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Micro(cid:977)lora in denture stomatitis - A review

Denture stomatitis is an in(cid:977)lammation that typically occurs in individuals that have a complete or partial denture. Denture stomatitis is commonly de(cid:977)ined as persistent in(cid:977)lammatory changes in the mucosa-bearing denture surface, often characterized by palatal erythema and alveolar ridges on which the denture is mounted. All relevant search engines were searched for the literature pertaining to denture stomatitis, various micro(cid:977)lora associated, prevention and treatment were searched. The required data was collected and quality analysis of the thus collected data was done. The knowledge in the current point of time-analyzed and thus the consensus was established. Denture stomatitis is induced by a variety of internal and external causes. The most perva-sive causative factor for denture stomatitis is the concentration of microbial plaque on palate-covered removable dentures that cause denture stomatitis in close to 69% of denture wearers. The various micro(cid:977)lora includes Candida, Streptococci, Staphylococci, Lactobacillus, Actinomyces, etc. Denture stomatitis has been shown to be a major oral disease seen on the denture wearers and is still prevalent in the majority of cases. Candida-associated denture stomatitis must be treated as it may serve as a repository for other infections and facilitate atrophy of the alveolar bone resulting in serious infections.

Denture stomatitis, micro lora, Candida albicans, Candida ABSTRACT Denture stomatitis is an in lammation that typically occurs in individuals that have a complete or partial denture. Denture stomatitis is commonly de ined as persistent in lammatory changes in the mucosa-bearing denture surface, often characterized by palatal erythema and alveolar ridges on which the denture is mounted. All relevant search engines were searched for the literature pertaining to denture stomatitis, various micro lora associated, prevention and treatment were searched. The required data was collected and quality analysis of the thus collected data was done. The knowledge in the current point of time-analyzed and thus the consensus was established. Denture stomatitis is induced by a variety of internal and external causes. The most pervasive causative factor for denture stomatitis is the concentration of microbial plaque on palate-covered removable dentures that cause denture stomatitis in close to 69% of denture wearers. The various micro lora includes Candida, Streptococci, Staphylococci, Lactobacillus, Actinomyces, etc. Denture stomatitis has been shown to be a major oral disease seen on the denture wearers and is still prevalent in the majority of cases. Candida-associated denture stomatitis must be treated as it may serve as a repository for other infections and facilitate atrophy of the alveolar bone resulting in serious infections.

INTRODUCTION
Denture stomatitis is an infection that usually occurs among individuals who wear a complete or a partial denture. Prosthetics, when introduced into the oral cavity in most cases results in severe alterations of the environmental conditions as the prosthesis leads to the development of colonization of microorganisms on the underlying mucosa resulting in distress of the denture wearer by causing denture stomatitis (Budtz-jørgensen, 2000). Denture stomatitis is generally described as the chronic in lammatory changes of the denture bearing mucosa, which is often characterized by erythema of the palate and the alveolar ridges on which the denture is placed (Budtz-Jørgensen, 1974). According to Arendorf and Walker (1987), Denture stomatitis has been reported in 11-67% of the complete denture wearers. It has also been mentioned that it is more prevalent in women than in men (Arendorf and Walker, 1987). Denture stomatitis is expressed in various other terms such as denture-induced stom-atitis, denture sore mouth, in lammatory papillary hyperplasia next chronic atrophic candidiasis (Pattanaik et al., 2010). The various micro lora associated with denture stomatitis are C. albicans, C. tropicalis, C. krusei, C. guilliermondii, C. lusitaniae, C. freyschusii (Arendorf and Walker, 1987) . In the Streptococci variety, S. mitior, S. milleri, S. mutans, S. salivarius , and S. sanguis, Staphylococci variety contained mainly S. aureus, Lactobacillus spp, Actinomycesspp (Theilade and Budtz-Jørgensen, 1988). However, According to Jeganathan and Lin (1992) Candida albicans has been implicated as the major causative organism in denture-induced stomatitis (Jeganathan and Lin, 1992).

MATERIALS AND METHODS
All relevant search engines (Google Scholar, PubMed ) were searched for the literature pertaining to denture stomatitis, various micro lora associated, prevention and treatment were searched. The required data was collected and quality analysis of the thus collected data was done. The knowledge in the current point of time analyzed and thus, the consensus was established.

Denture stomatitis
Denture stomatitis is linked to as a prevalent recurrent problem seen in denture wearers. It is known to be an erythematous tissue-bearing denture disease (Pattanaik et al., 2010). It is a non-speci ic in lammatory reaction due to action against microbial antigens. The key causes of denture stomatitis include in lammation, trauma or possibly a defect in the individual's host defense system (Jeganathan and Lin, 1992). Denture stomatitis has been identiied in approximately 11-67% of full denture wearers (Arendorf and Walker, 1987).

