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What are the options for treating Papillary Hyperplasia in chronic denture wearers?

Dentures.This question was submitted by a general dentist: What options do we have in treating Papillary Hyperplasia in chronic denture wearers?  How successful is treatment with medication (e.g. Nystatin ointment etc.) alone?

Drs Joseph Fava and Suham Alexander prepared the following response:

Inflammatory papillary hyperplasia, also known as denture stomatitis, is a reactive tissue growth that is related to denture wear in most instances. Some contributing factors include:

  • Chronic denture wear (i.e. 24 hours/day)
  • Poor oral and denture hygiene
  • Ill-fitting dentures
  • Yeast colonization
  • Allergic reactions to base materials
  • Smoking
  • Malignancies, nutritional deficiencies, endocrinologic disorders

The asymptomatic condition has a prevalence of approximately 50% in a randomized patient population rehabilitated with complete dentures. It is characterized by erythematous papillary lesions on the hard palate under the denture base and occasionally, on the edentulous mandibular alveolar ridge. It is usually associated with the growth of Candida organisms. Individuals that are habitual mouth-breathers with a high-palatal vault may also present with this condition. Clinicians should also be aware that Candida-associated inflammatory papillary hyperplasia can occur in dentate HIV-infected individuals.

Dental Management and Prevention 

The etiology of this condition is multifactorial in nature; hence, effective treatment and preventive measures cannot be singular.

Antifungal Therapy

  • Prescribe for:

o   Patients with a confirmed clinical diagnosis (mycological exam)

o   Patients who describe a burning sensation from the oral mucosa

o   Patients who are at risk of systemic mycotic infections due to other diseases, drugs, irradiation treatment (Candida infection may have spread to other site in oral cavity/pharynx)

  • Local therapy: Nystatin, Amphotericin B, Miconazole, Clotrimazole
  • Lozenges used without denture by sucking. Treatment with antifungals should continue for 4 weeks.

Thorough and meticulous oral/denture hygiene, using denture seldom during this period. Use 2% CHX disinfectant solution at night for dentures.

Effective Plaque Control

While antifungal treatment on its own can eradicate C. albicans contamination and relieve stomatitis symptoms, dentures must be disinfected and proper denture care must be maintained. 

Correction of Ill-fitting Dentures

Denture stomatitis can be improved with the previously mentioned therapies; however, hyperplastic tissue will not disappear. In advanced conditions, excision of the hyperplastic tissue may be necessary in conjunction with the fabrication of a new prosthesis. 

Correction of Denture-wearing Habits

Stomatitis may recur when antifungal therapy is discontinued. Therefore, it is crucial to educate patients regarding oral and denture hygiene/care to maintain optimal oral health in their edentulous states. Patients must also be reminded to remove dentures at night and when they sleep.

References

  1. Budtz-Jorgensen E. Sequelae caused by wearing complete dentures. In: Zarb GA, Bolender CL, Eckert S, Jacob R, Fenton A, Mericske-Stem R, eds. Prosthodontic Treatment for Edentulous Patients: Complete Dentures and Implant-Supported Prostheses , 12 edn. St. Louis: Mosby, 2004: 34 50.
  2. Gendreau, L. and Loewy, Z. G. (2011), Epidemiology and Etiology of Denture Stomatitis. Journal of Prosthodontics, 20: 251–260.
  3. Neville BW, Damm DD, Allen CM, Bouquot, JE. Oral and Maxillofacial Pathology. 2009. Saunders Elsevier. St. Louis, Missouri.
  4. Salonen MAM, Raustia AM and Oikarinen KS. Effect of treatment of palatal inflammatory papillary hyperplasia with local and systemic antifungal agents accompanied by renewal of complete dentures. Acta Odontol Scan. 1996; 54:87-91.

 

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4 comments

  1. Can one use 1:10 dilution of bleach to disinfect the dentures?

    • Pierre-Luc Michaud

      Yes. There are other products on the market that also show very good results (i.e. Novadent), but 1:10 dilution of bleach is usually good enough and won’t damage the denture.

  2. Dr ADRIAN LUCKHURST

    In many cases of papillary hyperplasia, the patient presents with ill-fitting dentures, does not leave them out at night and does not brush the tissues.The result is an overgrowth of candida. The denture surface is porous and allows candida access to deeper layers of acrylic. A solution of a teaspoon of bleach in a cup of water is effective in disinfecting the denture.

    In dealing with the ill-fitting denture and the candidal involvement in the tissues over which the denture sits, one can mix Nystatin powder 100,000 units into Viscogel tissue conditioner. This is now available again in a compounding pharmacy. This can be changed every 1-2 weeks depending on response and severity.

    One may also have to deal with mucosal candida, unfortunately the oral anti-fungal rinses are not substantive enough and effectiveness drops off quickly. Therefore,it is better to have the compounding pharmacy make up a Nystatin lozenge 100,000 units that the patient sucks without their dentures Q.I.D. for 7-10 days. Nystatin suppositories used to work well, were inexpensive and easy to obtain. However, some patients became skittish to use them as they were used to controlling candida in other areas of the body. So, now the lozenges will cost about $50-60 for 10days. Once you have the candida under control then you can plan how to reduce the hyperplasia.

    • So does it mean that Candida is the actual root of the problem in all cases of papillary hyperplasia in denture wearers?

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