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Management of denture stomatitis: An overview

Management of denture stomatitis: An overview Acta Marisiensis - Seria Medica 2023;69(1):23-29 DOI: 10.2478/amma-2023-0007 REVIEW 1 2 2* Nader Navabi , Parham Shakibaei , Alireza Ranjbar Hassani 1. Oral Medicine Department, Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran 2. Student Research Committee, Dental School, Kerman University of Medical Sciences, Kerman, Iran Denture stomatitis is a common inflammation of the palatal mucosa beneath removable dentures. The objective of this article was to examine the systematic reviews and clinical trials pertaining to the treatment of denture stomatitis. For this research, electronic databases (PubMed, Embase, Scopus, and ISI Web of Science) were searched from January 2000 to June 2021 using specified MESH keywords. Irrelevant articles were eliminated in three steps based on their titles, abstracts, and body texts. In the final analysis, 47 papers were selected, which included 12 systematic reviews and 35 clinical trials. Herbal compounds and denture disinfection were the interventions most commonly indicated. We concluded that, possibly due to the complex nature of this lesion’s etiology, there is no present definitive therapy guideline for this prevalent lesion. Keywords: denture stomatitis, clinical trial, management Received 15 November 2022 / Accepted 6 February 2023 Introduction and its pathogenesis is multifactorial. Candida albicans is Because dentures are foreign objects in the mouth, they considered the primary etiological factor in DS. However, can cause damage to the underlying tissues, which are not other factors such as opium use, diabetes mellitus, poor intended to withstand the pressure they exert. Some mu- denture hygiene, denture-related tissue injuries, and con- cosal lesions are caused by the acute or chronic stimulation stant denture use have also been implicated [1–8]. of dentures. These lesions are known as denture-related In this regard, we should take Candida albicans into mucosal lesions (DMLs). Denture stomatitis (DS)  is one consideration. This increases the likelihood that DS pa - of the most common DMLs [1]; it is a benign, chronic, tients will develop dysplasia and premalignant changes. It inflammatory pathological change that manifests as shiny has also been shown that DS kills cells in the oral mucosa. erythema in tissues covered by removable acrylic-based This means that even DS with no symptoms needs to be prostheses in the palatal mucosa and maxillary alveolar treated. Due to the complexity of the etiology of DS, there ridge. This condition is also known as denture-induced is no standard treatment protocol for DS patients. Various stomatitis or denture-related  stomatitis [2–5]. According recommendations, such as using antifungal drugs and dis- to the Newton classification and clinical signs, there are infectant compounds, constantly cleaning the denture, and three types of DS: replacing it, have been made. In addition, the increase in – Type I: Simple inflammation with pinpoint petechia. the number of elderly people is resulting in an increase in – Type II: Erythema and edema are more widespread in the prevalence of edentulism and the number of individu- denture-covered areas. als with complete dentures. Because of this, it is important – Type III: Erythematous areas with inflamed, red pa - to know what causes DS for sure and to have an effec - pules (granular level); this condition is also known tive treatment plan for this condition. The inconsistencies as inflammatory papillary hyperplasia (IPH), and the in the studies conducted on DS treatment have made it inflammation is often more severe in the hard palate difficult for dentists to interpret clinical data [1–11]. As a [6]. result, the goal of this review was to put together reliable Due to its asymptomatic nature, DS remains undetect- evidence about effective ways to treat DS. ed in nearly all patients, despite its high prevalence; only a small percentage of patients report mild bleeding, burn- Materials and Methods ing, itching, or pain in the affected area [7]. If this lesion This study was a structured review. The research question is found quickly and correctly, it can lead to more efficient (PICO) was as follows: care, the right treatment, and a better quality of life for – Population: denture-related stomatitis patients older people with full dentures. – Intervention: DS prevention or treatment (gathered The prevalence of DS among denture wearers ranges via Method A) from 15 to 70 percent (mean=50 percent) [8]. It is more – Comparison: comparison of the proposed treatment prevalent among older adults (those over 60) and women. with the gold standard The etiology of DS is unknown despite its high prevalence, – Outcome: improvement of the lesion following the proposed treatment Four databases (PubMed, Embase, Scopus and ISI Web * Correspondence to: Alireza Ranjbar Hassani E-mail: arh1377@gmail.com of Science) were searched for the relevant papers. 24 Acta Marisiensis - Seria Medica 2023;69(1) All papers written in English between January 1, 2000 experimental studies, animal studies, case-control studies, and June 30, 2021 were considered. MeSH was used to preliminary studies, and non-randomized interventions) choose the keywords based on the goals of the study. The were excluded. In addition, studies proposing the elimina- papers’ titles, abstracts, and full texts were scanned for the tion of underlying factors as a treatment for DS were not following keywords: considered to present a particular treatment. The selected “Candida-associated denture stomatitis, candida-related papers’ data were then extracted and imported into an Ex- denture stomatitis, denture-related stomatitis, sub-pros- cel spreadsheet [12]. thetic stomatitis, prosthetic stomatitis, stomatitis prosthet- The information that was taken from the chosen papers ica, denture-related erythematous stomatitis, granular sto- was the names of the researchers, the year the paper was matitis” and ”etiology, prevalence, treatment, prevention, published, the therapeutic methods that were compared in epidemiology, and management”. the paper, the more effective method, and the important The logical operators “AND” and “OR” were then ap - results that were relevant to the paper. plied between the keywords of the aforementioned two se- ries to locate papers. The result was saved as an EndNote Results document. The paper’s citations were reviewed to identify In the databases chosen for this structured review, 1460 grey literature. Two researchers screened the collected pa- papers were found. After removing 698 papers that were pers in three consecutive stages after eliminating duplicates duplicates, 558 papers with irrelevant titles, 118 papers af- using EndNote. In the initial phase, titles were examined ter reading the abstracts, and 39 papers after reading the and irrelevant papers were eliminated. In the subsequent full texts, the final review included 35 clinical trials and 12 step, the remaining papers were obtained and read by two systematic reviews (Figure 1). researchers, while irrelevant papers were eliminated. The The explanation of the 12 structured reviews on DS full texts of the papers that progressed to the next phase treatment is provided in Table I. Systematically reviewed were prepared, and the two researchers read them; the pa- DS