Management of Denture Infection with Phytomedicine.

Natural teeth are an integral part of the masticatory system. Absence of dentition subjects the individual to compromised oral function, facial appearance and phonetics. Rehabilitation with dental prosthesis is imperative to restore form and masticatory activity. Currently, fabrication of removable and fixed prosthesis has become most predictable. Nonetheless, there is an increased prevalence of oral stomatitis observed over the years in edentulous individuals wearing removable dentures. Amongst the many pathogens that cause denture infections, Candida albicans is assumed to be the most virulent opportunistic agent. Different methods, such as mechanical, chemical, chemicmechanical, and pharmacological are tried to fight such infections. Regardless of various management strategies developed to treat denture stomatitis, the research continues to evolve the most optimal one. Improper oral and or denture hygiene maintenance, surface irregularities on denture, persistence of xerostomia and associated systemic illness pose risk for exaggeration of the disease. In extreme conditions, the development of aspiration pneumonia in geriatric patients is considered a threat to both dental and medical specialists. Therapeutic administration of synthetic anti-microbial drugs, along with meticulous oral hygiene maintenance are recommended protocols till date. However, limitations such as antibiotic resistance, side effects, counter drug reactions, cost of the medicaments predispose to origin of natural herbal products to treat denture stomatitis. Vast array of plant products are studied in previous literature, yet no definitive edge of one over the other is proven. This article intends to provide a mini-review on the different organic plant materials, also called as phytomedicines used for the treatment of candida associated denture stomatitis (CADS).

Association between denture stomatitis, candida species and diabetic status.

Candida species are commensal yeasts of the oral cavity, which, under predisposing systemic and/or local circumstances, are responsible for a wide variety of clinical manifestations, globally known as oral candidiasis. Candida-associated denture stomatitis is an oral candidiasis particularly affecting the oral mucosa covered by a dental prosthesis, with several degree of severity. Diabetics suffer oral candidiasis more frequently than healthy individuals do and if they are denture wearers, the risk increases. Since various controversies still remain regarding the interrelationship among diabetes, oral Candida spp. strains involved in denture stomatitis and the presence of dentures, the present review aims to investigate the differences in Candida species frequencies and degree of denture stomatitis severity existing among diabetic and non- diabetic individuals, with and without dentures.

A case with tumor of left parotid gland and denture stomatitis.

The article discuss the case of an edentulous patient presented to the dental clinic for pain and burning sensation of oral mucosa and diagnosed subsequently with oxyphilic adenoma. A 58-year-old patient, with maxillary edentulism, treated with complete denture, presented to the Clinic of Prosthetic Dentistry of the Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, Romania, for pain of oral mucosa and bad stability of denture. The diagnosis of erythematous denture stomatitis as consequence of salivary flow reduction was establish after patient's clinical examination, and by unstimulated sialometry. Clinical exam suggested hyposalivation could be a consequence of a tumor situated at the level of the left parotid gland. The echography confirmed the diagnosis of left parotid gland tumor. The tumor was surgical removed and histopathological exam confirmed oxyphilic adenoma. Education of patient for wearing new denture while maintaining a strict oral hygiene and dealing with low salivary flow was the treatment for denture stomatitis. General dentist has an important role in finding and diagnosing patients with systemic diseases, especially salivary tumors.

Influence of denture plaque biofilm on oral mucosal membrane in patients with chronic obstructive pulmonary disease.

Patients with chronic obstructive pulmonary disease (COPD) have the lower airways colonized with pathogenic bacteria in a stable period of the disease and during exacerbations. The etiology of bacterial exacerbations of COPD depends on the underlying disease, the frequency of exacerbations and antibiotic therapy. Microorganisms can be aspirated off the denture plaque biofilm into the lower respiratory tract and could reduce the patient's immunity and cause pneumonia. COPD patients, who are using acrylic dentures in oral cavity, are exposed to denture stomatitis and oral candidiasis. The aim of this study was to establish the composition of denture plaque biofilm and its impact on the oral mucosa in COPD patients. The study included patients in a stable phase of COPD using removable denture and the control group included healthy wearer's appliances. Examinations concerned the oral mucosal membrane and the hygienic condition of prosthetic restorations. Microbiological examinations were performed by taking a direct swab from the surface of acrylic dentures. Seventeen bacterial and fungal strains were isolated from denture plaque of COPD patients, which could be a reservoir of pathogens in the upper and lower airways. The results showed a greater frequency of prosthetic stomatitis complicated by mucosal infections among COPD patients compared to healthy subjects.

