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FAKULTAS KEDOKTERAN
2020-2021
A REVIEW

Denture Stomatitis: A Literature Review

Shamimul Hasan1, Kuldeep2

Assistant Professor,
ABSTRACT
1

Department of Oral
Medicine and Radiology,
Faculty of Denture stomatitis is a denture-associated mucosal condition characterized by
Dentistry, Jamia Millia inflammation and erythema of the denture-bearing surfaces. The etiology is
Islamia,
New Delhi, India
multifactorial, although, Candida albicans is the commonly associated pathogenic
2
Reader, Department of organism. Predisposing factors include poor oral and denture hygiene, ill-fitting
Downloaded From IP - 14.139.62.114 on dated 28-Nov-2015

Prosthodontics, Teerthanker dentures, nocturnal denture wearing, allergic reactions to denture base material and
Mahaveer Dental College
and
underlying systemic conditions. Usually, the patients are asymptomatic, although
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Research Center, some patients may complain of burning sensations, bleeding from mucosal surfaces,
www.IndianJournals.com

Teerthanker bad smell and impaired taste sensations. Denture stomatitis can be managed by
Mahaveer University,
Moradabad, India elimination of predisposing factors, placement of dentures in antiseptic solutions, and
the use of antifungal agents. Surgical interventions may be required in severe
inflammatory states.
Keywords: Denture stomatitis, Candidal infections, Antifungal agents, Ill-fitting
Received : 10/03/15 denture, Chronic atrophic candidiasis, Candida albicans, Papillary hyperemia
Review completed :
06/04/15
Accepted : 16/04/15
INTRODUCTION
Oral mucosal lesions associated with the removable prostheses are usually related to the
reaction of oral biofilms, dental materials used in the fabrication of the dentures, or denture
injuries/trauma. Denture-related stomatitis refers to an inflammatory state of the denturebearing
mucosa, characterized by chronic erythema and edema of part or all the mucosa beneath maxillary
dentures.[1] It is also the most commonly encountered mucosal lesion with removable prostheses,
and affects one in every three complete denture wearers. [2] The frequency of its development is 25–
67%, frequently seen among female patients, and prevalence increases with age. [3] Denture
stomatitis has a multifactorial etiology; however, following predisposing factors are significant:
trauma due to ill-fitting denture, prolonged use of denture, improper denture cleanliness, dietary
factors, candida infections and underlying systemic conditions. The principle causative agent of
denture stomatitis is the Candida species, especially C. albicans, although

Address for correspondence:

Shamimul Hasan
Email id: shamim0571@gmail.com
Access this article online

Website: www.indianjournals.com
DOI: 10.5958/2229-3264.2015.00013.1

The predisposing factors and denture plaque bacteria may also be involved. [4] Diagnosis is
usually established after the observation of inflammation on the palatal mucosa and the presence of
C. albicans on the denture or underlying mucosa after culture has been done. [5] According to
MacFarlane and Samaranayake,[6] denture stomatitis can be effectively managed by strict denture
hygiene measures and the use of antifungal agents. Nocturnal wearing of dentures should be
discontinued and overnight soaking of dentures in an antiseptic solution should be encouraged.
Topical use of amphotericin B was also suggested.

CLASSIFICATION
Newton in 1962 was the first to propose a classification of denture stomatitis. Based on
Newton’s original method, Budtz–Jorgensen and Bertram in 1970 and Bergendal and Isacson in 1983
proposed other classifications of denture stomatitis. [5] According to the clinical aspects of the lesions,
Newton classified denture stomatitis into three types – punctiform hyperemia (class I), diffuse
hyperemia (class II) and granular hyperemia (class III).
Punctiform hyperemia (Class I): hyperemia signs of the minor palatine salivary glands; there
is an erythematous punctiform aspect, and small or diffuse areas in palate may be affected (Figure
1).
 Figure 1: Areas of pin point hyperemia and inflammation

Diffuse hyperemia (Class II): smooth and atrophic mucosa, with erythematous aspect under the
denture. It is considered the most common aspect of Candida

