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.

A novel rat model of denture stomatitis and the role of antibiotics in the development of the disease.

This study compared different conditions to establish a rat model of denture stomatitis. Immunocompetent Wistar rats were divided into two groups (n = 35): Tetracycline = administration of 0.83 mg/ml of tetracycline hydrochloride 7 days before induction of denture stomatitis and amoxicillin = administration of 0.156 mg/ml of amoxicillin with clavulanic acid 4 days before induction of denture stomatitis. A suspension of Candida albicans was inoculated on the palate followed by the use of a palatal device contaminated with C. albicans inoculum for 4 days to induce denture stomatitis. As controls, some rats were not submitted to any procedure or used a sterile palatal device for 4 days. The development of denture stomatitis was confirmed by visual analysis, colony-forming units per milliliter (CFU/ml) count, histopathological and immunohistochemical analyses, and through myeloperoxidase (MPO) and N-acetylglucosaminidase (NAG) assays. Rats were euthanized right after device removal (T0), 4 (T4), or 6 (T6) days after device removal. Tetracycline improved the development of the disease, with more severe clinical signs at T0. Similar results were observed in the CFU/ml count and in the histometric and immunohistochemical analyses. Higher MPO expression was detected in the palates of the tetracycline group (P = .006). Despite the subtle differences between antibiotics, tetracycline showed better results in inducing and maintaining denture stomatitis for at least 4 days after device removal.

Denture stomatitis is an oral inflammatory disease with high recurrence rates. Different animal models have been reported in the literature, but some gaps still need to be addressed. A reproducible in vivo model should be established to test new treatment approaches.

Experimental animal models for denture stomatitis: A methodological review.

Denture stomatitis is the most prevalent form of oral candidiasis and the most frequent oral lesion in removable prosthesis wearers. It is characterized by an inflammatory response of the denture-bearing mucosa, especially the palatal mucosa, and its clinical signs include chronic edema and erythema, and papillary hyperplasia. Despite having a multifactorial etiology, its main etiological agent is the infection by Candida albicans. Given its high treatment failure rates, an in vivo model of denture stomatitis should be established to test alternative treatments. The aim of this study is to review the existing denture stomatitis models and to provide an overview of the main methodological differences between them. Over the last 40 years, different animal models were developed in order to study denture stomatitis etiopathogenesis and to assess novel therapies. Many approaches, including the use of antibiotics and immunosuppressors, have to be further investigated in order to establish which protocol is more appropriate and effective for the development of an animal model of denture stomatitis.

Candida glabrata Has No Enhancing Role in the Pathogenesis of Candida-Associated Denture Stomatitis in a Rat Model.

Denture stomatitis (DS) is a condition characterized by inflammation of the oral mucosa in direct contact with dentures and affects a significant number of otherwise healthy denture wearers. Candida-associated DS is predominantly caused by Candida albicans, a dimorphic fungus that readily colonizes and forms biofilms on denture materials. Previous studies showed a requirement for Candida biofilm formation on both palate and dentures in infection and identified fungal morphogenic transcription factors, Efg1 and Bcr1, as key players in DS pathogenesis. While both C. albicans and Candida glabrata are frequently coisolated in mucosal candidiasis, a pathogenic role for C. glabrata in DS remains unknown. Using an established rat model of DS, we sought to determine whether C. glabrata alone or coinoculation with C. albicans establishes colonization and causes palatal tissue damage and inflammation. Rats fitted with custom dentures were inoculated with C. albicans and/or C. glabrata and monitored over a 4-week period for fungal burden (denture/palate), changes in body weight, and tissue damage via lactate dehydrogenase (LDH) release as well as palatal staining by hematoxylin and eosin (H&E) and immunohistochemistry for myeloperoxidase (MPO) as measures of inflammation. C. glabrata colonized the denture/palate similarly to C. albicans In contrast to C. albicans, colonization by C. glabrata resulted in minimal changes in body weight, palatal LDH release, and MPO expression. Coinoculation with both species had no obvious modulation of C. albicans-mediated pathogenic effects. These data suggest that C. glabrata readily establishes colonization on denture and palate but has no apparent role for inducing/enhancing C. albicans pathogenesis in DS.IMPORTANCE Many denture wearers suffer from Candida-associated denture stomatitis (DS), a fungal infection of the hard palate in contact with dentures. Biofilm formation by Candida albicans on denture/palate surfaces is considered a central process in the infection onset. Although Candida glabrata is frequently coisolated with C. albicans, its role in DS pathogenesis is unknown. We show here, using a contemporary rat model that employed a patented intraoral denture system, that C. glabrata established stable colonization on the denture/palate. However, in contrast to C. albicans inoculated rats, rats inoculated with C. glabrata exhibited minimal changes in weight gain or palatal tissue damage. Likewise, coinoculation with the two Candida species resulted in no exacerbation of C. albicans-induced DS pathology. Together, our findings indicate that C. glabrata has no inducing/enhancing role in DS pathogenesis.

