Lesions Due Denture

Drg. Rochman Mujayanto, Sp.PM

Fakultas Kedokteran Gigi
Universitas Islam Sultan Agung Semarang
INTRODUCTION
 Type of Denture
 Removable denture
1. Partial Denture
2. Full Denture

 Fixed Denture
1. Crown & Bridge
2. Implant

Type of Denture (2017)

https://www.ncbi.nlm.nih.gov/pubmedhealth/P
MH0072376/
Denture Materials

• Poly Methyl Metacrylate (PMMA)

– Heat-activated PMMA
• Powder : Polymethyl methacrylate beads along with Benzoyl peroxide (Initiator), Dibutyl phthalate
(plasticizer), pigments and opacifiers.
• Liquid : Methyl methacrylate monomer with Hydroquinone (inhibitor), Glycol dimethacrylate (cross-
linking agent) and plasticizers

– Chemically activated PMMA (cold-curing, self-

curing, autopolymerizing resins)
• dimethyl-para-toluidine
• benzoyl peroxide
• FLEXIBLE DENTURE BASE MATERIAL : nylon
based plastic (Polyamide)

• STAINLESS STEEL and BASE METAL ALLOYS

– Nickel Chrom
– Cobalt Chrom

• Titanium
Denture Problems
• Irritation  Traumatic Ulcer, Denture Fissuratum, Epulis Fissuratum
• Denture Stomatitis
• Infection  Oral candidiasis, Bacteria
• Allergy  Contact
• Halitosis
Why and How does Oral prostheses cause mucosal pathologies?

…the treatment
modalities which • Appliance put in oral cavity
deal with the 1
replacement of
missing teeth and • Appliance surrounded by mucous
contiguous 2 membrane
structures with a
suitable prostheses
can be broadly
• Disrupts normal oral conditions or oral
classified as 3 environment
removable and
fixed…
• Initiates response (pathological condition)
4
What mucosal pathologies does Oral prostheses cause?

• Prostheses are
Mucosal Pathologies of Oral Prostheses designed to conserve
the remaining
structures and maintain
Due to Removable Due to Fixed them.

• Prostheses act as
Mucosal Lesions Secondary Caries
etiological factors
either due to error
Burning Mouth Syndrome Pulpal and Periodontal Inflammation from operator,
inadequate
Allergic response Allergic Reactions
maintenance or the
properties of the
material itself.
Fungal Infection Occlusion Related Disorders

Trauma (metallic clasps) Periimplantitis

 Denture in the oral Environment
Mechanical irritation
‘Placement of Mucosal Accumulation of
removable prostheses reactions microbial plaque
in the oral cavity
produces profound Allergic reactions
changes of the oral
Negative effect on
environment that may Poor function muscle function
have an adverse effect Denture in
on the integrity of the the Oral Surface
oral tissues.’ Cavity Irregularities and Plaque formation
Microporosities

Increased permeability to
Local Irritation allergens

Accumulate Accumulate, form

Bacteria Bacterial plaque
 Interaction of prosthetic material With the oral environment
And Its consequences

• These are results of interaction of prosthetic material with the oral mucosa,
and are influenced by:
a. Surface Properties: Chemical stability, Adhesiveness,
Texture, Microporosities, Hardness
b. Chemical properties: Corrosion, Toxic Reactions, Allergic
Reactions
c. Physical properties: Mechanical irritation, Plaque
accumulation
d. Changes of environmental conditions: Plaque
Microbiology
DENTURE PAIN
• Possible causes of denture pain include :
– occlusion,
– denture base (fit and contour),
– vertical dimension,
– infection,
– a systemic disease or condition,
– allergy
Definition

• Denture stomatitis indicates an inflammatory

process of the mucosa that bears a complete or
partial removable dental appliance, typically a
denture.
“chronic denture palatitis”
“stomatitis prothetica”
“denture related candidiasis”
“denture-induced stomatitis”
“denture stomatitis”
Epidemiology

• it can affect as many as 35-50% of persons who

wear complete dentures, 10% to 70% of persons
who wear complete partial dentures.

