Volume 11, Issue 2 (Spring 2023)                   Iran J Health Sci 2023, 11(2): 137-142 | Back to browse issues page

Ethics code: IR.MAZUMS.REC.1400.217
Clinical trials code: none


XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Ramezani A, Mollaei M, Yazdani Charati J, Tavakolian H, Mesgarani A, Molania T. Prevalence of Denture Stomatitis in Patients Using Denture in Sari City, Iran, in 2020-2021. Iran J Health Sci 2023; 11 (2) :137-142
URL: http://jhs.mazums.ac.ir/article-1-864-en.html
Department of Oral Medicine, Dental Research Center, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran. , t_molania117@yahoo.com
Full-Text [PDF 611 kb]   (298 Downloads)     |   Abstract (HTML)  (629 Views)
Full-Text:   (168 Views)
1. Introduction
Given the close relationship between oral mucosa and microorganisms, dentures in the oral cavity might provide difficulties for both the patient and the dentist. Mechanical irritation or inflammatory responses caused by dentures can develop modifications in the oral mucosa [1]. In other words, denture-induced oral mucosal lesions are caused by acute or chronic responses to microbial plaque, which can be formed due to denture materials or mechanical damage imposed by the denture. Nearly 50% of denture wearers have at least one mucosal lesion. These lesions form a heterogeneous group in terms of pathogenesis. Denture stomatitis, traumatic ulceration, and angular cheilitis are the most frequent mucosal lesions associated with dentures in older people [23].
Denture stomatitis is a clinically diagnosed condition that affects people who wear removable dentures. This condition is characterized by edema and inflammation of the mucosa covered by the denture. Other symptoms, such as irritation, itching, and burning sensation, have also been observed; however, most patients with denture stomatitis are asymptomatic [4, 5]. This condition usually affects the palatal mucosa, which is covered by the denture, and the involvement of the lower jaw mucosa is uncommon. Previous studies indicate that this inflammatory process can affect anywhere from 15% to more than 70% of patients who wear dentures [6].
In 1962, Newton classified denture stomatitis into three categories: mild, moderate, and severe. In the mild form, local inflammation and punctate erythema are observed. Trauma imposed by the denture causes this type and is the most prevalent form in patients with normal oral hygiene who do not remove their dentures overnight. Erythema and general redness of the mucosa covering the denture are symptoms of the moderate form. In addition to the clinical aspects of the moderate type, papillary or granular hyperplasia is noticed in the severe form’s central part of the palate, which can only be removed surgically [7, 8].
Different variables, such as oral candida infection, mucosal trauma, improper denture hygiene, and using dentures overnight, are associated with denture stomatitis [9]. Studies have also suggested that women and older people are more susceptible to denture stomatitis [5]. Nevertheless, conflicting results have been reported regarding the effect of salivary pH, sugar consumption, and smoking in patients suffering from denture stomatitis [10]. 
A systematic review of several observational and experimental studies analyzing the relationship between mucosal lesions and the use of dentures has suggested that the prevalence of denture stomatitis varies from 1.1% to more than 36.7% [11]. Other studies have reported a prevalence of 18.1% among 380 Thai patients [12]. Considering the controversy in the prevalence of denture stomatitis among people using dentures and the lack of sufficient studies on this issue in Iran, this study was conducted to investigate the prevalence of denture stomatitis in patients using dentures in Sari City, Iran, in 2020-21. 
2. Materials and Methods
In the present descriptive-cross-sectional study, 130 patients referred to the Faculty of Dentistry and dental clinic centers in Sari from 2020 to 2021 were studied using the census method. The inclusion criteria included patients aged 41 to 70 with at least one full denture in their mouth and not under anti-inflammatory or antifungal treatment. Informed consent was obtained from all subjects. The study’s protocol gained ethical approval from Mazandaran University of Medical Sciences (IR.MAZUMS.REC.1400.217). The sample size was calculated according to the findings of Naik and Pai’s study [13] (Equation 1): 


Demographic information such as the patient’s age, sex, education level, and income was recorded. Additionally, information about denture hygiene, the duration of its use, denture use while sleeping, smoking and alcohol consumption, and the presence of diseases were gathered from the subjects using a checklist. The presence of denture stomatitis in the mucosa under the denture was diagnosed with clinical examination under the light source. Before the examination, the patients were asked to rinse their mouths. The diagnosis was recorded in the patients’ file based on Newton’s classification, mentioned in Naik and Pai’s study [13]. The denture was also clinically examined for its suitability in the mouth. Examinations were carried out by a final-year dentistry student under the supervision of a specialist.
Data were analyzed using SPSS, version 20 software. A frequency table was used for denture stomatitis prevalence. The association between denture stomatitis prevalence and related factors was evaluated through t-test and Chi-square test. P≤0.05 was considered statistically significant.
3. Results 
A total of 130 patients using dentures with an Mean±SD age of 66.23±4.08 years (ranging from 49 to 70) were investigated. Demographic features are shown in Table 1.


