In addition, application of the intraoral Selleck CB-839 light may affect patient compliance with the treatment. Furthermore, in patient 2, the poorer response to the treatment could be attributed to smoking, which is considered to be a risk factor for DS.30 and 31 During

the follow-up period, patients 4 and 5 showed the best response to the treatment, with no inflammation verified until day 60. Subjects 2 and 3 developed recurrence of the initial inflammation (DS type II) on day 60. Recurrence of DS is often reported,9, 25 and 32 because the tissue surface of the acrylic resin denture acts as a reservoir that harbors microorganisms33 and 34 and is therefore a potential source of reinfection of patients. In the present investigation, although no growth of Candida spp. from the palate was observed after treatment, most of the patients showed growth of Candida spp. from the denture on day 15 ( Table I). When dentures are very old, the indication

would be to provide new dentures as adjunctive therapy for complete resolution of DS. 7 and 35 In the present report, most of the patients had worn the same denture for >5 years. Although the age of a denture is related to DS, 31 and 36 patient 3 had been wearing his denture for only 2 years. Therefore, other predisposing factors should be considered when treating DS. Advancing age is also a risk factor for DS in the elderly, because cell-mediated immunity, which provides protection against candidal infection declines with age.37 According to Ryu et al.,38 some oral environmental factors, such as selleck products unstimulated salivary flow rate Digestive enzyme and age of subjects, are associated with higher numbers of microbes

in the saliva of complete denture wearers. Those authors suggest that a reduction in the salivary flow rate with aging induces an increase in concentration of microbes in saliva. Another predisposing factor associated with DS is medication use. Four patients were taking antihypertensive medications which induce xerostomia. Therefore, although an improvement in palatal inflammation was verified after the treatment (day 15), the recurrence that occurred during the follow-up period may be associated with these predisposing factors to DS. Because DS is a multifactorial disease, a suitable treatment should consider all of the host factors that predispose to Candida infection. In the present report, although improvement of palatal inflammation and reduction of cfu/mL values were verified after PDT, Candida spp. were recovered after treatment in most of the patients ( Table II). This was an expected finding, because Candida spp. are normally isolated from oral mucosa, mainly from dentures, even in denture wearers without DS. 39 In summary, in 4 patients, clinical resolution of DS was achieved after 6 sessions of PDT, and improvement was observed in 1 patient.