Association between denture stomatitis, candida species and diabetic status

Candida species are commensal yeasts of the oral cavity, which, under predisposing systemic and/or local circumstances, are responsible for a wide variety of clinical manifestations, globally known as oral candidiasis. Candida-associated denture stomatitis is an oral candidiasis particularly affecting the oral mucosa covered by a dental prosthesis, with several degree of severity. Diabetics suffer oral candidiasis more frequently than healthy individuals do and if they are denture wearers, the risk increases. Since various controversies still remain regarding the interrelationship among diabetes, oral Candida spp. strains involved in denture stomatitis and the presence of dentures, the present review aims to investigate the differences in Candida species frequencies and degree of denture stomatitis severity existing among diabetic and non- diabetic individuals, with and without dentures.

A case with tumor of left parotid gland and denture stomatitis

The article discuss the case of an edentulous patient presented to the dental clinic for pain and burning sensation of oral mucosa and diagnosed subsequently with oxyphilic adenoma. A 58-year-old patient, with maxillary edentulism, treated with complete denture, presented to the Clinic of Prosthetic Dentistry of the Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, Romania, for pain of oral mucosa and bad stability of denture. The diagnosis of erythematous denture stomatitis as consequence of salivary flow reduction was establish after patient's clinical examination, and by unstimulated sialometry. Clinical exam suggested hyposalivation could be a consequence of a tumor situated at the level of the left parotid gland. The echography confirmed the diagnosis of left parotid gland tumor. The tumor was surgical removed and histopathological exam confirmed oxyphilic adenoma. Education of patient for wearing new denture while maintaining a strict oral hygiene and dealing with low salivary flow was the treatment for denture stomatitis. General dentist has an important role in finding and diagnosing patients with systemic diseases, especially salivary tumors.

Oral candidiasis: pathogenesis, clinical presentation, diagnosis and treatment strategies

Oral candidiasis is a clinical fungal infection that is the most common opportunistic infection affecting the human oral cavity. This article reviews the pathogenesis, clinical presentations, diagnosis and treatmentstrategies for oral candidiasis.

Microbial colonization and their relation with potential cofactors in patients with denture stomatitis

AIM

To determine microbial prevalence in the mucous membrane and prosthesis of denture wearers with and without denture stomatitis and to study its relationship with potential clinical cofactors.

MATERIALS AND METHODS

Saliva was collected from 200 patients (100 female and 100 male) wearing dental prosthesis for measurement of pH. Oral samples of the mucous membrane and of dentures were taken with sterile swab for microbiological analysis. Medical and dietary history of the subjects was recorded. Chi-square test and analysis of varience were used for statistical analysis.

RESULTS

Diabetes, hypertension and high carbohydrate ingestion was observed in majority of patients. The pH average in saliva was of 5.1. The presence of C. albicans, S. aureus and S. mutans in the mucous membrane was of 55.4, 56.4 and 63.6% respectively. C. albicans was isolated in 69.7% from the prosthesis, whereas S. aureus and S. mutans were isolated in 45.3%. The isolation of C.albicans was more frequent in patients with denture stomatitis.

CONCLUSION

C. albicans, S. aureus and S. mutans frequently colonize the oral mucous of denture wearers. This is more frequently observed in patients with denture stomatitis.

CLINICAL SIGNIFICANCE

Denture stomatitis is associated to Candida albicans, different bacteria and other cofactors, such as salivary pH, carbohydrate ingestion, systemic illnesses and medication.

Microwave denture disinfection versus nystatin in treating patients with well-controlled type 2 diabetes and denture stomatitis: a randomized clinical trial

PURPOSE

The aim of this randomized clinical trial was to compare the effectiveness of microwave denture disinfection and nystatin in the treatment of well-controlled type 2 diabetic patients with denture stomatitis in terms of microbiologic and clinical outcomes.