Frecuencia de candidiasis oral asociada al uso de prótesis dentales en pacientes de la clínica odontológica de la Universidad Anáhuac Norte / The frequency of oral candidiasis associated with the use of dental prostheses in patients of the dental clinic at the Anahuac University

La candidiasis es la infección micótica más común de la cavidad bucaly es causada por el hongo Candida. Dentro de la población geriátricala candidiasis oral es uno de los tres principales motivos de consulta. El crecimiento en superfi cies es parte natural del modo de vivir del hongo Candida y es común que colonice las prótesis dentales, dando como resultado estomatitis por uso de dentadura o estomatitis subplaca.El diagnóstico de estomatitis por dentadura es relevante, ya quealrededor de 50 por ciento de las personas de edad promedio de 65 a 74 años, y 70 por ciento de 75 a 84 años utilizan prótesis dentales removibles. El objetivo del presente estudio fue determinar la frecuencia de candidiasis oral asociada a prótesis dentales removibles en los pacientes de la ClínicaOdontológica de la Universidad Anáhuac México Norte durante el periodo enero-mayo de 2016. Material y métodos: Se realizó un estudiodescriptivo, transversal y observacional. La muestra estuvo conformada por pacientes portadores de prótesis dentales removibles que acudieron a la Clínica Odontológica de la Universidad Anáhuac México Norte.Se interrogó al paciente respecto al uso de la prótesis y su condición de salud, posterior a la exploración clínica se tomó la citología exfoliativa de la mucosa debajo de la prótesis removible. Resultados: La muestraestuvo constituida por 22 pacientes de la clínica de prótesis removible,seis eran portadores de prótesis, de éstos 83 por ciento fueron positivos a candidiasis. Conclusiones: La falta de indicaciones sobre el cuidado, uso ehigiene de las prótesis dentales o la falta de apego a estas indicacionespor parte del paciente ocasionan el desarrollo de estomatitis subplaca.

Candidiasis is the most common mycotic infection in oral cavity andcaused by fungi candid. Oral candidiasis is one of three principalreasons for consultation in a geriatric population. A natural part of theway of living of the fungi Candida is the growth on surfaces. It growthmakes common that the fungi Candida colonize the dental prostheses,so the denture stomatitis or dental-related stomatitis is development.Denture stomatitis diagnosis is quite important because from the totalpopulation using dental removable prostheses around of 50% is between65-74 years old and 70% is between 75-84 years old. The ofthis study was identifying oral candidiasis frequency related to dentalremovable prostheses in patients from Universidad Anahuac, DentalSchool (México Norte), from January 2016 to May 2016. Material andmethods: Was made a descriptive, cross and observational study. Thesample was integrated by patients using dental removable prostheses,who went to Universidad Anahuac’s dental school (México Norte). Thepatients were interrogated about dental removable prostheses use andtheir health condition, after clinic exploration and exfoliative cytologywas taken from mucosa below dental removable prostheses. Results: 22patients from dental service using removable prosthesis constituted thesample, from this 22 patients only 6 were using a removable prosthesisand from this 6 patients only 83% were positive to oral candidiasis.Conclusions: Instructions scare about care, use, and hygiene of dentalprosthesis as well as not follow these instructions for patient’s partmake possible denture stomatitis development.