treatments included microwave therapy (two reviews), pers that would enter the final review were then determined. chemicals and denture cleaners (five reviews), natural com - Structured reviews and randomized clinical trials (single pounds (one review), antifungals (two reviews), nanotech- or double-blinded) entered the final review; as a result, nology (one review), and low-level laser therapy (one re- studies with low evidence levels (case reports, case series, view) [13–24]. Fig. 1. Diagram illustrating the study selection procedure used to identify papers for this review. Acta Marisiensis - Seria Medica 2023;69(1) 25 Table I. A summary of the 12 systematic reviews on the treatment of denture stomatitis Number of Author, Year reviewed Main Conclusion studies Using sodium hypochlorite at a concentration of 0.5% can help disinfect denture liners and tissue conditioners. Skupien et al, 2013 [13] 38 Incorporating nystatin into these substances also has the ability to treat or prevent oral candidiasis. In the treatment of denture stomatitis, disinfection methods could be considered as an adjunct or alternative to Emami et al, 2014 [14] 15 antifungal medications. At this time, it is not possible to confirm the existence of scientific evidence for the use of natural products in the Ferreira et al, 2015 [15] 3 treatment of oral candidiasis. Hilgert et al, 2016 [16] 35 The findings support the use of nystatin and disinfectants for the treatment of DS. Robeiro Rocha, 2016 [17] 5 Only chlorhexidine and chlorine dioxide demonstrated some evidence of a reduction in Candida spp Yarborough et al, 2016 Clinical strategies frequently involved multiple approaches with the combined objective of eradicating pathogenic [18] microorganisms and preventing the re-establishment of a pathogenic biofilm through preventive hygiene measures. LLLT plays an important role in the clinical treatment of Down syndrome. However, PDT outcomes were comparable Davoudi et al, 2018 [19] 4 to those of conventional antifungal treatments. Nanomaterials composed of metal oxides demonstrated cytotoxicity against Candida and other microorganisms Ahmad et al, 2020 [20] 27 present in oral biofilm, including PMMA denture surface. An et al, 2020 [21] 28 Incorporating antimicrobial agents into Denture Base Resins has not been conclusively demonstrated to be effective. For the treatment of denture stomatitis caused by Candida, microwave disinfection produced comparable outcomes De Costa et al, 2020 [22] 5 to conventional therapies. Santos Sousa et al, 2020 Microwave sterilisation of complete dentures is as effective as antifungal treatment for the treatment of denture [23] stomatitis. Most studies showed phytomedicines had fewer side effects and higher patient satisfaction than antifungals or disin- Shui et al, 2021 [24] 19 fectants. To verify the clinical efficacy of phytotherapy as an alternative or adjunctive therapy for denture stomatitis, more RCTs with standard herbal formulations are needed. Table II and Table III provide a summary of the data burning sensation in the mouth. In addition to prescrib- extracted from the 35 clinical trials pertaining to DS treat- ing topical nystatin, Skupien and Hilgert emphasized the ment. Herbal remedies (ginger, propolis gel, vinegar, garlic, efficacy of disinfecting dentures with substances such as etc.) and disinfecting the denture using different methods, sodium hypochlorite [13,16]. In their structured review, such as antiseptic mixtures (sodium hypochlorite, chlo- Emami et al. suggested that the use of such compounds rhexidine, etc.), brushing, and microwaving, were the most as a supplement or alternative to nystatin should be con- common methods studied. Consideration should also be sidered [14]. In addition to disinfecting dentures with an- given to the seven papers on the efficacy of photodynamic tiseptic compounds, their use in the denture resin base to therapy and low-level laser therapy. The use of antifungals prevent candida colonization on the denture surface has (nystatin and miconazole) was considered the treatment been discussed. However, the systematic review by An et standard and benchmark in clinical trials related to this al. did not confirm the efficacy of these disinfectants [21]. field [25–59]. Denture hygiene and daily brushing of denture impression surfaces are unquestionably effective in reducing the risk of Discussion DS. However, these studies raise the issue of a higher level This study examined 47 systematic reviews to provide a of routine “cleaning” and, in fact, “disinfection” of the den- structured overview of DS treatment. The significant ture. Because the proposed methods for disinfecting den- number of structured reviews (12 studies) conducted in tures are so diverse, De Costa and Santos Souza conducted this field was the first significant observation made dur - a systematic review on the use of microwaves [22,23]. Due ing the analysis of the chosen studies [26-42]. Skupien to insufficient evidence, the application of this method has and Hilgert highlighted the importance of nystatin in DS remained a suggestion. treatment in the results of their structured review [13,16]. In this review, eleven randomized clinical trials on the The colonization of Candida albicans on the impression treatment of DS with different disinfection methods were surface of maxillary dentures is the primary cause of DS. compiled. Regarding the effect of tooth brushing, Kabawat DS is categorized as chronic atrophic candidiasis or a le- et al. found that routine palatal brushing is beneficial in sion induced by candida. Consequently, the primary treat- preventing DS [40]. According to the findings of clini - ment for this lesion is a topical antifungal medication, and cal trials conducted by Araujo, Badaro, Aoun, Nittayan- nystatin is frequently the first choice of treatment.  The anta, and Uludamar, the proposed antiseptic compounds unpleasant and bitter taste of topical (oral) nystatin is a include sodium hypochlorite, triclosan, cetylpyridinium, significant disadvantage. In their systematic review [17], chlorhexidine immersion, lawsone methyl ether (LME) (a Robeiro Rocha et al. noted the beneficial effects of pre - naphthoquinone compound with potent antifungal prop- scribing chlorhexidine mouthwash in the treatment of DS. erties), and alkaline peroxide tablets [25, 28, 37, 38, 44, However, the antifungal properties of chlorhexidine are 53]. In addition to the variety of proposed antiseptic com- described as “mild” in the majority of texts, and it should pounds, which renders it difficult to choose a single treat - be noted that prolonged use can result in complications ment option, the routine use of some of these compounds such as tooth discoloration, increased dental tartar, and a is ambiguous. Denture immersion in chlorhexidine, for in- 26 Acta Marisiensis - Seria Medica 2023;69(1) Table II. A brief summary of the interventions and results discussed in the selected clinical trials. Sample Author Year Intervention Result Size Sodium hypochlorite 0.25% / 0.15% Triclosan/ Denture Araujo, et al. (25) 2021 108 All Groups had similar disinfecting effects. Cleanser Tablets Gonoudi, et al. Droplet Zataria Multiflora (ZM) was as effective as Ny - 2021 28 Nystatin Suspension / Zataria Multiflora (ZM) Droplet (26) statin Suspension in D.S treatment. Nystatin/ Antimicrobial Photodynamic Therapy (aPDT) via This method of implementing PDT can