About 35-50% of complete denture wearers have reported denture stomatitis. It is associated with local and systemic factors including reduced salivary flow, metabolic disorders medication use, smoking, nutritional factors, and denture hygiene. Most cases are linked to Candida Albicans with local and systemic antifungals being the standard treatment. Photodynamic therapy (PDT) which involves the use of light irradiation associated with a photosensitising agent that through an oxidation reaction, promotes the cell death of pathogenic species has been reported as an option for treating denture stomatitis. Some studies have compared the performance of PDT to antifungals suggesting favourable results.
The aim of this review was to evaluate the effectiveness of photodynamic therapy in reducing denture stomatitis.
Methods
A protocol for the review was registered in the PROSPERO database. The Cochrane library, Medline/PubMed, Web of Science and Google Scholar database were searched. This was supplemented by manual searches of the journals, Journal of Prosthetic Dentistry, International Journal of Prosthodontics, Journal of Dental Research, Journal of Oral Rehabilitation, Journal of Prosthodontics, Lasers in Medical Science, and Photodiagnosis and Photodynamic Therapy. Clinical trials (CT) and randomised controlled trials (RCTs) published in English compare antifungal agents with photodynamic therapy were considered. Two reviewers independently searches and selected studies, extracted data and assessed risk of bias using the Cochrane approach. A quantitative analysis was performed, and the data were grouped for the continuous variable colony-forming unit (CFU) by using data from the mean, standard deviation, and total patient/denture samples.
Results
- 5 studies (4 RCTs, 1 CT) involving a total of 218 patients were included.
- 3 studies were at unclear risk of bias and two at high risk of bias for the blinding of outcome assessment.
- 3 studies used Nystatin 100000 IU solution and two used 2% miconazole gel.
- 1 study used the light-emitting diode, the others a diode laser, with wavelength ranging from 660 nm to 830 nm.
- Frequency and duration of treatment varied with an average of 2-4 weeks.
- No significant mean difference was found in the comparison between the PDT group and the antifungal group, 0.069 CFU (95%CI; -0.170 to 0.308).
- a subgroup analysis found a significant difference in the reduction of CFU on the palate at 15 days and at the denture surface at 30 days in favour of the antifungal group.
Conclusions
The authors concluded: –
Photodynamic therapy is effective in the treatment of denture stomatitis, but after 30 days and 15 days, the antifungals demonstrated better performance.
Comments
While the reviews have searched a good range of sources including both databases and journals restricting their inclusions to studies published in English may have included some relevant studies. Previously we have looked at a review of low-level laser therapy of denture stomatitis (Dental Elf – 26th Jul 2018). That review included 4 studies two of which are included in this new review by Vila-Nova et al. Of the 5 studies included in this review 3 had at least one domain that was at unclear risk of bias with two being assessed at high risk of bias for the blinding of outcome assessment. The 5 included studies used 3 different photosensitisers (Indocyanine green, Methylene blue, Hematoporphyrin) with radiation dosages varying from 28J/cm2 to 122J/ cm2 and varying treatment regimens. This compared with the limited number of available studies makes assessing and comparing the effectiveness of the PDT protocols difficult. More studies are required to properly assess the effectiveness of PDT in the management of denture stomatitis and confirm the most effective protocols, these studies should be or appropriate size, well conducted and reported in line with SPIRIT and CONSORT guidelines .
Links
Primary Paper
Vila-Nova TEL, Leão RS, Santiago Junior JF, Pellizzer EP, Vasconcelos BCDE, Moraes SLD. Photodynamic therapy in the treatment of denture stomatitis: A systematic review and meta-analysis. J Prosthet Dent. 2022 Feb 4:S0022-3913(21)00697-1. doi: 10.1016/j.prosdent.2021.11.028. Epub ahead of print. PMID: 35125209.
Other references
Dental Elf – 26th Jul 2018
Denture stomatitis: Is there a role for low-level laser therapy?
Dental Elf – Denture Stomatitis blogs
