Caracterización de la estomatitis subprótesis en adultos mayores en la Clínica Estomatológica Ormani Arenado Llonch / Prosthesis stomatitis characterization in adults bigger in the Ormani Arenado Llonch Dentistry Clinic

Fundamento: la estomatitis subprótesis en adultos mayores representa una enfermedad inflamatoria de la cavidad bucal que puede degenerar en una lesión hiperplásica si no se trata de manera oportuna.Objetivo: caracterizar el comportamiento de la estomatitis subprótesis en adultos mayores.Métodos: se realizó un estudio observacional, descriptivo y transversal en adultos mayores atendidos en la consulta prótesis dental de la Clínica Estomatológica Ormani Arenado Llonch de la ciudad Pinar del Río, en el primer trimestre del año 2017. El universo lo constituyeron 663 adultos mayores de ambos sexos que acudieron en el período de la investigación, mientras que la muestra quedó constituida por 83 pacientes de ambos sexos seleccionados de forma no probabilística que presentaron estomatitis subprótesis. Se estudiaron las variables edad, sexo, tiempo de uso de la prótesis, clasificación de la lesión, tipo de prótesis y hábito de uso de la prótesis.Resultados: predominó la estomatitis subprótesis en adultos mayores con edades entre 60 a 69 años; con prevalencia el sexo masculino y la lesión grado II en aquellos pacientes con tiempo constructivo de prótesis entre cinco a nueve años. El tiempo de uso continuo y el tipo de prótesis total resultaron significativos en el estudio.Conclusiones: los adultos mayores con estomatitis subprótesis se caracterizaron por ser masculinos, de 60 a 69 años, con lesión grado II en pacientes con tiempo constructivo protésico entre cinco a nueve años, uso continuo de la misma y tipo de prótesis total(AU)

Background: prosthesis stomatitis in elderly adults represents an inflammatory pathology of the buccal cavity that can degenerate in a hyperplasic lesion if it is not treated in time.Objective: to characterize the behavior of the prosthesis stomatitis in elderly adults.Methods: an observational, descriptive and cross-sectional study was conducted in assisted in the Dentistry Clinic Ormani Arenado Llonch, Pinar del Rio, during the first trimester of 2017. The universe was composed of 663 elderly adults of both sexes that attended within the period of research, while the sample was constituted by 83 patients of both selected sexes in a non probabilistic way that presented prosthesis stomatitis. Age, sex, time of prosthesis use, classification of the lesion, prosthesis type and habit of prosthesis use were studied, taking into consideration medical ethics.Results: the presence of prosthesis stomatitis prevailed in elderly adults among 60 to 69 years; prevailing masculine sex and the lesion degree II in those patients in advance constructive prosthesis time among 5 to 9 years. The time of continuous use and the type of total prosthesis were significant in the study.Conclusions: elderly adults with prosthesis stomatitis from Dentistry Clinic Ormani Arenado Llonch were characterized. They were males, between 60 and 69 years of age, with lesion degree II and constructive prosthesis time among 5 to 9 years, continuous use of the same one and type of total prosthesis(AU)

Phase 1 clinical trial on the effect of palatal brushing on denture stomatitis.

PURPOSE: This study aimed to assess the efficacy of palatal brushing in the treatment of denture stomatitis. MATERIALS AND METHODS: After screening 143 individuals with a potential diagnosis of denture stomatitis, 48 patients (mean age: 66.0 ± 11.2 years) were enrolled in a two-center phase 1 clinical trial with a one-group pretest/posttest design. The intervention of interest was manual palatal brushing after each meal and before bedtime. Clinical and microbiologic examinations were performed at baseline and 1 and 3 months after treatment. Additional data were obtained using a validated questionnaire. The primary and secondary outcomes were the remission of denture stomatitis and diminution of Candida colony-forming units (CFUs), respectively. Descriptive and nonparametric statistical tests were conducted to analyze the data. RESULTS: At the 3-month follow-up, denture stomatitis was completely cured in 10.4% of the participants, and 70.8% of denture wearers showed improvement in the clinical signs of denture stomatitis. There was a significant reduction in the area and severity of the palatal inflammation (P < .0001). The effect size ranged from medium to large (0.34 to 0.54) depending on the classification used for the diagnosis of denture stomatitis. A significant reduction in the number of Candida CFUs isolated from the palatal mucosa and dentures (P ≤ .05) was observed. CONCLUSIONS: The results of this study suggest that palatal brushing is an effective treatment of denture stomatitis.

Clinical and microbiological efficacy of three different treatment methods in the management of denture stomatitis.