Biocompatibilidade in vivo de material resiliente temporário para base de prótese modificado por antimicrobianos para tratamento da estomatite protética / Biocompatibility in vivo of temporary soft denture liner for denture base modified by antimicrobials agents for denture stomatitis treatment

Reembasadores resilientes temporários contendo fármacos antifúngicos foram sugeridos como um tratamento adjunto para estomatite protética. No entanto, antes de utilizar clinicamente estes reembasadores modificados em humanos, é importante avaliar a sua biocompatibilidade em modelos animais. Este estudo avaliou a biocompatibilidade in vivo de um reembasador resiliente temporário para base de prótese (Trusoft) modificado por agentes antimicrobianos em suas mínimas concentrações inibitórias (MCIs) para biofilme de Candida albicans. Dispositivos acrílicos intra-orais (DIOs) foram confeccionados individualmente para 60 ratos Wistar. Os ratos foram divididos em 6 grupos (n=5): 3 grupos controle (Negativo: sem DIO; Geral: DIO sem reembasamento; Positivo: DIO reembasado com Trusoft sem fármacos) e 3 grupos experimentais (DIOs reembasados com Trusoft modificados por fármacos em suas respectivas MCIs: 0,032 g de nistatina, 0,064 g de diacetato de clorexidina e 0,128 g de cetoconazol). Os ratos com ou sem os DIOs foram eutanasiados após 7 e 14 dias de avaliação. A análise histopatológica qualitativa foi realizada comparando-se fotomicrografias de secções histológicas, que foram obtidas utilizando um microscópio óptico que abrangeu transversalmente a região intermolares. As alterações morfológicas no epitélio e queratina foram analisadas quantitativamente através da realização de planimetria computadorizada. Os dados quantitativos foram analisados utilizando ANOVA 2-fatores e teste de Tukey (=0,05). A análise quantitativa mostrou que apenas o grupo com DIO contendo cetoconazol diminuiu significativamente a espessura e a área do estrato córneo em comparação com os outros grupos (p<0,05), que não apresentaram diferenças significativas entre si (p>0,05). Estes resultados estiveram de acordo com os obtidos para análise qualitativa. A incorporação de MCIs de nistatina e diacetato de clorexidina no Trusoft não induziram alterações histopatológicas na mucosa palatina de ratos, sugerindo a biocompatibilidade in vivo deste protocolo para o tratamento de estomatite protética.(AU)

Temporary resilient denture liners containing antifungal drugs have been suggested as an adjunct treatment for denture stomatitis. However, before clinically using these modified liners in humans, it is important to assess their biocompatibility in animal models. This study evaluated the in vivo biocompatibility of a temporary soft denture liner (Trusoft) modified by antimicrobial agents at their minimum inhibitory concentrations (MICs) for biofilm formation by Candida albicans. Methods: Acrylic intraoral devices (IODs) were individually made for 60 Wistar rats. The rats were divided into the following 6 groups (n=5): 3 control groups (Negative: without IOD; General: IOD without relining; Positive: IOD relined with Trusoft without drugs) and 3 experimental groups (IOD relined with Trusoft modified by drugs at MICs: 0.032 g for nystatin, 0.064 g for chlorhexidine diacetate, and 0.128 g for ketoconazole). The rats with or without the IODs were sacrificed after 7 or 14 days of evaluation. Histopathological qualitative analysis was performed by comparing photomicrographs of histological sections, which were obtained using an optical microscope that transversely covered the inter-molar region. Morphological changes in the epithelium and keratin were quantitatively analyzed by performing computerized planimetry. Quantitative data were analyzed using 2-way ANOVA and Tukey's test (=0.05). Quantitative analysis showed that only the group with IOD containing ketoconazole significantly decreased the thickness and area of the stratum corneum compared with the other groups (p<0.05), which showed no significant differences between each other (p>0.05). These results were in accordance with those obtained for qualitative analysis. Incorporation of MICs of nystatin and chlorhexidine diacetate in Trusoft did not induce histopathological changes in the palatal mucosa of rats, suggesting the in vivo biocompatibility of this protocol for treating denture stomatitis.(AU)

Photodynamic inactivation of virulence factors of Candida strains isolated from patients with denture stomatitis.

