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    Candidiasis

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    Wr Newgate
    This document summarizes candidiasis, caused by the fungus Candida albicans. It describes different types of oral candidiasis including pseudomembranous (thrush), erythematous, chronic plaque-type, denture stomatitis, angular cheilitis and median rhomboid glossitis. Predisposing factors, clinical features, diagnosis and treatment are discussed for each type. Management involves eliminating predisposing factors, improving oral hygiene and using antifungal medications like nystatin or azoles. Denture hygiene is especially important for treating denture stomatitis.

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    Candidiasis

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    Wr Newgate
    4K views27 pages
    This document summarizes candidiasis, caused by the fungus Candida albicans. It describes different types of oral candidiasis including pseudomembranous (thrush), erythematous, chronic plaque-type, denture stomatitis, angular cheilitis and median rhomboid glossitis. Predisposing factors, clinical features, diagnosis and treatment are discussed for each type. Management involves eliminating predisposing factors, improving oral hygiene and using antifungal medications like nystatin or azoles. Denture hygiene is especially important for treating denture stomatitis.

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    This document summarizes candidiasis, caused by the fungus Candida albicans. It describes different types of oral candidiasis including pseudomembranous (thrush), erythematous, chronic plaque-type, denture stomatitis, angular cheilitis and median rhomboid glossitis. Predisposing factors, clinical features, diagnosis and treatment are discussed for each type. Management involves eliminating predisposing factors, improving oral hygiene and using antifungal medications like nystatin or azoles. Denture hygiene is especially important for treating denture stomatitis.

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    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    4K views27 pages

    Candidiasis

    Uploaded by

    Wr Newgate
    This document summarizes candidiasis, caused by the fungus Candida albicans. It describes different types of oral candidiasis including pseudomembranous (thrush), erythematous, chronic plaque-type, denture stomatitis, angular cheilitis and median rhomboid glossitis. Predisposing factors, clinical features, diagnosis and treatment are discussed for each type. Management involves eliminating predisposing factors, improving oral hygiene and using antifungal medications like nystatin or azoles. Denture hygiene is especially important for treating denture stomatitis.

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    of 27

    CANDIDIASIS

    CANDIDIASIS
    Caused by Candida Albicans C. Albican is usually weak pathogens, affected very young, very old, and very sick Pathogenesis:
    Predispos factors Candida normal (Saprophytic stage)

    Candida pathogenic organism (Parasitic stage)

    Oral Candidiasis
    Primary = restricted to the oral and perioral sites Secondary = systemic mucocutaneous manifes

    Predisposing factors :

    Epidemiologi
    Candida is more frequently isolated from woman Prevalence increase during the summer Denture-wearers 50 %

    Pseudomembrans Candidiasis (THRUSH)


    Predominantly affected medicated antibiotic, immunosuppressant drugs, disease that suppresses immune Presents with Loosely attached membranes comprising fungal organisms and cellular debris Unique sign :
    1. 2. Patches of creamy white pearl or bluish white Can be scarped red base, sometimes bleed

    Clinical symptoms:
    some discomfort but this is infrequent.

    Chronic form emerge as a result of HIV infections for a long period of time.

    Erythematous Candidiasis
    referred to as atrophic oral candidiasis Predisposing factors: use of inhalation steroids, smoking, and treatment with broad-spectrum antibiotics. Clinical appearance:
    Red (erythematous) lesion with diffuse border Most common area: in the palate and dorsum of the tongue

    Clinical symptoms: burn sensation and soreness.

    The acute and chronic identical clinical features Erythematous candidiasis could precede or follow thrush (pseudomembranous candidiasis)

    Chronic Plaque-type and Nodular Candidiasis (Chronic hyperplastic)


    Chronic plaque-type candidiasis previously termed as candidal leukoplakia. Predisposing factors: smoking Clinical appearance:
    White plaque (may be indistinguishable from oral leukoplakia)

    Most common area: buccal mucosa, lateral borders of the tongue, corner of the mouth Clinical symptoms: usually not painful These lesions are always chronic.