MATERIALS AND METHOD

Diabetic patients wearing maxillary complete dentures with denture stomatitis (n = 40) were divided into two groups: NYS (patients treated with topical nystatin 4 times/day for 14 days) and MW (patients who had their dentures microwaved [650 W for 3 minutes] 3 times/week for 14 days). Mycologic samples were taken from the palates and dentures of the patients for quantification and identification of Candida, and standardized photographs of the palates were taken for clinical analysis. Evaluations were repeated at baseline, the end of treatment (day 14), and throughout follow-up (days 30, 60, and 90). Microbiologic data were evaluated by analysis of variance using a random effects statistical model, Tukey post hoc test, and chi-square test (α = .05). Clinical results were analyzed using Mann-Whitney and Fisher exact tests (α = .05).

RESULTS

Both treatments were considered successful in reducing the clinical signs of denture stomatitis and significantly reduced the values of colony-forming units/mL from the palates and dentures at days 14 and 30. In addition, 40% of treated patients were cured by the end of treatment. No significant differences in the microbiologic and clinical outcomes were revealed between the two groups (P > .05). C albicans was the most predominant species isolated (P < .01), followed by C tropicalis and C glabrata.

CONCLUSION

Denture microwave disinfection was as effective as nystatin for the treatment of diabetic patients with denture stomatitis.

Candida-associated denture stomatitis in type 2 diabetes mellitus

OBJECTIVE

To describe the clinical appearance of Candida-associated denture stomatitis (DS) in subjects with type 2 diabetes (T2DM). The relationships between the types of DS, oral complaints and associated conditions were assessed in terms of glycemic control as determined by glycated hemoglobin (HbA1c) measurements.

MATERIALS AND METHODS

Demographic and clinical data were obtained from questionnaires and oral examinations of 110 edentulous patients with T2DM and 50 control subjects.

RESULTS

Type II DS commonly occurred in diabetics (57.3% vs 30%; p=0.002) together with DS related oral complaints (60.9% vs 24%; p<0.001) compared with controls. Burning sensation of the mouth (BS) was the most common complaint. Dryness of the oral mucosa (DOM) (50.9% vs 6%; p<0.001), angular cheilitis (26.4% vs 8%; p=0.01) and glossitis (27.3% vs 6%; p=0.003) occurred more frequently in diabetics. Oral complaints and associated conditions of DS coincided with elevated HbA1c levels (p<0.001). Diabetics with extensive type of inflammation had higher HbA1c levels than type I/III DS subjects (p<0.001).

CONCLUSIONS

Diffuse type of inflammation was associated with T2DM. BS and DOM were the most common oral complaints. Inadequately controlled diabetes with Candida-associated DS was linked to a high incidence of an extensive type of inflammation, oral complaints and associated conditions.

Denture-related stomatitis: identification of aetiological and predisposing factors - a large cohort

The aim of this study was to identify and characterize aetiological and predisposing factors in denture-related stomatitis (DRS), by means of a case-control, transversal study, in a large cohort of 140 persons wearing removable maxillary polymethylamethacrylate prostheses. Data were obtained by (1) a questionnaire that included the identification of the subject, demographic and social data, medical history and behaviour; (2) intra-oral examination; (3) evaluation of the prosthesis; (4) microbiological examination; (5) yeast identification and analyses using Epi-info and the chi-square test. Results showed significant associations between DRS and yeasts, gender, age and alcohol consumption. We also found a significant relationship between the presence of yeasts and hyposalivation and decreased salivary pH. We found a highly significant difference between groups with and without DRS concerning the presence or absence of yeasts, regardless of the sample origin. Most cases of DRS showed the presence of Candida albicans. The results confirm a highly significant difference between groups with and without DRS concerning the presence or absence of yeasts.

[Malnutrition in the elderly--a interdisciplinary problem for the dentist]

Success in dental treatment and long-term care of elderly persons requires an interdisciplinary consideration of aging. Medical knowledge, which is far beyond specific dental expertise, is assumed. A typical example is that of malnutrition, which in spite of its high frequency in the elderly, has not yet been considered to be important in dentistry. Missing diagnosis and therapy of malnutrition lead to increasing morbidity and mortality. Clarifying the nutritional conditions of aging persons therefore should also become a part of dental diagnosis to guarantee early medical diagnosis and therapy as well as to avoid oral complications.