be a considerable Alves, et al. (27) 2020 65 photodithazine(PDZ) with 660 nm Laserthrapy treatment for D.S. Ricinus communis 10% / chloramine-T 0.5% Sodium hypochlorite is more effective than other disinfect- Badaro, et al. (28) 2020 60 Control (Water) / Control (Sodium hypochlorite 0.25%) ing agents. Afroozi, et al. (29) 2019 66 Nystatin + photodynamic therapy (PDT)/ Nystatin Adding PDT to Nystatin enhances the treatment effect. Mouthwash Chitosan-Curcuminoid (CHI-CUR) / Chlorhexidine CHI-CUR Mouthwash has an acceptable alternative topi- Mustafa, et al. (30) 2019 30 / Chitosan with polyethylene glycol (PEG) 400 cal effect. Alrabiah, et al. photodynamic inactivation (PDI) 2019 36 PDI is as effective as nystatin in D.S treatment (31) and Nystatin Partial Denture Users Consuming milk with or without Lacto- This Probiotic decreases the severity of D.S in elders Lee, et al. (32) 2019 36 bacillus rhamnosus SP1 probiotic residing in nursing homes. De Senna, et al. Miconazole 2% Gel / Methylene blue + Photodynamic inacti- This method of applying PDI can decrease the load of 2018 - (33) vation (PDI) with 660 nm Low Level Lasertherapy fungal infection and inflammation. The effect of propolis gel is not inferior to miconazole and Pina, et al. (34) 2017 40 Miconazole 20mg/g Gel / 2% Brazilian Propolis Gel it could be considered an alternative treatment. methylene blue-mediated PDT with Low Level Lasertherapy / The effect of miconazole in the treatment of D.S was more Maciel, et al. (35) 2016 40 Miconazole prominent than PDT with low-level laser therapy. Alizadeh, et al. 2016 50 Mouthwash ginger / Mouthwash Nystatin Both treatments had the same results. (36) % /0.05 cetylpyridinium chloride Aoun, et al. (37) 2015 40 Both solutions were effective in denture disinfection Chlorhexidine 0.12% / Control (Water) Chlorhexidine 0.12% / 0.1%hexetidine / Distilled water Submerging the denture in hexetidine had a lesser effect Aoun, et al. (38) 2015 60 (Control) than disinfecting with chlorhexidine. Placebo Group / Group Taking Probiotic Capsule Containing: This probiotic treatment can be considered as a possible Ishikawa, et al. 2015 59 lyophilized Lactobacillus rhamnosus HS111, Lactobacillus alternative against candida infection in the elderly with (39) acidophillus HS101, and Bifidobacterium bifidum dentures. Kabawat, et al. 2014 48 Palatal Brushing Palatal brushing is an effective method for D.S treatment. (40) Dastjerdi, et al. This homemade mouthwash could be an alternative to 2014 30 Nystatin / Homemade Mouthwash (Vinegar and Rose Water) (41) nystatin in DS treatment. Uncaria tomentosa gel could be used as an supplemental Tay, et al. (42) 2014 50 Placebo/ Miconazole 2% / Uncaria tomentosa 2% Gel treatment for DS. Capistrano, et Miconazole 2% Gel / 2.5% Propolis Gel / 24% Propolis 2013 45 Propolis was found as effective as miconazole. al. (43) Mouthwash Nittayananta, et Lawsone methyl ether (LME) Mouthwash / Chlorhexidine The application of lME in HIV and DS patients may be ef- 2013 67 al. (44) Mouthwash fective in persistent cases. Treating with Ricinius Communis may clinically improve denture stomatitis in elderly patients residing in nursing Pinelli, et al. (45) 2013 30 Ricinius Communis / Nystatin / Miconazole homes. Additionally, this treatment has the same effect in comparison with miconazole. The therapeutic effects of garlic extra solution are similar Bakhshi, et al. (46) 2012 40 Nystatin Mouthwash/ Garlic Extract Solution to nystatin. Sabzghabaee, et The topical application of S. hortensis could be effective 2012 80 Placerbo / 1% S. hortensis essential oil Gel al. (47) in treating DS. Disinfection with microwave was as effective as nystatin in Silva , et al. (48) 2012 60 Nystatin / Microwave/ Control Group DS treatment. Mima, et al. (49) 2012 40 Nystatin / Photodynamic Therapy (PDT) PDT method was as effective as nystatin in DS treatment. the application of microwave was as effective as nystatin Sanita, et al. (50) 2012 40 Nystatin / Microwave in DS treatment in controlled type II diabetes patients. Sabzghabaee, et 2011 80 Placebo/ Pelargonium 1% Gel This gel was found to be more effective than placebo al. (51) Sefidgar, et al. artemisia extract could be used as a treatment option for 2010 30 Nystatin Mouthwash / Mouthwash Artemisia 1% (52) DS. Three Brand of Alkaline Peroxide Tablets The application of this mouthwash was effective in treating Uludamar, et al. (Polident, Efferdent, and Fittydent) 2010 90 DS. ( This article’s method was centered around disinfect- (53) CloSYS II and Corsodyl Mouthwashs ing dentures) Control Group Distilled water Neppelenbroek, Microwave with Miconazole / Miconazole / Microwave disinfecting the denture with microwave is effective in DS 2008 60 et al. (54) Control Group treatment and decreases the recurrence of candida. Zataria multiflora gel was better at alleviating palatal ery - Amanlou, et al. 2006 24 Miconazole 2% Gel / Zataria multiflora 0.1% Gel thema. While miconazole had a better effect in decreasing (55) the number of colonies on the denture surface. Webb, et al. (56) 2005 60 Sodium hypochlorite / Microwave / Control Group Both disinfecting methods were found effective. Maver-Biscanin, 685 nm Diode Laser / 830 nm Diode Laser /Anti-Fungal Gel The application of low-power laser could be valuable in 2004 70 et al. (57) and Disinfection Solution / Placebo treating DS. De Souza P.granatum could be considered as a topical antifungal Vasconcelos, et 2003 60 Miconazole Gel / Punica granatum agent in DS treatment. al. (58) These two drug forms could be used equally as supple- Cross, et al. (59) 2000 40 Itraconazole in Liquid and Capsule form mental therapy. Acta Marisiensis - Seria Medica 2023;69(1) 27 Table III. The classification of all treatment methods discussed in generalize the use of herbal compounds for patients in dif- the clinical trials under review. ferent parts of the world appears to be an additional limi- Treatment Method Number of Studies tation of such compounds. Photodynamic therapy (PDT) Herbal Medicine / Phytotherapy 12 and low-power laser therapy for the treatment of DS were Denture Disinfection 11 the subjects of a systematic review by Davoodi et al. [19]. Photodynamic and low-level laser therapy 7 Seven clinical trials were compiled for this analysis, in- Probiotics Application 3 Chitosan Based Materials 1 cluding studies by De Souza Alves, Afroozi, Alrabiah, Sen- na, Maciel, Mima, and Maver-Biscanin [27, 29, 31, 33, stance, can discolor the labial surface, resulting in patient 35, 49, 57, 58]. Different methods were proposed by the dissatisfaction with the denture’s appearance. Additionally, aforementioned researchers to administer photodynamic cetylpyridinium requires precise concentration control; therapy to patients with DS. Various compounds, such as otherwise, it can cause mucosal irritation and even chemi- photoditazine or methylene blue, were used for this pur- cal burns. In this review, three clinical trials conducted by pose in these studies, resulting in heterogeneity. Due to Silva, Sanita, and Neppelenbroek on the use of microwaves the use of various wavelengths by researchers, the same in denture disinfection were discussed [48, 50, 54]. Silva is true for low-power lasers. Some researchers, including and Sanita argued that microwaves are equally effective as Maver-Biscanin et al., questioned the efficacy of low-power nystatin for this purpose. It is important to note, though, lasers