Zvi G. Loewy

Epidemiology and Etiology of Denture Stomatitis

Denture stomatitis, a common disorder affecting denture wearers, is characterized as inflammation and erythema of the oral mucosal areas covered by the denture. Despite its commonality, the etiology of denture stomatitis is not completely understood. A search of the literature was conducted in the PubMed electronic database (through November 2009) to identify relevant articles for inclusion in a review updating information on the epidemiology and etiology of denture stomatitis and the potential role of denture materials in this disorder. Epidemiological studies report prevalence of denture stomatitis among denture wearers to range from 15% to over 70%. Studies have been conducted among various population samples, and this appears to influence prevalence rates. In general, where reported, incidence of denture stomatitis is higher among elderly denture users and among women. Etiological factors include poor denture hygiene, continual and nighttime wearing of removable dentures, accumulation of denture plaque, and bacterial and yeast contamination of denture surface. In addition, poor-fitting dentures can increase mucosal trauma. All of these factors appear to increase the ability of Candida albicans to colonize both the denture and oral mucosal surfaces, where it acts as an opportunistic pathogen. Antifungal treatment can eradicate C. albicans contamination and relieve stomatitis symptoms, but unless dentures are decontaminated and their cleanliness maintained, stomatitis will recur when antifungal therapy is discontinued. New developments related to denture materials are focusing on means to reduce development of adherent biofilms. These may have value in reducing bacterial and yeast colonization, and could lead to reductions in denture stomatitis with appropriate denture hygiene.

Evaluation of microbial flora found in previously worn prostheses from the Northeast and Southwest regions of the United States

STATEMENT OF PROBLEM Denture-induced stomatitis is a recognized clinical challenge. The responsible microorganisms have not been delineated and may differ among regions of the United States. PURPOSE The purpose of this study was to identify the microorganisms found in dentures from 2 geographic regions. MATERIAL AND METHODS Previously worn dentures from 51 available subjects living in the Southwest (41) and Northeast (10) were aseptically retrieved in sterile plastic bags. A posterior piece of the mandibular denture was removed and sampled on appropriate media under anaerobic conditions. The remaining denture material was divided into 7 equal pieces. Each piece was touched to appropriate aerobic media and incubated at 37 degrees C. Bacteria and yeasts were identified using standard clinical laboratory procedures. Data were analyzed by using descriptive statistics. Denture fragments were further analyzed by scanning electron microscopy (SEM). RESULTS A total of 916 isolates were carried to final speciation. Of these, 711 were aerobic bacteria, 67 were anaerobic bacteria, 125 were yeasts, and 13 were amoebae. Microorganisms were found on the denture surfaces and interstices (denture pores). Most subjects wore their dentures for extended periods without sanitization. SEM analyses confirmed substantial porosity of the denture material with microbial penetration and biofilm formation within the pores. CONCLUSIONS A wide range of potentially pathogenic microorganisms was found in dentures. There were also regional differences in the microbial flora.

A Cohort Study of the Impact of Tooth Loss and Periodontal Disease on Respiratory Events among COPD Subjects: Modulatory Role of Systemic Biomarkers of Inflammation

Background In COPD patients, fatal and non-fatal respiratory-related events are influenced by age, severity of respiratory disease, and comorbidities. Objectives Analyze the effects of edentulism, periodontal disease and systemic biomarkers of inflammation on the occurrence of serious fatal and non-fatal respiratory-related events among subjects with COPD. Methods Cases were identified from Dental Atherosclerosis Risk in Communities study. Edentulism was defined as study participants without any natural teeth or implants. Participants with one or more natural teeth (comprising 11,378 subjects) were studied as dentate subjects. Periodontal disease status among dentate individuals was determined using the consensus definitions published by the joint Center for Disease Control/American Association of Periodontology working group). Adjusted Hazard Models are developed to evaluate the relationship between edentulism/periodontal disease and COPD Related Events. Models were then stratified by GOLD Stage I, II and III/IV. Serum biomarkers were also evaluated to explore the effect of systemic inflammation. Results A statistically significant association was found between oral health status and COPD-related events, even adjusting for conditions such as hypertension, smoking and diabetes. Edentulous individuals who had been diagnosed with COPD had a higher incidence and were at greater risk of having a COPD related event (hospitalization and death) than individuals who had teeth and whose mouths had healthy periodontal status. However, being edentulous did not convey excess risk for COPD-related events for those study participants who were classified as GOLD III/IV at baseline. Finally, we showed that individuals who had levels of serum IL-6 in the highest two quartiles were at even higher risk for COPD-related events. Conclusions These findings suggest that the risk for COPD-related events after adjusting for potential confounders may be attributable to both edentulism and elevated serum IL-6 levels.