Oral candidosis in patients with advanced cancer

The objectives of the study were to determine the epidemiology, aetiology, clinical features and microbiological aspects of oral candidosis in a cohort of cancer patients receiving specialist palliative care. One hundred and twenty patients participated in the study. Seventy-nine (66%) of the patients had microbiological evidence of oral yeast carriage, whilst 36 (30%) of the patients had combined clinical and microbiological evidence of oral candidosis. Oral candidosis was associated with a poor performance status, the presence of xerostomia, and the presence of dentures; oral candidosis was not associated with the use of oral/parenteral antibiotics, or the use of oral/parenteral corticosteroids. Candida albicans was the predominant organism isolated from the oral swabs of patients with oral candidosis. However, non-C. albicans species were the predominant organism in 25% cases, and a contributing organism in a further 19% cases.

Fluconazole and/or hexetidine for management of oral candidiasis associated with denture-induced stomatitis

OBJECTIVE

The aim of the present study was to compare the influence of fluconazole capsules and/or hexetidine mouthrinses for the management of oral candidiasis associated with denture stomatitis. DESIGN RELEVANT: Sixty-one patients (ages 43-76 years, mean: 61) admitted to the Department of Oral Surgery and Medicine and diagnosed as suffering from oral candidiasis associated with denture stomatitis by microbiological examination were involved.

MATERIALS AND METHODS

Patients in group 1 (n = 21) were given only fluconazole capsules (Zolax 50 mg once a day), those in group 2 (n = 18) were given only hexetidine mouthrinses (Heksoral 0.1%, twice daily), whereas those in group 3 (n = 22) were given both fluconazole capsules and hexetidine mouthrinses for 14 days. The yeast colonies of the saliva samples were counted and calculated as the number of colony forming units per milliliter. The presence of yeasts in the lesion and denture samples were evaluated as present/absent according to their growth on cultures. Candida albicans was identified by means of germ tube analysis.

RESULTS

Patients in groups 1, 2 and 3 had a statistically significant decrease in the amount of C. albicans in saliva, lesions and dentures after treatment, when compared with pretreatment results (P < 0.05). Candida albicans counts in saliva, lesion and denture after treatment detected no statistically significant difference when the three groups were compared.

CONCLUSION

Of the three study groups, group 2, where hexetidine was the only medication prescribed, was found to be superior on account of fewer potential complications. We conclude that dentists should employ a more conservative intervention with oral mouthrinses rather than risk adverse effects and complications of systemic drugs for the management of oral candidiasis.

The impact of cigarette/tobacco smoking on oral candidosis: an overview

Smoking is associated with a variety of changes in the oral cavity. Cigarette smoke has effects on saliva, oral commensal bacteria and fungi, mainly Candida, which causes oral candidosis, the most common opportunistic fungal infection in man. How cigarette smoke affects oral Candida is still controversial. This brief overview is an attempt to address the clinical findings on the relationship between smoking and oral candidosis and possible mechanisms of pathogenicity.

Cutaneous facial sinus tract of denture-related aetiology? A case report

A case is reported of a chronic facial sinus on the mandible. It is postulated that this was due to chronic mucosal trauma associated with a poorly adapted denture in a patient rendered immunosuppressed by poorly controlled type II diabetes. Previous treatment with antibiotics alone was unsuccessful. Healing was only achieved when antibiotics were combined with removal of the denture and improved diabetic control.

Use of Punica granatum as an antifungal agent against candidosis associated with denture stomatitis

The aim of this study was to evaluate the use of a gel containing the extract of Punica granatum as an antifungal agent against candidosis associated with denture stomatitis. Sixty patients with denture stomatitis confirmed by clinical and mycologic examination were selected. The patients were randomly allocated in two groups of 30 individuals each according to the medication prescribed: group A used miconazole (Daktarin(R) gel oral) and group B used a gel of P. granatum Linné (pomegranate). Both groups used the medicines three times per day for 15 days. Forty-eight hours after finishing the treatment the patients were re-examined and a second set of samples was collected for mycologic examination. The medicines were evaluated for their clinical response and negativity for Candida. The clinical results showed a satisfactory and regular response in 27 and 21 subjects of groups A and B, respectively. Negativity of yeasts was observed in 25 subjects of group A and 23 of group B. It can be concluded that the extract of P. granatum may be used as a topical antifungal agent for the treatment of candidosis associated with denture stomatitis.