Figure 2: Diffuse areas of inflammation involving the denture-bearing region

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 (Figure 3). [7] Newton’s type I
has been shown to be the result of trauma, whereas Newton’s class III has a multivariable
interaction phenomenon.[3] Budtz–Jorgensen and Bertram classified denture stomatitis into three
types, according to the type of inflammation observed on the mucous membrane of the palate
under a maxillary denture.
 Figure 3: Papillary overgrowth involving the central part of hard palate

• Simple localized inflammation (involving a limited area)

• Simple diffuse inflammation (involving the whole area covered by the denture)

• Granular inflammation (often localized to the central part of the hard palate).
Bergendal and Isacsson followed Ostlund’s classification.
Local inflammation to describe red spots usually found around the small palatal minor salivary
glands; the lesion was thought to be associated with trauma from the dentures. Diffuse reddening
referred to a diffuse hyperaemic, smooth and atrophic mucosa extending over the entire
denture area and was associated with increased growth of yeasts. The third type of denture
stomatitis was described as granulated and was characterized by hyperaemic mucosa with a
nodular appearance in the central part of the palate and both trauma and candida infection
have been linked with this lesion.[4]
ETIOLOGY
Studies have pronounced different factors causing denture stomatitis such as traumatic
occlusion, poor oral and denture hygiene, 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, and medications. [3]

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, or dentures that do not
have correct vertical and horizontal arch relations. [8] According to Nyquist, trauma caused by
dentures accounted for the majority of cases of denture stomatitis. Cawson concluded that the
trauma and candidal infection are significant causes of denture stomatitis. The latest study pointed
out that trauma alone does not induce pictures of generalized denture stomatitis but, rather, it
could be the cause of localized forms. Instead, in the generalized forms the principal pathogenic role
is played by Candida albicans. In this case, 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. [9]

Nocturnal denture wearing: Nocturnal denture wear plays a role in the etiology of denture
stomatitis. Nocturnal and continuous prostheses wear could reduce the protective effect of saliva,
decrease the cleaning effect of the tongue, prevent proper oxygenation of the palatal mucosa and,
finally, increase local trauma to the mucosa. These effects make denture wearers more prone to
mucosal mechanical and microbial injuries and, therefore, increase the risk of denture stomatitis. [2]

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. [10]

Microorganisms: the importance of oral microorganisms in the etiology of denture-related

stomatitis is well understood as the series of studies by Cawson, and Budtz–Jorgensen established
that oral fungi, particularly Candida species, are essential for the development of denture stomatitis.
The mechanisms by which Candida species are believed to induce the infiammatory response that is
characteristic of denture stomatitis include the release of yeast antigens, toxins and irritants from
the denture plaque. Severe forms of denture-related stomatitis were associated with heavy smoking.
The effects of tobacco on this increased susceptibility to oral Candida infections are probably a result
of a combination of factors, including a suppression of the activity of oral leucocytes mediated by
smoking, changes in oral mucosal surface due to denture friction associated with tobacco smoking
and immunosuppression.[1]

Denture lining materials: Denture-lining materials, which include tissue conditioners and soft
denture liners, are widely used as adjuncts in the prosthodontic treatment and management of
traumatized oral mucosa and are most commonly used in association with the mandibular denture.
Recently materials which are available are either silicone elastomers, plasticized higher methacrylate
polymers, hydrophilic polymethacrylates or fluoropolymers. Even though these materials exhibit
excellent tissue tolerance, one of the problems is the colonization of Candida species on and within
the material. Fungal growth is known to destroy the surface properties of the liner and this may lead
to irritation of the oral tissues. This is due to a combination of increased surface roughness and high
concentrations of exotoxins and metabolic products produced by the fungal colonies. [11]

Poor denture hygiene: lack of denture cleanliness is considered to be one of the factors involved in
the etiology of denture stomatitis. Various factors stimulating yeast proliferation, such as poor oral
hygiene, high carbohydrate intake, reduced salivary flow, composition of saliva, design of the
prosthesis and continuous denture wearing can also enhance the pathogenicity of denture plaque. [12]