Candida species are major microorganisms isolated in denture stomatitis (DS), an inflammatory process of the mucosa underlying removable dental prostheses, and express a variety of virulence factors that can increase their pathogenicity. The potential of Photodynamic inactivation (PDI) in planktonic culture, biofilms and virulence factors of Candida strains was evaluated. A total of 48 clinical Candida isolates from individuals wearing removable maxillary prostheses with DS were included in the study. The effects of erythrosine (ER, 200 µM) and a green LED (λ 532 ± 10 nm, 237 mW/cm(2) and 42.63 J/cm(2)) in a planktonic culture were evaluated. The effect of the addition of ER at a concentration of 400 µM together with a green LED was evaluated in biofilms. The virulence factors of all of the Candida strains were evaluated before and after the PDI process in cells derived from biofilm and planktonic assays. All of the Candida species were susceptible to ER and green LED. However, the biofilm structures were more resistant to PDI than the planktonic cultures. PDI also promoted slight reductions in most of the virulence factors of C. albicans and some of the Candida tropicalis strains. These results suggest that the addition of PDI is effective for reducing yeasts and may also reduce the virulence of certain Candida species and decrease their pathogenicity.

Influence of denture plaque biofilm on oral mucosal membrane in patients with chronic obstructive pulmonary disease.

Patients with chronic obstructive pulmonary disease (COPD) have the lower airways colonized with pathogenic bacteria in a stable period of the disease and during exacerbations. The etiology of bacterial exacerbations of COPD depends on the underlying disease, the frequency of exacerbations and antibiotic therapy. Microorganisms can be aspirated off the denture plaque biofilm into the lower respiratory tract and could reduce the patient's immunity and cause pneumonia. COPD patients, who are using acrylic dentures in oral cavity, are exposed to denture stomatitis and oral candidiasis. The aim of this study was to establish the composition of denture plaque biofilm and its impact on the oral mucosa in COPD patients. The study included patients in a stable phase of COPD using removable denture and the control group included healthy wearer's appliances. Examinations concerned the oral mucosal membrane and the hygienic condition of prosthetic restorations. Microbiological examinations were performed by taking a direct swab from the surface of acrylic dentures. Seventeen bacterial and fungal strains were isolated from denture plaque of COPD patients, which could be a reservoir of pathogens in the upper and lower airways. The results showed a greater frequency of prosthetic stomatitis complicated by mucosal infections among COPD patients compared to healthy subjects.

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.

Is denture stomatitis always related with candida infection? A case control study.

AIM: To examine the oral mucosa under the denture base and to determine the influence of local factors that contribute to denture stomatitis. METHODS: In this prospective, case control study 30 patients with palatal inflammatory lesions were evaluated. A degree of palatal inflammation was scored. Swab samples were taken from tongue and palatal mucosa for microbiological examination. Denture plaque index, data of night wearing dentures, pH values of tongue and palatal mucosa were determined for all subjects. RESULTS: Significantly higher incidence of poor denture cleanliness index (p=0.01) and night wearing of dentures (p=0.009) were found in patients with denture stomatitis. There were significant differences between the groups in relation to the pH value of the tongue and palatal mucosa (p=0.016 and p=0.035, respectively). No significant association was found between denture stomatitis and microbiological findings, dentures age, type of dentures, presence of previous prosthesis, frequency or manner of dentures hygiene and smoking habits. CONCLUSION: Poor denture hygiene, overnight wearing of dentures and oral mucosa pH less than 6.5 are predominant local etiologycal factors that contribute to denture stomatitis development.

Terapia fotodinâmica antimicrobiana no tratamento de candidíase em paciente com prótese total mucossuportada superior - relato de caso / Candidiasis treatment with antimicrobial photodynamic therapy in patient with upper complete denture - case report

As próteses totais mucossuportada têm por objetivo reabilitar o sistema estomatognótico de pacientes desdentados totais, restabelecendo a saúde das estruturas de suporte bucais. Apesar da constante busca pela perfeição na confecção de próteses totais, lesões como a Candidíase podem estar associadas ao seu uso. O objetivo deste trabalho foi apresentar um caso clínico de estomatite protética tratada por meio da Terapia Fotodinâmica Antimicrobiana (aPDT), associada ao tratamento protético. O presente estudo mostrou que a luz emitida pelo laser associada ao CHIMIOLUX© foi eficiente em reduzir o número de células de C. albicans e regredir as manifestações clínicas da candidíase atrófica crônica. Assim, aPDT pode ser considerada uma alternativa viável ao tratamento coadjuvante para as lesões fúngicas intraorais e alternativa terapêutica para desinfecção de PTM. Apesar da eficiência da aPDT, a necessidade de orientar o paciente quanto … mudança de hábitos de higiene bucal e utilização de próteses adaptadas são de grande importância na manutenção da saúde dos tecidos orais

