, retained roots and denture-related stomatitis were recorded. RESULTS: Of the participants, 70% had only natural teeth. The prevalence of caries was 28%. A significant correlation showed that having more teeth gave a poorer Simplified Oral Hygiene Index (OHI-S) (p = 0.018). The number of retained roots increased with the severity of cognitive impairment (p < 0.05). Significant differences were found between nurses or residents doing the tooth cleaning on the OHI-S (p = 0.05) and percentage of dental plaque (p = 0.003). Unco-operative residents had poorer oral hygiene (p = 0.028), more caries (p = 0.008) and were more often moderate-severe cognitive impaired (p = 0.016). CONCLUSIONS: A high percentage of participants had unacceptable oral hygiene. Residents whose teeth were cleaned by the nurses had poorer oral hygiene. Unco-operative residents had the worst oral hygiene and more caries.

Loss of natural dentition: multi-level effects among a geriatric population.

OBJECTIVE: To quantify the impact of edentulousness on residual ridge volume, denture stomatitis (DS), as well as oral health behaviours among geriatric denture-wearers. BACKGROUND: Residual ridge resorption (RRR) is the primary intraoral complication of complete edentulism, but individual variation among geriatric patients has been observed. MATERIALS AND METHODS: Data collection relied upon a 10-year retrospective chart review of all complete denture-wearing geriatric patients presenting at the Removable Prosthodontics Clinic, Dental School of Athens, between 1993 and 2002. Analyses relied on descriptive, bivariate, and multivariate methods based on ordinal logistic regression. RESULTS: A total of 873 records of geriatric patients (age mean = 72; median = 70; range = 65-95) comprised our analytical sample. Subjects' mean (SD) time since edentulation was 7.7 (10.2) years. Eleven percent were diagnosed with temporomandibular disorder (TMD). While 28% of patients reported cleaning their dentures at least daily, 6% presented with denture stomatitis (DS). Each added year of edentulism increased the odds of mandibular RRR: OR (95% CI) = 1.05 (1.03, 1.07). Nightly denture wear was the strongest risk factor for DS. Finally, independent of age and sex, each year of being edentulous increased the odds of presenting with TMD: OR (95% CI) = 1.03 (1.01, 1.05). CONCLUSION: Time since edentulation was strongly associated with mandibular but not maxillary RRR, as well as TMD development.

Prevalence of oral mucosal lesions in institutionalized elderly people in Mashhad, Northeast Iran.

OBJECTIVE: The aim of this study was to determine the prevalence of oral mucosal lesions in institutionalized elderly people in Mashhad, northeast of Iran. BACKGROUND: This study was conducted to assess the prevalence of oral lesions in the institutionalized elderly. METHODS: In this survey, we studied all of the nursing homes in Mashhad; a total of five encompassing 237 residents. The subjects were examined and lesions recorded in a designed checklist. T-test, chi-square and Fisher's exact tests were used for the analysis. RESULTS: The mean age of the patients was 79.59 ± 8.88. Ninety-eight per cent of cases had at least one oral mucosal lesion. The most common lesions were fissured tongue (66.5%), atrophic glossitis (48.8%), sublingual varicosity (42%) and xerostomia (38%). There was no significant difference in the prevalence of denture-related lesions (DRLs) between men and women (p > 0.05). Xerostomia was more prevalent in 70-79-year-old than in 60-69-year-old subjects. No case of oral malignant lesion was detected. DISCUSSION: These findings revealed a higher prevalence of oral mucosal lesions in Mashhad city compared with other studies conducted in other major cities in Iran and abroad. The results emphasise the necessity of national programmes towards oral health promotion.

The prevalence of denture stomatitis and its predisposing conditions in an older Greek population.

BACKGROUND: Pathology related to complete denture-wearing will remain an important issue because of an increase in the ageing population. OBJECTIVE: To investigate the prevalence and the risk factors for denture-related stomatitis in the edentulous maxilla of older patients with a maxillary complete denture. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Factors affecting the distribution and prevalence of oral mucosal lesions in complete denture wearers.

OBJECTIVE: To determine the frequency of the oral lesions related to gender, age, the length of time of denture usage, education level and economic status. METHODS: The 153 patients with old complete dentures (CD) were asked to participate in the investigation. The subjects (76 male and 77 female) were 37-85 years of age with a mean age of 61.8 ± 9.8 years. Education, economic status and age factors were estimated in subgroups. The data obtained were evaluated by one-way anova, Mann-Whitney U-test, Kruskal-Wallis test, Student's t-test and chi-squared test. The level of statistical significance was set at p<0.05. RESULTS: The patients who had denture stomatitis and traumatic ulcers were statistically significantly older than the ones who did not have these lesions (p<0.05). Based on the length of denture usage, patients who had a flabby ridge, fibrous inflammatory hyperplasia, traumatic ulcers (p<0.01) and denture stomatitis (p<0.05) were using their dentures statistically significantly longer than the ones who had healthy tissues. CONCLUSIONS: The CD wearers should be advised to visit their dentist regularly to prevent oral mucosal lesions due to the changing supporting tissues during the length of denture usage and to improve their quality of life.