Oral candidiasis: pathogenesis, clinical presentation, diagnosis and treatment strategies.

Oral candidiasis is a clinical fungal infection that is the most common opportunistic infection affecting the human oral cavity. This article reviews the pathogenesis, clinical presentations, diagnosis and treatmentstrategies for oral candidiasis.

Clinical and histological findings of denture stomatitis as related to intraoral colonization patterns of Candida albicans, salivary flow, and dry mouth.

PURPOSE: Multifactorial etiological factors contribute to denture stomatitis (DS), a type of oral candidiasis; however, unlike other oral candidiasis, DS can occur in a healthy person wearing a denture. In this study, we therefore attempt to explore the association between candida, denture, and mucosal tissue using (1) exfoliative cytology, (2) the candidal levels present in saliva, on mucosal tissues and on denture surfaces, and (3) the salivary flow rate and xerostomic symptoms. MATERIALS AND METHODS: A cross-sectional study enrolled 32 edentulous participants, 17 without DS as controls and 15 with DS (Newton's classification type II and III). Participants with systemic or other known oral conditions were excluded. Participants completed a xerostomia questionnaire, and salivary flow rates were measured. Samples of unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) were collected. UWS was used for fungal culturing. Periodic acid-Schiff (PAS) stain and quantitative exfoliative cytology were performed on samples from affected and unaffected mucosa from each participant. Levels of Candida species (albicans and non-albicans) were determined in salivary samples (expressed as colony-forming units, CFU), as well as from swab samples obtained from denture fitting surfaces, in addition to affected and unaffected mucosa. RESULTS: There were no significant differences in salivary flow rates, mucosal wetness, or frequency of reported dry mouth comparing participants with and without DS. Exfoliative cytology of mucosal smears demonstrated significantly higher (p= 0.02) inflammatory cell counts in DS patients, as compared with smears of healthy denture-wearers. Candida albicans was significantly more prevalent in saliva (p= 0.03) and on denture surfaces (p= 0.002) of DS participants, whereas mucosal candidal counts and the presence of cytological hyphae did not show significant difference comparing DS to healthy participants. CONCLUSIONS: In this investigation, we presented a unique group of healthy edentulous patients. This population may reflect the general DS population without systemic or other oral diseases. The prominent etiological factor for DS in this population is the presence of candida in denture and saliva. We found that other factors such as saliva flow/xerostomia, fitting of the denture, and the presence of candida in the mucosa, are less important in this population. Therefore, DS treatments in healthy patients should first focus on sanitization of an existing denture and/or fabrication of a new denture.

Microbial colonization and their relation with potential cofactors in patients with denture stomatitis.

AIM: To determine microbial prevalence in the mucous membrane and prosthesis of denture wearers with and without denture stomatitis and to study its relationship with potential clinical cofactors. MATERIALS AND METHODS: Saliva was collected from 200 patients (100 female and 100 male) wearing dental prosthesis for measurement of pH. Oral samples of the mucous membrane and of dentures were taken with sterile swab for microbiological analysis. Medical and dietary history of the subjects was recorded. Chi-square test and analysis of varience were used for statistical analysis. RESULTS: Diabetes, hypertension and high carbohydrate ingestion was observed in majority of patients. The pH average in saliva was of 5.1. The presence of C. albicans, S. aureus and S. mutans in the mucous membrane was of 55.4, 56.4 and 63.6% respectively. C. albicans was isolated in 69.7% from the prosthesis, whereas S. aureus and S. mutans were isolated in 45.3%. The isolation of C.albicans was more frequent in patients with denture stomatitis. CONCLUSION: C. albicans, S. aureus and S. mutans frequently colonize the oral mucous of denture wearers. This is more frequently observed in patients with denture stomatitis. CLINICAL SIGNIFICANCE: Denture stomatitis is associated to Candida albicans, different bacteria and other cofactors, such as salivary pH, carbohydrate ingestion, systemic illnesses and medication.

