Contributing Factors in the higher incidence of
Candidiasis in denture users
Riverside Community College Dental Hygiene Program
Candida albicans is a fungus that is part of our normal oral flora. In the oral cavity there is 300 to 400 different species of candidiasis present in the oral cavity without harmful effects (Mizugai, Isogai, Hirose & Chiba, 2007). Local and systemic factors contribute to oral health problems. When there is change in the oral cavity the normal flora balance may change also. The studies show there is a higher incidence of a Candida albicans infection in the denture wearer when systemic or local factors are involved. Candida albicans grow when the fungus has the opportunity, such as on the surface materials of dentures as it ages, poor oral hygiene, and systemic diseases (Daniluk, Tokajuk, Stokowska, Fiedoruk, Sciepuk, Zaremba, Rozkiewicz, Cylwik-Rokicka, Kedra, Anielska, Gorska & Kedra., 2006).
Contributing Factors in the Higher Incidences of Candidacies in Denture Wearers
Candidiasis is a familiar oral fungal infection. Candida albicans is a form of candidiasis. Candida albican is the most common fungal infection in the oral cavity. Candidiasis is also called moniliasis and thrush (Ibsen & Phelan, 2004). If, Candida albicans over ride the normal flora, denture stomatitis may result in the oral cavity of a denture wearer. Stomatitis is an inflammation of the oral mucosa that may be painful. Candida is frequently on the palate and the maxillary alveolar ridge (Ibsen & Phelan, 2004). Denture stomaititis is often caused from Candida albicans when other factors are present; in the relationship to wearing a denture. Denture stomaititis can be confused with other red or white lesions in the oral cavity. A white or red lesion on the palate in a patient who wears dentures need to have it checked with their doctor for a biopsy (Newland, Meiller, Wynn & Crossley, 2000). A white lesion on the palate could also be leukoplakia. A red lesion on the palate could be erythroplakia. Leukoplakia and erythroplakia are premalignant lesions (Ibsen & Phelan, 2004). Antifungal treatment for oral candidiasis is by oral dose. Some medications used are Clotrimazole, Nystatin, Ketoconazole and Fluconazole. Follow-up treatment is recommended (Newland et al., 2000).
Patients who have immune deficiencies that take diabetic drugs, broad spectrum antibiotics, anti-histamines and elderly may have a higher risk of having different forms of candidiasis (Monroy, Maldonado, Martinez, Barrios, Quindos & Vargas. 2004). The different forms of candidiasis of a high risk patient are median rhomboid glossitis, atopic glossitis, denture stomatitis, and angular chelitits (Daniluk, Tokajuk, stokowska, Fiedoruk, Sciepuk, Aaremba, Tozkiewicz, Cylwik-Rokicka, Kedra, Anielska, Gorska & Kedra 2006). Candida albicans is found more frequently in patients that use dental prosthesis, or dentures. “Candida albicans has the greatest ability to bond to the oral epithelial tissue (Daniluk et al., 2006). Candida albican colonizes on the dental prosthesis in people wearing dentures who have other contributing factors, such as diabetes mellitus, HIV, and auto-immune deficient disease (Oliveira, Carvalho, Gomes, Bacellar, Barros & Carvalho., 2006).
The type of material the appliance is made from affects the formation and adherence of Candida albicans. Candida albicans is a contributing factor in denture sotmatitis, infection problems, and deterioration in the function of the aging prosthesis. Soft denture liners help the fitting of a denture for a more consistent distribution the on the palate and alveolar ridge (Tari et al., 2007). The rough surfaces on denture material can increase the risk for a fungal infection. Dentures are made with different types of material. Dentures are made with silicone rubber which is a soft lining material and acrylic resin. The study shows that Candida albicans adhere more to the silicone rubber more often because of texture, physical and chemical properties. As the pellicles age on a soft lining denture, the salivary proteins will form a rough surface on the denture. (Tari et al., 2007). The Candida albicans attach to the rough surface and grow. The acrylic resin has a smoother, surface, so there is less likely of a chance of Candida albcians attaching to the denture material (Tari et al., 2007).
Local factors will cause Candida albican infection. Inadequate denture hygiene care may show a higher degree of inflammation which may imbalance the oral cavity normal flora and cause and infection. The Hygiene habits of denture patients are a factor in Candida albicans occurrence (Mravak-Stipetic, Hemerich & Jurcie., 2000). Insufficient care of the denture can imbalance the normal oral flora. This will cause an increase amount of fungus in the oral cavity. If a denture is not properly cleaned regularly it will cause infection and inflammation on the mucosal surfaces. Denture Stomatitis can result from poor oral hygiene and soiled dentures (Mravak-Stipetic et al., 2000). Carbohydrates in the diet help the biofilm form on acrylic materials. Smoking or wearing dentures overnight is another factor that contributes to the fungal occurrence (Mravak-Stipetic et al., 2000).
The normal flora in the oral cavity lives in harmony with bacteria. Candidiasis is not an issue in the oral cavity without contributing factors. Denture patients with local or systemic factors need to take extra care of their oral hygiene, to prevent a Candida infection. The research show there is no relationship between Candida albican and a healthy denture wearer.
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Ibsen, O. A., Phelan, J. A., (2004) Oral Pathology for the Dental Hygienist. (4th Ed). St. Louis, Mo. Saunders. 134-137.
Mravak-Stipetic, M., Hemerich, L., Jurcic, I., Jerolimov, V., (2000) Stimulating Local factors in the Development of Denture stomatitis. Acta Stomatol Croat. (34) 133-136.
Mizugai, H., Isogai, E., Hirose,K., Chiba, I., (2007) Effect of denture wearing on occurrence of Candida species in the oral cavity. The Journal of Applied Research. 3(5) 250-253.
Monroy, T. B., Maldonado, V. M., Martinez, F. F., Barrios, B.A., Guillermo, Q., Vargas, L. O., (2004) Candida albican, staphylococcus aureus, and streptococcus mutans colonization in patients wearing dental prosthesis. Oral medicine and pathology. E27-E39.
Newland, R. J., Meiller, T. F., Wynn, T .L., Crossley, H. L., (2005) Oral Soft Tissue Diseases. (3rd Ed.) Hudson, Ohio. 36-37.
Oliveria, M. A., Carvalho, L. P., Gomes, M., Bacellar, O., Barros, T. F., Carvalho, E. M., (2007) Microbiological and Immunological features of oral Candidiasis. The Journal of Microbiol immunology. 51(8), 713-717.
Tari€, B. F., Nalbant, D., Al, F. D., Kustimur, S., (2007) Surface Roughness and Adherence of Candida Albicans on Soft lining Materials as Influenced by Accelerated Aging. The Journal of Contemporary Dental Practice. 5(5), 1-10.
Figure: Denture stomatitis