OBJECTIVE: This study evaluated. the effect of mouthrinses and tissue conditioner on the clinical findings and microbial flora of 60 patients with Newton's type II denture stomatitis (N2DS) BACKGROUND: Denture stomatitis is a common problem in complete denture wearers. MATERIALS AND METHODS: Sixty patients with N2DS were included in this study and divided into three groups. Two groups of patients were instructed to rinse their mouth with the designated mouthrinses DioxiDent and Corsodyl twice daily for 1 min and to soak their dentures overnight in these solutions for 15 days. For the third group, tissue conditioner was placed in each of 20 patients' existing maxillary dentures. Patients were evaluated both clinically and microbiologically at baseline and after 15 days. Palatal swabs and smears were taken from each patient before and after treatment and these samples were examined mycologically. The difference between Candida colonisation before and after treatment and the differences between pre-treatment and post-treatment clinical findings were assessed. RESULTS: DioxiDent and Corsodyl showed an improvement in palatal inflammation and a decrease in Candida colonisation compared to Visco-gel. CONCLUSIONS: The effectiveness of topical chlorine dioxide and chlorhexidine gluconate in the management of N2DS was demonstrated.

The role of Candida albicans hyphae and Lactobacillus in denture-related stomatitis.

Denture-related stomatitis (DRS) is still a dilemma in removable prosthodontics. The aim of this study was to investigate the relationship of DRS with the presence of Candida albicans hyphae and Lactobacillus. A total of 91 patients wearing maxillary and mandibular complete dentures were included in the present study and tested mycologically as well as bacteriologically. A statistically significant association of DRS was found with denture age (p = 0.003) and continuous denture wearing (p = 0.015). Presence of C. albicans hyphae was shown to be significantly higher in DRS cases (p < 0.01), and there was a statistically significant positive correlation between presence of hyphae and C. albicans (p < 0.01). Another interesting finding was that DRS patients showed higher Lactobacillus counts in their saliva (p = 0.04), as well as in the palate (p = 0.028). C. albicans is an important factor in the development of DRS. Hyphae seem to facilitate the rise of C. albicans counts and be related to the inflammatory response of the tissues. Lactobacillus seems to play an important role in the presence of DRS, as well. In agreement with many other studies, the results of this study confirm the importance of denture age and continuous denture wearing in the development of DRS.

Mixed Candida albicans and Candida glabrata populations associated with the pathogenesis of denture stomatitis.

INTRODUCTION: Oral yeasts are an important component of the resident microbial ecology of the oral cavity, but they are also associated with various forms of oral candidosis, such as denture stomatitis. Although Candida albicans is the predominant oral fungal pathogen, other species may also play an integral role in pathogenesis. The aim of this study was to examine the mycological ecology in patients with denture stomatitis, using an improved sampling technique, to determine whether species diversity and species quantity were related to oral pathology. METHODS: Thirty-seven patients attending the Glasgow Dental Hospital were enrolled in this study following informed consent. A full clinical history was obtained, including details of their oral hygiene practices and the levels of erythema based on Newton's classification scale. Oral rinse, denture sonicate, and swab samples were taken, which were processed for quantitative and qualitative analysis of oral yeasts. RESULTS: The proportion of patients with no inflammation or Newton's Types I, II, and III were 31, 33, 25, and 14%, respectively. Denture sonication was a superior sampling procedure, with statistically greater quantities of yeasts isolated using this methodology (P < 0.01). The predominant oral yeasts isolated were C. albicans (75%) and Candida glabrata (30%), which were isolated in higher proportions in patients with the highest grades of inflammation (100 and 80%), and in combination from 80% of these patients. CONCLUSIONS: This study has demonstrated that mixed C. albicans and C. glabrata biofilms may play an important role in the pathogenesis associated with severe inflammation in denture wearers.

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.

Investigation of the cleanliness of dentures in a university hospital.

PURPOSE: The purpose of this study was to determine denture cleanliness of a population sample, as well as to investigate denture cleaning habits and attitudes. MATERIALS AND METHODS: Two hundred thirty-four denture-wearing patients were surveyed via a questionnaire to identify types and frequency of use of denture cleaning methods. Patients were also clinically examined to determine denture cleanliness. Dentures were classified as clean, dirty, or extremely dirty based on the level of debris and stain present. The oral mucosa was also examined and rated. RESULTS: The most common regimen employed was brushing with toothpaste (40.59% of patients), while only 1 patient reported soaking the denture in mouthwash. Results showed that 38.9% of patients were not satisfied with their cleansing methods, and 82.9% of patients claimed their dentists did not inform them how to clean their dentures. Only 11.9% of patients had clean dentures. Older dentures tended to be dirtier than newer ones (P = .0001) and had a higher incidence rate of accompanying denture stomatitis (P= .0001). CONCLUSION: In this population sample, most denture wearers did not clean their dentures satisfactorily.