Causes of denture stomatitis
Denture stomatitis is in luenced by a number of internal and external factors (Gonzalez and Laney, 1966). The most common cause of denture stomatitis is the deposition of microbial plaque on removable dentures that cover the palate inducing denture stomatitis in close to 69% of denture wearers (Budtz-Jørgensen, 1974). Other potential causes of denture stomatitis includes diabetes mellitus, neoplastic diseases, chemotherapy, radiotherapy, broad-spectrum antibiotic treatment, etc (Dorko et al., 2001). Aging, malnutrition and immunosuppression could be other possible causes for acquiring denture stomatitis (Budtz-jørgensen, 2000).

Micro lora associated with denture stomatitis Candida
The role of Candida in denture stomatitis is remarkable. Candida, due to its high infectivity and ability to adhere and bio ilm on oral tissues (Gleiznys et al., 2015). A swab test was performed on 171 patients and seven different Candida species in oral mucosal lesions and adjacent denture surfaces. C.albicans has been seen in 95 cases, C. Tropicalis, 26 patients, C. Around 20 patients with parapsilosis, C. Krusei in approximately 14 patients, C. Guilliermondii, 12 patients, C. Lusitaniae for 1 patient and C. Freyshot in 1 patient (Dorko et al., 2001). Another research used oral swabs and swish samples obtained from a patient group and observed the recovery of C.albicans isolates. The evident presence of implicating Candida albicans has led to colonization on the tissue surfaces of the prosthesis. It occurs as an in lammation of the oral mucosa seen in denture stomatitis caused by continuous dentures (Ramage, 2004).

Cocci
There was an inventory of predominant lora, where the indings showed that the dominant micro lora in both groups comprised mostly of Gram-positive bacteria and, in the control group, about 69% of the denture lora comprised of cocci. It should be noted that neither group of palates had any variations in the proportions of cocci. The most common species of cocci is Streptococcus bacteria (Cawson, 1965;Lytle, 1957). It has also been asserted that S. Salivarius was mostly present in the palate of both groups (Koopmans et al., 1988).

Torulopsisglabrata
An experiment was performed in which yeast samples from 100 different patients were segregated with a generalized simple or granular form of denture stomatitis. Candida albicans and Torulopsisglabrata have been identi ied to be the most com-  (Olsen, 1974).

Other
Other kinds of microbiota that are known to cause denture stomatitis are Veillonellaparvula, certain Lactobacillus, Bacteroides and Actinomyces species (Theilade and Budtz-Jørgensen, 1988).

Treatment for denture stomatitis
Research by (Lytle, 1957), (Ampil, 1966), (Gonzalez and Laney, 1966), Cahn 1936 ('SEM analysis of denture plaque and oral mucosa of denture-related stomatitis,' 1993) and (Cawson, 1965) found that antifungal therapy is the most effective treatment choice for denture stomatitis. Recent work has proposed the use of denture liner products containing antifungal, antiseptic and microwave irradiation to treat Candida-associated denture stomatitis (Douglas and Walker, 1973).

Immunity to Candida
Immunity in Candida-associated denture stomatitis is given by IgA antibodies. It follows the concept of cell-mediated immunity, wherein the high serum antibodies work against C.albicans or other microorganisms, and continues to suggest a serious infection, much of which tends to be in lammation of the mucosa supporting the denture Ajay et al., 2017). Vitro cellmediated immune response of circulating C lymphocytes. Albicans-no signs of compromised clinically signi icant immune response (Dorko et al., 2001).

Prevention for denture stomatitis
Mitigation of denture stomatitis requires good oral and denture care and adequate denture construction (Budtz-jørgensen, 2000). The study noted that increased levels of anti-Candida antibody present in infected individuals and clinical improvement of mucosa due to the eradication of yeast lora typically serve as a preventive measure for potential denture stomatitis attacks. It also mentions the regular use of antiseptic or antimycotic drugs seems excessive (Arendorf and Walker, 1987).

CONCLUSION
From this study, denture stomatitis can be considered to be a signi icant oral disease seen in denture wearers and is still prevalent in the majority of cases. Candida-associated denture stomatitis should be treated as a reservoir for other infections that are more severe and encourage alveolar bone resorption leading to serious infections. The eradication and management of the microbial plaque is known to be the most effective treatment in both therapy and prevention.