The patients’ Mean±SD income was 5.87±3.25 million tomans (ranging from 0 to 12). The Mean±SD number of years of denture use was 8.01±4.26 years. 
Denture stomatitis was observed in 26.2% of the study population (34 people), of whom 58.8% (20 people) were classified as type II and 41.2% (14 people) as type III denture stomatitis.
Based on Table 2, there were significant relationships between the duration of wearing dentures per day, the age of the denture, and the patient’s age with the prevalence of denture stomatitis.


No significant relationships existed between the prevalence of denture stomatitis and the patients’ sex, smoking, or alcohol intake. On the other hand, denture stomatitis was much more common in patients with improper denture status, patients who used dentures while sleeping, and those with diseases. The frequency of denture stomatitis is reduced by raising the number of times the denture is cleaned during the day (Table 3).


4. Discussion 
The findings of the current investigation suggested that denture stomatitis was prevalent in 26.2% of denture wearers. In line with our results, a study conducted in Iran also showed that the prevalence of denture stomatitis among their subjects was 21.6% [14]. Another study in Saudi Arabia also found the prevalence of denture stomatitis at 23.4% (60 patients) [15]. 
On the other hand, the findings of Sharon Keziah et al. contradicted our findings; they observed denture stomatitis in 80 people, with a prevalence of 57.4% in women and 42.6% in men [16]. However, in the current study, the prevalence of denture stomatitis was higher in men (65.4%). The study population in Sharon Keziah’s study was substantially higher, which could explain the disparity in the outcomes of these two investigations.
In the current study, the prevalence of denture stomatitis was reduced by increasing the number of denture cleaning times during the day. Similarly, Dos Santos et al. found that those who cleaned their dentures only once a week had the highest prevalence of denture stomatitis. In their study, 43.1% of patients used brushing, 42.3% used special soap, and 14.1% used special tablets to clean their dentures; Patients who used a toothbrush to clean their dentures were likelier to have denture stomatitis [17]. Previous research has also suggested that this condition is closely associated with denture hygiene and its use overnight [18].
Our findings show denture stomatitis was not significantly associated with alcohol consumption (P=0.905). In a study in 2011, out of 235 patients with oral lesions, about 180 (17.3%) consumed alcohol, and 268 (25.7%) smoked cigarettes. The authors suggested that additional care should be devoted to the oral mucosa in these patients, especially if they are unwell, old, have dentures, and smoke, since combining these factors increases the likelihood of oral lesions [19]. Moreover, other studies also support the association between the prevalence of oral mucosal lesions and alcohol consumption [2021].
According to Sharon Keziah et al.’s study, the incidence of denture stomatitis demonstrates a significant relationship with systemic diseases. Similar to their findings, in the present investigation, diabetes was shown to be the most associated systematic disease with the incidence of denture stomatitis [16]. 
The prevalence rates of this inflammatory disease were 20.6% and 79.4% in patients with appropriate and inappropriate denture status, respectively. Consistent with previous investigations [14, 15], our findings demonstrated a significant correlation between patients’ denture status and the prevalence of denture stomatitis (P<0.001), and those with unsuitable denture status had a greater prevalence of denture stomatitis. 
5. Conclusion 
In the present study, the prevalence of denture stomatitis in patients wearing dentures was 26.2%. (34 people). The prevalence of denture stomatitis was statistically associated with the age of the denture, the patient’s age, systemic diseases, smoking, using the denture overnight, the frequency of denture cleaning, the duration of using the denture, and the appropriate denture status. on the contrary, no significant relationship was observed between alcohol consumption and patients’ sex, with denture stomatitis. 
Study limitations 
The small sample size was one of the limitations of the current study; therefore, it is suggested to conduct more studies with larger sample sizes in the future.

Ethical Considerations
Compliance with ethical guidelines

The study’s protocol gained ethical approval from Mazandaran University of Medical Sciences (Ethics Code: IR.MAZUMS.REC.1400.217).

Funding
The paper was extracted from the doctoral dissertation ofHakhamanesh Tavakolian, Department of Prosthodontics, Faculty of Dentistry, Mazandaran University of Medical Sciences (No.: 4243).

Authors contributions
All authors equally contributed to preparing this article.

Conflict of interest
The authors declared no conflict of interest. 

Acknowledgements
The authors would like to appreciate the continued support of the Student Research Committee of Mazandaran University of Medical Sciences, Sari, Iran.


