Denture Pathology

Question 1

What is denture induced stomatitis?

Answer 1

Chronic inflammatory response of denture bearing tissues to harmful stimuli as in the biofilm on denture fit surface. Often called denture sore mouth but it is not painful and not noticed by patients. 11-67% of denture wearing population

Question 2

What is classification for DIS?

Answer 2

Newton classification

1: pinpoint hyperaemia
2: diffuse erythema of denture bearing tissue
3: papillary hyperplasia usually on hard palate and alveolar ridge

Question 3

Aetiological factors for DIS?

Answer 3

Multi factorial
Chronic wear - not removing denture
Poor denture and oral hygiene
Trauma - occlusal error, fit, extension 
Candida (usually albicans) adhering and colonating to denture fit surface
Systemic factors exacerbate (haematological deficiencies, diabetes, immunosuppression)
Allergic and primary irritants 
Restriction of Salivary secretions

Question 4

Why is it important to manage denture induced stomatitis

Answer 4

Avoid systemic Candida involvement
Poor denture fit
Tissue hyperplasia

Question 5

Management of DIS

Answer 5

Leave dentures out at night
Tissue conditioner
Correct errors with occlusion, fit or extension
Denture and oral hygiene - Milton solution,1% sodium hypochlorite, chlorhexidine
Only prescribe anti fungal if confirmed diagnosis of Candida
Miconazole gel rubbed on fit surface of denture qid for 2 weeks
Nystatin oral suspension swish around mouth after food for 7 days
Fluconazole 50mg 1-2 weeks, avoid on warfarin or anticoagulant.

Question 6

Other conditions affecting complete denture prosthetics ?

Answer 6

Prominent mylohyoid ridges
Enlarged tuberosities
Tori
Prominent frenal attachment
Other pathology

Question 7

How would you manage a pinpoint ulcer caused by direct mechanical trauma from denture?

Answer 7

Pressure relief cream

Reduce denture

Question 8

What is denture induced hyperplasia?

Answer 8

Raised areas of tissue related to the periphery or fit surface of a denture
Lesions are often found in the buccal or labial sulcus anteriorly
Lesions are composed of fibrous tissue and are pedunculated

Question 9

Cause of denture induced hyperplasia

Answer 9

Trauma, occlusion, overextension

Question 10

Incidence of denture induced hyperplasia

Answer 10

2-13%

Question 11

Treatment of denture induced hyperplasia

Answer 11

Remove irritant, improve fit, tissue conditioner, leave dentures out at night, review, surgery, remake dentures