Surface texture and permeability of denture base material: the tissue surface of the dentures
usually shows micropits and microporosities. Micro-organisms harbouring in these areas are difficult
to remove mechanically or by chemical cleansing. According to several in vitro studies, the microbial
contamination of denture acrylic resin occurs very quickly, and yeasts seem to adhere well to
denture base materials. Surface roughness may facilitate microbial retention and infection. Dentures
with a fine texture and absence of porosity did not allow attachment of plaque by penetration of
surface defects or by mechanical fixation to surface irregularities. Van Reenen showed in vitro that
C. albicans penetrated the commonly used acrylic resin, which was confirmed with the use of a
fluorescent dye and C. albicans. Penetration of the unpolished surface, which is in contact with the
mucosa, was greater than that of the polished surface.
Saliva: the role of the saliva in the colonization of C. albicans is still controversial. Some studies
have shown that it reduces the adhesion of C. albicans. In fact, the saliva possesses defensive
molecules as lysozyme, lactoferrine, calprotectin, IgA that decrease the adhesion of Candida to the
oral surfaces. The decrease or the complete absence of saliva in individuals with xerostomia induces
the change and the imbalance of the normal microbial communities favouring the proliferation of
bacteria as Staphylococcus aureus that inhibits the normal adaptation of the commensals. [9]

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, thymic aplasia, xerostomia due to irradiation, drug therapy,
cytotoxic drug therapy and Sjogren’s syndrome. [4]

PREVENTION AND TREATMENT OF DENTURE STOMATITIS

Patients with denture associated erythematous candidiasis should be examined for the
adequacy of the dentures. Thorough evaluation and correction of oral and denture hygiene
measures should be done and nocturnal wearing of dentures should be discouraged. Emphasis
should be made on twice weekly soaking of dentures for 15–30 min in white vinegar (diluted 1:20),
0.1% hypochlorite solution (diluted Milton’s solution), or chlorhexidine solution. [13]

Denture stomatitis can be effectively managed with antifungal agents, and the condition
shows complete resolution within 12–14 days. [14] 2% Miconazole, available in gel form, can be applied
(two to three times daily for 1 or 2 weeks) directly to the previously cleaned denture surface.
Nystatin is another topical antifungal agent used in cases of denture stomatitis. It can be used in the
form of liquid suspension, cream and pastille. However, systemic antifungal agents should be
reserved for cases which do not respond well to topical antifungal therapy. Fluconazole (FLZ) has
been widely used because the drug is economic, has lower toxicity and has high bioavailability.
Ketoconazole is also used systemically in a single dose of 200 mg during 14 days. This is a
hepatotoxic drug and can result in cardiac arrhythmias when used in combination with
antihistamines or macrolide antibiotics. Amphotericin B was previously used in the treatment of
Candidaassociated denture stomatitis. However, its use has shown a decline because it is extremely
nephrotoxic and is administered intravenously. [7]

Laser beam, cryosurgery, electrosurgery and scalpel surgery are successfully practiced in
treating the infection, especially for type II and type III infection. [1] Implant overdentures can be
effective in controlling denture stomatitis by preventing trauma to the oral mucosa in edentulous
elderly. [1]

