Oral Candidiasis Dentaltutor.in

Introduction In human beings, Candida species are present as normal flora of the skin and mucocutaneous areas, intestines and vagina. Various forms of candidiasis – Oral thrush – Candidal vaginitis: thick, yellow, curdy discharge – Cutaneous candidiasis nail folds producing change in the shape of nail plate – paronychia intertriginous areas of the skin, axilla, groin, infra- and inter-mammary, intergluteal folds and interdigital space – Systemic candidiasis: kidneys,heart,

Oral Candidiasis Also known as moniliasis or thrush or candidosis Caused by the infection with yeast like fungus Candida albician. Other causative organism may be Candida tropicalis, Candida famata, Candida krusei

Classification Primary Oral Candidiasis – ACUTE Pseudomembranous Erythematous – CHRONIC Hyperblastic Erythematous Pseudomembranous – CANDIDA ASSOCIATED LESSION Denture stomatitis Angular stomatitis Median rhomboid glositis – Keratinized primary lesion super infected with candida Leukaplakia Lichen planus Lupus erythematous Secondary candidiasis – Manifestation of Systematic mucocutaneous candidiasis – thymic aplasia and candida endocrinopathy syndrome

Predisposing Factor Change in oral microbial flora – Administration of antibiotics specially broad spectrum – Xerostomia secondary to anticholinergic agents – Salivary gland disease Local Irritation – Denture, orthodontic appliance – Heavy smoking

Predisposing Factor Drug therapy – Corticosteroid or cyto-toxic drug or immunosuppressive drug – Radiation therapy Other systemic disease – Leukemia – Lymphoma – Diabetes – Tuberculosis – Epithelial dysplesia

Predisposing Factor Malnutrition status – Low serum vit A – Pyridoxine – Iron level Age Infancy – Pregnancy – Old age

Predisposing Factor Endocrine deficiency – Hypoparathyroidism – Hypothyroidism – Addison’s disease Others – Tight fitting garments – Indwelling catheter

Pseudomembranous candidiasis Thrush Superficial infection of upper layer of oral mucous membrane Fungal growth – desquamation of epithelial cell and accumaltion of bacteria, keratin and necrotic tissue forming pseudomembrane

Clinical features: Infants – 6 th and 10 th day after birth – Infection from maternal vaginal canal – Soft white/bluish whit, adherent patches on oral mucos – Painless – Removed with little difficulty

Clinical features : Adult – Site : roof of mouth, retromolar area, Mucobuccal fold – Sex: female – Prodromal symptom : rapid onset of bad taste and discomfort from spicy food – Burnig sensation – White plaque pearly white or bluish white – resemble cottage cheese or curdled milk Composed of tangled mass of hyphae, yeast, desquammated epithelial cell and debris Easily wiped out – erythematous/atrophic area which is painful

Diagnosis White lesion which can be scraped off easily Diffrential diagnosis – Plaque from lichen planus – Leukolplakia – Chemical burn – Gangrenous stomatitis

Acute atrophic candidiasis Antibiotics sore mouth It may be squeal of pseudomembranous candidiasis after white patch has been shed off AIDS patient Prolonged drug therapy Topical steroid Broad spectrum antibiotics Denture wearers

Clinical feature Any site but mainly involves tongue or area facing prosthesis Red or erythematous Vague pain or burning sensation Careful examination – white thickened foci that can be rubbed off

Diagnosis Erythematous area with diminished host resistance Differential diagnosis – Chemical burn – Drug reaction – Syphilitic mucus patches – Necrotic ulcer and gangrenous stomatitis – Traumatic ulcer

Chronic hyperplastic candidiasis Candidal leukoplakia Firm adherent white patches Predominantly in men of middle age or above – heavy smokers Site: cheek, lip and tongue Appearance: firm and white leathery plaque

Clinical features Persist without any pain for years Doesn’t rubs off with lateral pressure Slightly white to dense white with cracks and fissures occasionally Vague border – epithelial dysplasia

Diagnosis Firm and white leathery appearance which is difficult to rub Diffrential diagnosis – Lichen planus – Hairy leukoplakia – Superficial bacterial infection – microscopic culture

Id Reaction Secondary response characterized by localized or generalized sterile vesicopapular rash that is believed to be allergic response – candida antigen (monoloids)

Chronic atrophic candidiasis Also known as Denture stomatitis Manifestation of Erythematous candidiasis Found under complete denture or partial denture – mostly under the palate Speckeled curd like white lesion – patchy distribution Soreness and dryness of mouth

Clinical sign Bright red palatal tissue – edematous and granular Sharply outline of redness Multiple pinpoint foci of hyperemia usually involving the maxilla

Diagnosis An erythematous are under complete denture Diffrential diagnosis – Allergic reaction due to denture base – Erosive lichen planus – Dermatitis herpetiform

Treatment of Oral Candidiasis Topical: Clotrimazole, 1% genitian violet, Nystatin, Amphotericin B, Mycostatin cream, Idoquinol Systematic: Fluconazole, Itraconazole, Ketaconazole, Nystatin 7 days treatment Oral symptoms disappears in 2-5 days Relapse common – underlying immunodeficiency Removal of causative factors – Ill fitting denture – Withdrawal or change of antibiotics – Proper cleaning of denture and use of antifungal agent

Reffrences Harsh Mohan - Textbook of Pathology 6th Ed Shafer’s Textbook of Oral Pathology, 6 th edition Textbook of Oral medicine, Anil Govindrao Ghoom, 2 nd edition Burkitt’s Oral medicine, 11 th edition

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