Epidemiology and etiology of denture stomatitis.

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.

Efficacy of Rose Bengal and Curcumin mediated photodynamic therapy for the treatment of denture stomatitis in patients with habitual cigarette smoking: A randomized controlled clinical trial.

BACKGROUND: Cigarette smoking in conjugation with bad oral hygiene is considered a typical predisposing factor for many oral diseases including denture stomatitis. This study investigated the effect of Rose Bengal (RB)-and Curcumin (CUR)-mediated photodynamic therapy (PDT) in comparison with nystatin therapy in the intervention of denture stomatitis in cigarette smokers. METHODS: Overall, 45 habitual cigarette smokers aged ~58 years having denture stomatitis were categorized into three groups: Group-I - RB-mediated PDT, Group-II - CUR-mediated PDT, and Group-III - Nystatin therapy. The primary outcome of the interest was: counts of Candida colony from denture surface and palatal mucosa, calculated as CFU/mL, whereas the prevalence of Candida species determined in 3 research groups comprised the secondary outcome. Oral swab specimens were gathered from the denture surfaces and palatal mucosa. All clinical assessments were performed at baseline, 6 weeks, and 12 weeks. RESULTS: C. albicans was the most prevalent yeast identified on both denture surfaces and palatal mucosa, followed by C. tropicalis and C. glabrata. A considerable decrease in the CFU/mL scores were observed in Group-I and Group-II at the end of the interventions and on the 12-week follow-up (p<0.05). Group-I, II, and III demonstrated clinical efficacy rates of 53%, 51%, and 49%, respectively. CONCLUSION: CUR-and RB-mediated PDT was found to be as effective as topical Nystatin therapy for the intervention of denture stomatitis among cigarette smokers.

Influence of hormone supplementation therapy on the incidence of denture stomatitis and on chemiluminescent activity of polymorphonuclear granulocytes in blood of menopausal-aged women.

BACKGROUND: Menopause is a health and social problem that affects a large number of women. Inadequate quantity of steroid hormones also impacts quality of the mucous membrane of the oral cavity. During menopausal age, many women wear removable prosthetic restorations in order to replace missing teeth. Such restorations may facilitate the development of inflammations in the surface of the oral cavity, referred to as denture stomatitis. OBJECTIVE: The aim of the study was to evaluate the influence of hormone supplementation therapy on the incidence of Candida-associated denture stomatitis and on the metabolic activity of polymorphonuclear granulocytes in peripheral blood of female patients. MATERIAL AND METHODS: The study was conducted on a group of women in menopausal age, users of hormone replacement therapy and of removable prosthetic restorations. Female patients were subjected to a clinical study that included interviews and physical examinations. Laboratory microbiological examinations were completed on the basis of direct swabs collected from the mucous membrane of the oral cavity and from the surface of dentures. Metabolic activity of polymorphonuclear granulocytes in peripheral blood of female patients was evaluated by means of a chemiluminescence test. RESULTS: Candida-associated denture stomatitis observed was characterized by a strong growth of fungi and a lower chemiluminescent activity of neutrophils in blood of female patients undergoing hormone supplementation therapy. CONCLUSIONS: Patients using hormone supplementation therapy and removable prosthetic restorations constitute a high-risk group for Candida infections and inflammations of the mucous membrane of the oral cavity; thus they should remain under constant dental control.

Determining Candida spp. incidence in denture wearers.

The aim of this study was to determine Candida spp. incidence in the oral cavity of denture wearers and characterize predisposing factors in denture-related stomatitis (DRS). Three groups of denture wearers and a control group were evaluated for DRS according to Newton's classification. The amount of yeast in saliva and the presence of yeast on mucosal surfaces were determined by phenotyping methods, and the impact of some risk factors on candidal carriage was evaluated. The development of DRS is most common in complete prosthesis users. When the count of yeast in saliva is >or=400 cfu/ml, the frequency of DRS is increased. In individuals who develop DRS, the most frequently encountered species that was identified as C. albicans. Prosthetic hygiene was related to the intensity of candidal growth and the development of DRS. C. albicans live as saprophyte in the oral cavity. But, it is capable of causing infection if there are predisposing conditions related to the host. Usage of removable prosthesis may cause these microorganisms to gain pathogenicity.