# Denture Stomatitis > Denture stomatitis for BDS Prosthodontics: Newton's three types, Candida biofilm on the fitting surface, treatment steps and exam picks. - Canonical URL: https://prepelephant.com/topics/bds/prosthodontics/denture-stomatitis-detail - Exam / course: BDS · Subject: Prosthodontics - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Denture Stomatitis", PrepElephant, https://prepelephant.com/topics/bds/prosthodontics/denture-stomatitis-detail ## Direct answer Chronic erythema confined to the mucosa beneath a denture — denture stomatitis, also called chronic atrophic candidiasis — is an inflammatory, usually Candida-associated condition seen mostly in the maxilla under a worn, poorly cleansed prosthesis. Newton, in 1962, classified it into three types: type I localised pin-point hyperaemia, type II diffuse erythema across the whole denture-bearing mucosa, and type III inflammatory papillary hyperplasia of the palate. Continuous night wear, microbial biofilm on the fitting surface, ill fit and trauma, a carbohydrate-rich diet, broad-spectrum antibiotics, corticosteroids, iron and B-complex deficiency, diabetes and xerostomia all predispose. Treatment stands on four legs simultaneously: denture hygiene with night removal, antifungal therapy for mucosa and prosthesis, correction of the ill-fitting denture, and control of the systemic factors that keep it burning. ## What you must remember - **Newton's classification (1962), verbatim:** type I — localised inflammation, pin-point hyperaemia; type II — diffuse erythema involving the denture-bearing mucosa; type III — inflammatory papillary hyperplasia involving the palate. - **The reservoir logic:** Candida albicans colonises the pores and surface of the acrylic fitting surface, so the denture — not just the mucosa — must be treated, or infection simply recurs. - **Predisposing factors to list:** continuous wear, poor denture hygiene, ill-fitting prosthesis, carbohydrate-rich diet, antibiotics, corticosteroids, diabetes, xerostomia, iron and folate or B12 deficiency, smoking and immunosuppression. - **Hygiene prescription:** daily brushing of the denture plus overnight soaking — chlorhexidine solution, dilute sodium hypochlorite for acrylic without metal, or enzymatic cleansers; hypochlorite corrodes cobalt-chromium frameworks. - **Pharmacology:** topical nystatin suspension or miconazole oral gel against the mucosa; fluconazole systemically in resistant or extensive cases; medicated tissue conditioners carrying miconazole for the intaglio early on. - **Night removal and dry storage:** candida survives poorly on a dry denture — leaving the prosthesis out at night is therapeutic in itself. - **Type III persistence:** established papillary hyperplasia rarely resolves medically and may need surgical excision, laser or cryotherapy once inflammation is controlled and the denture is corrected. ## Treating a type II case step by step Take the standard presentation: a 68-year-old with a five-year-old upper denture worn around the clock, and diffuse fiery erythema mapping exactly to the fitting surface. Begin with diagnosis — the sharp demarcation along the denture borders, the sparing of the hard palate's non-contact zones, swabs or smears showing candidal hyphae if needed, and a quick screen for diabetes and anaemia. Then treat all four legs at once. Stop night wear today and prescribe the hygiene routine: brush the denture morning and night, soak overnight in chlorhexidine or dilute hypochlorite, and rinse with chlorhexidine mouthwash for the mucosa. Add antifungals — nystatin suspension or miconazole gel to the palate, and miconazole-impregnated tissue conditioner relining the denture's fitting surface so the reservoir itself is medicated. Investigate and correct the prosthesis: a denture this old has lost its fit and likely its occlusal vertical dimension; reline, rebase or remake once the erythema settles. Review in two weeks — most type II lesions resolve within a fortnight of disciplined care, and recurrence always means the hygiene leg failed. ## How the exam frames it Newton's classification is the single most reliably examined item in this whole topic — as MCQ, as a two-marker, and as viva rapid fire — and candidates lose it by merging types II and III. The theory five-marker, "denture stomatitis — aetiology and management", is answered well only when the denture-as-reservoir idea appears: treating the mucosa alone fails because the acrylic is colonised. Indian boards add the practical layer: asked how to disinfect a denture, the complete answer distinguishes acrylic (chlorhexidine, dilute hypochlorite) from metal-containing prostheses (hypochlorite corrodes chrome-cobalt). The traps are small but frequent: denture stomatitis is usually painless, which is why patients ignore it; it is strongly associated with angular cheilitis, and the examiner expects that connection named; and type III, the papillary hyperplasia, is the one that outlives medical therapy and needs surgery. ## Frequently asked questions ### What are Newton's three types of denture stomatitis? Type I localised pin-point hyperaemia, type II diffuse erythema of the denture-bearing mucosa, and type III inflammatory papillary hyperplasia of the palate. ### Why must the denture itself be treated along with the mucosa? Candida albicans colonises the pores and fitting surface of the acrylic, acting as a reservoir that reinfects the mucosa unless hygiene, disinfection or a medicated reline clears it. ### How should an acrylic denture be disinfected at home? Brushing morning and night plus overnight soaking in chlorhexidine solution or dilute sodium hypochlorite — the latter only for all-acrylic dentures, since it corrodes cobalt-chromium. ### When does denture stomatitis require surgery? Established type III inflammatory papillary hyperplasia that persists after infection control and denture correction is excised surgically, by laser or cryotherapy. ### Why does wearing the denture at night worsen stomatitis? Continuous wear keeps tissue macerated under plaque and candida biofilm without salivary flow or cleansing, whereas a denture stored dry overnight is hostile to the organism.