Interventions for the Management of Denture Stomatitis: A Systematic Review and Meta-Analysis

OBJECTIVES: To assess the effectiveness of different interventions for treating or preventing denture stomatitis (DS). DESIGN: Systematic review. SETTING: Randomized controlled trials (RCTs) comparing any agent or procedure prescribed to treat or prevent DS in adults. PARTICIPANTS: Older adults with denture stomatitis. MEASUREMENTS: There were two main outcomes reported in the trials included in this review: clinical signs of DS and remaining presence of yeast. There were no restrictions regarding language or date of publication. The search period was up to February 2016. RESULTS: Thirty-five studies were included in the systematic review, with 32 judged as having high risk of bias. Three RCTs compared nystatin with placebo and found a significant effect on the reduction of clinical signs of stomatitis (risk ratio (RR) = 0.51, 95% confidence interval (CI) = 0.36-0.72), four RCTs compared nystatin with placebo and found a significant effect on mycological assessment (RR = 0.61, 95% CI = 0.46-0.80). Five studies of disinfectant agents also showed a significant effect in comparison with an inactive agent (RR = 0.52, 95% CI = 0.30-0.92) in clinical assessment. No evidence was found of an effect of miconazole, amphotericin, or imidazolic drugs. No RCT evaluated the effectiveness of preventive approaches. CONCLUSION: The results are supportive of the use of nystatin and disinfecting agents in the treatment of DS, but clinicians need to be aware that individual studies had high risk of bias and that the overall quality of the individual reports was judged to be low.