Complete mucous membrane-supported dentures aim to rehabilitate the stomatognathic system of edentulous patients, restoring oral health. Even with a constant search to improve complete dentures’ manufacturing process some adverse effects such as candidiasis may still occur. The aim of this study was to present a clinical case of denture stomatitis treated by Antimicrobial Photodynamic Therapy (aPDT), associated with prosthetic treatment. This study showed that the laser light associated with CHIMIOLUX© is effective in reducing the number of cells of C. albicans and to reverse clinical manifestations of chronic atrophic candidiasis. Thus, the aPDT can be considered a viable alternative to adjuvant treatment for denture stomatitis caused by C. albicans and to reverse clinical manifestations of chronic atrophic candidiasis. The aPDT can also be used for disinfection of complete dentures. Despite the efficiency of the aPDT, counseling the patients about oral hygiene and the use of adapted prostheses has great importance in preserving the health of oral tissues

Candidíase oral: um enfoque sobre a estomatite por prótese / Oral candidiasis: a focus on denture stomatitis

A estomatite por prótese é uma condição patológica caracterizada por um processo inflamatório que acomete a mucosa oral. Objetivo: à luz da literatura, discutir as relações de candidíase oral e estomatite por prótese. Resultados e Discussão: Diversos fatores, encontrados com frequência, podem estar relacionados à sua etiologia, entre eles: fungos, especialmente do gênero Candida; traumas na mucosa, que podem ser provocados pela prótese mal adaptada; idade avançada; xerostomia; tabagismo; doenças que levam o paciente a um estado de imunossupressão e higiene precária. Nesses casos, são observadas alterações teciduais, especialmente na presença de próteses superiores. Normalmente associados à doença, estão os fungos do gênero Candida, espécies leveduriformes, onde a C. albicans é a mais conhecida e frequentemente associada à manifestação clínica. A capacidade dos microrganismos envolvidos de formar biofilmes é condição precípua para a evolução da infecção. O biofilme acumula-se em superfícies duras como dentes e próteses, produzindo uma película envolta por matriz extracelular proveniente tanto do hospedeiro quanto dos microrganismos; trata-sede uma estrutura organizada, composta por seres unicelulares que formam uma estrutura multicelular, garantindo a sobrevivência coletiva destes em seu interior. Supõe-se que essa característica seja regulada por um mecanismo chamado quorum sensing, mediado pela densidade celular no interior dos biofilmes e por moléculas autoindutoras. Conclusão: Sendo assim, a estomatite por prótese é uma doença infecciosa multifatorial que envolve fatores relacionados ao microrganismo e ao hospedeiro. Tais fatores contribuem para a manifestação da doença que afeta uma parcela significativa dos usuários de prótese dentária...

Denture stomatitis is a pathological condition characterized by an inflammatory process that affects the oral mucosa. Objective: to discuss the relation among oral candidiasis and denture stomatitis thorough an ample literature review. Results and Discussion : Several factors, frequently found, may be related to its etiology, including: fungi, especially genus Candida; trauma in the mucosa, which can be caused by badly fitting denture; old age; xerostomia; smoking; diseases that lead the patient to a state of immunosuppression and poor hygiene. In those cases, tissue changes are observed, especially in the presence of upper dentures. Usually associated with the disease are fungi of the genus Candida, where the C. albicans is the most widely known and frequently associated with clinical manifestations. The ability of involved microorganisms to form biofilms is essential condition for the infection development. The plaque accumulates on hard surfaces such as teeth and prostheses, producing a film surrounded by extracellular matrix from both the host and the microorganisms; it's an organized structure, consisting of unicellular beings that form a multicellular structure, ensuring the collective survival these inside. It is believed that this characteristic is regulated by a mechanism called quorum sensing, mediated by cell density within the biofilm and self-inducing molecules. Conclusion: Thus, the denture stomatitis is a multifactorial infectious disease that involves factors related to the microorganism and host. Such factors contribute to the manifestation of the disease that affects a significant portion of dentures users...

Clinical and histological findings of denture stomatitis as related to intraoral colonization patterns of Candida albicans, salivary flow, and dry mouth.

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. Candida 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.

In vitro Candida albicans biofilm induced proteinase activity and SAP8 expression correlates with in vivo denture stomatitis severity.

