Pathology · patient case question
The diffuse palatal erythema conforming to the denture outline is caused by which organism?
Patient case: Sore mouth corners in a long-term denture wearer
Patient: Female, 85 years old
Chief complaint: “The corners of my lips are all chapped and they sting.”
History: Hypertension, urinary incontinence. Medication: amlodipine. Maxillary and mandibular complete dentures fabricated five years ago and never relined.
Findings: Erythema and white patches at both oral commissures. Diffuse erythema of the palatal mucosa beneath the maxillary denture, conforming exactly to its outline. Reduced facial vertical dimension with over-closure.
Show answer and explanation
Correct answer: A. Candida albicans
- A. CORRECT. Denture stomatitis, or chronic atrophic candidiasis, is Candida albicans proliferating on the fitting surface of the denture and the mucosa beneath it. The giveaway is that the erythema stops precisely at the denture border. It is characteristically ASYMPTOMATIC, which is why patients are unaware of it. Risk factors are continuous denture wear including overnight, poor denture hygiene, and a porous or ill-fitting acrylic surface.
- B. Streptococcus mutans is a caries pathogen and has no role in denture stomatitis — nor is there a tooth surface here for it to colonise.
- C. Staphylococcus aureus contributes to angular cheilitis at the commissures but is not the agent of the palatal lesion.
- D. Herpes simplex causes vesicular, ulcerative lesions on KERATINISED mucosa in its recurrent intra-oral form. It does not produce diffuse erythema shaped like a denture.
Note: Management is threefold: leave the denture out at night, disinfect it by soaking (chlorhexidine, or dilute hypochlorite for acrylic only — never for a denture with metal components), and treat the mucosa with a topical antifungal. Relining or remaking a poorly fitting denture is part of the cure.