ORAL CANDIDIASIS

By

Asma Qasm Rahman

B.D.S, M.Sc
Oral Medicine Department
College of Dentistry 1
OUTLINE
• Introduction

• Epidemiology

• Predisposing factors

• Classification

• Diagnosis

• Management

• Summary 2
 Learning outcome

• To know Oral candidal infections and their causes.

• To diagnose different types.

• Prescribe appropriate treatment.

3
 Introduction
• The most prevalent opportunistic infection affecting the
oral mucosa.

• The lesions are caused by the yeast Candida albicans

• Change from harmless commensal existence of Candida

to a pathogenic state can occur following alteration in
oral environment .
Epidemiology
• The prevalence of 35%

• Women > Men

• Affect the very young, the very old, and the very sick.
Predisposing factors
Local tissue trauma
Physiological
Immune defect
Malnutrition
Endocrine disorders
Malignancy
Drugs
Salivary gland hypofunction 6
 Classification
Primary Secondary

Acute Chronic Candida- Oral

associated manifestations
lesions of systemic
pseudomemb mucocutaneous
pseudomemb ranous, Candida- candidosis
ranous, erythematous associated denture-
erythematous induced stomatitis,
, hyperplastic angular cheilitis,
median rhomboid
glossitis
1. Acute Pseudomembranous Candidiasis (Thrush)
• Superficial infection.
• Formation of white plaques on the mucosal surface
• Easily removed, leaving an area of erythema or ulceration.
• Common in neonates and young children.
• Bad or loss of taste, burning sensation of the mouth and
throat.
• Any of the mucosal surfaces
2. Erythematous candidiasis (acute atrophic
candidiasis, antibiotic sore mouth )
• Due to chronic use of antibiotic or steroids.

• Resembles 'thrush' without the overlying pseudomembrane.

• Clinically, the mucosa involved is red and painful.

• The epithelium is thin and atrophic with candidal hyphae

embedded superficially in the epithelium.
 3. Hyperplastic candidiasis (candidal
leukoplakia)
• Premalignant lesion.

• Patients who smoke.

• Raised irregular white plaque at the commissures of the

mouth, palate, which may be speckled or nodular in
appearance.
4. Candida –associated, denture- induced
stomatitis
• The most common form of oral candidiasis and is also
referred to as chronic erythematous candidiasis
• This form represents the end-result of secondary
candidal infection of tissues, traumatized by a dental
appliance.
Newton's classification of Candida-associated
denture stomatitis
Pin-point hyperaemia

Diffuse erythema, limited to the

fitting surfaces of denture

Nodular appearance of palatal

mucosa
5. Candidal assiociated angular chelitis

• Presents as erythema and cracking at the angles of the

mouth.

• Dryness and a burning sensation at corner of the mouth.

• Etiology is denture sore mouth, reduced vertical dimension,

Haematinic defeciency.
6. Median rhomboid glossitis
• Depapillation on the midline
of the dorsum of the tongue.

• 'rhomboid-shaped'—hence the
name.

• Its surface may be red, white,

or yellow in appearance.
7. Chronic mucocutanuous candidiasis

• persistent infection with candida albicans occur as

a result of defect in cell-mediated immunity or
associated with iron deficiency anemia. In
addition to oral candidiasis, lesions of skin and
nails are involved.
 LABORATORY DIAGNOSIS
ORAL
SMEAR SWAB BIOPSY
RINSE

CBC
Ferritin,
vitB12
Blood glucose test
 Management by topical agents:
DRUG FORM DOSAGE
Amphotericin B Lozenge, Slowly dissolved in the
10 mg mouth, 3-4 times/day after
meals, for 2 weeks
Nystatin Cream Apply to affected areas 3-
4 times/day

Clotrimazole Cream Apply to the affected

areas, 2-3 times/day, for 3
days
 Management by Systemic drugs:
DRUG FORM DOSAGE

Ketoconazole Tablets 200-400mg tablets,

taken once or twice
daily with food, for 2
weeks.
Fluconazole Capsules 50-100 mg capsules,
once daily, for 2-3
weeks.
 SUMMARY
• Oral candidiasis is an opportunistic infection. Affecting very
young, very old and very sick.

• More common among females than males.

• It has many predisposing factors.

• Classified to primary and secondary.

• Diagnosis is by clinical and laboratory.

• Topical or systemic treatment in severe cases. 25

References

• Scully C (2013). Oral and maxillofacial medicine; the basis of

diagnosis and treatment. 3rded. London, UK: Elsevier Ltd. P.
228-229.

• Lewis MAO, Jordan RCK (2012). A color handbook of oral

medicine. 2nd ed. London UK: Manson Publishing Ltd. P.25

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