Intra-oral findings and general health conditions among institutionalized and non-institutionalized elderly in Greece.

BACKGROUND: The aim of the study was to record the findings from intra-oral examination and the general health conditions encountered in a group of Greek individuals 65 years of age or older. PATIENTS AND METHODS: The study subjects were derived from the elderly attending 12 randomly selected community centres located in Athens and neighbouring municipalities, consisting the non-institutionalized study group and from the elderly living in three ecclesiastical nursing homes, consisting the institutionalized study group. The research data comprised information from the subjects' interviews, self-defined health status, medical records and intra-oral examination on the following variables: sex, age, general health condition, dentate or not, use of dentures and oral conditions. Fisher's exact two-sided test was used for statistical analysis. RESULTS: Overall, 316 patients were examined; 120 male (38%), 196 female (62%), mean age 78 years (range: 65-99). Of those, 150 were non-institutionalized (59 male, 91 female) and 166 institutionalized (61 male and 105 female). The vast majority (90%) of the patients had at least one general health problem, for which they were taking daily medication. Twenty-three different medical conditions were recorded. The most frequent medical problems were hypertension (56%), cardiovascular problems (41%), depression/anxiety (39%), arthritis (18.5%) and visual problems (16%). The vast majority of the study patients (79%) were edentulous, while 33% were not wearing or using their dentures. Almost half of them (47%) had at least one oral condition. Twenty-seven different oral conditions were recorded. The most frequent oral findings were denture-induced stomatitis (17.2%), dry mouth (14.6%), atrophy of tongue papillae (10.5%), fissured tongue (9.8%) and haemangioma (6.8%). No cases of malignant lesions were observed. CONCLUSIONS: The present study confirms that in this particular age group, general health problems are frequent, variable, coexistent, necessitating the daily administration of multiple medications, while oral examination by a specialist is an essential part of the multidisciplinary medical care in this group of individuals.

Reassessing the presence of Candida albicans in denture-related stomatitis.

OBJECTIVE: The aim of this study was to reevaluate the link between Candida albicans and denture-related stomatitis according to a modified Newton classification, which reflects the classic types of inflammation as well as the extent to which the tissue is affected. STUDY DESIGN: Two groups of denture wearers were evaluated for denture-related stomatitis. The presence and number of yeasts on the dentures, the identification of the Candida species present, and the amount of plaque coverage were determined. Putative risk factors were included in the study. Relations between these variables and stomatitis were analyzed statistically. RESULTS: According to Newton's classification, the presence of yeast on the denture was not linked to whether subjects had stomatitis. But with our classification, higher prevalence of yeast carriers, yeast colony number, and plaque coverage were found on the dentures of individuals with the most extensive inflammation, regardless of Newton type. Among risk factors evaluated, wearing dentures at night and smoking were associated with the most extensive inflammation. We also demonstrated that the presence of C albicans as well as the cohabitation of different Candida species was more frequent in denture-related stomatitis. The differences were statistically significant. CONCLUSIONS: Statistical analysis of microbiologic data from different denture-related stomatitis categories according to our modified classification showed that the presence of yeast on dentures was significantly associated with the extent of the inflammation, rather than with the Newton type. Our findings suggest that the inflammatory process of stomatitis favors the colonization of Candida. These results could have new implications for diagnosis and management of the condition.

Influence of occlusal factors on treatment outcome: a study of 109 consecutive patients with mandibular implant-supported fixed prostheses opposing maxillary complete dentures.

PURPOSE: This study was undertaken to investigate the relationship between occlusal variables and clinical and radiologic findings as well as patient response to treatment outcome in patients with mandibular implant-supported fixed prostheses opposing maxillary complete dentures. MATERIALS AND METHODS: The study group consisted of 109 consecutive patients attending for annual control. They had received their mandibular implant-supported prostheses according to the Brånemark system on average 8 years previously (range 1 to 27 years). All patients were interviewed with standardized questions by one examiner, who also performed the clinical examination. The questions focused on the patients' opinion on masticatory and prosthetic function and problems. The clinical examination comprised occlusal and prosthetic factors and the health of the oral mucosa. RESULTS: The great majority of the patients were very satisfied with their present dental situation and masticatory function. Two thirds reported no problems with their maxillary complete dentures at all. Balanced occlusion was found bilaterally in 61%, and a further 4% had balanced function on one side. More than one third thus lacked balanced occlusion. Only about 60% had optimal occlusion, and 8% had poor occlusion according to common prosthodontic criteria. This was interpreted as a continuing impairment of the occlusion with time. The mean bone loss was 0.5 mm, according to available radiographs, for a mean observation period of 54 months. There were no or only weak correlations between the variables examined. CONCLUSION: The occlusal factors registered were of limited importance for patient satisfaction and treatment outcome recorded clinically and radiographically at follow-up examination of the actual prosthodontic rehabilitation.