Denture stomatitis is a common inflammatory disorder of the palatal mucosa amongst denture wearers. The pathological changes are induced by Candida albicans biofilm on the fitting surface of the upper denture, and different individuals experience different levels of disease. C. albicans is known to produce secreted aspartyl proteinases (SAPs) to aid adhesion, invasion and tissue destruction. We hypothesised that differential expression and activity of SAPs from denture stomatitis isolates results in different levels of disease amongst denture wearers. We selected C. albicans isolates from asymptomatic controls and three different severities of disease [Newton's type (NT) 0, I, II and III]. We assessed biofilm formation and proteinase activity for each biofilm and investigated the transcriptional profile of SAPs 1, 2, 5, 6 and 8 from early (12 h) and mature (24 h) biofilms. There were no significant differences between isolates with respect to biofilm formation, whereas proteinase activity normalised to biofilm growth was significantly increased in the diseased groups (p < 0.0001). Proteinase activity correlated strongly with SAP expression (p < 0.0001). SAP8 expression was the greatest, followed by SAP5, 6, 2 and 1. The diseased groups showed the greatest levels of SAP expression, with significant differences also observed between the groups (p < 0.005). All SAPs except SAP5 were expressed in greater amounts in the mature biofilms compared to early biofilms. Overall, this study suggests that SAP activity in biofilms determined in vitro may help to explain differences in disease severity. SAP8 has been shown for the first time to play a prominent role in biofilms.

Comparison of therapeutic effect of aqueous extract of garlic and nystatin mouthwash in denture stomatitis.

INTRODUCTION: Denture stomatitis (DS) is the most common form of chronic oral candidiasis. The standard treatment for DS is nystatin, which is accompanied with complications such as a bitter taste. The aim of this study was to compare the effect of garlic with nystatin in DS. MATERIAL AND METHODS: This randomised clinical trial study was performed on 40 patients with DS. After obtaining written consent, patients were divided into two groups while members of each group were given either nystatin or garlic extract for 4 weeks. The length and width of erythema area was measured at the end of the first, second, third, and the fourth weeks using a calliper. Data were analysed by SPSS and statistical tests including variance analysis with anova repeated measures, chi-square, and least square differences. RESULTS: The changes in the length and width of erythema at different times according to the type of treatment were found to be significant while an accelerated recovery was demonstrated for nystatin (p < 0.001). Both regimens resulted in significant recovery (p < 0.0001). Greater satisfaction with the use of garlic rather than nystatin was mentioned (p < 0.0001). CONCLUSION: Considering the efficacy of garlic and lack of side effects for this compound and also regarding the nystatin-associated complications, garlic extract can be introduced as a substitution for standard treatment in DS.

Correlation between factors associated with the removable partial dentures use and Candida spp. in saliva.

OBJECTIVES: To correlate the presence and number of Candida spp. in the saliva of wearers of removable partial dentures retained with precision attachments with the proportion of metal/acrylic resin present in the dentures. METHODS: Saliva samples from 40 removable partial denture wearers (test) and one paired sample of individuals, non-wearers of any type of removable denture (control) were collected, seeded, and the colony forming units of Candida counted and identified. The metal/acrylic resin proportion of each denture was quantified, using silicone plates pressed over each denture. RESULTS: Candida spp. was found in the saliva of 80% of the individuals in the test group and 65% of the control, with C. albicans being the most prevalent species. The test group presented with the highest number of colony forming units of Candida per ml of saliva, and there was weak correlation between this number and the metal and resin area of the denture (Pearson's coefficient of correlation). Greater prevalence and a higher number of colony forming units of Candida per ml of saliva occurred in removable partial denture wearers (p = 0.04) with a weak positive correlation between the metal and resin area and the number of colony forming units of Candida per ml of saliva. However, this correlation was more significant for the area of resin.

Avaliação da expressão gênica da proteína aspartil secretada 2, 5 e 9 (SAP-2, SAP-5 e SAP-9) e sua correlação com a invasão epitelial por Candida albicans em modelo experimetal de estomatite protéica in vivo / Evaluation of gene expression of secreted aspartyl proteinase -2, -5 and -9 (SAP-2, SAP-5 and SAP-9) and its correlation with epithelial invasion by Candida albicans in a in vivo denture stomatitis experimental model

