Denture Stomatitis: Symptoms, Types, Causes and Treatment

Denture stomatitis is a common yet often overlooked condition affecting many people who wear dentures. Characterized by inflammation and redness of the oral mucosa beneath a dental appliance, this disease can impact quality of life, oral health, and even systemic health if not managed properly. In this article, you'll discover what denture stomatitis looks like, the different forms it can take, what causes it, and the latest evidence-based treatment approaches.

Symptoms of Denture Stomatitis

Denture stomatitis often sneaks up on people, as it can be remarkably subtle in its early stages. Many individuals may not even realize they have it until a dental professional points it out. However, for others, the symptoms can be bothersome and affect daily life.

Symptom	Description	Frequency/Severity	Source(s)
Redness	Erythema under denture surface	Common, often diffuse	1 5 7 12
Swelling	Mild inflammation of mucosa	Mild to moderate	1 5 7
Burning Sensation	Oral discomfort or burning	Variable	5 9
Dryness	Sensation of oral dryness	Sometimes present	5 9
Bleeding	Mucosal bleeding, usually mild	Rare	5
Soreness	General discomfort	Sometimes present	5 13
No Symptoms	Asymptomatic in many cases	Very common	5 7 12

Table 1: Key Symptoms

Asymptomatic Nature and Common Complaints

Most cases of denture stomatitis are asymptomatic, meaning affected individuals notice little or no discomfort. When symptoms do arise, they may include a burning sensation, dryness, mild soreness, or even mucosal bleeding—though these are less common 5 7 12. Notably, patients with diabetes are more likely to report symptoms like burning or dryness 9.

Visible Signs

The hallmark sign is redness (erythema) of the mucosa directly beneath the denture, especially the upper denture. Swelling and mild inflammation are also frequently observed 1 5 7. In severe cases, patients may notice bleeding upon removing their dentures or when cleaning them.

Associated Oral Conditions

Denture stomatitis can sometimes be accompanied by other oral issues, including angular cheilitis (cracking at the corners of the mouth) and glossitis (inflammation of the tongue), particularly in patients with underlying systemic conditions such as diabetes 9.

Types of Denture Stomatitis

Denture stomatitis is not a one-size-fits-all condition. Recognizing its various clinical presentations helps guide diagnosis and treatment.

Type	Description	Clinical Features	Source(s)
Type I	Localized simple inflammation	Pinpoint redness	7 10 12
Type II	Generalized simple inflammation	Diffuse erythema	2 7 9 10
Type III	Granular/inflammatory papillary hyperplasia	Nodular/pebbled mucosa	2 7 10 12

Table 2: Types of Denture Stomatitis (Newton’s Classification)

Newton’s Classification

The most widely used system for classifying denture stomatitis is Newton’s classification. It divides the condition into three main types based on the appearance and extent of the lesions 7 10 12:

• Type I (Localized Simple Inflammation): Characterized by small, pinpoint areas of redness, usually caused by localized trauma from the denture 7 10.
• Type II (Generalized Simple Inflammation): Presents as diffuse redness (erythema) involving much or all of the mucosa in contact with the denture base. This is the most common form and often linked to microbial (especially Candida) overgrowth 2 7 9.
• Type III (Granular or Inflammatory Papillary Hyperplasia): Features a pebbled or nodular appearance of the mucosa, typically on the midline of the palate. This type often results from chronic irritation, poor denture fit, and continuous denture wear 7 10 12.

Inflammatory Papillary Hyperplasia

Type III is also referred to as inflammatory papillary hyperplasia (IPH). While rare, it is strongly associated with ill-fitting dentures, poor hygiene, and sometimes smoking. IPH is almost exclusive to denture wearers and rarely occurs without a prosthesis 10.

Other Considerations

While Newton’s system is the standard, clinicians may also consider other clinical features such as the presence of co-existing angular cheilitis, median rhomboid glossitis, or the extent and severity of the inflammation when diagnosing and planning treatment 3 9.

Causes of Denture Stomatitis

Understanding why denture stomatitis develops is crucial for both prevention and effective management. The disease is multifactorial—meaning several risk factors usually come together to trigger it.

Cause	Mechanism/Explanation	Risk Factor Level	Source(s)
Candida albicans	Fungal colonization and biofilm formation	Primary	1 2 3 6 8 11 12
Poor Denture Hygiene	Accumulation of microbial plaque	Major	1 3 6 12
Continuous Denture Wearing	Nighttime/nonstop use limits tissue recovery	Major	1 3 7 12
Poor Denture Fit	Mucosal trauma, irritation	Major	1 7 10
Systemic Factors	Diabetes, immunosuppression, nutritional issues	Variable	7 9 12
Xerostomia (Dry Mouth)	Reduced saliva, less cleansing	Minor	2 9 12
Allergic Reactions	Sensitivity to denture materials	Rare	7
Smoking	Increases risk, especially for IPH	Variable	10

Table 3: Major Causes and Risk Factors

Microbial Factors: The Role of Candida

The leading culprit is the overgrowth of Candida albicans, a type of fungus that thrives in the warm, moist environment beneath dentures. The rough or irregular surface of dentures—especially when hygiene lapses—creates an ideal habitat for Candida biofilm formation 1 2 3 8 11 12.

Other Candida species, such as C. glabrata and C. dubliniensis, are also implicated, particularly in long-term denture wearers 11. These fungal colonies can irritate the mucosa, leading to inflammation and, in some cases, infection.

Hygiene and Denture Care

Poor denture hygiene is a well-established risk factor. Plaque and food debris accumulate on the fitting surface, providing nutrients for microbial growth 1 3 6 12. Without regular and proper cleaning, both bacterial and fungal populations can flourish.

