Abstract
Statement of problem
Symptomatic denture stomatitis (DS) is a painful oral mucosal disorder that can impair
quality of life in denture wearers. A complete cure of DS is difficult to achieve,
and the most efficacious regimen to treat DS has not yet been conclusively established.
Purpose
The purpose of this network meta-analysis was to assess the comparative efficacy of
interventions used for the treatment of DS.
Material and methods
A search was conducted for trials published in Medline, Scopus, PubMed, and Cochrane
Central Register of Controlled Trials from inception until February 2022 (PROSPERO
Reg no: CRD42021271366). Network meta-analysis was performed on data from randomized
controlled trials that assessed the comparative efficacy of any form of intervention
for the treatment of DS in denture wearers. Agents were ranked according to their
effectiveness in the treatment of DS based on outcomes using surface under the cumulative
ranking (SUCRA).
Results
A total of 25 articles were included in the quantitative analysis. Topical antifungal
agents (risk ratio [RR]=4.37[95% confidence interval [CI]: 2.15,8.90), topical antimicrobial
agents used along with systemic antifungal agents (RR=4.25[95% CI: 1.79,10.33]), systemic
antifungal agents (RR=4.25[95% CI: 1.79,10.10]), photodynamic therapy (RR=4.25[95%
CI: 1.75,8.98]), and topical plant products (RR=3.40[95% CI: 1.59,7.26]) were found
to effectively improve DS. Microwave disinfection concurrently administered with topical
antifungal agents (RR=7.38(95% CI: 2.75,19.81), microwave disinfection 7.38[95% CI:
2.75,19.81]), topical antifungal agents (RR=4.88[95% CI: 1.92,12.42]), topical plant
products (RR=4.49[95% CI: 1.70,11.82]), systemic antifungal agents together with topical
antimicrobial agents (RR=3.85[95% CI: 1.33,11.10]), topical antimicrobial agents (RR=3.39[95%
CI: 1.17,9.81]), systemic antifungal agents (RR=3.37[95% CI: 1.21,9.34]), and photodynamic
therapy or photochemotherapy (PDT) (RR=2.93[95% CI: 1.01,8.47]) were found to effectively
resolve mycological DS. Topical antifungals ranked highest in the SUCRA ranking for
clinical improvement, whereas microwave disinfection concurrently administered with
topical antifungal agents ranked highest for mycological resolution. None of the agents
demonstrated significant side effects except for topical antimicrobial agents which
demonstrated altered taste and staining of oral structures.
Conclusions
Available evidence suggests that topical antifungals, microwave, and systemic antifungals
are effective in the treatment of DS, but confidence in these findings is low because
of the limited number of studies and a high risk of bias. Additional clinical trials
are needed on photodynamic therapy, topical plant products, and topical antimicrobials.
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Article info
Publication history
Published online: February 28, 2023
Publication stage
In Press Corrected ProofIdentification
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© 2023 by the Editorial Council for the Journal of Prosthetic Dentistry.