• This disorder is more frequent among elderly

people, as they are more likely to wear
removable dentures.
Clinical presentation

• Denture stomatitis lesions may show different

clinical patterns, and are more frequently found
in the upper jaw, especially on the palate.

• The absence of denture stomatitis in the lower

jaw is probably due to the washing action of
saliva.
• Despite the fact that denture stomatitis is
frequently asymptomatic, patients may
complain of halitosis, slight bleeding and
swelling in the involved area, or a burning
sensation, xerostomia, or taste alterations
(dysgeusia).
• Different classifications have been proposed, but
the reference classification for denture stomatitis
is the one suggested by Newton in 1962, based
exclusively on clinical criteria :
 Newton in 1962 was the first to propose a classification
of denture stomatitis :
punctiform hyperemia (class I)
diffuse hyperemia (class II)
granular hyperemia (class III)
Punctiform hyperemia (Class I):
 hyperemia signs of the minor
palatine salivary glands;
 there is an erythematous
punctiform aspect,
 Small or diffuse areas in
palate may be affected
 Newton’s type I has been
shown to be the result of
trauma
Newton Type 1

• Pinpoint lesion
Diffuse hyperemia (Class II):
 smooth and atrophic
mucosa, with erythematous
aspect under the denture.
 the most common aspect of
Candida Associated
Denture Stomatitis
Newton Type 2

• Diffuse erythema
Granular hyperemia (Class
III):
 more common in dentures
with suction chambers.
 Affect the central region of
the palate, with rough and
nodular appearance of
the mucosa.
 Newton’s class III has a
multivariable interaction
phenomenon
Newton Type 3

• Granular lesion
Aetiopathogenesis

• The aetiology is best considered multifactorial, but

denture wearing, especially when worn during the
night, represents the major causative factor.
traumatic occlusion
poor oral and denture hygiene
• Factor  microbial factors
age of the denture
allergy to the denture base materials
Residual monomer
thermal stoppage below the denture
Smoking
various types of irradiation
dryness of mouth
Systemic conditions
diabetes mellitus and immunodeficiency
nutritional deficiencies
medications
Trauma

• Denture stomatitis is multifactorial in nature,

with trauma being a major independent cause.
• The trauma may originate from :
– ill-fitting or continuously worn dentures
– dentures that do not have correct vertical and
horizontal arch relations.
DENTURE IRITATION

Ulcer
DENTURE IRITATION

Epulis Fisuratum
• Denture-induced hyperplasia is a
reactive lesion arising from excessive
and chronic mechanical pressure on
the vestibular oral mucosa.
• Trauma could act as co-factor that favours the
adhesion and the penetration of the yeast,
sustains phlogosis of the palate and increases
the permeability of the epithelium to toxins and
soluble agents produced by Candida yeast.
Denture age

• Denture age is thought to be a predisposing

factor for the development of denture stomatitis,
mainly due to the poor possible fitting of the
denture, roughness of its surface, impossibility of
adequate cleaning and accumulation of plaque
and microbial pathogens
Microorganisms

• Denture can produce a number of ecological changes

that facilitate the accumulation of bacteria and yeasts.
– Bacteria proliferate. Certain bacterial species, like
Staphylococcus Sp, Streptococcus Sp, Neisseria Sp,
Fusobacterium Sp. or Bacteroides Sp has been
identified in patients with denture stomatitis.
– Candida Sp, particularly Candida albicans, have been
identified in most patients.
Poor denture hygiene