in the treatment of DS [57]. However, Mima et al. that Sanita et al. did their research on people with type 2 noted that photodynamic therapy and drugs like nystatin diabetes [48, 50]. Overall, it is essential to emphasize that have the same effect (49%). Additionally, Afroozi et al. ar - there is no universally acknowledged procedure for denture gued that combining photodynamic therapy with nystatin disinfection; hence, the difficulties associated with denture improves the therapeutic effects [29]. Consequently, the stomatitis continue. There are a variety of approaches and precise status of treatments such as photodynamic therapy products dedicated to this issue now accessible on the mar- and low-power laser for the management of DS is uncer- ket. However, it is recommended to adhere to best prac- tain. The fact that there are so many studies on DS can be tices, such as the aforementioned procedures. seen as a weakness of this structured review since it made it Ferreira and Shui conducted two systematic reviews that harder to choose the final papers. investigated the efficacy of herbal medicine in the treatment Due to the recurring nature of denture stomatitis, it be- of DS. The results of both reviews indicated that although comes crucial to arrange follow-up appointments at regular the reviewed studies have shown the positive impact of intervals to verify that adequate cleaning and hygiene pro- using such treatments to improve this complication, due cedures are being followed. However, there is no generally to the lack of precise formulations and the probable side agreed upon strategy for doing so. Therefore, a professional effects, their superiority over standard treatment options agreement is essential for patient recalls and follow-ups. (such as nystatin) is questionable and in need of further research [15, 24]. Iranian traditional medicine is very Conclusion popular among researchers, and the clinical trials exam- The present systematic review revealed that due to the mul - ined in this review confirmed that Iranian researchers are tifactorial nature of DS incidence, the interpretation of its interested in treating DS with traditional medicine. Seven most likely causes varied greatly between studies. Possibly, studies conducted by Alizadeh, Dastjerdi, Bakhshi, Sefid - for this reason, different treatments have been proposed in gar, Sabzqabai, and Amanloo investigated the use of gin- research, and no single treatment has been proposed for ger, homemade vinegar and rose water, garlic, Pelargonium this complication to date. Therefore, the following recom - graveolens, Satureja Hortensis, Artemisia Sieberi, and Za- mendations are made to rectify the existing deficiencies: taria multiflora in DS treatment, respectively [36, 41, 46, Providing a valid treatment guideline for DS is an is- 47, 51, 52, 55]. Tay, Pinelli, and De Souza Vasconcelos sue that should be considered by researchers. For example, noted the use of Uncaria tomentosa, Ricinus communis, should antifungal medications be administered topically and pomegranate herbal compounds for this purpose [42, or systemically to patients with DS who have an immune 45, 58]. Tay et al. argued that Uncaria tomentosa extract deficiency or dry mouth? What are the initial topical and could play a complementary role in the treatment of DS. systemic treatment options? What dosages should be used? Furthermore, Pinelli et al. argued that the effect of Rici - How and for how long are they to be utilized? Up to this nus communis in this instance is comparable to that of the point, DS prevention has not been discussed seriously. This well-known antifungal drug miconazole [42]. A country’s can be accomplished by educating patients when they be- culture, geography, and flora play a role in the selection of gin using dentures. The patients should be given educa - a herbal compound for the study of its effect or lack thereof tional pamphlets, and their contents should be explained. on diseases. In the two clinical trials conducted in Brazil by Smoking cessation, frequent visits to clinicians to resolve Pina and Capistrano, for instance, the effect of a botanical denture problems, daily denture brushing, avoiding wear- compound called propolis, which appears to be regionally ing dentures at night, and storing dentures in disinfecting specific, was evaluated [34, 43]. Therefore, the inability to solutions are all methods for preventing this complication. 28 Acta Marisiensis - Seria Medica 2023;69(1) colonized by Candida spp.: A systematic review. J Prosthet Dent. 2020 Also necessary seems to be the education of clinicians in Dec;124(6):653-658. this field. 18. Yarborough A, Cooper L, Duqum I, Mendonça G, McGraw K, Stoner L. Evidence Regarding the Treatment of Denture Stomatitis. J Prosthodont. 2016 Jun;25(4):288-301. Authors’ Contribution 19. Davoudi A, Ebadian B, Nosouhian S. Role of laser or photodynamic NN contributed to the study’s conception and design. PS therapy in treatment of denture stomatitis: A systematic review. J Prosthet Dent. 2018 Oct;120(4):498-505. was responsible for the literature search, study selection, 20. Ahmad N, Jafri Z, Khan ZH. Evaluation of nanomaterials to prevent oral and collection of data. NN and PS examined the gathered Candidiasis in PMMA based denture wearing patients. A systematic data. ARH was responsible for drafting the manuscript. All analysis. J Oral Biol Craniofac Res. 2020 Apr-Jun;10(2):189-193. 21. An S, Evans JL, Hamlet S, Love RM. Incorporation of antimicrobial authors have read and approved the final manuscript ver - agents in denture base resin: A systematic review. J Prosthet Dent. sion. 2021 Aug;126(2):188-195. 22. da Costa RMB, Poluha RL, De la Torre Canales G, Junior JFS, Conti PCR, Neppelenbroek KH, Porto VC. The effectiveness of microwave Conflict of Interest disinfection in treating Candida-associated denture stomatitis: None to declare. a systematic review and metaanalysis. 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Dent Res J (Isfahan). 2012;9(2):198-202. on denture stomatitis candidiasis. J Mazandaran Univ Med Sci. 52. Sefidgar SAA, Moghadamnia A, Tafti AA, Sahebjami M, Heydari 2014;24(SUPPL. 1):186-95. M, Motallebnejad M. Evaluation of the effect of Artemisia Sieberi 42. Tay LY, Jorge JH, Herrera DR, Campanha NH, Gomes BP, Andre Dos mouthwash 1% on denture stomatitis (A preliminary study). Caspian J Santos F. Evaluation of different treatment methods against denture Int Med. 2010;1(2):47-9. stomatitis: a randomized clinical study. Oral Surg Oral Med Oral Pathol 53. Uludamar A, Ozkan YK, Kadir T, Ceyhan I. In vivo efficacy of alkaline Oral Radiol. 2014;118(1):72-7. peroxide tablets and mouthwashes on Candida albicans in patients with 43. Capistrano HM, De Assis EM, Leal RM, Alvarez-Leite ME, Brener S, denture stomatitis. J Appl Oral Sci. 2010;18(3):291-6. Bastos EMAF. Brazilian green propolis compared to miconazole gel in 54. Neppelenbroek KH, Pavarina AC, Spolidorio DMP, Massucato EMS, the treatment of Candida -associated denture stomatitis. Evid-Based Spolidorio LC, Vergani CE. Effectiveness of microwave disinfection Complement Altern Med. 2013;2013. of complete dentures on the treatment of Candida-related denture 44. Nittayananta W, Pangsomboon K, Panichayupakaranant P, stomatitis. J Oral Rehabil. 