Denture Wear Habits

Wearing dentures continuously, especially overnight, prevents the oral tissues from recovering and increases the risk of denture stomatitis 1 3 7 12. Removing dentures at night allows the mucosa to "breathe" and reduces microbial load.

Denture Fit and Mechanical Irritation

Ill-fitting dentures can cause chronic trauma to the mucosal tissues, leading to localized inflammation (Type I) and, over time, more generalized or nodular changes (Types II and III) 1 7 10. Adjusting or replacing poorly fitting dentures is a key preventive step.

Systemic and Local Predisposing Factors

• Medical conditions: Diabetes (especially if poorly controlled), immunosuppression, nutritional deficiencies, and other systemic illnesses increase susceptibility 7 9 12.
• Dry mouth (xerostomia): Decreased salivary flow, whether from medications or medical conditions, can contribute—though not as prominently as once thought 2 9 12.
• Allergies: Rarely, sensitivity to denture materials can trigger stomatitis 7.
• Smoking: Particularly relevant for the development of inflammatory papillary hyperplasia (Type III) 10.

It’s Multifactorial

Most cases arise from a combination of these factors, rather than a single cause. Addressing all potential contributors is essential for effective management 1 3 7 12.

Treatment of Denture Stomatitis

Managing denture stomatitis involves more than just eliminating symptoms—it requires tackling the underlying causes to prevent recurrence. Modern treatment approaches are evidence-based and often multimodal.

Treatment Approach	Main Strategy/Method	Effectiveness/Notes	Source(s)
Improved Hygiene	Daily denture cleaning/disinfection	Highly effective	1 3 6 12 15
Denture Removal at Night	Remove dentures nightly	Strongly recommended	1 3 7 12
Antifungal Medications	Topical (nystatin, miconazole) or systemic	Short-term relief, may recur	1 13 14 15 16
Denture Disinfection	Soaks, microwave, antiseptic mouthwashes	As effective as antifungals	14 15
Denture Replacement	New/fitting dentures	Resolves trauma-linked cases	1 6 3
Probiotics	S. salivarius K12 reduces symptoms	Promising adjunct	4
Antifungal-Enhanced Materials	Antifungals in tissue conditioners or base	Effective, experimental	16 17

Table 4: Evidence-Based Treatment Options

Oral and Denture Hygiene

• Daily cleaning: Scrubbing dentures with a brush and soaking them in disinfectant reduces biofilm and microbial load 1 3 6 12 15.
• Professional cleaning: Regular dental check-ups for professional cleaning and denture maintenance are important 3.

Removing Dentures at Night

Taking dentures out every night is a powerful preventive and therapeutic measure. This simple habit allows oral tissues to recover and interrupts the cycle of fungal colonization 1 3 7 12.

Antifungal Medications

• Topical agents: Nystatin and miconazole are commonly prescribed to reduce Candida overgrowth 1 13 14 15 16.
• Systemic agents: Fluconazole can be effective but is reserved for refractory cases or when topical therapy fails 13.
• Limitations: Recurrence is common unless denture hygiene is improved alongside medication. Long-term antifungal use is discouraged due to resistance concerns 1 3 13 14.

Denture Disinfection Methods

Non-antifungal disinfection methods (e.g., soaking in antiseptic solutions, microwave disinfection, photodynamic therapy) are as effective as antifungal medications for reducing clinical signs and microbial counts 14 15. These approaches are especially valuable for those who cannot tolerate antifungals.

Denture Replacement and Adjustment

Replacing old, ill-fitting, or damaged dentures, or relining them to improve fit, helps resolve cases caused by mechanical trauma 1 6 3. This is particularly effective for Newton’s Type I and II.

Probiotics and Novel Therapies

Recent studies show that certain probiotics, such as Streptococcus salivarius K12, can help reduce symptoms and Candida load, with effects lasting beyond the treatment period 4. Modifying the denture base with antifungal agents (including nanoparticles) or tissue conditioners is an emerging area of research 16 17.

Combined and Individualized Approach

Successful management typically involves a combination of the above strategies, tailored to the individual's risk factors and needs. Ongoing maintenance and patient education are vital to prevent recurrence 1 3 12 15.

Conclusion

Denture stomatitis is a prevalent, multifactorial condition with both local and systemic ramifications. While often asymptomatic, it can cause significant discomfort and increase the risk of secondary infections, especially in vulnerable populations. Understanding its varied presentations, underlying causes, and evidence-based treatment strategies is essential for both patients and dental professionals.

Key Points:

• Denture stomatitis most commonly presents as redness and inflammation under a denture, often without symptoms, but can also cause burning, dryness, and soreness 1 5 7 12.
• It is classified into three types (Newton’s I–III) based on clinical features, ranging from localized inflammation to pebbled hyperplasia 7 10 12.
• Primary causes include Candida overgrowth, poor denture hygiene, continuous denture wear, and poor denture fit. Systemic factors like diabetes and smoking can increase risk 1 2 3 7 9 10 12.
• Treatment focuses on meticulous oral and denture hygiene, nightly removal of dentures, antifungal therapy, disinfection, and, when needed, denture replacement. Emerging therapies include probiotics and antifungal-enhanced materials 1 3 4 6 12 14 15 16 17.
• Consistent, long-term behavioral change is crucial for effective management and prevention of recurrence 1 3 12 15.

By staying proactive with denture care and working closely with dental professionals, individuals can prevent, manage, and even reverse denture stomatitis, ensuring a healthier and more comfortable oral environment.