Denture stomatitis

A 70-year-old woman presented for evaluation of an eruption localized to the area covered by her partial upper denture. Her medical history and physical examination were otherwise unremarkable. She originally had a metal upper partial denture, which she used for many years without difficulty. Four years before presentation, she developed a painful eruption affecting only the tissue covered by the upper partial denture. Contact dermatitis to metal was suspected, and a new upper partial denture constructed primarily of acrylates was fashioned. When she transitioned to the new denture, the inflammation in her oral mucosa persisted and perhaps worsened, despite an excellent fit. Examination revealed striking erythema and mild edema sharply localized to the areas where the partial upper denture contacted the gum ridge. Patch testing was performed and revealed allergies to multiple acrylates, including methyl methacrylate. A swab from the gums was sent for yeast culture. No Candida was detected. Based on suspected candidal overgrowth on the denture, the patient was advised to begin applying nystatin ointment between the gums and the denture, and to start soaking the dentures nightly in chlorhexidine 0.12% solution. In addition, because the relevance of the acrylate allergy was unclear, her dentist was contacted and it was recommended that the dentures be boiled to induce polymerization of any residual un-reacted methacrylate monomers. The patient had a 90% improvement in the clinical appearance and in symptoms at an 8-week follow-up appointment. Due to logistic issues, the dentures had not yet been boiled. The improvement, despite the dentures not having been boiled, was felt to demonstrate that the acrylate allergy was not relevant. The patient has continued to slowly show further improvement over 6 months of follow-up.