ETIOLOGY 1. Multifactorial Findings The etiology of denture stomatitis remains controversial as it is of multifactorial nature.

Denture trauma, night time denture wearing, denture cleanliness, dietary factors, Candida infections and predisposing systemic conditions have been proposed as associated factors in denture stomatitis (A. Zissis, et. al, 2006). 2. Trauma Denture trauma due to ill-fitting is believed as one of the etiology factors of denture stomatitis. According to Nyquist; trauma caused by debture was the dominnat factor in denture stomatitis. Cawson; iconcluded of denture stomatitis. Immunohistochemica; analysis of the mucosal tissue also has demonstrated a possible role of trauma in denture stomatitis (P.Bars L,2001). Incorrect vertical dimension of occlusion has also been suggested as a contributing factor in the occurrence of denture stomatitis. The result of the studies by Emami E et al. research suggest traumatict occlusion result in an inflammatory reaction which may create an eviroment favourable to microorganisms found in denture stomatitis. According to some recent evidence, nocturnal wear of denture and smoking are suggest as other significant risk factors for denture stomatitis (E. Emami, et. al, 2008). 3. Micro-organisms Although some earlier investigators linked denture stomatitis with trauma or bacterial infection, others had isolated the strains of the genus Candida, in particular Candida albicans from the mouths of patients with this condition (G. Ramage, et. al, 2004) it has been recently shown that the presence of Candidia albicans in denture stomatitis is probably related to an extensive degree of inflammation and the denture stomatitis is usually associated with detection of Candida spesies while other factors such as denture hygiene habits and trauma are impotant to the development of the disease. The severity of the denture stomatitis has been correlated with the presence of yeast colonizing the denture surface (J. Berbeau, et. al, 2003). Denture induced stomatitis or chronic atrophic Candidiasis is the commonest form of oral Candididasi and is present in 24-60 percent of denture wearers. Denture stomatitis has been associated with angular cheilitis, atropic glossitis, acute pseudomembranous

Candidiasis and chronic hyperplastic Candidiasis, and has been found to be more common in females than males. 4. Denture Lining Materials For the prosthodontics treatment ang management of traumatized oral mucosa denture lining materials wich include tissue conditioners and soft denture liners, are widely used. Denture lining materials are most commonly used in association with the mandibular denture. Recently materials wich are available are their silicone elastomers, plasticized higher mathecrylate polymers, hydrophilic polymethacrylates or fluoropolymers. Candidal growth has been associated with mandibular denture relined with soft liner. The most commonly detected yeasts were strains of the genus Candida, in particular C. albicans, C. glabarata and C. tropicalis (P.S Wrigth, et. al, 1985). 5. Denture Plaque Poor denture hygiene is considered to be one of the etiologic for factors denture

stomatitis. Various factors stimulating yeast proliferation, such as poor aral hygiene, high carbohydrate intake, reduce salivary flow, composition of saliva, design of the prosthesis and continuous denture wearing can also enhance the pathogenicity of denture plaque (J. Budtz, et. al, 2007). 6. Surface Texture and Permeability of Denture Base The tissue surface the dentures usually shows micropits and mictoporosities. Microorganisms harboring in these areas are difficult to remove mechanically or by chemical cleansing. According to several in vitro studies, the microbial contamination of denture acrylic resin occurs very quickly, and yeasts seem to adhere well to denture materials. Surface roughness may facilitate ,icrobial retention and infection. The porosity and surface texture of acrylic resin were investigated, and it was found that the denture surface with a fine texture with an absence of porosity did not allow attachment of plaque by penetration of surface defect or by mechanical fixation to surface irregulerities. In vitro study, Van Reenen showed that C. albicans penetrated the commonly used acrylic resin; penetration of the unpolish surface that is in contact with the mucosa was greater than that of the polished surface. It was further confirmed with the used of a fluorescent (JF. R Van, 1973).

7. Allergenic Condition/Reaction Toxicity is usually manifestated by the release of several chemical constituents from the material, which can induces an allergic response in term of localized or generalized stomatitis/ mutagenic effect. An allergenic reaction to constituens of the denture material in the form of contact mucositis is also suggested. The reaction may be related to the presence of resin monomer, hydroquinone peroxide, dimethyl-p-toluidine, or

methacrylate in the denture. Furthermore, contact sensitivities are more common to occur with cold or autoplymerized resins than with heat-cured denture-base materials. Several forms of allergenies including type IV hypersensitivity, urticarial, allergic stomatitis, dermatitis and psoriasis have been reported in literature from deiffenrent polymer components (J. Verran, et. al, 1997). 8. Systematic Factors In cases that fail to respond to the usual treatments, consider the role of systemic conditions such as diabetes mellitus, nutritional deficiencis (iron, folate, or vitamin B12), hypothyroidism, immunocompromised conditions (HIV infection), malignancies (acute leukemia, agranulocytosis), iatrogenic immunosuppressive drugs, e.g. Corticosteroids, may also predispose the host to candida-associated denture stomatitis (FR. Pires, et. al, 2002).

Prognosis and complication If untreated, denture stomatitis can cause soreness and palatal inflammatory papillary hyperplasia and may lead to poorly fitting dentures in the future. The administration of topical antifungal therapy, removal of mechanical traumatism caused by the denture and reinforcement or hygienic measures, ease the disappearance of the lesions. However, local recurrences are frequent if aetiopathologic factors persist. The prognosis of this disorder is good, as malignant transformation has not been reported, although continuous aspiration and swallowing of Candida species may rarely have potentially fatal consequences in immunocompromised patients.

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