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 ([alpha] = .05). Clinical resuts were analyzed using Mann-Whitney and Fisher exact tests ([alpha] = .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.
In this randomized clinical trial, the clinical and mycological efficacy of Photodynamic Therapy (PDT) was compared with that of topical antifungal therapy for the treatment of denture stomatitis (DS) and the prevalence of Candida species was identified. Patients were randomly assigned to one of two groups (n = 20 each); in the nystatin (NYT) group patients received topical treatment with nystatin (100,000 IU) four times daily for 15 days and in the PDT group the denture and palate of patients were sprayed with 500 mg/L of Photogem(®), and after 30 min of incubation, were illuminated by light emitting-diode light at 455 nm (37.5 and 122 J/cm(2), respectively) three times a week for 15 days. Mycological cultures taken from dentures and palates and standard photographs of the palates were taken at baseline (day 0), at the end of the treatment (day 15) and at the follow-up time intervals (days 30, 60 and 90). Colonies were quantified (CFU/mL) and identified by biochemical tests. Data were analysed by Fisher's exact test, analysis of variance and Tukey tests and κ test (α = 0.05). Both treatments significantly reduced the CFU/mL at the end of the treatments and on day 30 of the follow-up period (p <0.05). The NYT and PDT groups showed clinical success rates of 53% and 45%, respectively. Candida albicans was the most prevalent species identified. PDT was as effective as topical nystatin in the treatment of DS.
OBJECTIVE: The aim of this study was to identify in vitro and in vivo activity of Melaleuca alternifolia oil mixed with different tissue conditioners on the Candida albicans strain.
STUDY DESIGN: Microbiological tests were used to isolate Candida albicans from patients with denture stomatitis. The in vitro antifungal activity of Melaleuca alternifolia against Candida albicans was determined when it was applied directly and when it was mixed with tissue conditioners (Fitt, Lynal, Coe-Comfort). The responses of 27 denture stomatitis patients treated with Melaleuca alternifolia mixed with Coe-Comfort (n = 9), Nystatin mixed with Coe-Comfort (n = 9), and Coe-Comfort (Control Group, n = 9), were evaluated over a period of 12 days.
RESULTS: In the in vitro study, Coe-Comfort or Fitt conditioners mixed with 1 mL, 20% (vol/vol) of Melaleuca alternifolia oil exhibited a total inhibition of Candida albicans. Patients treated with M. alternifolia mixed with Coe-Comfort showed a significant decrease in palatal inflammation compared with those treated with Coe Comfort (P = .001). In addition, a significant inhibition of C. albicans growth was observed with M. alternifolia mixed with Coe-Comfort compared with only Coe-Comfort (P = .000004).
CONCLUSION: M. alternifolia oil mixed with Coe-Comfort tissue conditioner is effective in treating denture stomatitis.
An open, randomized, controlled study with two parallel treatment groups was done to evaluate the efficacy of a miconazole 2% gel compared with Zataria multiflora 0.1% gel applied four times daily for 2 weeks, in the treatment of Candida-associated denture stomatitis. Twenty four patients were included in the study. The efficacy variables were the colony count of Candida from the palatal mucosa and the denture surface and the erythema surface of the palatal mucosa on days 0, 7, 14, 21 and 28 after commencement of therapy. Twelve patients received miconazole gel and twelve Z. multiflora gel. The erythema surface was significantly reduced by both gels. No significant difference was seen between the two groups (p < 0.05). There was a significant reduction in the colony count of the palatal mucosa in both groups (except on days 21 and 28 in the Zataria group p = 0.07 and 0.08). Miconazole treatment reduced the number of denture colonies more efficiently than Z. multiflora except for day 21 when the efficacy of both groups was similar (p = 0.17). The results indicate that Z. multiflora gel reduced the surface erythema of the palate more efficiently than miconazole gel but did not reduce the colony count of the denture surface as efficiently as miconazole.
A double-blind trial was carried out to study the effect of oral administration of fluconazole in the treatment of Candida-associated denture stomatitis. The study group consisted of 38 denture stomatitis patients who harbored yeasts, predominantly Candida spp., in significant numbers as determined by culture from the lesions. Half of the patients received 50 mg of fluconazole per day orally for 14 days, and the other half received placebo capsules. The following parameters were studied: degree of palatal erythema, presence of yeast cells (by plate count and microscopy of smears), identification to the species level of dominant yeast organisms, biotyping of Candida albicans, and treatment-related side effects. A significant reduction of erythema was seen after treatment with fluconazole, but the inflammation showed partial relapse 2 to 4 weeks after treatment was terminated. Reduced soreness of the oral mucosa was reported by six of the patients in the fluconazole group. No significant clinical or yeast flora changes were observed in the placebo group. Extensive changes in the yeast flora were observed in the fluconazole group, both in quantity and in composition of yeast species and C. albicans strains (biotypes), which perhaps indicated differences in pathogenicity and fluconazole susceptibility among various yeast species and C. albicans strains. Fluconazole did not produce any changes in the results of blood and urine analyses. The results indicate that fluconazole is a safe and well-tolerated antimycotic drug. The transient clinical and antimycotic effect may have been due in part to the possibility that therapeutic concentrations of the drug were not reached beneath the fitting denture surface and within the denture plaque.