Oral health of the elderly with Alzheimer's disease.

OBJECTIVE: The objective of this study was to describe the oral health of elderly people diagnosed with Alzheimer's disease (AD). STUDY DESIGN: Thirty elderly subjects with AD (mild, moderate, and severe) and 30 without AD (controls) were included in the study. Volunteer-reported oral health data were collected using the General Oral Health Assessment Index (GOHAI). Demographic and oral characteristics were assessed, including the number of natural teeth; number of decayed, missing, and filled teeth (DMTF); oral health index (OHI); removable prosthesis conditions; and oral pathologies. RESULTS: GOHAI values were similar for both groups. Compared with the controls, the subjects with AD had a higher age, DMTF, OHI, and number of oral pathologies and a lower educational level and number of natural teeth. CONCLUSIONS: Elderly subjects with AD had poorer oral health than those without the disease. Despite the positive self-perception of their oral health, the oral health of subjects with AD tended to decline as their disease progressed.

Microwave denture disinfection versus nystatin in treating patients with well-controlled type 2 diabetes and denture stomatitis: a randomized clinical trial.

PURPOSE: The aim of this randomized clinical trial was to compare the effectiveness of microwave denture disinfection and nystatin in the treatment of well-controlled type 2 diabetic patients with denture stomatitis in terms of microbiologic and clinical outcomes. MATERIALS AND METHOD: Diabetic patients wearing maxillary complete dentures with denture stomatitis (n = 40) were divided into two groups: NYS (patients treated with topical nystatin 4 times/day for 14 days) and MW (patients who had their dentures microwaved [650 W for 3 minutes] 3 times/week for 14 days). Mycologic samples were taken from the palates and dentures of the patients for quantification and identification of Candida, and standardized photographs of the palates were taken for clinical analysis. Evaluations were repeated at baseline, the end of treatment (day 14), and throughout follow-up (days 30, 60, and 90). Microbiologic data were evaluated by analysis of variance using a random effects statistical model, Tukey post hoc test, and chi-square test (α = .05). Clinical results were analyzed using Mann-Whitney and Fisher exact tests (α = .05). RESULTS: Both treatments were considered successful in reducing the clinical signs of denture stomatitis and significantly reduced the values of colony-forming units/mL from the palates and dentures at days 14 and 30. In addition, 40% of treated patients were cured by the end of treatment. No significant differences in the microbiologic and clinical outcomes were revealed between the two groups (P > .05). C albicans was the most predominant species isolated (P < .01), followed by C tropicalis and C glabrata. CONCLUSION: Denture microwave disinfection was as effective as nystatin for the treatment of diabetic patients with denture stomatitis.

Candida spp. prevalence in well controlled type 2 diabetic patients with denture stomatitis.

OBJECTIVE: The aim of this study was to compare the prevalence of Candida spp. in diabetics and nondiabetics with and without denture stomatitis (DS). STUDY DESIGN: Mycologic samples were taken from the dentures of 90 healthy subjects (control group [CG]), 80 denture stomatitis nondiabetics (DSND), and 40 denture stomatitis diabetics (DSD; well controlled type 2) for identification of Candida spp. Results were analyzed by Fisher exact test, Bonferroni-corrected confidence interval, and χ(2) test (α = .05). RESULTS: Candida albicans was the predominant species isolated (81.9%; P < .016), with C. tropicalis and C. glabrata demonstrating similar prevalence (15.71% and 15.24%, respectively). The prevalence of C. albicans and C. tropicalis in the DS groups were significantly higher (P < .01) than in the CG. The prevalence of C. tropicalis significantly increased with the highest degree of inflammation (P < .05). CONCLUSIONS: The prevalence of Candida spp. was similar between diabetic and nondiabetic patients with DS. Candida tropicalis may play a role in the progression of DS.

