Ecology of Candida-associated denture stomatitis

Abstract

Introduction of a prosthesis into the oral cavity results in profound alterations of the environmental conditions as the prosthesis and the underlying mucosa become colonized with oral microorganisms, including Candida spp. This may lead to denture stomatitis, a non-specific inflammatory reaction against microbial antigens, toxins and enzymes produced by the colonizing microorganisms. The role of Candida in the etiology of denture stomatitis is indicated by an increased number of yeasts on the mucosa and the dentures, increased levels of anti-Candida antibody titres in affected individuals and the clinical improvement of the mucosa due to eradication of the yeast flora. The colonization of the fitting denture surface by Candida depends on several factors including adherence of yeast cells, interaction with oral commensal bacteria, redox potential of the site, and surface properties of the acrylic resin. The pathogenicity of denture plaque can be enhanced by factors stimulating yeast propagation, such as poor oral hygiene, high carbohydrate intake, reduced salivary flow and continuous denture wearing. The more important factors which can modulate the host-parasite relationship and increase the susceptibility to Candida-associated denture stomatitis may be ageing, malnutrition, immunosuppression, radiation therapy, diabetes mellitus, and possibly treatment with antibacterial antibiotics. To control plaque formation on the fitting denture surface and the underlying mucosa it is important to install appropriate oral and denture hygiene measures as well as denture wearing habits. The Candida infection associated with denture stomatitis is a relatively harmless condition in healthy individuals; however, the infection may spread in susceptible individuals.