2008;35(11):836-46. Chanowanna N, Chelae S, Vuddhakul V, et al. Effects of lawsone 55. Amanlou M, Beitollahi JM, Abdollahzadeh S, Tohidast-Ekrad Z. methyl ether mouthwash on oral Candida in HIV-infected subjects and Miconazole gel compared with Zataria multiflora Boiss. gel in the subjects with denture stomatitis. Journal of Oral Pathology & Medicine. treatment of denture stomatitis. Phytother Res. 2006;20(11):966-9. 2013;42(9):698-704. 56. Webb BC, Thomas CJ, Whittle T. A 2-year study of Candida-associated 45. Pinelli LAP, Montandon AAB, Corbi SCT, Moraes TA, Fais LMG. Ricinus denture stomatitis treatment in aged care subjects. Gerodontology. communis treatment of denture stomatitis in institutionalised elderly. J 2005;22(3):168-76. Oral Rehabil. 2013;40(5):375-80. 57. Maver-Biscanin M, Mravak-Stipetic M, Jerolimov V, Biscanin A. 46. Bakhshi M, Taheri JB, Shabestari SB, Tanik A, Pahlevan R. Comparison Fungicidal effect of diode laser irradiation in patients with denture of therapeutic effect of aqueous extract of garlic and nystatin mouthwash stomatitis. Lasers Surg Med. 2004;35(4):259-62. in denture stomatitis. Gerodontology. 2012;29(2):e680-4. 47. Sabzghabaee AM, Shirdare Z, Ebadian B, Aslani A, Ghannadi A. 58. De Souza Vasconcelos LC, Correia Sampaio MC, Correia Sampaio Clinical evaluation of the essential oil of Pelargonium graveolens for F, Higino JS. Use of Punica granatum as an antifungal agent against the treatment of denture stomatitis. Dent Res J (Isfahan). 2011;8(Suppl candidosis associated with denture stomatitis. Mycoses. 2003;46(5- 1):S105-8. 6):192-6. 48. Silva MM, Mima EGDO, Colombo AL, Sanitá PV, Jorge JH, Massucato 59. Cross LJ, Bagg J, Aitchison TC. Efficacy of the cyclodextrin liquid EMS, et al. Comparison of denture microwave disinfection and preparation of itraconazole in treatment of denture stomatitis: conventional antifungal therapy in the treatment of denture stomatitis: A comparison with itraconazole capsules. Antimicrob Agents Chemother. randomized clinical study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2000;44(2):425-7. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Acta Marisiensis - Seria Medica de Gruyter

Management of denture stomatitis: An overview

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de Gruyter
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© 2023 Nader Navabi et al., published by Sciendo
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10.2478/amma-2023-0007
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Acta Marisiensis - Seria Medica 2023;69(1):23-29 DOI: 10.2478/amma-2023-0007 REVIEW 1 2 2* Nader Navabi , Parham Shakibaei , Alireza Ranjbar Hassani 1. Oral Medicine Department, Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran 2. Student Research Committee, Dental School, Kerman University of Medical Sciences, Kerman, Iran Denture stomatitis is a common inflammation of the palatal mucosa beneath removable dentures. The objective of this article was to examine the systematic reviews and clinical trials pertaining to the treatment of denture stomatitis. For this research, electronic databases (PubMed, Embase, Scopus, and ISI Web of Science) were searched from January 2000 to June 2021 using specified MESH keywords. Irrelevant articles were eliminated in three steps based on their titles, abstracts, and body texts. In the final analysis, 47 papers were selected, which included 12 systematic reviews and 35 clinical trials. Herbal compounds and denture disinfection were the interventions most commonly indicated. We concluded that, possibly due to the complex nature of this lesion’s etiology, there is no present definitive therapy guideline for this prevalent lesion. Keywords: denture stomatitis, clinical trial, management Received 15 November 2022 / Accepted 6 February 2023 Introduction and its pathogenesis is multifactorial. Candida albicans is Because dentures are foreign objects in the mouth, they considered the primary etiological factor in DS. However, can cause damage to the underlying tissues, which are not other factors such as opium use, diabetes mellitus, poor intended to withstand the pressure they exert. Some mu- denture hygiene, denture-related tissue injuries, and con- cosal lesions are caused by the acute or chronic stimulation stant denture use have also been implicated [1–8]. of dentures. These lesions are known as denture-related In this regard, we should take Candida albicans into mucosal lesions (DMLs). Denture stomatitis (DS)  is one consideration. This increases the likelihood that DS pa - of the most common DMLs [1]; it is a benign, chronic, tients will develop dysplasia and premalignant changes. It inflammatory pathological change that manifests as shiny has also been shown that DS kills cells in the oral mucosa. erythema in tissues covered by removable acrylic-based This means that even DS with no symptoms needs to be prostheses in the palatal mucosa and maxillary alveolar treated. Due to the complexity of the etiology of DS, there ridge. This condition is also known as denture-induced is no standard treatment protocol for DS patients. Various stomatitis or denture-related  stomatitis [2–5]. According recommendations, such as using antifungal drugs and dis- to the Newton classification and clinical signs, there are infectant compounds, constantly cleaning the denture, and three types of DS: replacing it, have been made. In addition, the increase in – Type I: Simple inflammation with pinpoint petechia. the number of elderly people is resulting in an increase in – Type II: Erythema and edema are more widespread in the prevalence of edentulism and the number of individu- denture-covered areas. als with complete dentures. Because of this, it is important – Type III: Erythematous areas with inflamed, red pa - to know what causes DS for sure and to have an effec - pules (granular level); this condition is also known tive treatment plan for this condition. The inconsistencies as inflammatory papillary hyperplasia (IPH), and the in the studies conducted on DS treatment have made it inflammation is often more severe in the hard palate difficult for dentists to interpret clinical data [1–11]. As a [6]. result, the goal of this review was to put together reliable Due to its asymptomatic nature, DS remains undetect- evidence about effective ways to treat DS. ed in nearly all patients, despite its high prevalence; only a small percentage of patients report mild bleeding, burn- Materials and Methods ing, itching, or pain in the affected area [7]. If this lesion This study was a structured review. The research question is found quickly and correctly, it can lead to more efficient (PICO) was as follows: care, the right treatment, and a better quality of life for – Population: denture-related stomatitis patients older people with full dentures. – Intervention: DS prevention or treatment (gathered The prevalence of DS among denture wearers ranges via Method A) from 15 to 70 percent (mean=50 percent) [8]. It is more – Comparison: comparison of the proposed treatment prevalent among older adults (those over 60) and women. with the gold standard The etiology of DS is unknown despite its high prevalence, – Outcome: improvement of the lesion following the proposed treatment Four databases (PubMed, Embase, Scopus and ISI Web * Correspondence to: Alireza Ranjbar Hassani E-mail: arh1377@gmail.com of Science) were searched for the relevant papers. 