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  1. Denture Stomatitis By: Tiffany Montes

  2. What is Denture Stomatitis? Denture stomatitis is a candidiasis (fungal infection) that occurs only beneath a denture. It can be asymptomatic or symptomatic causing a burning sensation, discomfort and bad taste.

  3. Candida albicans • Diploid • fungus • Kingdom: • Fungi • Class: • Saccharomycetes • Genius: • Candida candidaconquered.wordpress.com

  4. 8 different types of Candida • Candida albicans • Candida glabrara • Candida tropicalis • Candida guilliermondii • Candida cruser • Candida parapsilosis • Candida stelatoidea • Candida kefyr

  5. Question time • What is another name for denture stomatitis? • Chronic atrophic candidiasis • Papillary hyperplasia • Palatal papillomatosis • All of the above

  6. Correct Answer is… D) All of the above

  7. Contributing factors: • denture wearers • Candida albicans • Poor oral hygiene • Lack of knowledge: removing @ night • Smoking • Ill fitting dentures • Decreased salivary flow • Vitamin A deficiency

  8. Newton’s Classification ofDenture stomatitis • Type 1= localized inflammation • Type 2= diffuse erythema (redness) without hyperplasia • Type 3= Inflammation, erythema and involves papillary hyperplasia

  9. CASE STUDY William aka Sal

  10. William • 62 year old Caucasian male • Currently under the care of a physician • Previously hospitalized: Hernia 1996 ; broken neck 1995 • Last visit 3months ago for a cleaning? (1 yr) Coming to CCC since 2008

  11. Medical History “Yes” answers • Arthritis • Cold Sores • Drug addiction • Hepatitis • High blood pressure • Persistent cough • Psychiatric disorders • Recreational drug use • STD’s • Tobacco use • Other-smoking herbs

  12. EO/IOSignificant findings • 2 5x5mm bilateral scars above eyebrows (from halo brace) • Red, irritated tissue on upper ridge bilaterally • Multiple red papules on hard palate (12x6mm)= Denture stomatitis • Slightly fissured and coated tongue • Xerostomia

  13. Dental History • William has a (FUD) full upper denture. -Fits poorly, chewed by dog uniquedental.co.nz

  14. Dental Findings • Gen. 6-7mm pockets • Gen BOP • Gen. 4-5 mm recession • Loc. class II mobility • Loc. class 1 furcations • Gen. Horizontal bone loss Case Class V AAP IIB

  15. QUESTION TIME: • If Williams probing depth was 7mm and his recession was 5mm, his total CAL (clinical attachment level) would be? A) 12mm B) 10mm C) 2mm

  16. CORRECT ANSWER IS… A) 12mm *Can anyone tell me the Clinical attachment loss??

  17. Social History • Previous Meth/Cocaine addiction; quit in 1985 • Tobacco use previously • Patient wears an ankle monitor • On probation so can’t smoke marijuana • Currently smoking herbs from co-op (Mullen, Mugwart, Catnip, White sage, Yerba Santa, Damiana) • Has a dog that he speaks of at every visit

  18. Chief Complaint • William just wants his teeth cleaned and to prevent loosing more teeth. • Would like to find a place to fix his dentures. • Mentioned getting rid of gaps in his teeth and whitening them.

  19. Oral Hygiene Status • Appointment 1= 1.66 • Appointment 2= 1.66 • Overall Fair according to the OHI-S. Only scored from lower teeth. *Reviewed denture brushing on each appointment. Gum go betweens for diastemas.

  20. Oral Hygiene Status Cont. • Oral hygiene with dentures= non existent • No removal of dentures • No cleaning of dentures • Broken dentures • Brushed remaining teeth well. Just struggled with interproximal areas.

  21. Concerns Denture stomatitis Carrington College California DH Clinic

  22. Concerns Denture stomatitis Carrington College California DH Clinic

  23. QUESTION TIME: • According to Newton’s Classification of denture stomatitis, William is a Type…? A) Type 1 B) Type 2 C) Type 3 D) He does not have denture stomatitis

  24. CORRECT ANSWER IS… C) Type 3 due to involvement of papillary hyperplasia

  25. Possible causes: • Smoking with dentures in • Leaving dentures in to sleep • Not cleaning dentures • Ill fitting dentures

  26. Suggested Modifications • Removing dentures while smoking/quitting • Daily denture brushing/cleaning • Removing dentures to sleep • Denture reline or new dentures

  27. Treatment Plan • 1st appointment: 7 PA’s, local anesthesia, SRP LR sextant, tobacco/herb cessation, Medical referral for denture stomatitis. • 2nd appointment: Tobacco/herb cessation, local anesthesia, SRP mand. anterior sextant and LL sextant, dental referral. Recommend 3mon recare appointment.

  28. THE 8 HUMAN NEEDS • Protection from health risks • Freedom from fear and stress • Freedom from pain • Wholesome facial image • Skin & mucous membrane integrity of the head and neck • Biologically sound and functional dentition • Conceptualization and problem solving • Responsibility for oral health.

  29. Williams Unmet needs (7) • Protection from health risks • Freedom from fear and stress • Wholesome facial image • Skin and mucous membrane integrity of the head and neck • Biologically sound and functional dentition • Conceptualization and problem solving • Responsibility for oral health

  30. In Conclusion… • Denture stomatitis was not being cared for and grew from 12x6mm to 20x10mm • Patient didn’t seem concerned • I would have liked to recommend some of the research findings, but was unsure about liability to the clinic and myself. • Additional denture care and tobacco cessation could be beneficial.

  31. References • Hadžić, S. D.-V. (2008, June 26). Influence of candida infection on denture stomatitis. Retrieved June 1, 2011, from Ebscohost: http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid • Kulak-Ozkan, E. (2002). Oral hygiene habits, denture cleanliness, presence of yeast and stomatitis in elderly people. Journal of Oral Rehabilitation , 300-304. • Neppelenbroek, K. P. (2008). Effectiveness of microwave disinfection of complete dentures on the treatment of Candida-related denture stomatitis. Journal of Oral Rehabilitation , 836-846. • Rosenberg, J. D. (2010, Feb 22). Periodontitis. Retrieved June 1, 2011, from PubMed: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002054/ • Shulman, J. R.-H. (2005). Risk factors associated with denture stomatitis in the United States. J Oral Pathol Med , 340-346. • Yuntzu-Yen Chen, A. B., & Zirwas, M. J. (2007). Denture Stomatitis . SKINmed , 92-94. • Yuntzu-Yen Chen, A. (2007, March). Denture Stomatitis. Retrieved May 30, 2011, from Ebsco: http://web.ebscohost.com/ehost/detail?sid