The Roof of Her Mouth Was Red and Nobody Had Looked

Quick answer: A burning, red palate under an upper denture, often with cracked corners of the mouth, is usually a fungal infection called denture stomatitis. It is caused mainly by wearing the denture at night, and it clears reliably once the denture comes out and both mouth and denture are treated.

The call

Bruria, 69, from Migdal HaMayim, came in about the corners of her mouth, which had been cracked and sore for four months. Two courses of a topical cream from the pharmacy had not helped. She also mentioned, when asked directly, a burning feeling on the roof of her mouth and that food had started tasting odd.

Nobody had asked her to take her denture out.

What we found

Once it was out, the picture was immediate. The palate beneath the upper denture was uniformly bright red, sharply demarcated at exactly the outline of the denture, with a pebbly surface texture. It was not painful to touch but felt burning to her.

The corners of her mouth were cracked, red and slightly crusted — angular cheilitis.

The denture itself had a soft, slippery biofilm on the fitting surface and staining in the microscopic pores of the acrylic. It also rocked noticeably; it had not been relined in over a decade.

This is denture stomatitis, and the pieces fit together in a specific way.

Candida lives harmlessly in most mouths. Acrylic denture surfaces are porous and give it a place to form a biofilm that saliva and the tongue cannot reach.

Wearing the denture at night is the single biggest factor. It covers the palate for 24 hours a day, keeping the tissue warm, moist and cut off from saliva's cleansing and antimicrobial action. She had worn hers day and night for eleven years, and had never been told not to.

A poorly fitting denture rubs and traumatises the tissue, and a rocking denture pumps organisms into the pores.

Angular cheilitis is the same organism at the corners of the mouth. It is common when the bite has collapsed with age or denture wear, so the corners fold and stay damp — which is why creams alone rarely resolve it.

The general medical picture is worth checking too: diabetes, dry mouth from medication, steroid inhalers used without rinsing, iron or B12 deficiency, and immunosuppression all predispose. We asked about all of them and referred her for blood tests, which came back normal.

What we did

Four things together, because doing only one fails.

1. Denture out at night, without exception. Stored dry, or in water, in a clean box. This alone resolves a substantial proportion of cases.
2. Treat the denture, not just the mouth. The denture is the reservoir. Daily brushing of the fitting surface with soap and a denture brush, and soaking in a suitable disinfectant solution — the specific choice depends on whether the denture has metal parts.
3. Antifungal treatment for the mouth and the corners, prescribed and used for the full course.
4. Fix the fit. A reline, and a review of the bite height, which had collapsed over the years and was causing the corner folding.

The outcome

The palate returned to normal pink within three weeks. The corners of her mouth healed in about ten days once the fungal element was treated and the bite height restored.

She has not slept in the denture since, and it has not recurred in two years.

What to do if this happens to you

1. Take your denture out at night. This is the most important single change.
2. Clean the fitting surface daily with a denture brush and soap — not toothpaste, which is abrasive on acrylic.
3. Look at your own palate in a mirror with the denture out. It should be pink, not red.
4. Do not treat cracked mouth corners with cream alone. Look for the cause inside the mouth.
5. Have the fit checked yearly. A rocking denture is part of the problem.
6. Any red or white patch that persists beyond three weeks needs examining, whether or not you wear a denture.

Sore mouth or a denture that no longer fits? Ramat Beit Shemesh Urgent Dental Care examines the tissue, not just the denture. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.