Triazoles in the Management of Candida-Associated Denture Stomatitis

Cross, Laura Jayne (1998) Triazoles in the Management of Candida-Associated Denture Stomatitis. PhD thesis, University of Glasgow.

Abstract

Denture stomatitis is characterised by erythema and oedema of the palatal mucosa beneath an upper denture. It is common, affecting approximately 50% of denture wearers. The recurrence rate is high and the repeated failure of current methods of treatment of denture stomatitis results in the prescribing of repeated courses of antifungal medication. The aims of this study were to evaluate the use of itraconazole in the treatment of denture stomatitis and to determine by molecular typing of C. albicans species isolated before and after treatment whether there had been a recurrence of infection with the same strain, selection of particular strains or infection with new strains of C. albicans. Forty patients with long-standing Candida associated denture stomatitis were enrolled in a single blind clinical trial to compare the new cyclodextrin solution of itraconazole and itraconazole capsules in the management of denture stomatitis. The trial design also encompassed determination of the safety of itraconazole, itraconazole sensitivity of yeasts isolated from the mouths of patients before and after treatment and measurement of itraconazole levels achieved in blood and saliva. Strain differentiation of C. albicans isolates was achieved by extracting genomic DNA from selected stored yeast isolates. The DNA was digested with the restriction enzyme EcoRl then hybridised with the C albicans-specific 27A probe. A pilot study was conducted to evaluate the use of an electro-optical instrument, the Erythema meter, as a means of objectively measuring erythema of the palatal mucosa. A series of non-clinical and clinical investigations were carried out. Erythema meter readings were taken from 40 patients with healthy palatal mucosa, 20 denture wearers and 20 non-denture wearers. Readings were also taken from 20 denture stomatitis patients who were then enrolled in a pilot clinical trial comparing fluconazole and itraconazole capsules in the management of denture stomatitis. As a result of the preliminary investigations the Erythema meter was found to be a sensitive and reproducible means of measuring palatal erythema. It was quick and easy to use and was well tolerated by patients. Fluconazole and itraconazole capsules were found to have similar efficacy in the management of denture stomatitis. In the main clinical trial patients were randomly assigned to take either the cyclodextrin solution of itraconazole or itraconazole capsules at a dose of 100 mg twice daily for 15 days. Of the 40 patients enrolled in the clinical trial, two patients from each treatment group failed to complete the course of medication. Resuhs from the remaining patients indicated that both the cyclodextrin solution of itraconazole and itraconazole capsules showed similar efficacy in the management of denture stomatitis, in terms of reduction in erythema and mycological response. However, a high incidence of gastro-intestinal side-effects was reported by patients in the cyclodextrin group suggesting that, since the response to treatment was similar with both preparations, the itraconazole capsules would be preferred to the cyclodextrin solution of itraconazole for the treatment of denture stomatitis. The multifactorial aetiology of denture stomatitis was highlighted by the results of the trial leading to the conclusions that maintenance of good denture hygiene, the provision of new dentures and the cessation of smoking are all important factors in ensuring a long-term resolution of the condition. Denture stomatitis patients should also be routinely screened for underlying haematinic deficiencies and diabetes mellitus. The molecular typing of C. albicans revealed that the strain of C albicans present six months after treatment commenced is likely to be the same as the strain isolated at baseline in any given patient. This implies that recurrence of denture stomatitis is due to re-colonisation by the original infecting strain, rather than re-infection with a different strain. A wide variety of genotypes of C. albicans were isolated in this study, suggesting that no one particular virulent strain of C. albicans is associated with denture stomatitis.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Additional Information: Adviser: Jeremy Bagg
• Keywords: Dentistry, Medicine, Microbiology
• Date of Award: 1998
• Depositing User: Enlighten Team
• Unique ID: glathesis:1998-75916
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 19 Nov 2019 17:37
• Last Modified: 19 Nov 2019 17:37
• URI: https://theses.gla.ac.uk/id/eprint/75916