Oral candidosis in patients with removable dentures

The prevalence of Candida species with and without denture-related stomatitis were evaluated in 167 Jordanian patients. The study revealed that 47 (28%) of the patients with denture-related stomatitis were colonized with Candida species (clinical group). Candida albicans was responsible for most cases of denture-related stomatitis (72%), and it was the only species capable of secreting aspartic proteinases. The study also indicated that candidal colonization was not influenced by predisposing haematological deficiencies, as both the clinical and control patient groups showed comparable haematological parameters and the differences were not significant (P > 0.05). All Candida species isolates were 100% susceptible to amphotericin B, while these isolates were less susceptible (25-75%) to fluconazole.

Differences in risk factors among clinical types of oral candidiasis in the Women's Interagency HIV Study

OBJECTIVES

The purpose of this study was to determine the prevalence and concurrence/associations of oral candidiasis types and multiple risk factors in women.

STUDY DESIGN

A cross-sectional analysis of baseline data for 577 human immunodeficiency virus (HIV)-seropositive and 152 HIV-seronegative women from the Women's Interagency HIV Study was conducted. Pseudomembranous candidiasis (PC) and erythematous (EC) candidiasis, angular cheilitis (AC), and denture stomatitis (DS) were studied, and bivariate and multivariate regression analyses were performed.

RESULTS

Prevalences were 8% for PC, 7% for EC, 18% for DS, and 3% for AC; all except AC usually occurred alone. HIV seropositivity was associated with PC, EC, and DS, but not AC. Among HIV-seropositive women, low CD4 cell counts were associated with PC, but not with EC or DS. Heroin/methadone use was associated with PC and EC; salivary hypofunction was associated with PC; high viral load was associated with EC, and poor oral hygiene, with EC and DS.

CONCLUSIONS

Risk factors varied among candidiasis types, suggesting differences in pathogenic mechanisms and usefulness as markers of HIV infection/progression.

Oral candidosis

Oral candidoses are frequently encountered in the practice of dentistry. Although most oral candidoses are symptomless, the can indicate the presence of an underlying systemic disease, and the persistence of oral candidosis following appropriate conventional management may be one of the first signs of undiagnosed immunosuppression. The opportunistic pathogen Candida albicans is the most commonly isolated species from oral candidal lesions; however, the non-albicans Candida spp. are also implicated in the aetiology of oral candidoses. The effective management of oral candidosis is dependent on an accurate diagnosis, identification and elimination of any predisposing factors (where possible), and the prescription of either topical or systemic antifungal agents. Oral candidosis may have significant implications for the general health of immunosuppressed patients, particularly when caused by the non-albicans spp. and, in cases of severe immunosuppression, systemic candidosis can be life-threatening. This article outlines the clinical presentation and appropriate management for the commonly presenting oral candidal conditions.

Glycaemic disorders in denture stomatitis

The prevalence of glycaemic disorders was investigated in native Upper-Austrians with Candida-associated denture stomatitis. All patients with previously unknown diabetes mellitus were subjected to an oral glucose tolerance test (OGTT) and as a result diabetes was diagnosed in 13% of the patients over 50 years of age. Thirty-five percent of all inspected patients over 50 years of age with denture stomatitis had type 2 diabetes mellitus and 36% had impaired glucose tolerance (IGT). The correlation between Candida-associated denture stomatitis and diabetes mellitus indicates a means for the early diagnosis of diabetes. Hyperglycaemia could not be a predisposition to denture stomatitis, since all patients with denture stomatitis in the age-bracket 26-50 years were without diabetes and only very few of the older patients with diabetes were obese. The correlation between Candica-associated denture stomatitis and type 2 diabetes mellitus could be traced back to a reduced resistance to Candida that preceded the diabetes.

