Denture Stomatitis

Abstract

A 70-year-old woman presented for evaluation of an eruption localized to the area covered by her partial upper denture. Her medical history and physical examination were otherwise unremarkable. She originally had a metal upper partial denture, which she used for many years without difficulty. Four years before presentation, she developed a painful eruption affecting only the tissue covered by the upper partial denture. Contact dermatitis to metal was suspected, and a new upper partial denture constructed primarily of acrylates was fashioned. When she transitioned to the new denture, the inflammation in her oral mucosa persisted and perhaps worsened, despite an excellent fit. Examination revealed striking erythema and mild edema sharply localized to the areas where the partial upper denture contacted the gum ridge. Patch testing was performed and revealed allergies to multiple acrylates, including methyl methacrylate. A swab from the gums was sent for yeast culture. No Candida was detected. Based on suspected candidal overgrowth on the denture, the patient was advised to begin applying nystatin ointment between the gums and the denture, and to start soaking the dentures nightly in chlorhexidine 0.12% solution. In addition, because the relevance of the acrylate allergy was unclear, her dentist was contacted and it was recommended that the dentures be boiled to induce polymerization of any residual un-reacted methacrylate monomers. The patient had a 90% improvement in the clinical appearance and in symptoms at an 8-week follow-up appointment. Due to logistic issues, the dentures had not yet been boiled. The improvement, despite the dentures not having been boiled, was felt to demonstrate that the acrylate allergy was not relevant. The patient has continued to slowly show further improvement over 6 months of follow-up.

Occupational contact allergic dermatitis in dentistry

“…Methacrylates are frequently used in dentistry (fillings, coating of teeth and in prosthetics, in dental plates and dentures). Methyl methacrylate as the residual acrylic monomer in the self-cured portion of denture may be present in concentrations sufficient to cause reactions on the skin and the oral mucosa in sensitized individuals (stomatitis, burning mouth syndrome) 7,8 . Also, methyl methacrylate is found in bone cement and adhesives [9][10][11] .…”

In vivo biofilm formation on a soft denture liner in elderly patients with controlled diabetes

“…The use of soft denture lining materials for denture prostheses in selected clinical situations has long been recognised, but, problems with its physical properties have resulted in the use of these materials as a last treatment option 3,7,12,17–19 . Although soft liners alleviate denture trauma, the porosity of these materials increase the potential for microbial colonisation, biofilm formation and consequent risk of tissue inflammation 4 .…”

“…Our results showed that a higher biofilm formation on the soft denture lining material tested was observed after six weeks. It is possible to relate this result to the durability of the material (natural degradation) and the deficient physical‐mechanical properties that promote superficial alterations and transform the soft base into a suitable environment for fungal proliferation 3–5,12 . The use of soft denture lining materials for denture prostheses in selected clinical situations has long been recognised, but, problems with its physical properties have resulted in the use of these materials as a last treatment option 3,7,12,17–19 .…”

“…The use of liners in patients with atrophic ridges, bony undercuts, bruxism and xerostomia may enhance comfort and avoid damages to the underlying mucosal tissues 1,2 . There might, however, be physical and microbiological disadvantages in the use of soft liners 1,3–5 . One of the main problems is the surface characteristics of the liners that impair efficient mechanical cleansing, favouring colonisation by Candida albicans , and the development of denture stomatitis.…”

Systemic contact dermatitis

“…[100][101][102][103] Surprisingly, very little has been reported about contact stomatitis from acrylate-based dental restorations. 104…”