    But the probable role of yeast in oral carcinogenesis remains unclear.

    Denture Stomatitis
    Characterized by localized chronic erythema of tissues covered by denture. Denture stomatitis is classified into three different types:
    Type I localized to minor erythematous sites caused by trauma from the denture Type II affects major part of the denture-covered mucosa Type III in addition to type II, it has a granular mucosa in the central part of the palate

    Predisposing factor: dental appliance denture

    Clinical appearance:
    Localized erythema of denture-covered tissues Most common area: palate, upper jaw

    Clinical symptoms: usually not painful

    Angular Cheilitis
    Predisposing factors: vitamin B12 deficiency, iron deficiency, loss of vertical dimension (facial wrinkling), dry skin (develop skin fissures) Clinical appearance:
    Erythematous fissuring at one or both corners of the mouth 30% of patients with denture stomatitis also have angular cheilitis

    Median rhomboid glossitis


    It is a chronic erythematous lesion in the center of the posterior part of the dorsum of tongue resulting from atrophy of the filiform papillae. Predisposing factors: smoking, use of denture, use of inhalation steroids Clinical appearance:
    Erythematous area with oval configuration in the center of the posterior part of the dorsum of tongue.

    Clinical symptoms: - (asymptomatic)

    Oral candidiasis associated with HIV


    More than 90% of AIDS patients had oral candidiasis Most common types of oral candidiasis associated with HIV:
    Pseudomembranous candidiasis, erythematous candidiasis, angular cheilitis, and chronic hyperplastic candidiasis

    Clinical Manifestations
    Secondary oral candidiasis is accompanied by systemic mucocutaneous candidiasis & other immune deficiencies. Chronic mucocutaneous candidiasis (CMC) can occur as part of endocrine disorders such as hyperparathyroidism & Addisons disease. In addition to oral candidiasis, CMC also affects the skin, typically the nail bed, and other mucosal linings, such as genital mucosa. The face and scalp may be involved. Approx. 90% of patients with CMC also present with oral

    Diagnosis
    Clinical diagnosis by giving antifungal treatment and review patients condition after 1-2 weeks. If the lesion disappears, this confirms our diagnosis. If it doesnt, then we need a biopsy. Biopsy technique:
    Smear from infected area Swab taken by rubbing cotton tipped Imprint culture sterile plastic foam Impression culture alginate impressions Salivary culture patient expectorates ml saliva into sterile container Oral rinse Subject rinses for 60 s with PBS at pH 7.2, 0.1 The result is expressed as colony forming units per cubic millimeter (CFU/mm2)

    Oral Candidiasis: Principle of Management


    Elimination or reduction of predisposing factors Improve oral hygiene Therapy by giving antifungal drugs
    The most commonly used drugs group of polyenes or azoles. Polyenes (ex: nystatin, amphotericin B) first alternatives in primary oral candidiasis. Polyenes are not absorbed from the gastrointestinal tract and are not associated with development of resistance.

    Topical treatment with azoles (ex: miconazole) is the treatment of choice in angular cheilitis If angular cheilitis comprises an erythema surrounding the fissures, a mild steroid ointment may be required to reduce the inflammation.
    To prevent recurrences patients must apply a moisturizing cream to prevent new fissure formation

    Systemic azoles may be used for deeply seated primary oral candidiasis, such as chronic hyperplastic candidiasis, denture stomatitis, median rhomboid glossitis, and for therapyresistant infections

    The azoles are also used in the treatment of secondary oral candidiasis Several disadvantages with azoles:
    increasing bleeding propensity Azoles are fully or partly resorbed from the G.I. tract

    Special Consideration for Denture Stomatitis


    Educate the patients to improve denture hygiene
    Denture should be stored in antimicrobial solutions, ex: alkaline peroxides, alkaline hypochlorites, acids, disinfectants, enzymes. Chlorhexidine may be used, but can discolor the denture and counteracts the effect of nystatin. Recommend the patients for not using denture while sleeping

    Type III denture stomatitis may be treated with surgical excision if it is necesssary,

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