References
  1. Zomorodian K, Haghighi NN, Rajaee N, Pakshir K, Tarazooie B, Vojdani M, et al. Assessment of candida species colonization and denture-related stomatitis in complete denture wearers. Medical Mycology. 2011; 49(2):208-11. [DOI:10.3109/13693786.2010.507605] [PMID]
  2. Brantes MF, Azevedo RS, Rozza-de-Menezes RE, Póvoa HC, Tucci R, Gouvêa AF, et al. Analysis of risk factors for maxillary denture-related oral mucosal lesions: A cross-sectional study. Medicina Oral Patologia Oral y Cirugia Bucal. 2019; 24(3):e305-13. [DOI:10.4317/medoral.22826] [PMID] [PMCID]
  3. Martori E, Ayuso-Montero R, Martinez-Gomis J, Viñas M, Peraire M. Risk factors for denture-related oral mucosal lesions in a geriatric population. The Journal of Prosthetic Dentistry. 2014; 111(4):273-9. [DOI:10.1016/j.prosdent.2013.07.015] [PMID]
  4. Dangi YS, Soni ML, Namdeo KP. Oral candidiasis: A review. International Journal of Pharmacy and Pharmaceutical Sciences. 2010; 2(4):36-41. [Link]
  5. Pereira-Cenci T, Del Bel Cury AA, Crielaard W, Ten Cate JM. Development of candida-associated denture stomatitis: New insights. Journal of Applied Oral Science. 2008; 16:86-94. [DOI:10.1590/S1678-77572008000200002] [PMID] [PMCID]
  6. Gendreau L, Loewy ZG. Epidemiology and etiology of denture stomatitis. Journal of Prosthodontics. 2011; 20(4):251-60. [DOI:10.1111/j.1532-849X.2011.00698.x] [PMID]
  7. Shah AA, Ahmad TJ. Oral mucosal lesions in complete denture wearers. Journal of Pakistan Association of Dermatologists. 2011; 21(3):170-3. [Link]
  8. Hannah VE, O’Donnell L, Robertson D, Ramage G. Denture stomatitis: Causes, cures and prevention. Primary Dental Journal. 2017; 6(4):46-51. [DOI:10.1308/205016817822230175] [PMID]
  9. Verhaeghe TV, Wyatt CC, Mostafa NZ. The effect of overnight storage conditions on complete denture colonization by candida albicans and dimensional stability: A systematic review. The Journal of Prosthetic Dentistry. 2020; 124(2):176-82. [DOI:10.1016/j.prosdent.2019.07.014] [PMID]
  10. Emami E, De Grandmont P, Rompré P, Barbeau J, Pan S, Feine J. Favoring trauma as an etiological factor in denture stomatitis. Journal of Dental Research. 2008; 87(5):440-4. [DOI:10.1177/154405910808700505] [PMID]
  11. Emami E, Taraf H, de Grandmont P, Gauthier G, de Koninck L, Lamarche C, et al. The association of denture stomatitis and partial removable dental prostheses: A systematic review. International Journal of Prosthodontics. 2012; 25(2):113-9. [PMID]
  12. Jainkittivong A, Aneksuk V, Langlais RP. Oral mucosal lesions in denture wearers. Gerodontology. 2010; 27(1):26-32. [DOI:10.1111/j.1741-2358.2009.00289.x] [PMID]
  13. Naik AV, Pai RC. A study of factors contributing to denture stomatitis in a north Indian community. International Journal of Dentistry. 2011; 2011:589064. [DOI:10.1155/2011/589064] [PMID] [PMCID]
  14. Sardari F, Khalili P, Hakimi H, Mahmoudaghaei S, Abedi P. The prevalence of denture stomatitis in cigarette and hookah smokers and opium addicts: Findings from Rafsanjan cohort study. BMC Oral Health. 2021; 21(1):455. [DOI:10.1186/s12903-021-01807-6] [PMID] [PMCID]
  15. Fayad M, Hosny M, Sakr H, Al Kahtany F. Prevalence of denture stomatitis among complete denture wearers in Aljouf. Al-Azhara Journal of Dentistry. 2018; 5(3):219-23. [DOI:10.21608/adjg.2018.17094]
  16. Sharon K, Deepika Rajendran R, Pradeep K. Prevalence of denture stomatitis among denture wearers in patients reported to a private dental hospital. European Journal of Molecular & Clinical Medicine. 2020; 7(1):1237-46. [Link]
  17. Dos Santos CM, Hilgert JB, Padilha DMP, Hugo FN. Denture stomatitis and its risk indicators in south Brazilian older adults. Gerodontology. 2010; 27(2):134-40. [DOI:10.1111/j.1741-2358.2009.00295.x] [PMID]
  18. Grover C, Dhawan P, Mehta D, Nautiyal M. Denture stomatitis-a review. The Journal of Prosthetic and Implant. 2022; 5(2):8-73. [DOI:10.55231/jpid.2022.v05.i02.01]
  19. Gönül M, Gül Ü, Kaya İ, Koçak O, Çakmak SK, Kılıç A, et al. Smoking, alcohol consumption and denture use in patients with oral mucosal lesions. Journal of Dermatological Case Reports. 2011; 5(4):64-8. [DOI:10.3315/jdcr.2011.1079] [PMID] [PMCID]
  20. Lynge Pedersen A, Nauntofte B, Smidt D, Torpet L. Oral mucosal lesions in older people: Relation to salivary secretion, systemic diseases and medications. Oral Diseases. 2015; 21(6):721-9. [DOI:10.1111/odi.12337] [PMID]
  21. Pentenero M, Broccoletti R, Carbone M, Conrotto D, Gandolfo S. The prevalence of oral mucosal lesions in adults from the Turin area. Oral Diseases. 2008; 14(4):356-66. [DOI:10.1111/j.1601-0825.2007.01391.x] [PMID]
Type of Study: Original Article | Subject: Health

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Iranian Journal of Health Sciences

Designed & Developed by : Yektaweb