Denture Stomatitis

The pathological reactions of the denture-bearing palatal

mucosa appear under several titles and terms such as dentureinduced stomatitis, denture sore
mouth, denture stomatitis, inflammatory papillary hyperplasia, and chronic
atrophic candidosis. The term denture stomatitis is used with
the prefix Candida-associated if the yeast Candida is
involved. In the randomized populations, the prevalence of
denture stomatitis is about 50% among complete denture
wearers. Detailed clinical and histologic features are
discussed elsewhere.

The ‘denture sore mouth’ is an uncommon condition

occurring in patients who may or may not have a new set of
dentures. The condition is not due to a true allergy, since
patch
testing with the denture material gives negative results. Some
cases appear to be due to an infection with Candida albicans,
although the typical white patches of thrush (q.v.) do not
usually develop, according to Calm and Bartels. Lehner has
classified the condition as chronic atrophic candidiasis.
Newton has suggested that denture sore mouth may be related
to the ‘sweat retention syndrome’ in which keratin plug
formation of the sweat glands or accessory salivary glands
forces sweat or saliva into the adjacent tissues with
subsequent inflammation. This concept has not been accepted
widely, however Budtz-Jørgensen and Bertram demonstrated
that yeast like fungi of C. albicans type could be cultivated
from 90% of patients with denture stomatitis, but from only
40% of patients with dentures but without stomatitis. Theyalso showed that poor denture
cleanliness was associated with
severe inflammation.
Renner and his associates emphasized that this condition is a
multifaceted disease entity in which parasitism by C. albicans
may be an extremely important factor often in association
with other major contributions from denture trauma and
continual denture wearing, poor oral hygiene habits and
possibly dietary and systemic alterations.
Clinical Features
The mucosa beneath the denture becomes extremely red,
swollen, smooth or granular and painful. Multiple pinpointfoci of hyperemia, usually involving
the maxilla, frequently
occur. A severe burning sensation is common. The redness of
the mucosa is rather sharply outlined and restricted to the
tissue actually in contact with the denture.
Treatment of this condition may not be successful. However,
Budtz-Jørgensen and Bertram have reported significant
therapeutic effects on denture stomatitis by antifungal
therapy. Nystatin tablets 500,000 units, were allowed to
dissolve in the mouth three times a day for 14 days.
Bergendal and Isacsson reported similar results by treating
denture stomatitis with nystatin powder placed on the fitting
surface of the denture three times a day for 14 days. In
addition, when the dentures fit poorly, construction of new
appliances and instruction on hygienic care of the dentures
aid in correcting the situation. If new dentures are not
constructed, the old dentures must be sterilized daily by
soaking in a nystatin solution overnight during the treatment
period. Rebasing dentures with soft-tissue conditioners is also
reported of benefit in addition to nystatin.

Denture Stomatitis: (Chronic atrophic candidiasis)

Denture stomatitis is now considered to be synonymous with the condition better known as
denture sore mouth, a diffuse erythema and edema of the denture-bearing area, often occurring
with angular cheilitis. Usually asymptomatic except for the soreness and the presenting
complaint may be angular stomatitis. Mandibular mucosa is rarely affected. There is no apparent
age limit and some studies show women are affected more frequently than men. Denture-related
candidiasis may be the most common form of the oral disease. For example, in a study reported
by Holbrook and Rodgers, they found that in nearly two-thirds of a group of 100 patients with
candidiasis, dentures were theone ‘disorder’ or situation predisposing or traceable to the
development of the infection. Other lesions under this category namely angular stomatitis and
median rhomboid glossitis are discussed elsewhere.