Candida-associated denture stomatitis. Aetiology and management: a review. Part 3. Treatment of oral candidosis

Treatment of oral candidosis with topical antifungal agents such as nystatin and amphotericin B is effective initially. However, medication can produce side effects in some patients and when therapy is stopped the condition can recur. Alternative treatment involving the use of antiseptics and disinfecting agents has been shown to play an important role in the control of dental plaque. The use of sodium hypochlorite as an overnight denture soak has been shown to eliminate denture plaque and recent investigations have demonstrated that microwave irradiation of dentures at a specified setting and exposure time is bactericidal and candidacidal.

Oral candidiasis: clinical manifestations, diagnosis, and treatment

Oral candidiasis (candidosis) is an infection with multiple manifestations. To prevent prolongation of undiagnosed cases, it is essential that the dental clinicians have an understanding of the etiology, pathogenesis, and treatment of this disease. The learning objective of this article is the identification of the various clinical features of candidiasis. The underlying causes of oral candidiasis include antibiotic therapy, poor denture hygiene, xerostomia, immune deficiencies, diabetes, and some less common conditions. Candidal infection may be superimposed on other mucosal diseases and may disguise the underlying disease. The diagnosis is established using clinical appearance and patient history, and it may require diagnostic tests. A significant segment of the population carries intraoral Candida, without any symptoms of infection, complicating the use of diagnostic tests.

Atypical cartilage in reactive osteocartilagenous metaplasia of the traumatized edentulous mandibular ridge

Eighteen cases of reactive osteocartilagenous metaplasia of the edentulous mandibular alveolar ridge forming clinical masses that mimic neoplasms are reported. Although most of these lesions appeared histologically benign, three exhibited atypical microscopic features suggestive of chondrosarcoma. Of those cases that were followed, none of the lesions recurred after simple surgical excision. Because many investigators consider all cartilagenous lesions of the jaws potentially malignant, the importance of recognizing this benign condition is stressed.

Oral candidosis in long-term hospital care: comparison of edentulous and dentate subjects

OBJECTIVE

To obtain information on the oral health status of the elderly living in a medicalized, geriatric institution.

DESIGN

A cross-sectional clinical investigation with complementary microbiological studies.

SUBJECTS AND METHODS

A cohort of 233 elderly in one long-term care ward; collection of demographic data; clinical examination to determine dental and prosthetic status and health of the oral mucosae; swabs for detection of mucosal and denture colonization by Candida; paraffin stimulated saliva for detection of colonization by mutans streptococci and lactobacilli.

MAIN OUTCOME MEASURES

Oral and denture hygiene; oral mucosal health; degree of colonization by Candida, mutans streptococci and lactobacilli.

RESULTS

Mean age of the 233 patients was 85.6 +/- 6.9 years; 61% were totally dependent, 62.7% were wearing one or two complete dentures; 19.7% had natural teeth and no denture and 17.6% neither teeth nor denture. Of those wearing dentures 72% had denture stomatitis. Of those with natural teeth 72% were affected by active caries. Yeast counts were significantly correlated with the intensity of the erythema of the palatal mucosa, plaque score of the natural teeth, denture plaque score, and salivary counts of mutans streptococci and lactobacilli.

CONCLUSIONS

High oral yeast counts and frequent prevalence of oral candidosis in elderly subjects living in institutions are associated with poor oral hygiene and neglect of denture care.

General health factors and denture function in patients with burning mouth syndrome and matched control subjects

A total of 30 denture-wearing patients with burning mouth syndrome (BMS) referred to a Pain Clinic Unit and 26 age- and sex-matched control subjects were examined and compared with respect to general health factors and denture function. The study demonstrated a significantly higher frequency of multiple chronic diseases, psychosocial stress factors, and tenderness/pain in masticatory, neck, shoulder, and suprahyoid muscles in patients with BMS. Denture function differed also between the two groups as patients with BMS had significantly less daily use of dentures, reduced tongue space, incorrect placement of occlusal table and increased vertical dimension. Pain interview with the use of the McGill Pain Questionnaire demonstrated that pain in parts of the body other than the oral cavity were reported more frequently and that the intensity of past pain experiences was not rated higher except for pain in the head in patients with BMS. The results suggested a complex interaction between several general health factors, psychosocial stressors and denture dysfunction in order to explain an idiopathic burning pain in the anterior part of the oral cavity. The existence of demonstrable load factors does not seem to support the suggestion that BMS is primarily a psychogenic disorder.