REFERENCES
1. Dos Santos CM, Hilgert JB, Padilha DM, Hugo FN. Denture stomatitis and its risk
indicators in south Brazilian older adults. Gerodontology 2009;27(2):134–40.
2. Emami E, Kabawat M, Rompre PH, Feine JS. Linking evidence to treatment for
denture stomatitis: A meta-analysis of randomized controlled trials. J Dentist
2014;42:99–106.
3. Naik AV and Pai RC. A study of factors contributing to denture stomatitis in a North
Indian community. Int J Dent 2011; doi:10.1155/2011/589064, Article ID 589064, 4
pages. 4. Webb BC, Thomas CJ, Willcox MD, Harty DW, Knox KW. Candida-associated
 denture stomatitis. Aetiology and management: a review. Part 2. Oral diseases
caused by Candida species. Aust Dent J 1998;43:160–66.
4. Barbeau J, Séguin J, Goulet JP, de Koninck L, Avon SL, Lalonde B, et al. Reassessing
the presence of Candida albicans in denture related stomatitis. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 2003;95:51–9.
5. Webb BC, Thomas CJ, Willcox MD, Harty DW, Knox KW. Candida-associated denture
stomatitis. Aetiology and management: a review. Part 3. Treatment of oral
candidosis. Aust Dent J 1998;43:244–9.
6. Vasconcellos AAD, Vasconcellos AAD, Chagas RB, Gonçalve LM. Candida-associated
denture stomatitis: Clinical relevant aspects. Clin Microbial 2014;3:4.
7. Zissis A, Yannikakis S. Comparison of denture stomatitis prevalence in 2 population
groups. Int J Prosthodont 2006;19:621–5.
8. Salerno C, Pascale M, Contaldo M, Esposito V, Busciolano M Milillo L, Guida A,
Petruzzi M, Serpico R. Candidaassociated denture stomatitis. Med Oral Patol Oral Cir
Bucal 2011;16(2):139–43.
9. Sahebjamee M, Basir Shabestari S, Asadi G, NeishabouriK. Predisposing factors
associated with denture induced stomatitis in complete denture wearers. Shiraz Univ
Dent J 2011;11(Supplement):35–9.
10. Koteswara RP, Kamalakanth SK, Lakshmi KN, Mereddy RR. Denture stomatitis – A
review. Indian J Dent Adv 2013;5(1):1107–1112.
11. Seema P, Vikas BVJ, Bikash P, Shailendra S, Savita L.Denture stomatitis: A literature
review. JIAOMR 2010;22(3):136–40.
12. Farah CS, Lynch N, McCullough MJ. Oral fungal infections: an update for the general
practitioner. Aus Dent Jour 2010;55:(1 suppl):48–54.
13. Sivakumar K, Palanivelu S, Ramalingam S, Seshadri S.Denture stomatitis: Treatment
with Diode Laser. Int J Prosthodontics Restorative Dentist 2011;1(1):55–7.
ABSTRACK
Denture stomatitis merupakan suatu kondisi mukosa terkait gigi tiruan yang ditandai
dengan adanya peradangan dan eritema pada permukaan dasar gigi tiruan. Etiologinya
multifaktorial, salah satunya seperti Candida albicans yang merupakan organisme patogen
yang umumnya sering ditemukan pada kasus Denture stomatitis sedangkan untuk faktor
predisposisi seperti kebersihan mulut dan gigi tiruan yang buruk, gigi palsu yang tidak pas,
pemakaian gigi tiruan pada malam hari, reaksi alergi terhadap bahan dasar gigi tiruan dan
kondisi sistemik yang mendasarinya. Biasanya, pasien tidak menunjukkan gejala, namun ada
beberapa pasien mungkin mengeluhkan sensasi terbakar, adanya perdarahan di permukaan
mukosa, bau tak sedap dan gangguan sensasi rasa. Denture stomatitis dapat dikelola dengan
cara menghilangkan faktor predisposisi dari gigi tiruan menggunakan larutan antiseptik,
penggunaan agen antijamur. Serta perlu adanya tindakan bedah mungkin diperlukan pada
keadaan inflamasi yang parah.

Introduction
Lesi yang terdapat dimukosa mulut biasanya berhubungan dengan protesa lepasan,
hal ini terjadi karna adanya reaksi biofilm oral, bahan dari gigi tiruan serta adanya
cedera/trauma. Stomatitis terkait gigi tiruan biasanya ada dalam keadaan inflamasi pada
mukosa gigi tiruan seperti adanya eritema kronis, serta edema sebagian atau seluruh mukosa
di bawah gigi tiruan rahang atas. Biasanya untuk kasus Denture stomatitis frekuensi
perkembangannya sekitar 25-67% pada pasien wanita dan prevalensi ini biasanya meningkat
seiring dengan bertambahnya usia.
Denture stomatitis memiliki etiologi multifaktorial; namun, faktor predisposisinya
yaitu : trauma karena adanya gigi tiruan yang tidak pas, penggunaan gigi tiruan yang lama,
kebersihan gigi tiruan yang tidak tepat, infeksi candida dan adanya kondisi sistemik. Pada
jurnal ini diagnosis biasanya ditegakkan setelah adanya pengamatan inflamasi pada mukosa
palatal dan adanya Candida albicans pada gigi tiruan.
Menurut MacFarlane dan Samaranayake, Denture stomatitis dapat dikelola secara
efektif dengan adanya tindakan kebersihan gigi tiruan yang ketat, penggunaan antijamur,
mengurangi pemakaian gigi palsu pada malam hari serta melakukan perendaman gigi palsu
semalaman dalam larutan antiseptic, Penggunaan topikal amfoterisin B juga disarankan.
KLASIFIKASI
Pada tahun 1962 Newton adalah orang pertama yang mengusulkan tentang klasifikasi
dari Denture stomatitis. Menurut aspek klinis dari segi lesi, Newton mengklasifikasikan
Denture stomatitis menjadi tiga jenis yaitu Hiperemia punctiform (kelas I), Hiperemia difus
(kelas II) dan Hiperemia granular (kelas III).
Hiperemia punctiform (Kelas I) memiliki tanda-tanda yaitu : adanya hiperemia pada
kelenjar ludah palatina minor serta adanya eritematosa yang menyebar di bagian palatal
(Gambar 1).