A Estomatite protética associada a Candida (EPC) acomete a mucosa bucal em contato com próteses removíveis e, clinicamente, caracteriza-se por eritema com diferentes graus de inflamação. Esta doença é considerada de etiologia multifatorial, isto é, uma associação de fatores como trauma, falta de higienização, uso contínuo da prótese, hipersensibilidade ao material usado na dentadura, diabetes, terapia imunossupressora e infecção por fungo, como diferentes espécies de Candida. Os principais fatores de virulência deste fungo são a formação de hifas, dimorfismo, alterações fenotípicas, aderência, persistência, sinergismo com as bactérias, interferências com o sistema de defesa do hospedeiro e a produção de enzimas hidrolíticas. Dentre as enzimas hidrolíticas, a proteinase aspartil secretada (SAP) é uma das mais importantes para a patogenia de C. albicans, sendo nociva para o tecido epitelial e para o sistema imune do hospedeiro. Não está totalmente compreendida a real penetração do fungo nos tecidos e sua correlação com a presença da SAP, na doença estomatite protética. Essa dificuldade de avaliação pode ser justificada pelas divergências intrínsecas e extrínsecas observadas em muitos aspectos, como diferentes costumes, hábitos sociais, estado emocional e fisiológico. A utilização de um modelo experimental em animais poderá minimizar essas divergências e fornecer condições mais padronizadas para o experimento. Neste trabalho, foram avaliadas, quantitativamente, a expressão gênica das enzimas SAP-2, SAP-5 e SAP-9, presentes no biofilme formado na superfície interna das placas acrílicas superiores de ratos e, microscopicamente, a invasão do fungo no tecido epitelial do palato. Para isso, foram selecionados 49 ratos Wistar, com 90 dias de vida, pesando em média 300g, os quais foram divididos em 3 grupos: Controle, Placa/Candida e Placa, acompanhados durante 2, 4 e 6 dias. Os resultados demostraram que, em 4 dias de uso da placa acrílica...

Denture stomatitis (D.S.) affects the oral mucosa in contact with removable dentures, and clinically characterized by erythema with varying degrees of inflammation. This disease is considered a multifactorial etiology, with a combination of factors such as trauma, lack of hygiene, continuous use of stents, hypersensitivity to the material used for dentures, diabetes, immunosuppressive therapy and fungal infection, such as different species of Candida. The main virulence factors of the fungus are the formation of hyphae, dimorphism, phenotypic changes, adherence, persistence, synergism with bacteria, interference with the host defense system and the production of hydrolytic proteins. Among the hydrolytic proteins, the secreted aspartyl proteinase (SAP) is one of the most important in the pathogenesis of C. albicans. SAP is harmful to both the epithelial tissue and to the host's immune system. It is not fully understood the real penetration of the fungus in the epithelium tissue and its correlation with the presence of SAP, in denture stomatitis. This difficulty in evaluation can be justified by the intrinsic and extrinsic differences observed in many aspects, different customs, social`s habits, emotional and physiological state. Using an experimental animal model may minimize these differences and provide more standardized conditions for the experiment. In the present work, the aim was to evaluate quantitatively the gene expression of enzymes SAP-2, SAP-5 and SAP-9 of the biofilm formed in internal surface of rat`s upper acrylic plates, and to analysis microscopically, the fungal invasion in palatal epithelial tissue. 49 Wistar rats were selected, 90 days old, weighing on average 300g. They were divided into three groups: Control Group, Plate/Candida and Plate, follow by 2, 4 and 6 days of the use of the plates. The results demonstrated, in four days of use of the acrylic plate, clinical signs of inflammation in the hard palate; microscopically epithelial...

Atividade antifúngica de uma pomada à base de chamomilla recutita sobre candida albicans / Antifungal activity of chamomilla recutita based pomade on candida albicans