Adenomatoid hyperplasia of oral minor salivary glands

Adenomatoid hyperplasia is a rare cause of swelling of the oral minor salivary glands, but is of significance because of its clinical resemblance to salivary gland tumors. The histologic appearance is one of benign hyperplasia and hypertrophy of the minor mucous glands. The clinical and histologic features of 20 new cases are reported, 19 of which occurred in the hard or soft palate. The cause of adenomatoid hyperplasia has hitherto been unclear, but the observation that 14 subjects were tobacco smokers or denture wearers, or both, suggests chronic, local trauma may be an important factor in the development of the condition.

Enhanced cytokine production and collagen synthesis of gingival fibroblasts from patients with denture fibromatosis

The mechanisms of denture-induced gingival hypertrophy remain to be explored. Since fibroblast proliferation and bone resorption characterize this disorder, the possible involvement of cytokines was investigated. Gingival fibroblasts were obtained from six patients with denture fibromatosis (Den-Fb) and six healthy persons (Nor-Fb). Cells were compared for proliferation, collagen synthesis, and cytokine production. Incorporation of [3H]thymidine (TdR) was increased in 3 Den-Fb and 3 Nor-Fb lines in the presence of interleukin-1-beta (IL-1 beta) (10 U/mL) and tumor necrosis factor-alpha (TNF-alpha) (from 10 to 100 U/mL). Proline incorporation in Den-Fb was higher than that in Nor-Fb, and the mean collagen synthesis level in Den-Fb was significantly higher than that in Nor-Fb. Although there was no difference between the up-regulation of protein synthesis in Den-Fb and Nor-Fb induced by IL-1 beta or TNF-alpha, the receptors for these cytokines were expressed at higher levels in cell lines which exhibited higher protein synthesis. Between Nor-Fb and Den-Fb, there was no difference in the generation of granulocyte-macrophage colony-stimulating factor (GM-CSF) or interleukin-6 (IL-6). However, most Den-Fb produced more GM-CSF and IL-6 in the presence of TNF-alpha. Enhancement of IL-6 generation by GM-CSF was also more prominent in Den-Fb. GM-CSF and IL-6 were synergistically generated after co-culture of the fibroblasts with gingival keratinocytes. GM-CSF and IL-6 generation of Den-Fb was markedly enhanced by co-culture of Den-Fb with peripheral blood mononuclear cells (PBMC), especially PBMC from patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of Candida-infected denture stomatitis with a miconazole lacquer

The efficacy of a topically administered miconazole denture lacquer was compared with that of a placebo lacquer in the treatment of Candida-infected denture stomatitis. The study was a double-blind, randomized, controlled clinical trial with two parallel treatment groups. The lacquer was applied once on the fitting denture surface. Follow-up examinations took place on days 3, 7, 14, 21, 28, and 35. On day 14 the effect of the treatment was assessed. Thirty-six patients were included in the statistical analysis. Eighteen received miconazole and 18 received placebo lacquer. Primary efficacy endpoints were the number of colonies cultured from the palatal mucosa and denture surface on day 14. Thirteen of 16 patients in the miconazole group A showed < 10 colonies on culture medium on day 14 in the specimens from the palatal mucosa as did 5 of 18 patients in the placebo group B (p < 0.05). Corresponding results for the denture surface were 6 of 17 and 3 of 18, respectively (p < 0.05). Reapplication of lacquer was considered necessary (> 100 colonies in at least one sampling site within 14 days) in 35% of the patients from group A and in 83% of the patients from group B. The results indicate that a single application of a miconazole denture lacquer considerably reduces the number of Candida yeasts for a substantial period of time.