Hiperemia difus (Kelas II) memiliki tanda – tanda yaitu : mukosa terasa halus dan
atrofi, adanya eritematosa di bagian bawah gigi tiruan. Tanda tanda ini merupakan aspek
yang paling umum dari Candida Associated Denture Stomatitis (Gambar 2).

Hiperemia granular (Kelas III) memiliki tanda – tanda yaitu : lebih sering terjadi pada
gigi palsu dengan adanya ruang isap / suction chambers. Terdapat mukosa yang terasa kasar
& adanya nodular pada bagian tengah palatal (Gambar 3). Penyebab dari klasifikasi Newton
tipe I adalah trauma, sedangkan untuk kelas III yaitu multivariabel.
 Budtz-Jorgensen dan Bertram mengklasifikasikan Denture stomatitis menjadi tiga
jenis berdasarkan peradangannya yang diamati pada selaput lendir langit-langit di bawah gigi
tiruan rahang atas yaitu :
1. Peradangan lokal sederhana (melibatkan area terbatas)
2. Peradangan difus sederhana (melibatkan seluruh area yang ditutupi oleh gigi tiruan)
3. Inflamasi granular (seringkali terlokalisasi di bagian tengah palatum durum).

Peradangan lokal sederhana biasanya memiliki ciri ciri adanya bintik-bintik merah yang
biasanya ditemukan di sekitar kelenjar ludah minor palatal kecil, adanya lesi tersebut
biasanya karna trauma dari gigi palsu. Peradangan difus sederhana biasanya terjadi karna
adanya hiperemis difus, mukosa halus dan atrofi yang meluas ke seluruh area gigi tiruan serta
adanya peningkatan pertumbuhan jamur. Pada tipe ketiga digambarkan adanya granulasi ,
pada mukosa terjadi hiperemis, adanya nodular di bagian tengah langit-langit mulut , trauma,
serta ditemukannya infeksi candida .

ETIOLOGI
Pada penelitian ini telah menyatakan bahwa berbagai faktor penyebab dari Denture
stomatitis adalah trauma oklusi, kebersihan mulut dan gigi tiruan yang kurang baik atau
buruk, faktor mikroba, usia gigi tiruan, alergi terhadap bahan dasar gigi tiruan, monomer
residu, merokok, berbagai jenis iradiasi, mulut kering, kondisi sistemik, diabetes mellitus,
defisiensi imun, defisiensi nutrisi, dan obat-obatan.
TRAUMA
Penyebab dari Denture stomatitis bersifat multifaktorial, dengan adanya trauma
menjadi penyebab faktor utama. Trauma mungkin berasal dari gigi palsu yang tidak pas atau
pemakaian yang terus menerus dan gigi palsu yang tidak memiliki hubungan lengkung
vertikal dan horizontal yang benar. Cawson menyimpulkan bahwa trauma dan infeksi
Candida albicans merupakan penyebab signifikan dari Denture stomatitis. Studi terbaru
menunjukkan bahwa trauma saja tidak menyebabkan gambaran terjadinya Denture stomatitis
tetapi, sebaliknya, biasanya untuk penyebabnya berbentuk local seperti adanya peran patogen
utama dimainkan oleh Candida albicans. Dalam hal ini, trauma dapat bertindak sebagai co-
faktor yang mendukung terjadinya adhesi dan penetrasi jamur, menopang bagian palatal
rongga mulut dan meningkatkan permeabilitas epitel terhadap racun serta agen larut yang
diproduksi oleh jamur Candida albicans.