24 Acta Marisiensis - Seria Medica 2023;69(1) All papers written in English between January 1, 2000 experimental studies, animal studies, case-control studies, and June 30, 2021 were considered. MeSH was used to preliminary studies, and non-randomized interventions) choose the keywords based on the goals of the study. The were excluded. In addition, studies proposing the elimina- papers’ titles, abstracts, and full texts were scanned for the tion of underlying factors as a treatment for DS were not following keywords: considered to present a particular treatment. The selected “Candida-associated denture stomatitis, candida-related papers’ data were then extracted and imported into an Ex- denture stomatitis, denture-related stomatitis, sub-pros- cel spreadsheet [12]. thetic stomatitis, prosthetic stomatitis, stomatitis prosthet- The information that was taken from the chosen papers ica, denture-related erythematous stomatitis, granular sto- was the names of the researchers, the year the paper was matitis” and ”etiology, prevalence, treatment, prevention, published, the therapeutic methods that were compared in epidemiology, and management”. the paper, the more effective method, and the important The logical operators “AND” and “OR” were then ap - results that were relevant to the paper. plied between the keywords of the aforementioned two se- ries to locate papers. The result was saved as an EndNote Results document. The paper’s citations were reviewed to identify In the databases chosen for this structured review, 1460 grey literature. Two researchers screened the collected pa- papers were found. After removing 698 papers that were pers in three consecutive stages after eliminating duplicates duplicates, 558 papers with irrelevant titles, 118 papers af- using EndNote. In the initial phase, titles were examined ter reading the abstracts, and 39 papers after reading the and irrelevant papers were eliminated. In the subsequent full texts, the final review included 35 clinical trials and 12 step, the remaining papers were obtained and read by two systematic reviews (Figure 1). researchers, while irrelevant papers were eliminated. The The explanation of the 12 structured reviews on DS full texts of the papers that progressed to the next phase treatment is provided in Table I. Systematically reviewed were prepared, and the two researchers read them; the pa- DS treatments included microwave therapy (two reviews), pers that would enter the final review were then determined. chemicals and denture cleaners (five reviews), natural com - Structured reviews and randomized clinical trials (single pounds (one review), antifungals (two reviews), nanotech- or double-blinded) entered the final review; as a result, nology (one review), and low-level laser therapy (one re- studies with low evidence levels (case reports, case series, view) [13–24]. Fig. 1. Diagram illustrating the study selection procedure used to identify papers for this review. Acta Marisiensis - Seria Medica 2023;69(1) 25 Table I. A summary of the 12 systematic reviews on the treatment of denture stomatitis Number of Author, Year reviewed Main Conclusion studies Using sodium hypochlorite at a concentration of 0.5% can help disinfect denture liners and tissue conditioners. Skupien et al, 2013 [13] 38 Incorporating nystatin into these substances also has the ability to treat or prevent oral candidiasis. In the treatment of denture stomatitis, disinfection methods could be considered as an adjunct or alternative to Emami et al, 2014 [14] 15 antifungal medications. At this time, it is not possible to confirm the existence of scientific evidence for the use of natural products in the Ferreira et al, 2015 [15] 3 treatment of oral candidiasis. Hilgert et al, 2016 [16] 35 The findings support the use of nystatin and disinfectants for the treatment of DS. Robeiro Rocha, 2016 [17] 5 Only chlorhexidine and chlorine dioxide demonstrated some evidence of a reduction in Candida spp Yarborough et al, 2016 Clinical strategies frequently involved multiple approaches with the combined objective of eradicating pathogenic [18] microorganisms and preventing the re-establishment of a pathogenic biofilm through preventive hygiene measures. LLLT plays an important role in the clinical treatment of Down syndrome. However, PDT outcomes were comparable Davoudi et al, 2018 [19] 4 to those of conventional antifungal treatments. Nanomaterials composed of metal oxides demonstrated cytotoxicity against Candida and other microorganisms Ahmad et al, 2020 [20] 27 present in oral biofilm, including PMMA denture surface. An et al, 2020 [21] 28 Incorporating antimicrobial agents into Denture Base Resins has not been conclusively demonstrated to be effective. For the treatment of denture stomatitis caused by Candida, microwave disinfection produced comparable outcomes De Costa et al, 2020 [22] 5 to conventional therapies. Santos Sousa et al, 2020 Microwave sterilisation of complete dentures is as effective as antifungal treatment for the treatment of denture [23] stomatitis. Most studies showed phytomedicines had fewer side effects and higher patient satisfaction than antifungals or disin- Shui et al, 2021 [24] 19 fectants. To verify the clinical efficacy of phytotherapy as an alternative or adjunctive therapy for denture stomatitis, more RCTs with standard herbal formulations are needed. Table II and Table III provide a summary of the data burning sensation in the mouth. In addition to prescrib- extracted from the 35 clinical trials pertaining to DS treat- ing topical nystatin, Skupien and Hilgert emphasized the ment. Herbal remedies (ginger, propolis gel, vinegar, garlic, efficacy of disinfecting dentures with substances such as etc.) and disinfecting the denture using different methods, sodium hypochlorite [13,16]. In their structured review, such as antiseptic mixtures (sodium hypochlorite, chlo- Emami et al. suggested that the use of such compounds rhexidine, etc.), brushing, and microwaving, were the most as a supplement or alternative to nystatin should be con- common methods studied. Consideration should also be sidered [14]. In addition to disinfecting dentures with an- given to the seven papers on the efficacy of photodynamic tiseptic compounds, their use in the denture resin base to therapy and low-level laser therapy. The use of antifungals prevent candida colonization on the denture surface has (nystatin and miconazole) was considered the treatment been discussed. However, the systematic review by An et standard and benchmark in clinical trials related to this al. did not confirm the efficacy of these disinfectants [21]. field [25–59]. Denture hygiene and daily brushing of denture impression surfaces are unquestionably effective in reducing the risk of Discussion DS. However, these studies raise the issue of a higher level This study examined 47 systematic reviews to provide a of routine “cleaning” and, in fact, “disinfection” of the den- structured overview of DS treatment. The significant ture. Because the proposed methods for disinfecting den- number of structured reviews (12 studies) conducted in tures are so diverse, De Costa and Santos Souza conducted this field was the first significant observation made dur - a systematic review on the use of microwaves [22,23]. Due ing the analysis of the chosen studies [26-42]. Skupien to insufficient evidence, the application of this method has and Hilgert highlighted the importance of nystatin in DS remained a suggestion. treatment in the results of their structured review [13,16]. In this review, eleven randomized clinical trials on the The colonization of Candida albicans on the impression treatment of DS with different disinfection methods were surface of maxillary dentures is the primary cause of DS. compiled. Regarding the effect of tooth brushing, Kabawat DS is categorized as chronic atrophic candidiasis or a le- et al. found that routine palatal brushing is beneficial in sion induced by candida. Consequently, the primary treat- preventing DS [40]. According to the findings of clini - ment for this lesion is a topical antifungal medication, and cal trials conducted by Araujo, Badaro, Aoun, Nittayan- nystatin is frequently the first choice of treatment.  