Burning mouth syndrome. Evaluation of multiple variables among 85 patients

The relationship between burning mouth syndrome and 48 variables was investigated in 241 patients, 45 years old and older, who had attended the Oral Medicine Clinic of the Faculty of Dentistry, University of Stellenbosch during a period of 4 years. A total of 85 cases of burning mouth syndrome were diagnosed in 65 women and 20 men. Statistically significant relationships (p < 0.05) were found with self-medication, xerostomia, and other salivary disturbances in both men and women with burning mouth syndrome when compared with their respective controls. Among the women with BMS, significant relationships were also found with anemia, inadequate diet, chronic infection, hormone therapy, ulcerative/erosive lesions, and atrophy. In contrast men with BMS showed statistically significant relationships between taking prescribed medication, central nervous system disturbances, gingivitis, and denture-related problems. In addition, significant associations were related to variables such as psychogenic factors, regurgitation, flatulence, and periodontitis.

Oral candidal infection and denture stomatitis: a comprehensive review

Denture stomatitis rarely occurs without at least one predisposing factor that lowers patient resistance. A new disinfection technique for dentures and oral tissue may eliminate topical or anti-fungal drug use.

Oral health in the terminally ill: a cross-sectional pilot survey

This study of 20 hospice patients provided baseline information on oral and dental status in the terminally ill. For each patient, a questionnaire was completed, the mouth was examined, and an oral rinse and imprint cultures were collected to establish the prevalence and intra-oral density of yeasts, staphylococci and coliforms. Oral symptoms reported included disturbance of taste (26%), dysphagia (37%), soreness (42%), and dryness (58%). Of the 75% who wore dentures, 71% had difficulty with their prosthesis (es). A clinical diagnosis of oral candidiasis was made in 70% of subjects. The high prevalence of oral symptoms, denture problems, and candidiasis clearly affect the quality of remaining life in terminally ill patients.

Factors predisposing to oral yeast infections

The discussion of factors predisposing to oral yeast infections is very important, and we can ask: what is primary and what is secondary? Without predisposing factors it is difficult to have oral yeast infection, and a yeast infection may also be the first sign of a developing basic illness. As long as the predisposing factors cannot be eliminated, recurrences of oral yeast infections are to be expected. We can say that local and systemic factors permit this micro-organism to cause disease and that it is extremely rare to find a case of oral candidosis in which one or more of these factors cannot be identified. There are many kinds of lists in the textbooks and some review articles in the literature, but more research is needed for better understanding of factors predisposing to oral yeast infections.

General oral status in adults with rheumatoid arthritis

The oral status of an adult population of 204 patients with rheumatoid arthritis (RA) was compared with that of an age and sex-matched random sample of non-rheumatic subjects. The percentage of edentulous subjects, number of existing teeth in dentate subjects, prevalence, and quality of fixed and removable prostheses and prevalence of disorders of the stomatognathic system was recorded. The percentage of edentulousness among RA-patients was 17% and among non-RA subjects 19%. Number of remaining teeth was equal. 75% of removable partial and 62% of complete dentures among RA-patients were considered unsatisfactory compared to 25% and 56% respectively among non-RA subjects. Disorders related to the TMJ occurred much more frequently among RA-patients than among non-RA subjects. It is suggested that thorough stomatognathic examination and TMJ-prophylaxis be included in the overall care of RA-patients.

Treatment of angular cheilitis. The significance of microbial analysis, antimicrobial treatment, and interfering factors

This prospective study evaluated the significance of microbial analysis and antimicrobial treatment for the cure of angular cheilitis. Furthermore, various etiologic factors were investigated for their relative effect on the healing process. The study included 1) an open trial with 50 patients infected by Candida albicans and/or Staphylococcus aureus, and 2) an intraindividual comparison of eight patients with bilateral lesions infected by Candida albicans as the only detected pathogen. After a base-line examination the patients received ointments containing nystatin and/or fusidic acid, on the basis of the outcome of an initial microbial analysis. The patients were evaluated clinically, photographed, and examined for microorganisms at different time intervals. Ninety-six per cent of the patients who participated in the open trial had no sign of infection after 42 days of treatment. Lesions in the double-blind study, treated with nystatin, were healed after 28 days, whereas lesions that received placebo persisted throughout the treatment period. Increasing age, dry skin, and extended skinfolds at the corner of the mouth were factors closely related to the length of the healing process.