Detección de especies de Cándida en pacientes con estomatitis subprotésica / Detection of Candida species in patients with denture stomatitis

La estomatitis subprotésica (E.S.P.) es una de las patologías que se presentan con más frecuencia a nivel mundial en la población total y parcialmente edéntula portadora de prótesis dental removible. Se han señalado diversos agentes involucrados en la etiología de esta entidad, entre otros: alergia, estrés, trauma y factores endógenos relacionado con enfermedades sistémicas, pero cobra especial importancia como agente etiológico la infección producida por microorganismos del género Cándida, principalmente C. albicans. No obstante, algunos autores cuestionan el hecho de que C. albicans sea el único agente implicado en la etiología de la E.S.P. y refieren que otras especies de Cándida también se encuentran implicadas en la etiología y desarrollo de esta afección. El objetivo de este estudio fue detectar las especies de Cándida presentes en pacientes con E.S.P. que acudieron al Servicio de Clínica Estomatológica de la Facultad de Odontología UCV. Se seleccionaron 40 pacientes, los cuales fueron divididos en 2 grupos: 1) grupo experimental, conformado por 30 pacientes con E.S.P. y 2) grupo control, conformado por 10 pacienrtes sin E.S.P. La identificación de las especies de Cándida se basó en la observación de las colonias, en la visualización de las levaduras, tubos germinales y clamidosporas, así como en la realización de pruebas rápidas de asimiliación de carbohidratos mediante el sistema API 20 C AUX (Biomerieux). Los resultados de este estudio demostraron que C. albicans fue la especies más frecuentemente detectada en los pacientes con E.S.P. tanto a partir de muestras tomadas de paladar como de prótesis, en tanto que otras 6 especies de C. se encontraron en una baja porporción de pacientes con esta lesión. De igual forma, C. albicans se identificó en algunos de los pacientes del grupo control a partir de muestras tomadas de paladar

Oral health status of patients 5-6 years after placement of cobalt-chromium removable partial dentures.

This study is a clinical survey of cobalt-chromium (Co-Cr) removable partial denture (RPD) wearers that aimed to investigate the effects of denture wearing on oral tissues. A random sample of patients who had received their dentures 5-6 years previously from a dental teaching hospital in Hong Kong was selected. Those who had been constantly wearing the RPDs were examined by one calibrated examiner under an optimal clinical setting. The patients' dental, periodontal and mucosal status were assessed. A total of 87 patients were examined. Mucosal lesions under the Co-Cr RPDs were uncommon in this study sample. However, there was a high prevalence of plaque, gingivitis and gingival recession, especially in dento-gingival surfaces in close proximity (within 3 mm) to the dentures. Thus, there is a special need for regular oral hygiene reinforcement, scaling and prophylaxis among RPD wearers. Despite a low caries incidence in the study sample, root caries were found to be associated with contact with the RPDs (P < 0.05) but coronal caries were not. It is recommended that coverage of the exposed root surfaces by RPD components should be avoided. Also, topical fluorides should be regularly applied onto exposed root surfaces as a preventive measure.

Oral health status in an institutionalised elderly Jewish population.

The oral health status and treatment needs of 95 institutionalised elderly Jewish persons were determined. The mean DMFT was 23.4, with the M component increasing with age. Untreated carious lesions were identified in men and women of all ages. A relatively small percentage (10.5%) of subjects were affected by root caries. In 75% of cases of identified periodontal disease, the condition presented as bleeding or calculus. All subjects were in need of oral hygiene instruction and 64 (67.3%) required scaling and root planing. Complex treatment formed only a small percentage of the overall treatment needs. A low prevalence of temporomandibular joint problems, denture stomatitis and angular cheilitis was noted. A relatively high prevalence of untreated oral disease of low severity was observed, indicating the need for a comprehensive form of preventive and basic oral care.

Classification and clinical manifestations of oral yeast infections.

By tradition oral candidosis has been classified into acute pseudomembranous (thrush), acute atrophic, chronic atrophic, and chronic hyperplastic types. However, pseudomembranous candidosis is not always acute but may last for many months. Furthermore, the value of using the term atrophic to describe an erythematous area is limited. Moreover, some of the various types have been associated with other clinical entities, which appear to have a combined bacterial/mycologic etiology. A revision of the classification should be based on the use of clinical terms, and in a previous study of multifocal oral candidosis, erythematous, plaque-like, and nodular forms were identified. A revised classification of oral candidosis which considers these aspects could be as follows: acute types: pseudomembranous and erythematous; chronic types: pseudomembranous, erythematous, plaque-like, and nodular; and Candida-associated lesions: denture stomatitis, angular cheilitis, and median rhomboid glossitis.