Definisi

Denture stomatitis sekarang dianggap identik dengan kondisi yang lebih dikenal sebagai denture
sore mouth, eritema difus dan edema pada denture-bearing area, sering terjadi dengan angular
cheilitis. Biasanya tidak menunjukkan gejala kecuali untuk rasa sakit dan keluhan yang muncul
mungkin akibat angular stomatitis. Mukosa mandibula jarang terpengaruh. Tidak ada batasan
usia yang jelas dan beberapa penelitian menunjukkan wanita lebih sering terkena daripada pria.
Denture-related candidiasis mungkin merupakan bentuk paling umum dari penyakit mulut.
Sebagai contoh, dalam sebuah penelitian yang dilaporkan oleh Holbrook dan Rodgers, mereka
menemukan bahwa pada hampir dua pertiga dari 100 pasien dengan kandidiasis, gigi palsu
adalah satu-satunya 'gangguan' atau situasi yang menjadi predisposisi atau dapat dilacak pada
perkembangan infeksi. Lesi lain di bawah kategori ini yaitu stomatitis sudut dan median
rhomboid glossitis dibahas di tempat lain.
Denture Stomatitis: (Chronic atrophic candidiasis)
Beberapa istiah denture stomatitis yang banyak digunakan yaitu stomatitis prostetica, denture
sore mouth, inflammatory papillary hyperplasia dan candidiasis associated denture stomatitis.
Definisi
Denture stomatitis is now considered to be synonymous with the condition better known as
denture sore mouth, a diffuse erythema and edema of the denture-bearing area, often occurring
with angular cheilitis. Usually asymptomatic except for the soreness and the presenting
complaint may be angular stomatitis. Mandibular mucosa is rarely affected. There is no apparent
age limit and some studies show women are affected more frequently than men. Denture-related
candidiasis may be the most common form of the oral disease.
Denture stomatitis sekarang dianggap identik dengan kondisi yang lebih dikenal sebagai denture
sore mouth, eritema difus dan edema pada denture-bearing area, sering terjadi dengan angular
cheilitis. Biasanya tidak menunjukkan gejala kecuali untuk rasa sakit dan keluhan yang muncul
mungkin akibat angular stomatitis. Mukosa mandibula jarang terpengaruh. Tidak ada batasan
usia yang jelas dan beberapa penelitian menunjukkan wanita lebih sering terkena daripada pria.
Denture-related candidiasis mungkin merupakan bentuk paling umum dari penyakit mulut.
Candida-associated denture stomatitis, also called denture sore mouth or chronic atrophic
candidiasis, is one of the most common ailments in wearers of full dentures; in some areas such
as Scandinavia, 60% of wearers over 60 years old were reported to suffer from the condition. It
is also associated with patients wearing orthodontic appliances or obturators for cleft palate. The
characteristic presenting signs are erythema and oedema of the mucosa that is in contact with the
fitting surface of the upper denture. The mucosa below the lower dentures is hardly ever
involved.
Tanda-tanda yang menunjukkan karakteristik adalah eritema dan edema mukosa yang
bersentuhan dengan permukaan pas gigi palsu bagian atas. Mukosa di bawah gigi palsu bawah
hampir tidak pernah terlibat.
Denture stomatitis adalah suatu istilah untuk menjelaskan perubahan – perubahan pada jaringan
mukosa penyangga gigi tiruan didalam mulut. Perubahan tersebut dintandai dengan eritem
dibawah gigi tiruan lengkap atau sebagian, baik di Rahang Atas maupun Rahang Bawah.
Denture stomatitis bias disebut juga sebagai denture sore mouth ( chronic atropic candidiasis )
( Laskaris, 2006 ).
The patient may occasionally experience slight soreness but is usually free from symptoms; the
only presenting complaint is sometimes an associated angular stomatitis.
Denture stomatitis adalah inflamasi mukosa mulut yang berkontak dengan permukaan
anatomis geligi tiruan. Mukosa mandibula jarang terpengaruh. Denture stomatitis umumnya
terjadi pada daerah palatal, gambaran klinisnya berupa macula eritomatous atau granular.
eritema difus dan edema pada denture-bearing area, sering terjadi dengan angular cheilitis.
Biasanya tidak menunjukkan gejala kecuali untuk rasa sakit dan keluhan yang muncul
mungkin akibat angular stomatitis. Denture-related candidiasis mungkin merupakan
bentuk paling umum dari penyakit mulut.