PEMAKAIAN GIGI PALSU NOCTURNAL

Pemakaian gigi tiruan nokturnal berperan dalam etiologi Denture stomatitis.
Pemakaian prostesis nokturnal yang terus menerus dapat mengurangi efek protektif saliva,
mengurangi efek pembersihan lidah, mencegah masuknya oksigen pada mukosa bagian
palatal, sehingga meningkatkan terjadinya trauma lokal pada mukosa. Efek ini membuat
pemakai gigi tiruan lebih rentan terhadap cedera mekanik, meningkatkan mikroba mukosa
dan risiko Stomatitis dari gigi tiruan.

USIA GIGI TIRUAN

Usia gigi tiruan dianggap sebagai faktor predisposisi untuk perkembangan Denture
stomatitis, terutama karena kemungkinan pemasangan gigi tiruan yang kurang pas,
permukaannya yang kasar, pemakaian yang tidak bersih, adanya akumulasi plak dan adanya
mikroba yang patogen.

MIKROORGANISME
Pentingnya mikroorganisme rongga mulut dalam etiologi Denture stomatitis telah
dipahami dengan baik, sebagai rangkaian studi oleh Cawson, dan Budtz-Jorgensen
menetapkan bahwa jamur mulut, khususnya spesies Candida albicans, sangat penting untuk
perkembangan Denture stomatitis. Mekanisme dimana terjadinya spesies Candida albicans
diyakini menginduksi terjadinya respon inflamasi yang merupakan karakteristik Denture
stomatitis, racun dan iritasi dari plak gigi tiruan. Efek karna adanya tembakau dapat
meningkatkan kerentanan terhadap infeksi Candida albicans di rongga mulut hal ini mungkin
hasil dari kombinasi banyak faktor, termasuk adanya aktivitas leukosit oral yang dimediasi
karna merokok, perubahan permukaan mukosa mulut karena gesekan gigi tiruan terkait
dengan merokok tembakau dan imunosupresi.

Bahan dasar gigi tiruan

Bahan pelapis gigi tiruan, yang meliputi kondisioner jaringan dan pelapis gigi tiruan
yg lunak, banyak digunakan sebagai tambahan dalam perawatan prostodontik dan manajemen
mukosa mulut biasanya banyak digunakan pada rahang bawah. Baru-baru ini bahan yang
tersedia adalah Elastomer silikon, Polimer metakrilat, Polimetakrilat hidrofilik atau
Fluoropolimer. Meskipun bahan ini menunjukkan adanya toleransi jaringan yang sangat baik,
namun terdapat masalah juga seperti adanya kolonisasi spesies Candida albicans. Adanya
pertumbuhan jamur diketahui dapat merusak sifat dari permukaan liner sehingga dapat
menyebabkan iritasi pada jaringan mulut. Hal ini disebabkan karna adanya kombinasi
peningkatan kekasaran permukaan dan adanya konsentrasi tinggi eksotoksin dan produk
metabolisme yang dihasilkan oleh koloni jamur.

Kebersihan Gigi Tiruan yang buruk

Kurangnya kebersihan gigi tiruan dianggap sebagai salah satu faktor yang terlibat
dalam etiologi Denture stomatitis. Berbagai faktor yang merangsang terjadinya proliferasi
jamur, seperti kebersihan mulut yang buruk, asupan karbohidrat yang tinggi, adanya aliran
saliva yang kurang, desain protesa dan pemakaian gigi tiruan yang terus menerus juga dapat
meningkatkan patogenisitas dari plak gigi tiruan.

Textur permukaan & permeabilitas bahan dasar

Permukaan jaringan gigi tiruan biasanya menunjukkan adanya micropits dan
microporos. Mikroorganisme yang bersembunyi di area ini sulit dihilangkan secara mekanis
atau dengan pembersihan kimia. Menurut beberapa penelitian in vitro, kontaminasi mikroba
resin akrilik gigi tiruan terjadi dengan sangat cepat, dan jamur tampaknya melekat dengan
baik pada bahan dasar gigi tiruan tersebut. Kekasaran permukaan dapat memfasilitasi
terjadinya retensi mikroba dan infeksi. Gigi tiruan dengan tekstur halus dan tidak adanya
porositas tidak memungkinkan perlekatan plak dengan penetrasi defek permukaan atau
fiksasi mekanis pada ketidak teraturan permukaan.
 Van Reenen menunjukkan secara in vitro bahwa Candida albicans dapat menembus
resin akrilik yang umum digunakan dengan penggunaan pewarna fluoresen. Penetrasi
permukaan yang tidak dipoles serta adanya permukaan yang bersentuhan dengan mukosa,
lebih besar kemungkinannya dari pada permukaan yang dipoles.

