Oral candidiasis and its treatment
Introduction
● Majority of the cases → caused by Candida albicans (which is a WEAK pathogen)
○ Only affect the sick/ young/ old people
Pathogenesis
● Candida albicans/ C. tropicalis/ C. glabratas
○ Changes from normal commensal flora (saprophytic state) → pathogenic (parasitic state)
○ Due to some predisposing factors:
■ Local
● Denture wearing
● Xerostomia (due to radiation therapy/ auto-immune disease)
● Steroids (esp. Asthma drug)
● Smoking
● Low pH
● Imbalance of oral microflora
■ General
● Immunosuppression
● Impaired health status
● Chemotherapy
Classification
Primary Oral Candidiasis = restricted to oral/ peri-oral region
1. Acute 2. Chronic
Pseudomembranous CLINICALLY SAME CLINICALLY SAME
● Loosely attached membrane = ● Mainly affect px ● HIV/ steroid inhaler (asthma
fungus + cellular debris (can be with Ab/ px)
wiped off) immunosuppression ● Common presentation
● Red surface underneath ○ Good OH, clear MH but
very severe infection
Erythematous age CLINICALLY SAME CLINICALLY SAME
● Red/ bleeding surface
● Successor to Pseudomembranous
● Causing kissing lesion = palate and
dorsum of the tongue (esp. Steroid
inhaler & smoker)
2. Chronic (con’t)
Plaque-like/ Nodular
● Not common, but high risk of neoplasm
● Unlike Pseudomembranous → CANNOT be wiped off easily
● Similar clinical appearance as Leukoplakia
● Can be transformed into malignant carcinoma (unclear carcinogenesis)
○ Determined by biopsy
3. Candida-related
Denture stomatitis Il 61 In completedenture wearer
● Denture bearing sites (usually palatal surface)
infammet lpin majorfat or
Type I = focal
minor erythematous site point
caused erythema
by the trauma of denture
Type II = diffuse
affects erythema
majority of the denture-bearing mucosa
Type III = Type II + has a granular mucosa at the central palate multifactorial
Angular cheilitis inflammatorypapillaryhyperplasia
● Commissures of mouth, surrounded by erythema
● Co-infection = mix infection of fungus (Candida) + bacteria (Staphylococcus aureus)
● Associated with Vitamin B12, iron deficiency, loss of OVD
Median rhomboid glossitis
centralpapillaryatrophy xpapille ontongue
***Still controversial if it’s a type of Candidiasis***
● Etiology not known, show a mixed bacterial/ fungal microflora BUT 唔知C.Albican係cause定result
● X symptoms at all
○ X papilla
○ X redness
○ X inflammation
Secondary Oral Candidiasis = accompanied by systemic mucocutaneous manifestations
Rare but severe condition (淨係記名)
● Familial chronic mucocutaneous candidiasis
● Diffuse chronic mucocutaneous candidiasis
● Candidiasis endocrinopathy candidiasis l
● Severe combined immunodeficiency
Diagnosis
1. Clinical findings
2. Medical history
3. Further investigations
a. Salivary culture
i. Primary diagnostic method, usually assisted by other tests
b. Smear
cottonroll to Fk
i. When you suspect pseudomembranous oral candidiasis/ angular cheilitis
c. Imprint culture
i. only EPerythematous candidiasis and denture stomatitis
When you diagnose
d. Histopathologic examination (Biopsy)
i. When you diagnose chronic plaque-type and nodular candidiasis
Management
1. Eliminate the local factors (or else relapse is very common)
a. Leave denture out of the mouth during sleeping
b. Remove plaque thoroughly
c. Disinfect/ replace denture
d. Treat underlying medical conditions
2. Drugs (anti-fungal drugs)
a. Topical (1st line drug)
i. Nystatin (most commonly as oral suspension)
● Spit out after rinsing (it won’t be absorbed in GI tract)
● :) well-tolerated, won’t develop resistance → can be used frequently and
repeatedly
ii. Miconazole 2% cream
● ***1st choice for angular cheilitis caused by Candidiasis***
iii. Ketoconazole 2% cream
b. Systemic (for severe case only)
i. Fluconazole: tablet, powder
ii. Itraconazole: solution
iii. Ketoconazole: tablets
Important conclusions:
Candida is a normal oral commensal flora → only cause disease of a diseased → always focus on
eradicating the underlying medical conditions NOT only treating the symptoms
