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Oral Candidiasis - Clinical Presentation, Causes, Treatment, and Prevention

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Oral Candidiasis - Clinical Presentation, Causes, Treatment, and Prevention

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This article discusses fungal infection known as oral candidiasis. It is the most common opportunistic infection of the oral cavity.

Medically reviewed by

Dr. Sneha Kannan

Published At June 3, 2019
Reviewed AtApril 29, 2024

Introduction

Oral candidiasis, also known as oral thrush, is the most common opportunistic infection of the oral cavity, which is observed mostly in patients who have low immunity, like HIV, diabetic patients, and those who belong to an older age group wearing dentures. Though there are several Candida species, Candida albicans is most commonly associated with it. It is common in infants, the elderly, and those with weakened immune systems. Treatment usually involves antifungal medications like clotrimazole or fluconazole. Maintaining good oral hygiene and addressing underlying factors like immunodeficiency or diabetes can help prevent recurrence.

What Is the Clinical Presentation of Oral Candidiasis?

It presents as a curd-like, atrophic, speckled, and hyperplastic lesion. Accordingly, there are several types of candidiasis. These are:

  • Pseudomembranous or oral thrush: It usually presents as extensive whitish membrane-like curd on the buccal and labial mucosa, palate, tongue, and oropharynx. It is the most common form found in patients.

  • Chronic hyperplastic: It is speckled or homogenous and is commonly found along buccal mucosa and lateral borders of the tongue. It is commonly found among smokers.

  • Angular cheilitis: It presents as fissures on the corners of the mouth.

  • Atrophic: It presents as erythematous or atrophic reddish areas among old-age patients wearing dentures. It is commonly observed on the maxillae's palate and upper edentulous ridge. It is also known as denture stomatitis.

What Causes Oral Candidiasis?

There are several causes associated with it, which are:

  • Decreased Immunity: Patients with a weak immune system are susceptible to it. HIV, diabetes, and leukemia patients are at high risk.

  • Deficiency of Vitamins: Vitamin deficiencies like Vitamin B12, B6, and iron deficiency can cause it, particularly angular cheilitis.

  • Denture-Wearing Old Patients: Old-age patients wearing dentures are at high risk, as dentures create anaerobic conditions under them. Moreover, the flow of saliva decreases, and the pH also decreases. These factors result in the growth of Candida species, particularly Candida albicans.

  • Smoking: Smokers are at high risk. They usually develop a hyperplastic form.

  • Drugs: Patients taking steroids and inhalers are at increased risk. These drugs cause xerostomia, which increases the chances of Candida growth.

  • Xerostomia: Patients with xerostomia due to radiotherapy, diabetes, or autoimmune diseases like Sjogren's syndrome are at risk of developing candidiasis.

What Is the Diagnosis of Oral Candidiasis?

Clinical examinations, followed by investigations, are usually done to diagnose this condition. Usually, the scraping of the lesion exposes the erythematous red surface beneath, distinguishing it from leukoplakia. The culture of the lesion shows the presence of fungi. Other investigations like complete blood count, glucose levels, hemoglobin estimation, and various tests for antibodies reveal underlying diseases like diabetes, anemia, leukemia, and autoimmune disorders.

What Is the Management of Oral Candidiasis?

Management requires a multipronged strategy, depending on the cause. The various strategies are:

  • Treatment of oral candidiasis typically involves antifungal medications, such as clotrimazole, nystatin, fluconazole, or miconazole, which can be administered as oral rinses, lozenges, or tablets. These medications help eliminate the fungal overgrowth in the mouth.

  • Topical antifungals are used in cases where there are no systemic manifestations. For example, topical antifungal cream can be used for fissures on the corners of the mouth or atrophic areas in the mouth. These are usually prescribed for two weeks.

  • Systemic antifungals like Ketoconazole are used in certain circumstances. Based on clinical and other findings, they are usually prescribed as a two-week therapy.

  • Vitamin supplementation is given in case there is a deficiency.

  • Treatment of the underlying disease.

What Are the Measures for the Prevention of Oral Candidiasis?

Several preventive measures can be taken to prevent the infection.

These are:

  • Susceptible patients should visit the dentist after two to three months for a general checkup.

  • Older people remove dentures for some time, particularly during the night.

  • Washing dentures after eating.

  • Complete cessation of smoking in susceptible cases.

  • Vitamin supplementation by proper diet among older adults, undernourished, and medically compromised patients.

