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Title: Correlation of systemic diseases and hygiene in patients using removable prosthetic restoration without signs of inflammatory process
Abstract:
Oral fungal infection is a common disease in denture wearers [1-9]The long term use of removable dentures due to the lack of teeth, creates the ideal environment for yeasts to grow, which results in the development of denture related stomatitis (DRS) [10-12]. DRS is defined as an inflammatory process of the mucosa underlying a removable partial or full denture. It is characterized as inflammation and erythema of the oral mucosal areas covered by the denture [12-15]. DRS presents different degrees of severity ranging from petechiae to generalized inflammation with papillary hyperplasia. Diagnosis is usually made after the observation of inflammation on the palatal mucosa [3]. The first classification of denture stomatitis stems from the work of Newton in 1962 . It describes three types of stomatitis according to the level of inflammation: 1. Pink spots on healthy mucosa located near the salivary duct ends. 2. Erythema covers the whole mucosa under the dentures. The mucosa itself is quite sensitive and bleeds easily. 3. Papillary hyperplasia of the palate The etiology of denture stomatitis is multifactorial. Etiological factors in DRS include the trauma caused by an ill-fitting denture, increasing age of the denture user, increased age of dentures, lack of prosthesis hygiene and a favorable environment for proliferation for mainly Candida albicans [1-4,18,28,39-42]. I ; n accordance with this study’s requirements, a fourth level was established – zero - (“0”) to accommodate patients without inflammation of the oral mucosa. This group of denture wearers have healthy mucosa and no clinical signs of inflammations. In some of those cases after mycological examinations, intensive fungal growth was found. It directs me to analyze the results of clinical and mycological examinations of that group of patients. In this study, I concern on patients without mucosal inflammation. Patients with candidiasis may report varied symptoms like painful sensations, local discomfort, swallowing difficulty, burning, change of taste, but most often are asymptomatic [49-51]. In addiction to its high incidence in denture users ( 60-100%) there is a concern that Candida species from the oral cavity may colonize the upper gastrointestinal tract in immunosuppressed patients and can lead to septicaemia, which can cause a 40% - 79% mortality rate and prolonged hospital stay [ 3,47,52-55] so it is essential for all physicians looking after older patients to be aware of the risk factors, diagnosis and treatment of oral candidiasis. The aim of the study The purpose of this study was to provide answers to the following questions: Is there any relationship between oral hygiene and the growth of yeast in patients without mucosal inflammation? Is there a correlation be ; tween the growth of yeasts and systemic diseases in that group of denture users ? Is there the need for antymycological treatment in the group of denture wearers patients without mucosal inflammation? Material and methods Retrospective study was carried out in a group of patients who requested prosthetic treatment at the Prosthetic Department in the University Dental Clinic (UKS) from March 2012 to February 2013. All data were collected in the electronic medical journal of patients using software system KS-SOMED produced by KAMSOFT S. A. (Katowice, Poland). Inclusion criteria: patients using upper full or partial denture and that from them who received a test result of clinical mucosa examination as 0 in modified Newton classification (as described previously). Exclusion criteria: patients with postoperative or framework denture, smoking, xerostomia, immunosuppresion, hormonal disorders and with patients luck of necessary data. The mycological examination was made following uniform protocol, by swabbing of the palate between second and third palatal folds, immediately after removal of the upper denture The specialist of prosthetic dentistry clinically examined all patients. The mycological examination was made following uniform protocol by swabbing the palate between second and third palatal folds immediately after removing the upper denture. The intensity of yeasts ; growth was classified by quantitative assessment, as follows: Level 0 – lack of fungal growth - up to 10 colonies; Level 1 - scare growth - 11-20 colonies; Level 2 - intermediate growth - 21-50 colonies; Level 3 - intensive growth of 51-100 colonies; Level 4 - abundant growth of more than 100 colonies. After mycological examination, the antifungal susceptibility was made for 2, 3 and 4 levels of yeast growth using Fungi test (Bio-Rad Marnes-la-Coquette,France) and by the disk-diffusion method with Nystatin 100 units (EMAPOL Gdańsk, Poland). An assessment of the oral hygiene was done by the use of modification of Mombelli classification: 0 – no plague, very good hygiene, 1 – good hygiene, 2 – satisfactory hygiene, 3 – bad hygiene and 4 – bad breath (faetor ex ore). The data concerning the general health status, including systemic diseases, such as diabetes, high blood pressure and heart diseases were analyzed compared to fungal growth. Statistical Analysis A number of statistical analyses were carried out using program R, v 3.5.1., R Core Team (2017). A value of P < 0, 05 was considered significant. Results 91 Patients, full or partial denture wearers were without signs of clinical inflammation at the palatal mucosa (level 0 in modified Newton scale) participated in the study. Candida albicans was predominantly yeast in 33 patients ( 36% of whole group ; – 91 patients). In the analyzed group, yeast growth in level higher than 1 was observed in 34 (37%) of patients. All of these patients require antifungal treatment despite they had no visible signs of DRS. According to systemic diseases, the most common in study group was hypertension 58%, and cardiovascular disease 22%. On the third place was diabetes (14%). There was found statistically significant difference for hypertension and diabetes mellitus between patients with no signs of inflammation of oral mucosa, and with inflammation of oral mucosa. Conclusions There was no found relationship between hygiene and fungal microorganisms' growth rate in patients without signs of inflammation and statistical correlation with systematic diseases. In patients without clinical symptoms of stomatitis should be considered a mycological examination. The occurrence of systemic diseases in edentulous people using removable prosthetic restorations and the subsequent use of medications for these diseases may result in the lack of clinical symptoms of concomitant fungal infection.
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Rada Dyscypliny Nauki medyczne
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Aug 6, 2024
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Aug 6, 2024
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http://dl.cm-uj.krakow.pl:8080/publication/5147
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