Prevalensi
In the randomized populations, the prevalence of denture stomatitis is about 50% among
complete denture wearers. Pasien dengan pemakaian gigi tiruan, sebanyak 70 % ditemukan. Pada
usia middle age atau usia lanjut. Dimana prevalensi wanita lebih tinggi daripada laki – laki.
Penelitian epidemiologi menunjukan prevalensi DS cukup tinggi yaitu berkisar antara 30-50%
pada pengguna gigi tiruan lengkap. Pada umumnya ditemukan pada usia lanjut dan lebih
banyak ditemukan pada wanita
Etiologi
Some cases appear to be due to an infection with Candida albicans, although the typical white
patches of thrush (q.v.) do not usually develop, according to Calm and Bartels.
Budtz-Jørgensen and Bertram demonstrated that yeast like fungi of C. albicans type could be
cultivated from 90% of patients with denture stomatitis, but from only 40% of patients with
dentures but without stomatitis. Theyalso showed that poor denture cleanliness was associated
with severe inflammation.
Renner and his associates emphasized that this condition is a multifaceted disease entity in which
parasitism by C. albicans may be an extremely important factor often in association with other
major contributions from denture trauma and continual denture wearing, poor oral hygiene habits
and possibly dietary and systemic alterations.
1. local factors: poor denture hygiene, ill-fitting dentures, traumatic dentures, carbohydrate-
rich diets, xerostomia (e.g. Sjögren’s syndrome)
2. systemic factors: iron and folate deficiency, diabetes mellitus, immune defects.
Beberapa faktor yang dapat menyebabkan denture stomatitis adalah trauma gigi tiruan yang
longgar yang dapat juga disertai adanya invasi mikroba terutama Candida spp.
Faktor–faktor yang menyebabkan denture stomatitis yaitu trauma dari gigi tiruan dan adanya
keterlibatan mikroba umumnya disebabkan oleh jamur Candida spp atau akibat kedua faktor
tersebut.1,2
Generally considered to be due to accumulation of plaque biofilms with yeasts and bacteria on
the fitting surface of the denture and the underlying mucosa. In the papillary hyperplastic variety,
Candida species do not invade the epithelium. Other aetiological factors, such as mechanical
irritation or an allergic reaction to the denture base material, may be involved.
1. Faktor yang berasal dari gigi tiruan Denture stomatitis terjadi akibat dari gigi tiruan yang tidak
retentif, adanya trauma dari pemakaian gigi tiruan, dan pemeliharaan gigi tiruan yang buruk. 2.
Faktor infeksi Gigi tiruan mampu menghasilkan perubahan ekologi yang mempermudah
akumulasi bakteri dan jamur.Bakteri yang berproliferasi adalah spesies bakteri tertentu, seperti
Staphylococcus sp, Streptococcus sp, Fusobacterium sp, atau bacteroides sp yang telah
diidentifikasi pada pasien dengan denture stomatitis.Candida sp terutama Candida albicans, telah
diidentifikasi terjadi pada sebagian besar pasien denture stomatitis.Walaupun begitu, tidak ada
hubungan langsung antara bakteri dengan etiologi dari denture stomatitis yang dapat dibuktikan.
Faktor Predisposisi
Faktor-faktor predisposisi yang dapat menyebabkan denture stomatitis, yaitu: 33
1. Faktor sistemik Faktor sistemik penyebab denture stomatitis yaitu fisiologis (usia tua),
disfungsi endokrin, defisiensi nutrisi, neoplasma, immunosupresi, dan antibiotic spectrum luas.
2. Faktor lokal Faktor lokal penyebab denture stomatitis yaitu antimikroba dan kortikosteroid
topical maupun inhalasi, diet tinggi karbohidrat, konsumsi tembakau dan alkohol, hiposalivasi,
oral higiene yang buruk, serta pemakaian gigi tiruan khususnya pada malam hari.
Gambaran Klinis
The mucosa beneath the denture becomes extremely red, swollen, smooth or granular and
painful. Multiple pinpointfoci of hyperemia, usually involving the maxilla, frequently occur. A
severe burning sensation is common. The redness of the mucosa is rather sharply outlined and
restricted to the tissue actually in contact with the denture.
Gambaran klinis pada umumnya berupa makula eritem, granular atau berbentuk beberapa nodula
Klasifikasi
Depending on the severity of inflammation, the lesions may appear as:
• pinpoint erythema of the denture-bearing mucosa (Newton’s type 1)
• diffuse and confluent erythema and oedema of the denture-bearing mucosa (Newton’s type 2;
Fig. 35.6)
• papillary hyperplasia and inflammation, commonly involving the central part of the hard
palate and the alveolar ridge (Newton’s type 3; Fig. 35.7).
Menurut Newton3 , Denture stomatitis di klasifikasikan menjadi tiga tipe yaitu: tipe 1 berupa
eritema terlokalisir atau pinpoint, tipe 2 berupa eritema difus, dan tipe 3 berupa granuler atau
papillary hyperplasia.
Berdasarkan klasifikasi Newton, denture stomatitis dibedakan menjadi tiga tipe, yaitu :36
1.Tipe I : tahap inisial berupa petechiae / lesi hiperemik pin-point (bintik merah) yang terlokalisir
atau tersebar pada mukosa palatum yang berkontak langsung dengan gigi tiruan (Gambar 2).
2. Tipe II : terjadi eritema difus dan edema terbatas pada daerah mukosa palatum yang ditutupi
gigi tiruan. Tipe II Newton ini adalah tipe yang paling sering terjadi (Gambar 3).
3. Tipe III : hiperplasia papila dengan eritema difus. Tipe III Newton lima kali lipat lebih sering
terjadi pada gigi tiruan basis akrilik dari pada gigi tiruan kerangka logam (Gambar 4).