O objetivo do estudo foi avaliar a atividade antifúngica de uma pomada à base de [Chamomilla recutita (L) Rauschert] (camomila) sobre espécies do gênero Cândida. Vinte e seis isolados clínicos Cân- dida (e. a/bicans, e. dub/iniensis, e. krusei, e. parapsi/osis) e três cepas de referência foram semeadas em ágar Sabouraud dextrose a 3rC/24h antes da realização do experimento. Foi realizada a diluição seriada do produto nas concentrações de 500f0, 250f0, 12,5%, 6,25%, 3,12%, 1,56% e 0,78% em ágar RPMI tamponado com MOPS. Foram obtidas suspensões padronizadas na escala 5 de McFarland em solução fisiológica esterilizada (NaCI 0,9%) de cada isolado a ser avaliado. Posteriormente, as suspensões dos microrganismos foram semeadas em placas de Petri contendo o produto teste + ágar RPMI através de replicador de Steers e incubadas em estufa bacteriológica a 3rC/24h. Um controle de crescimento foi incluído no estudo e os testes foram realizados em duplicata. O resultado foi avaliado através da observação da presença ou ausência de crescimento de colônias no ágar. Os testes mostraram que das 26 amostras avaliadas, 14 amostras (53,9%) foram inibidas na concentração de 500f0, 11 amostras (42,3%) foram inibidas na concentração de 25%, uma amostra (3,9%) foi inibida na concentração de 12,5%. A pomada não teve efeitos inibitórios sobre a cepa de referência e. krusei. A partir dos resultados obtidos, concluiu-se que o produto testado apresentou atividade antifúngica in vitro sobre a maioria dos isolados de Cândida avaliados.

The aim of this study was to evaluate the antifungal activity of a chamomile [Chamomilla recutita (L) Rauschert] based ointment. Twenty-six clinical isolates of Candida (e. a/bicans, e. dub/iniensis, e. krusei, e. parapsi/osis) and three reference strains were spread onto Sabouraud dextrose agar and incubated under 37°C/24 h before the experiment. The ointment was serially diluted (500f0, 25%, 12.5%, 6.25%,3.12%, 1.56% and 0.78%) in RMPI agar buffered with MOPS. Standardized suspensions of each strain were prepared in saline solution (NaCl 0.9%) based on scale 5 of McFarland. Next, the suspensions of each microorganism were plated on Petri using a Steers replicator and incubated at 37°C/24 h. A positive control was included and the tests were performed in duplicate. The result was evaluated by the observation the presence or absence the colonies on the agar. The tests showed that from the 26 isolates evaluated, 14 (53,9%) were inhibited by the concentration of 500/0, 11 strains (42,3%) were inhibited by the concentration of 25%, one strain (3.9%) were inhibited by the concentration of 12.5%. The ointment did not show inhibitory effects on e. krusei reference strain. Based on the results obtained, we concluded that the product evaluated showed antifungal activity in vitro on the majority of the tested isolates.

Cytogenetical damage in exfoliated oral mucosa cells in elderly people suffering denture stomatitis.

OBJECTIVES: The aim of this study was to evaluate comparatively the DNA damage (micronucleus) and cellular death (pyknosis, karyolysis and karyorrhexis) in exfoliated oral mucosa cells from chronic denture stomatitis patients and healthy controls. BACKGROUND: Over the course of ageing, individuals may develop many diseases such as denture stomatitis. MATERIAL AND METHODS: A total of 23 chronic denture stomatitis patients and 23 controls presenting good oral conditions were included in this study. Individuals had epithelial cells mechanically exfoliated, placed in fixative and placed on clean slides, which were checked for nuclear phenotypes. RESULTS: The results indicated no statistically significant differences (p > 0.05) of micronucleated oral mucosa cells from chronic denture stomatitis patients when compared to healthy controls. Nevertheless, chronic denture stomatitis was able to increase other nuclear alterations closely related to cytotoxicity such as karyorrhexis, pyknosis and karyolysis as depicted by significant differences (p < 0.05) between groups. No interaction was observed between smoking and chronic denture stomatitis. CONCLUSION: In summary, these data indicated that chronic denture stomatitis was able to induce cytotoxic effects as assessed by a micronucleus test.

Correct complete denture rehabilitation, a chance for recovering abused tissues.

The prosthodontic treatment must provide for the edentulous patients bio-functional prosthetic restorations, bio-prophylactic for the surrounding tissues. In this aim, an edentulous patient must be submitted to a methodical clinical examination in order to establish the quality of hard and soft tissues, which will indicate the degree of difficulty of the prosthetic treatment. Additional investigation as a microbiologic examination and cephalometric radiographs can be useful in a modern investigation. In our daily practice, we are rarely confronted with a normal morphology of the denture bearing oral structures. The problem of managing abused tissues in a patient with morphologic abnormalities due to faulty prostheses is sometimes difficult to solve. Preventing the deterioration of oral status must be a condition in providing a chance for the success of the following rehabilitations, mainly in the situation when the complete edentulousness succeeds in a young or middle age patient.