Denture Stomatitis By Tiffany Montes What is Denture

Denture Stomatitis By: Tiffany Montes

What is Denture Stomatitis? Denture stomatitis is a candidiasis (fungal infection) that occurs only beneath a denture. It can be asymptomatic or symptomatic causing a burning sensation, discomfort and bad taste.

Candida albicans v. Diploid fungus v. Kingdom: Fungi v Class: Saccharomycetes v. Genius: Candida candidaconquered. wordpress. com

8 different types of Candida • Candida albicans • Candida cruser • Candida glabrara • Candida parapsilosis • Candida tropicalis • Candida stelatoidea • Candida kefyr guilliermondii

Question time • What is another name for denture stomatitis? A) B) C) D) Chronic atrophic candidiasis Papillary hyperplasia Palatal papillomatosis All of the above

Correct Answer is… D) All of the above

Contributing factors: v denture wearers v Candida albicans v Poor oral hygiene v Lack of knowledge: removing @ night v Smoking v Ill fitting dentures v Decreased salivary flow v Vitamin A deficiency

Newton’s Classification of Denture stomatitis • Type 1= localized inflammation • Type 2= diffuse erythema (redness) without hyperplasia • Type 3= Inflammation, erythema and involves papillary hyperplasia

CASE STUDY William aka Sal

William • 62 year old Caucasian male • Currently under the care of a physician • Previously hospitalized: Hernia 1996 ; broken neck 1995 • Last visit 3 months ago for a cleaning? (1 yr) Coming to CCC since 2008

Medical History “Yes” answers • • • Arthritis Cold Sores Drug addiction Hepatitis High blood pressure Persistent cough • Psychiatric disorders • Recreational drug use • STD’s • Tobacco use • Other-smoking herbs

EO/IO Significant findings • 2 5 x 5 mm bilateral scars above eyebrows (from halo brace) • Red, irritated tissue on upper ridge bilaterally • Multiple red papules on hard palate (12 x 6 mm)= Denture stomatitis • Slightly fissured and coated tongue • Xerostomia

Dental History • William has a (FUD) full upper denture. -Fits poorly, chewed by dog uniquedental. co. nz

Dental Findings • • • Gen. 6 -7 mm pockets Gen BOP Gen. 4 -5 mm recession Loc. class II mobility Loc. class 1 furcations Gen. Horizontal bone loss Case Class V AAP IIB

QUESTION TIME: • If Williams probing depth was 7 mm and his recession was 5 mm, his total CAL (clinical attachment level) would be? A) 12 mm B) 10 mm C) 2 mm

CORRECT ANSWER IS… A) 12 mm *Can anyone tell me the Clinical attachment loss? ?

Social History Previous Meth/Cocaine addiction; quit in 1985 Tobacco use previously Patient wears an ankle monitor On probation so can’t smoke marijuana Currently smoking herbs from co-op (Mullen, Mugwart, Catnip, White sage, Yerba Santa, Damiana) • Has a dog that he speaks of at every visit • • •

Chief Complaint • William just wants his teeth cleaned and to prevent loosing more teeth. • Would like to find a place to fix his dentures. • Mentioned getting rid of gaps in his teeth and whitening them.

Oral Hygiene Status • Appointment 1= 1. 66 • Appointment 2= 1. 66 • Overall Fair according to the OHI-S. Only scored from lower teeth. *Reviewed denture brushing on each appointment. Gum go betweens for diastemas.

Oral Hygiene Status Cont. • • • Oral hygiene with dentures= non existent No removal of dentures No cleaning of dentures Broken dentures Brushed remaining teeth well. Just struggled with interproximal areas.

Concerns Denture stomatitis Carrington College California DH Clinic

QUESTION TIME: • According to Newton’s Classification of denture stomatitis, William is a Type…? A) Type 1 B) Type 2 C) Type 3 D) He does not have denture stomatitis

CORRECT ANSWER IS… C) Type 3 due to involvement of papillary hyperplasia

Possible causes: • Smoking with dentures in • Leaving dentures in to sleep • Not cleaning dentures • Ill fitting dentures

Suggested Modifications • • Removing dentures while smoking/quitting Daily denture brushing/cleaning Removing dentures to sleep Denture reline or new dentures

Treatment Plan • 1 st appointment: 7 PA’s, local anesthesia, SRP LR sextant, tobacco/herb cessation, Medical referral for denture stomatitis. • 2 nd appointment: Tobacco/herb cessation, local anesthesia, SRP mand. anterior sextant and LL sextant, dental referral. Recommend 3 mon recare appointment.

THE 8 HUMAN NEEDS • Skin & mucous • Protection from membrane integrity of health risks the head and neck • Freedom from fear • Biologically sound and stress functional dentition • Freedom from pain • Conceptualization and • Wholesome facial problem solving image • Responsibility for oral health.

Williams Unmet needs (7) Protection from health risks Freedom from fear and stress Wholesome facial image Skin and mucous membrane integrity of the head and neck • Biologically sound and functional dentition • Conceptualization and problem solving • Responsibility for oral health • •

In Conclusion… • Denture stomatitis was not being cared for and grew from 12 x 6 mm to 20 x 10 mm • Patient didn’t seem concerned • I would have liked to recommend some of the research findings, but was unsure about liability to the clinic and myself. • Additional denture care and tobacco cessation could be beneficial.

References • • • • Hadžić, S. D. -V. (2008, June 26). Influence of candida infection on denture stomatitis. Retrieved June 1, 2011, from Ebscohost: http: //web. ebscohost. com/ehost/pdfviewer? vid Kulak-Ozkan, E. (2002). Oral hygiene habits, denture cleanliness, presence of yeast and stomatitis in elderly people. Journal of Oral Rehabilitation , 300 -304. Neppelenbroek, K. P. (2008). Effectiveness of microwave disinfection of complete dentures on the treatment of Candida-related denture stomatitis. Journal of Oral Rehabilitation , 836 -846. Rosenberg, J. D. (2010, Feb 22). Periodontitis. Retrieved June 1, 2011, from Pub. Med: http: //www. ncbi. nlm. nih. gov/pubmedhealth/PMH 0002054/ Shulman, J. R. -H. (2005). Risk factors associated with denture stomatitis in the United States. J Oral Pathol Med , 340 -346. Yuntzu-Yen Chen, A. B. , & Zirwas, M. J. (2007). Denture Stomatitis. SKINmed , 92 -94. Yuntzu-Yen Chen, A. (2007, March). Denture Stomatitis. Retrieved May 30, 2011, from Ebsco: http: //web. ebscohost. com/ehost/detail? sid