Linking evidence to treatment for denture stomatitis: A meta-analysis of randomized controlled trials

Objectives: The aim of this meta-analysis was to compare the efficacy of antifungal therapy with any other alternative methods used for the treatment of denture stomatitis. Data sources: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews were searched, complemented by hand searching, until the first week of January 2013. Study selection: Included studies consisted of randomized clinical trials published in English or French, which compared antifungals with any other alternative or placebo, used for the treatment of denture stomatitis. The remission of clinical signs of denture stomatitis, and the reduction in Candida colony counts were considered as the clinical and microbiological outcomes, respectively. Random effects models were used to conduct the statistical analyses. Results: From 233 identified articles, a total of 15 manuscripts on 14 randomized controlled trials were included in systematic review and 8 in the meta-analysis. No statistically significant difference between antifungal treatment and disinfection methods was found for both clinical (OR = 0.7; 95% CI: 0.32-1.36; Z = -1.14; p = 0.256) and microbiological (OR = 0.8; 95% CI: 0.26-2.5; Z = -0.35; p = 0.724) outcomes. The meta-analysis showed a statistically significant difference between an antifungal and a placebo for the microbiological outcome (OR = 0.32; 95% CI: 0.12-0.89; Z = -2.2; p = 0.028), favouring the antifungals. However, there was no statistically significant difference between antifungal and placebo for the clinical outcome (OR = 0.2; 95% CI: 0.04-1.04; Z = -1.9; p = 0.056). Conclusions: Disinfection agents, antiseptic mouthwashes, natural substances with antimicrobial properties, microwave disinfection and photodynamic therapy could be suggested as an adjunct or alternative to antifungal medications in the treatment of denture stomatitis. (C) 2013 Elsevier Ltd. All rights reserved.