The anta, and Uludamar, the proposed antiseptic compounds unpleasant and bitter taste of topical (oral) nystatin is a include sodium hypochlorite, triclosan, cetylpyridinium, significant disadvantage. In their systematic review [17], chlorhexidine immersion, lawsone methyl ether (LME) (a Robeiro Rocha et al. noted the beneficial effects of pre - naphthoquinone compound with potent antifungal prop- scribing chlorhexidine mouthwash in the treatment of DS. erties), and alkaline peroxide tablets [25, 28, 37, 38, 44, However, the antifungal properties of chlorhexidine are 53]. In addition to the variety of proposed antiseptic com- described as “mild” in the majority of texts, and it should pounds, which renders it difficult to choose a single treat - be noted that prolonged use can result in complications ment option, the routine use of some of these compounds such as tooth discoloration, increased dental tartar, and a is ambiguous. Denture immersion in chlorhexidine, for in- 26 Acta Marisiensis - Seria Medica 2023;69(1) Table II. A brief summary of the interventions and results discussed in the selected clinical trials. Sample Author Year Intervention Result Size Sodium hypochlorite 0.25% / 0.15% Triclosan/ Denture Araujo, et al. (25) 2021 108 All Groups had similar disinfecting effects. Cleanser Tablets Gonoudi, et al. Droplet Zataria Multiflora (ZM) was as effective as Ny - 2021 28 Nystatin Suspension / Zataria Multiflora (ZM) Droplet (26) statin Suspension in D.S treatment. Nystatin/ Antimicrobial Photodynamic Therapy (aPDT) via This method of implementing PDT can be a considerable Alves, et al. (27) 2020 65 photodithazine(PDZ) with 660 nm Laserthrapy treatment for D.S. Ricinus communis 10% / chloramine-T 0.5% Sodium hypochlorite is more effective than other disinfect- Badaro, et al. (28) 2020 60 Control (Water) / Control (Sodium hypochlorite 0.25%) ing agents. Afroozi, et al. (29) 2019 66 Nystatin + photodynamic therapy (PDT)/ Nystatin Adding PDT to Nystatin enhances the treatment effect. Mouthwash Chitosan-Curcuminoid (CHI-CUR) / Chlorhexidine CHI-CUR Mouthwash has an acceptable alternative topi- Mustafa, et al. (30) 2019 30 / Chitosan with polyethylene glycol (PEG) 400 cal effect. Alrabiah, et al. photodynamic inactivation (PDI) 2019 36 PDI is as effective as nystatin in D.S treatment (31) and Nystatin Partial Denture Users Consuming milk with or without Lacto- This Probiotic decreases the severity of D.S in elders Lee, et al. (32) 2019 36 bacillus rhamnosus SP1 probiotic residing in nursing homes. De Senna, et al. Miconazole 2% Gel / Methylene blue + Photodynamic inacti- This method of applying PDI can decrease the load of 2018 - (33) vation (PDI) with 660 nm Low Level Lasertherapy fungal infection and inflammation. The effect of propolis gel is not inferior to miconazole and Pina, et al. (34) 2017 40 Miconazole 20mg/g Gel / 2% Brazilian Propolis Gel it could be considered an alternative treatment. methylene blue-mediated PDT with Low Level Lasertherapy / The effect of miconazole in the treatment of D.S was more Maciel, et al. (35) 2016 40 Miconazole prominent than PDT with low-level laser therapy. Alizadeh, et al. 2016 50 Mouthwash ginger / Mouthwash Nystatin Both treatments had the same results. (36) % /0.05 cetylpyridinium chloride Aoun, et al. (37) 2015 40 Both solutions were effective in denture disinfection Chlorhexidine 0.12% / Control (Water) Chlorhexidine 0.12% / 0.1%hexetidine / Distilled water Submerging the denture in hexetidine had a lesser effect Aoun, et al. (38) 2015 60 (Control) than disinfecting with chlorhexidine. Placebo Group / Group Taking Probiotic Capsule Containing: This probiotic treatment can be considered as a possible Ishikawa, et al. 2015 59 lyophilized Lactobacillus rhamnosus HS111, Lactobacillus alternative against candida infection in the elderly with (39) acidophillus HS101, and Bifidobacterium bifidum dentures. Kabawat, et al. 2014 48 Palatal Brushing Palatal brushing is an effective method for D.S treatment. (40) Dastjerdi, et al. This homemade mouthwash could be an alternative to 2014 30 Nystatin / Homemade Mouthwash (Vinegar and Rose Water) (41) nystatin in DS treatment. Uncaria tomentosa gel could be used as an supplemental Tay, et al. (42) 2014 50 Placebo/ Miconazole 2% / Uncaria tomentosa 2% Gel treatment for DS. Capistrano, et Miconazole 2% Gel / 2.5% Propolis Gel / 24% Propolis 2013 45 Propolis was found as effective as miconazole. al. (43) Mouthwash Nittayananta, et Lawsone methyl ether (LME) Mouthwash / Chlorhexidine The application of lME in HIV and DS patients may be ef- 2013 67 al. (44) Mouthwash fective in persistent cases. Treating with Ricinius Communis may clinically improve denture stomatitis in elderly patients residing in nursing Pinelli, et al. (45) 2013 30 Ricinius Communis / Nystatin / Miconazole homes. Additionally, this treatment has the same effect in comparison with miconazole. The therapeutic effects of garlic extra solution are similar Bakhshi, et al. (46) 2012 40 Nystatin Mouthwash/ Garlic Extract Solution to nystatin. Sabzghabaee, et The topical application of S. hortensis could be effective 2012 80 Placerbo / 1% S. hortensis essential oil Gel al. (47) in treating DS. Disinfection with microwave was as effective as nystatin in Silva , et al. (48) 2012 60 Nystatin / Microwave/ Control Group DS treatment. Mima, et al. (49) 2012 40 Nystatin / Photodynamic Therapy (PDT) PDT method was as effective as nystatin in DS treatment. the application of microwave was as effective as nystatin Sanita, et al. (50) 2012 40 Nystatin / Microwave in DS treatment in controlled type II diabetes patients. Sabzghabaee, et 2011 80 Placebo/ Pelargonium 1% Gel This gel was found to be more effective than placebo al. (51) Sefidgar, et al. artemisia extract could be used as a treatment option for 2010 30 Nystatin Mouthwash / Mouthwash Artemisia 1% (52) DS. Three Brand of Alkaline Peroxide Tablets The application of this mouthwash was effective in treating Uludamar, et al. (Polident, Efferdent, and Fittydent) 2010 90 DS. ( This article’s method was centered around disinfect- (53) CloSYS II and Corsodyl Mouthwashs ing dentures) Control Group Distilled water Neppelenbroek, Microwave with Miconazole / Miconazole / Microwave disinfecting the denture with microwave is effective in DS 2008 60 et al. (54) Control Group treatment and decreases the recurrence of candida. Zataria multiflora gel was better at alleviating palatal ery - Amanlou, et al. 2006 24 Miconazole 2% Gel / Zataria multiflora 0.1% Gel thema. While miconazole had a better effect in decreasing (55) the number of colonies on the denture surface. Webb, et al. (56) 2005 60 Sodium hypochlorite / Microwave / Control Group Both disinfecting methods were found effective. Maver-Biscanin, 685 nm Diode