[Burning tongue (author's transl)]

Burning tongue mostly does not occur as a disease per se, but as a symptom primarily of internal but also of neurological, dermatological, psychiatric and dental diseases. To facilitate differential diagnostic considerations, a short description is given of the individual clinical pictures as well as of the pertinent findings. The knowledge of these diseases is a prerequisite to the causal and lasting treatment of patients affected by the obstinate and occasionally even painful symptom of the burning tongue.

[Symptom: changes at the corners of the mouth (author's transl)]

The multiplicity of the pathological changes discussed have already been called many names: rhagades, perlèche, angular cheilosis, interlabial mycosis. It is often a poly-etiologic disease picture the causes of which must be recognized and then if necessary be clarified in greater detail by close interdisciplinary cooperation. Beside the common internal and dermatological diseases which may lead to changes at the angles of the mouth it is intended to show which dental and stomatological considerations are to be included in the differential diagnosis and therapy of this symptom complex.

Central papillary atrophy of the tongue and denture stomatitis

A retrospective study of the epidemiologic data of 4,417 subjects has been undertaken to study the possibility of a link existing between glossal central papillary atrophy (median rhomboid glossitis) and denture stomatitis. Neither the association between glossal central papillary atrophy and denture stomatitis nor the association between glossal central papillary atrophy and denture use was statistically significant. However, the correlation between wearing removable dental prostheses and finding candidal mycelia in smears from these tongue lesions was statistically highly significant. Debilitation caused by general age changes would not appear to predispose to atrophy of the pappillae of the middle portion of the tongue-dorsum.

Initiation and aggravation of denture stomatitis by sucrose rinses

The purpose of this study was to assess whether frequent exposure to sucrose would aggravate or initiate a palatal candidosis in denture wearers. Eight subjects with generalized simple or granular inflammation in the palate (inflammation group) and six with clinically healthy palatal mucosa (control group) carried out 1-min mouthrinses with 10 ml of a 25% sucrose solution four times daily for 15 d. In the inflammation group an aggravated palatal erythema was seen in two subjects after 7 d, and in another subject after 15 d. Among the controls a generalized simple inflammation had developed in the palate of one subject after 7 d, and in another one after 15 d. An increased number of yeast colonies on palatal and denture agar models and/or hyphae on palatal and denture smears was found in all subjects with clinical signs of aggravated or initiated denture stomatitis.

Nystatin and amphotericin B in the treatment of denture-related candidiasis

A double-blind trial of nystatin, amphotericin B, and a placebo was carried out in fifty-two cases of denture-related candidiasis and/or angular cheilitis. The drugs effected a significant clinical cure, but recurrence of the signs was common after withdrawal of the drugs. Concurrent bacteriologic examination showed few cures and continued presence of Candida albicans during the trial. A specimen from a red palate was examined histologically.

Denture stomatitis. The clinical effects of chlorhexidine and amphotericin B

The clinical effects of an antibacterial substance with antifungal activity (chlorhexidine) and specific antimycotic (amphotericin B) in denture stomatitis were studied in 100 patients. Five 14-day regimens of chlorhexidine, amphotericin B or placebo lozenges combined with denture immersion in 0.2% chlorhexidine or water were tested. The efficiency of amphotericin B and chlorhexidine was comparable. This indicates that chlorhexidine has a considerable antifungal effect in the oral cavity and, further, that fungi are the responsible micro-organism in denture stomatitis rather than bacteria. Chlorhexidine frequently discloured the dentures. A high incidence of local and general predisposing factors to denture stomatitis, as well as of relapse 14 days after treatment, was observed.

Oral infections with Candida albicans

The majority of oral infections with Candida albicans have a local cause. However some Candida infections, such as chronic muco-cutaneous candidosis, which may be widespread over skin and mucous membranes are associated with systemic disorders. Indeed, antibiotic or corticosteroid therapy and severe debilitating disease are proven causes of Candida infection while the association of various endocrinopathies with candidosis has now become well established. More recently, other systemic factors such as impaired cellular immunity and nutritional deficiency have been recognised as influencing Candida infections, and this knowledge is now being successfully applied to the treatment of the disease.