Sustained drug-delivery system: a promising therapy for denture stomatitis?

Dear Readers, Denture-induced stomatitis is the most common type of oral candidosis and the most frequent mucosal alteration associated with complete or removable partial dentures in the elderly. Despite being an infection of multifactorial etiology, this condition has as main etiological factor the colonization of denture-bearing mucosa and acrylic bases by species of Candida spp., especially Candida albicans, found in 50 to 98% of all cases25. Different treatments are indicated for denture stomatitis, including topical antifungal and systemic therapy, care with oral hygiene, denture cleaning and disinfection procedures, replacement of old dentures, elimination of anatomic irregularities, re-establishment of atraumatic occlusion, removing the denture at night and nutritional restitution12. Although systemic antifungal therapy is suggested for immunosuppressed patients, these drugs may present potential hepatotoxic and nephrotoxic effects and interaction with other drugs, thus increasing the adverse systemic effects6.Topical antifungal agents as nystatin and miconazole are largely used for the treatment of denture stomatitis12,15.These antifungal drugs are effective in relieving the clinical signs and symptoms of denture stomatitis associated with Candida spp.; however, they cannot reach a therapeutic antifungal concentration on the inner denture surfaces15. Consequently, re-infection of the treated oral mucosa may occur after conventional therapy with topical and systemic antifungal drugs. The high rates of clinical relapse and recurrence in up to two weeks post-treatment make the treatment of denture stomatitis challenging15,18. Factors other than inability to maintain therapeutic concentrations of antifungal drugs on the surface of dentures are associated with failure of conventional antifungal therapy including the following: 1)