Candida-associated denture stomatitis in type 2 diabetes mellitus.

OBJECTIVE: To describe the clinical appearance of Candida-associated denture stomatitis (DS) in subjects with type 2 diabetes (T2DM). The relationships between the types of DS, oral complaints and associated conditions were assessed in terms of glycemic control as determined by glycated hemoglobin (HbA1c) measurements. MATERIALS AND METHODS: Demographic and clinical data were obtained from questionnaires and oral examinations of 110 edentulous patients with T2DM and 50 control subjects. RESULTS: Type II DS commonly occurred in diabetics (57.3% vs 30%; p=0.002) together with DS related oral complaints (60.9% vs 24%; p<0.001) compared with controls. Burning sensation of the mouth (BS) was the most common complaint. Dryness of the oral mucosa (DOM) (50.9% vs 6%; p<0.001), angular cheilitis (26.4% vs 8%; p=0.01) and glossitis (27.3% vs 6%; p=0.003) occurred more frequently in diabetics. Oral complaints and associated conditions of DS coincided with elevated HbA1c levels (p<0.001). Diabetics with extensive type of inflammation had higher HbA1c levels than type I/III DS subjects (p<0.001). CONCLUSIONS: Diffuse type of inflammation was associated with T2DM. BS and DOM were the most common oral complaints. Inadequately controlled diabetes with Candida-associated DS was linked to a high incidence of an extensive type of inflammation, oral complaints and associated conditions.

Comparison of efficacy of fluconazole mouthrinse and clotrimazole mouthpaint in the treatment of oral candidiasis.

Candidiasis is by far the most common oral fungal infection in humans and has a variety of clinical features. It is considered to be an opportunistic infection, affecting individuals who are debilitated by another disease. Fluconazole, one of the newer azoles available for systemic use and clotrimazole as a topical ointment are both shown to be effective in the treatment of oral candidiasis and are considered to be well tolerated and useful medications. No study has evaluated the comparison of clinical and mycological response of oral candidiasis to fluconazole mouthrinse and clotrimazole mouthpaint. The aim of this study was to evaluate the efficacy of fluconazole mouthrinse and compare it with clotrimazole mouthpaint in the treatment of oral candidiasis.

La candidiasis en pacientes con estomatitis subprótesis / Candidiasis in patients with stomatitis sub-prosthesis

Fundamento: Cuando la candidiasis se asocia con la prótesis removible puede inducir a la formación de estomatitis subprótesis, esencialmente en aparatos desajustados y con muchos años de uso. Objetivo: Determinar la prevalencia de la candidiasis en pacientes con estomatitis subprótesis. Método: Se realizó un estudio observacional, descriptivo y transversal en la Clínica Estomatológica Docente de La Vigía desde enero a marzo de 2008 en 30 pacientes mayores de 20 años y de ambos sexos con estomatitis subprótesis (10 en cada grado clínico de la lesión), portadores de prótesis removibles. Resultados: El comportamiento microbiológico de los pacientes con estomatitis subprótesis afloró que no todos los pacientes afectados presentaron candidiasis, solo se evidenció la presencia de la misma en 21 para un 70 por ciento de la muestra. Según el grado de la lesión esta afección se presentó en cuatro pacientes de grado I para un 19,04 por ciento, 7 del grado II para un 33,33 por ciento y en el 100 por ciento del grado III con diferencia significativa entre la proporción de pacientes con cándida de los grados I y II con respecto al grado III. En el estudio predominaron los pacientes con afecciones de grado III. Conclusiones: No todos los pacientes con estomatitis subprótesis presentaron cándida albicans. Se incrementó la candidiasis en los grados avanzados de la estomatitis subprótesis. La totalidad de las prótesis en pacientes con lesiones grado II y III presentaron cándida albicans (AU)