• lack of denture cleanliness is considered to be

one of the factors involved in the etiology of
denture stomatitis.
• Factors stimulating yeast proliferation, such as :
» poor oral hygiene
» high carbohydrate intake
» reduced salivary flow
» composition of saliva
» design of the prosthesis
» continuous denture wearing
Surface texture and permeability of
denture base material
• The surface of the dentures usually shows micropits
and microporosities.
• Micro-organisms harbouring in these areas are difficult
to remove mechanically or by chemical cleansing
• the microbial contamination of denture acrylic resin
occurs very quickly, and yeasts (the commonly C.
Albicans) seem to adhere well to denture base
materials.
Systemic conditions
• a variety of systemic conditions may also predispose
the individuals to candida associated denture
stomatitis.
» Malnutrition, as it occurs in high carbohydrate diets
» deficiencies in iron
» folate or vitamin B12
» hypoendocrine states such as hypothyroidism
» Addison’s disease (adrenocortical insufficiency)
» diabetes mellitus
» blood disorders (acute leukemia, agranulocytosis)
» immune disorders such as HIV infection
» xerostomia due to irradiation
» drug therapy
» cytotoxic drug therapy
» Sjogren’s syndrome
Allergy

• The most common allergens in prosthetic

materials are (meth)acrylates and metals
• Allergy to acrylates and metals is a rare
• Caused the polymerization cycle of the denture.
• Differential diagnosis Stomatittis Allergica
Contacta
ALLERGY
• The residual monomer contents tended to be
lower in dentures used for long periods than in
those used or short periods.

• Short curing cycle produces dentures with

increased residual monomer which are more
likely to induce mucosal reactions then dentures
cured by a long curing cycle.
Halitosis due Denture

• Surface roughness may facilitate microbial retention

and infection.
• Fusobacterium Sp, which excrete volatile sulfur
compounds associated with halitosis
• Volatile sulfur compound (VSC)-producing bacteria
colonizing the lingual dorsum have recently been
implicated in the generation of halitosis.
• Halitosis arising from the lingual dorsum secondary to
overpopulated VSC-producing bacteria can be
successfully managed with a combination of mechanical
cleansing using tongue brushes or scrapes and chemical
solutions containing essential oils, zinc chloride, and
cetylpyridinium chloride.
Inflamation due Denture Stomatitis

• Accumulation of plaque  colonization by

bacterial or candida increased enzymatic
activity due to ↘ salivary flow & ↘ Ph 
INFLAMMATION
How is denture stomatitis treated?

1. Patient counselling
2. Cessation of smoking in smokers.
3. Patients are advised to clean their dentures regularly
after each meal with a soft brush and soap.
4. Patients are instructed to remove their dentures before
sleeping and immerse them overnight in an alkaline
peroxide cleanser or alkaline hypochlorites.
5. soaked overnight in an antiseptic solution
(chlorhexidine  not when the denture has metal
components)
6. If suspected candidiasis, do swab to identify the
types of candida  Reffer to Microbiology
Laboratory
• A smear of the palate stained with KOH or
periodic acid-Schiff can demonstrate the
presence of Candida species.

Swab Procedur
• Topical antifungals include :
– nystatin suspension
– miconazole gel
– fluconazole suspension
– topical ketoconazole if available
– an oral antiseptic with antifungal activity such
as chlorhexidine.
Reference
• Hasan, S. and Kuldeep, (2015). Denture Stomatitis: A Literature Review. Journal of
Orofacial and Health Sciences, 6(2), pp.65-69.
• Karthikeyan, S., Fernandez, T. and Deepthi, P. (2016). Denture Stomatitis: A Brief
Review. IOSR Journal of Dental and Medical Sciences, 15(3), pp.114-115.
• KRESPI, Y., SHRIME, M. and KACKER, A. (2006). The relationship between oral malodor
and volatile sulfur compound–producing bacteria. Otolaryngology - Head and Neck
Surgery, 135(5), pp.671-676.
• Pattanaik, S., BVJ, V., Pattanaik, B., Sahu, S. and Lodam, S. (2010). Denture Stomatitis: A
Literature Review. Journal of Indian Academy of Oral Medicine and Radiology, 22,
pp.136-140.
• Stoeva, I. (2010). THE ORAL TOLERANCE TO CONTACT ALLERGENS IN
PROSTHODONTIC BIOMATERIALS. Case reports. JofIMAB, 16, book 4(2010), pp.31-34.