Title	Fluconazole and Clotrimazole Mouth-Paint Effective Medications for Patients with Denture Stomatitis
Clinical Question	In a patient with denture stomatitis, would the use of anti-fungal medication be more effective than no treatment?
Clinical Bottom Line	The evidence strongly supports the use of fluconazole mouthrinse or clotrimazole mouth-paint for denture stomatitis as anti-mycotic drugs. Mild gastrointestinal discomfort shown with Fluconazole. (See Comments on the CAT below)
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 2854455 BUDTZ-J0RGENSEN/ 1988 38 patients with denture stomatitis Randomized Controlled Trial Key results Significant reduction of erythema and soreness of the oral mucosa was found. No significant clinical or yeast flora changes were observed in the placebo group. 20415933 Sholapurkar/2009 89 patients with oral candidiasis Case control study Key results The results show that there was no statistically significant differences between two groups: one using fluconazole mouth rinse and one using clotrimazole mouth-paint. They are both effective in treating oral candidiasis.
Evidence Search	"Candidiasis" [Mesh] and, "denture stomatitis" [Mesh] and, "fluconazole" [Mesh], "treatment" [Mesh]
Comments on The Evidence	The first article, a randomized double-blinded, placebo controlled study started with 38 patients with denture stomatitis. Completion rate was more than 80%. Compliance and follow-up were adequate and clinician bias was unlikely. Because the method in the second article was not randomized or double blinded, clinician bias was possible. Also, the completion rate was around 65%.
Applicability	Fluconazole mouth rinse and clotrimazole mouth-paint are effective for patients with denture stomatitis. Only clotrimazole mouth paint is effective for angular cheilitis because it is applied directly to affected areas. Clotrimazole mouth paint is difficult to use in hard to reach sites (tonsils, soft palate).
Specialty	(General Dentistry) (Prosthodontics)
Keywords	Denture stomatitis, anti-fungal medicine, fluconazole, clotrimazole.
ID#	802
Date of submission	04/14/2011
E-mail	mind@livemail.uthscsa.edu
Author	Daniel Min
Co-author(s)	Cynthia Dominessy
Co-author(s) e-mail	Dominessy@livemail.uthscsa.edu
Faculty mentor	Erica Oliveira, DDS, MPH
Faculty mentor e-mail	OLIVEIRAE@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Giang Tran DDS, Keaton Forrester, DMD (San Antonio, TX) on 11/13/2015 A PubMed & Trip Database search on this question in November, 2015 found more recent publication by Emami E et al 2014 ( PubMed ID 24316341). This meta-analysis found from 233 articles, 14 RCTs were included in systematic review and 8 in the meta- analysis. This study concluded that disinfection agents, antiseptic mouthwashes, natural substances with antimicrobial properties, microwave disinfection and photodynamic therapy could be recommended as an alternative to anti fungal medications in treatment for denture stomatitis. Therefore, this study adds relevant information to this CAT. by Cynthia Dominessy (San Antonio, TX) on 07/13/2011 This CAT is still clinically relevant. I found an article PMID 16120118 that concluded the use of a more conservative treatment such as oral mouth rinses over risking complications from systemic drugs.