Background: When candidiasis is associated with removable prosthesis may induced to the formation of stomatitis sub-prothesis, essentially in non-adjusted appliance and with many years of use. Objective: To determine the prevalence of candidiasis in patients with stomatitis sub-prosthesis. Method: An observational, descriptive and cross-sectional study at La Vigía Teaching Odontology Clinic from January to March 2008 was conducted in 30 patients older than 20 years and from both sexes with stomatitis sub-prosthesis (10 in each clinical degree of the lesion), carriers of removable prosthesis. Results: The microbiological behavior of patients with stomatitis sub-prosthesis showed that not all the affected patients presented candidiasis, only showed its presence in 21 for a 70 percent of the sample. According to the degree of the lesion this affection was presented in four patients of I degree for a 19,04 percent, 7 of II degree for a 33,33 percent and in the 100 percent of III degree with significant difference among the proportion of patients with Candida of I and II degrees regarding to III degree. In the study predominated patients with affections of III degree. Conclusions: Not all the patients with stomatitis sub-prosthesis showed Candida albicans. Candidiasis in advanced degrees of the stomatitis sub-prothesis was incremented. The totality of the prosthesis in patients with II and III degree lesions showed Candida albicans (AU)

La candidiasis en pacientes con estomatitis subprótesis / Candidiasis in patients with stomatitis sub-prosthesis

Fundamento: Cuando la candidiasis se asocia con la prótesis removible puede inducir a la formación de estomatitis subprótesis, esencialmente en aparatos desajustados y con muchos años de uso. Objetivo: Determinar la prevalencia de la candidiasis en pacientes con estomatitis subprótesis. Método: Se realizó un estudio observacional, descriptivo y transversal en la Clínica Estomatológica Docente de La Vigía desde enero a marzo de 2008 en 30 pacientes mayores de 20 años y de ambos sexos con estomatitis subprótesis (10 en cada grado clínico de la lesión), portadores de prótesis removibles. Resultados: El comportamiento microbiológico de los pacientes con estomatitis subprótesis afloró que no todos los pacientes afectados presentaron candidiasis, solo se evidenció la presencia de la misma en 21 para un 70 por ciento de la muestra. Según el grado de la lesión esta afección se presentó en cuatro pacientes de grado I para un 19,04 por ciento, 7 del grado II para un 33,33 por ciento y en el 100 por ciento del grado III con diferencia significativa entre la proporción de pacientes con cándida de los grados I y II con respecto al grado III. En el estudio predominaron los pacientes con afecciones de grado III. Conclusiones: No todos los pacientes con estomatitis subprótesis presentaron cándida albicans. Se incrementó la candidiasis en los grados avanzados de la estomatitis subprótesis. La totalidad de las prótesis en pacientes con lesiones grado II y III presentaron cándida albicans.

Background: When candidiasis is associated with removable prosthesis may induced to the formation of stomatitis sub-prothesis, essentially in non-adjusted appliance and with many years of use. Objective: To determine the prevalence of candidiasis in patients with stomatitis sub-prosthesis. Method: An observational, descriptive and cross-sectional study at La Vigía Teaching Odontology Clinic from January to March 2008 was conducted in 30 patients older than 20 years and from both sexes with stomatitis sub-prosthesis (10 in each clinical degree of the lesion), carriers of removable prosthesis. Results: The microbiological behavior of patients with stomatitis sub-prosthesis showed that not all the affected patients presented candidiasis, only showed its presence in 21 for a 70 percent of the sample. According to the degree of the lesion this affection was presented in four patients of I degree for a 19,04 percent, 7 of II degree for a 33,33 percent and in the 100 percent of III degree with significant difference among the proportion of patients with Candida of I and II degrees regarding to III degree. In the study predominated patients with affections of III degree. Conclusions: Not all the patients with stomatitis sub-prosthesis showed Candida albicans. Candidiasis in advanced degrees of the stomatitis sub-prothesis was incremented. The totality of the prosthesis in patients with II and III degree lesions showed Candida albicans.