Laser / 830 nm Diode Laser /Anti-Fungal Gel The application of low-power laser could be valuable in 2004 70 et al. (57) and Disinfection Solution / Placebo treating DS. De Souza P.granatum could be considered as a topical antifungal Vasconcelos, et 2003 60 Miconazole Gel / Punica granatum agent in DS treatment. al. (58) These two drug forms could be used equally as supple- Cross, et al. (59) 2000 40 Itraconazole in Liquid and Capsule form mental therapy. Acta Marisiensis - Seria Medica 2023;69(1) 27 Table III. The classification of all treatment methods discussed in generalize the use of herbal compounds for patients in dif- the clinical trials under review. ferent parts of the world appears to be an additional limi- Treatment Method Number of Studies tation of such compounds. Photodynamic therapy (PDT) Herbal Medicine / Phytotherapy 12 and low-power laser therapy for the treatment of DS were Denture Disinfection 11 the subjects of a systematic review by Davoodi et al. [19]. Photodynamic and low-level laser therapy 7 Seven clinical trials were compiled for this analysis, in- Probiotics Application 3 Chitosan Based Materials 1 cluding studies by De Souza Alves, Afroozi, Alrabiah, Sen- na, Maciel, Mima, and Maver-Biscanin [27, 29, 31, 33, stance, can discolor the labial surface, resulting in patient 35, 49, 57, 58]. Different methods were proposed by the dissatisfaction with the denture’s appearance. Additionally, aforementioned researchers to administer photodynamic cetylpyridinium requires precise concentration control; therapy to patients with DS. Various compounds, such as otherwise, it can cause mucosal irritation and even chemi- photoditazine or methylene blue, were used for this pur- cal burns. In this review, three clinical trials conducted by pose in these studies, resulting in heterogeneity. Due to Silva, Sanita, and Neppelenbroek on the use of microwaves the use of various wavelengths by researchers, the same in denture disinfection were discussed [48, 50, 54]. Silva is true for low-power lasers. Some researchers, including and Sanita argued that microwaves are equally effective as Maver-Biscanin et al., questioned the efficacy of low-power nystatin for this purpose. It is important to note, though, lasers in the treatment of DS [57]. However, Mima et al. that Sanita et al. did their research on people with type 2 noted that photodynamic therapy and drugs like nystatin diabetes [48, 50]. Overall, it is essential to emphasize that have the same effect (49%). Additionally, Afroozi et al. ar - there is no universally acknowledged procedure for denture gued that combining photodynamic therapy with nystatin disinfection; hence, the difficulties associated with denture improves the therapeutic effects [29]. Consequently, the stomatitis continue. There are a variety of approaches and precise status of treatments such as photodynamic therapy products dedicated to this issue now accessible on the mar- and low-power laser for the management of DS is uncer- ket. However, it is recommended to adhere to best prac- tain. The fact that there are so many studies on DS can be tices, such as the aforementioned procedures. seen as a weakness of this structured review since it made it Ferreira and Shui conducted two systematic reviews that harder to choose the final papers. investigated the efficacy of herbal medicine in the treatment Due to the recurring nature of denture stomatitis, it be- of DS. The results of both reviews indicated that although comes crucial to arrange follow-up appointments at regular the reviewed studies have shown the positive impact of intervals to verify that adequate cleaning and hygiene pro- using such treatments to improve this complication, due cedures are being followed. However, there is no generally to the lack of precise formulations and the probable side agreed upon strategy for doing so. Therefore, a professional effects, their superiority over standard treatment options agreement is essential for patient recalls and follow-ups. (such as nystatin) is questionable and in need of further research [15, 24]. Iranian traditional medicine is very Conclusion popular among researchers, and the clinical trials exam- The present systematic review revealed that due to the mul - ined in this review confirmed that Iranian researchers are tifactorial nature of DS incidence, the interpretation of its interested in treating DS with traditional medicine. Seven most likely causes varied greatly between studies. Possibly, studies conducted by Alizadeh, Dastjerdi, Bakhshi, Sefid - for this reason, different treatments have been proposed in gar, Sabzqabai, and Amanloo investigated the use of gin- research, and no single treatment has been proposed for ger, homemade vinegar and rose water, garlic, Pelargonium this complication to date. Therefore, the following recom - graveolens, Satureja Hortensis, Artemisia Sieberi, and Za- mendations are made to rectify the existing deficiencies: taria multiflora in DS treatment, respectively [36, 41, 46, Providing a valid treatment guideline for DS is an is- 47, 51, 52, 55]. Tay, Pinelli, and De Souza Vasconcelos sue that should be considered by researchers. For example, noted the use of Uncaria tomentosa, Ricinus communis, should antifungal medications be administered topically and pomegranate herbal compounds for this purpose [42, or systemically to patients with DS who have an immune 45, 58]. Tay et al. argued that Uncaria tomentosa extract deficiency or dry mouth? What are the initial topical and could play a complementary role in the treatment of DS. systemic treatment options? What dosages should be used? Furthermore, Pinelli et al. argued that the effect of Rici - How and for how long are they to be utilized? Up to this nus communis in this instance is comparable to that of the point, DS prevention has not been discussed seriously. This well-known antifungal drug miconazole [42]. A country’s can be accomplished by educating patients when they be- culture, geography, and flora play a role in the selection of gin using dentures. The patients should be given educa - a herbal compound for the study of its effect or lack thereof tional pamphlets, and their contents should be explained. on diseases. In the two clinical trials conducted in Brazil by Smoking cessation, frequent visits to clinicians to resolve Pina and Capistrano, for instance, the effect of a botanical denture problems, daily denture brushing, avoiding wear- compound called propolis, which appears to be regionally ing dentures at night, and storing dentures in disinfecting specific, was evaluated [34, 43]. Therefore, the inability to solutions are all methods for preventing this complication. 28 Acta Marisiensis - Seria Medica 2023;69(1) colonized by Candida spp.: A systematic review. J Prosthet Dent. 2020 Also necessary seems to be the education of clinicians in Dec;124(6):653-658. this field. 18. Yarborough A, Cooper L, Duqum I, Mendonça G, McGraw K, Stoner L. Evidence Regarding the Treatment of Denture Stomatitis. J Prosthodont. 2016 Jun;25(4):288-301. Authors’ Contribution 19. Davoudi A, Ebadian B, Nosouhian S. Role of laser or photodynamic NN contributed to the study’s conception and design. 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Journal

Acta Marisiensis - Seria Medicade Gruyter

Published: Mar 1, 2023

Keywords: denture stomatitis; clinical trial; management

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