SALIVA
Adanya peran saliva dalam kolonisasi Candida albicans masih bersifat kontroversial.
Beberapa penelitian telah menunjukkan bahwa hal tersebut dapat mengurangi terjadinya
adhesi dari jamur Candida albicans. Bahkan didalam saliva terdapat molekul pertahanan
seperti lisozim, laktoferin, calprotectin, IgA yang menurunkan adhesi Candida ke permukaan
mulut. Penurunan atau tidak adanya saliva pada setiap individu dengan xerostomia
menginduksi terjadinya perubahan dan ketidak seimbangan komunitas mikroba normal dalam
mendukung proliferasi bakteri sebagai Staphylococcus aureus yang menghambat adaptasi
normal dari komensal.

KONDISI SISTEMIK
Berbagai kondisi sistemik juga dapat mempengaruhi Candida albicans terkait Denture
stomatitis. Adanya malnutrisi seperti yang terjadi pada diet tinggi karbohidrat, kekurangan
zat besi, folat atau vitamin B12, keadaan hipoendokrin seperti hipotiroidisme, penyakit
Addison (insufisiensi adrenokortikal), Diabetes mellitus, kelainan darah (leukemia akut,
agranulositosis), gangguan kekebalan seperti infeksi HIV , aplasia timus, xerostomia akibat
iradiasi, terapi obat, terapi obat sitotoksik dan sindrom Sjogren.

PERAWATAN PREVENTIV
Pasien dengan Candidiasis eritematosa terkait gigi tiruan harus diperiksa kecukupan
gigi tiruannya. Lakukan Evaluasi menyeluruh dan koreksi tindakan kebersihan mulut dan
pemakaian gigi palsu pada malam hari harus dihindari, perendaman gigi tiruan dua kali
seminggu selama 15-30 menit menggunakan cuka putih (diencerkan 1:20), larutan hipoklorit
0,1% (larutan Milton encer), atau larutan klorheksidin.
Denture stomatitis dapat dikelola secara efektif dengan agen antijamur, dan kondisi
ini menunjukkan adanya resolusi lengkap dalam 12-14 hari. 2% Miconazole, tersedia dalam
bentuk gel, dapat dioleskan (dua sampai tiga kali sehari selama 1 atau 2 minggu) langsung ke
permukaan gigi tiruan yang telah dibersihkan sebelumnya. Nistatin adalah agen antijamur
topikal lain yang digunakan dalam kasus Denture stomatitis. Hal ini dapat digunakan dalam
bentuk suspensi cair, krim dan pasta. Namun agen antijamur sistemik harus disediakan untuk
kasus-kasus yang tidak merespon dengan baik terhadap terapi antijamur topikal.
Flukonazol (FLZ) telah banyak digunakan karena obat ini cukup ekonomis, memiliki
toksisitas yang lebih rendah dan memiliki bioavailabilitas yang tinggi. Ketoconazole juga
digunakan secara sistemik dalam dosis tunggal 200 mg selama 14 hari. Obat ini merupakan
obat hepatotoksik dan dapat menyebabkan aritmia jantung bila digunakan dalam kombinasi
dengan antihistamin atau antibiotik makrolida. Amfoterisin B sebelumnya digunakan dalam
pengobatan Candida albicans terkait Denture stomatitis. Namun, penggunaannya telah
menunjukkan penurunan karena sangat nefrotoksik dan diberikan secara intravena.
Laser beam, cryosurgery, electrosurgery dan bedah scalpel berhasil digunakan dalam
mengobati infeksi terutama untuk infeksi tipe kelas II dan tipe kelas III. Pada Overdentures
implan dapat efektif dalam mengendalikan Denture stomatitis dengan mencegah trauma pada
mukosa mulut pada lansia edentulous.