Dental and periodontal history of oncologic patients on parenteral bisphosphonates with or without osteonecrosis of the jaws: a pilot study.

OBJECTIVES: We tested the hypothesis that patients on bisphosphonates with ONJ might have a poorer dental and periodontal history than non-ONJ patients. Our aim was to retrospectively compare medical and oral history of patients on bisphosphonates with and without ONJ. STUDY DESIGN: A total of 39 oncologic patients on bisphosphonates were interviewed, examined, and had a panoramic radiograph taken. DMFT values and residual bone levels were calculated and compared for ONJ and non-ONJ patients. RESULTS: Twenty of 39 patients had ONJ. No statistical differences in caries or residual bone level as well as dental extractions were detected, although twice as many patients with ONJ underwent dental extractions. ONJ patients had received statistically more administrations of bisphosphonates compared to non-ONJ patients. CONCLUSION: A long history of bisphosphonate administration might represent a risk for ONJ onset.

[Malnutrition in the elderly--a interdisciplinary problem for the dentist]. / Malnutrition im Alter--Eine interdisziplinäre Problemstellung auch für den Zahnarzt.

Success in dental treatment and long-term care of elderly persons requires an interdisciplinary consideration of aging. Medical knowledge, which is far beyond specific dental expertise, is assumed. A typical example is that of malnutrition, which in spite of its high frequency in the elderly, has not yet been considered to be important in dentistry. Missing diagnosis and therapy of malnutrition lead to increasing morbidity and mortality. Clarifying the nutritional conditions of aging persons therefore should also become a part of dental diagnosis to guarantee early medical diagnosis and therapy as well as to avoid oral complications.

Denture-related stomatitis: identification of aetiological and predisposing factors - a large cohort.

The aim of this study was to identify and characterize aetiological and predisposing factors in denture-related stomatitis (DRS), by means of a case-control, transversal study, in a large cohort of 140 persons wearing removable maxillary polymethylamethacrylate prostheses. Data were obtained by (1) a questionnaire that included the identification of the subject, demographic and social data, medical history and behaviour; (2) intra-oral examination; (3) evaluation of the prosthesis; (4) microbiological examination; (5) yeast identification and analyses using Epi-info and the chi-square test. Results showed significant associations between DRS and yeasts, gender, age and alcohol consumption. We also found a significant relationship between the presence of yeasts and hyposalivation and decreased salivary pH. We found a highly significant difference between groups with and without DRS concerning the presence or absence of yeasts, regardless of the sample origin. Most cases of DRS showed the presence of Candida albicans. The results confirm a highly significant difference between groups with and without DRS concerning the presence or absence of yeasts.

Oral candidosis in patients with advanced cancer.

The objectives of the study were to determine the epidemiology, aetiology, clinical features and microbiological aspects of oral candidosis in a cohort of cancer patients receiving specialist palliative care. One hundred and twenty patients participated in the study. Seventy-nine (66%) of the patients had microbiological evidence of oral yeast carriage, whilst 36 (30%) of the patients had combined clinical and microbiological evidence of oral candidosis. Oral candidosis was associated with a poor performance status, the presence of xerostomia, and the presence of dentures; oral candidosis was not associated with the use of oral/parenteral antibiotics, or the use of oral/parenteral corticosteroids. Candida albicans was the predominant organism isolated from the oral swabs of patients with oral candidosis. However, non-C. albicans species were the predominant organism in 25% cases, and a contributing organism in a further 19% cases.

The impact of cigarette/tobacco smoking on oral candidosis: an overview.

Smoking is associated with a variety of changes in the oral cavity. Cigarette smoke has effects on saliva, oral commensal bacteria and fungi, mainly Candida, which causes oral candidosis, the most common opportunistic fungal infection in man. How cigarette smoke affects oral Candida is still controversial. This brief overview is an attempt to address the clinical findings on the relationship between smoking and oral candidosis and possible mechanisms of pathogenicity.