Denture stomatitis is common among denture wearers being reported in between 35-50% of complete denture wearers. Mild inflammation and erythema of the oral mucosa are common characteristics with most cases being associated with Candida Albicans. Conventional treatment involved the use of antifungals and adjustments to dentures and denture hygiene. A number of studies using Low-level laser therapy and photodynamic antimicrobial therapy for denture stomatitis have indicated potential benefits.
The aim of this review was to evaluate the clinical outcomes of using low-level laser therapy (LLLT) or photodynamic therapy (PDT) in the treatment of denture stomatitis (DS)
Methods
Searches were conducted in the Cochrane Library, Web of Science, Google Scholar, PubMed, Pro- Quest, Scopus, Embase, and Ovid electronic databases. Randomised controlled trials (RCTs) and prospective studies investigating the use of LLLT or PDT on denture stomatitis in a minimum of 5 patients were considered. Two reviewers independently selected studies. Data was abstracted with Jadad score being used to assess study quality.
Results
- 4 studies involving a total of 190 patients were included.
- 2 studies used LLLT and 2 PDT
- All studies irradiated the palate with 2 studies also irradiating the denture base.
- The wavelengths applied on both the palatal mucosa and denture bases varied between 455 nm and 830 nm.
- Exposure times varied between 10 seconds to 26 minutes.
- Antifungals were used as controls in 3 of the included studies.
Conclusions
The authors concluded: –
Low-level laser therapy has a significant role in the clinical treatment of denture stomatitis and seemed to be successful in reducing the CFU/mL of C albicans and alleviating soft tissue inflammation caused by DS, without any significant side effects.
Photodynamic therapy seems to provide results similar to those of conventional antifungal therapies.
Additional randomized clinical trials on low-level laser therapy and especially photodynamic therapy are suggested.
Comments
A broad search for relevant studies has been conducted. The Jadad score was used to assess study quality with 2 low scoring trials being excluded. The Jadad score and similar scoring systems are no longer a recommended approach for assessing study quality in systematic review. The Cochrane Risk of bias tool would have been a better approach. All the included studies are small and a good discussion of findings of the individual studies is presented. However, the outcomes of the studies focus on reduction in levels of cytokines and colony forming units rather than clinical resolution of the DS.
While the review suggests the possibility that LLLT and PDT many have some potential in the management of DS the limited number of small RCTs that are currently available are insufficient. High quality well reported studies with appropriate sample sizes are needed to clarify whether there any real clinical benefit form LLLT and PDT in the management of denture stomatitis.
Links
Primary Paper
Davoudi A, Ebadian B, Nosouhian S. Role of laser or photodynamic therapy in treatment of denture stomatitis: A systematic review. J Prosthet Dent. 2018 May 25. pii:S0022-3913(18)30067-2. doi: 10.1016/j.prosdent.2018.01.003. [Epub ahead of print] Review. PubMed PMID: 29807743.
Other references
Dental Elf – 10th May 2017
Denture stomatitis: some evidence for nystatin and disinfecting agents