  • To prevent fungus growth in high-risk patients, a prophylactic mouthwash like Hexidine should be used on the recommendation of a registered dentist.

Remember: "Prevention is always better than cure."

What If Candidiasis Is Left Untreated?

If left untreated, candidiasis can spread to other body parts beyond the mouth, leading to systemic candidiasis. This can result in more serious complications, especially in individuals with weakened immune systems. In severe cases, systemic candidiasis can lead to bloodstream infections (candidemia), which can be life-threatening. In immunocompromised individuals, untreated oral candidiasis can also indicate a decline in overall health and may warrant further medical evaluation and management.

What Are the Differential Diagnoses of Oral Candidiasis?

Differential diagnoses for oral candidiasis include:

  • Oral Leukoplakia: White patches in the mouth that can not be wiped away and may indicate a precancerous condition.

  • Oral Lichen Planus: White, lacy patches that may cause discomfort or pain.

  • Geographic Tongue: Benign condition characterized by irregular patches on the tongue’s surface.

  • Oral Hairy Leukoplakia: White, hairy patches on the sides of the tongue, often seen in people with HIV/AIDS.

  • Oral Psoriasis: Rare condition characterized by white patches, typically accompanied by other symptoms of psoriasis.

Is Oral Candidiasis Contagious?

Oral candidiasis is typically not considered contagious in healthy individuals. However, in some cases, it can be transmitted from mother to newborn during childbirth or through breastfeeding. Additionally, individuals with weakened immune systems, such as those with HIV/AIDS, may be more susceptible to acquiring or transmitting oral candidiasis. Regular hand hygiene and avoiding sharing items like toothbrushes or utensils can help reduce the risk of transmission.

Conclusion:

Oral candidiasis is a common human fungal infection. It is a common opportunistic infection affecting the oral cavity. It manifests as white patches or plaques on the tongue, inner cheeks, or throat. It can occur due to various predisposing factors, such as a weakened immune system, diabetes, antibiotic use, or wearing dentures. While typically not contagious in healthy individuals, it can be transmitted from mother to newborn or between individuals with compromised immune systems. Treatment involves antifungal medications and addressing underlying factors to prevent recurrence. Early diagnosis and management are important to prevent complications and ensure oral health.

Frequently Asked Questions

1.

What Symptoms Do Candida Cause in Mouth?

Burning sensation of the mouth, pain in the mouth during eating, creamy white patches on the gums, inner cheeks, tongue, palate, and throat that can be rubbed off to reveal red spots underneath, mouth sore, redness, reduced or no taste sensation, and cracked corners of the mouth are the presenting features of oral candidal infection.

2.

What Confirms Oral Candidiasis?

Diagnostic investigations for oral candidiasis include a visual inspection of the creamy white curd-like intraoral patches involving the gums, palate, cheeks, tongue, bacterial cultures, and microscopic examination of the smeared scrapped off white plaques. A potassium hydroxide preparation reveals spores and non-septate mycelium. Also, the intraepithelial pseudomycelia of Candida albicans can be identified in the biopsy.

3.

How to Identify Oral Thrush?

There are creamy curd-like white patches or plaques over the gingiva, roof of the mouth (palate), tongue, and inner cheek in oral thrush. These white plaques are easily scraped off or removed upon which it reveals an erythematous area, and gingival redness indicates oral thrush.

4.

How Does Oral Thrush Feel?

Oral thrush causes the burning sensation of the mouth, bad taste, discomfort with spicy food, mouth soreness, and painful cracks at the corners of the mouth.

5.

Does Oral Thrush Spread From One Person to Another?

Oral thrush does not spread from one person to another. It occurs when there is poor body immunity, poor oral hygiene, dry mouth, and prolonged steroid or antibiotic therapy.
The causative organism of oral thrush, Candida species, is present in everyone’s oral cavity and skin in normal conditions. Upon favorable conditions, they grow and multiply to cause oral thrush.

6.

How Does One Get Oral Thrush?

Oral thrush occurs due to a weak immune system, excessive use of inhaled or systemic steroids, diabetes, smoking, long-term antibiotic therapy altering the oral microbial environment, altered immunity in people with cancer, HIV, etc., and poor oral hygiene.

7.

Why Does Oral Thrush Occur?

Yeast or fungal (Candida species) infection of the oral cavity leads to oral thrush. In conditions of immune deficiency like cancer chemo or radiotherapy, HIV, long-term steroids, etc., poor oral hygiene, smoking, and overzealous antibiotic therapy make a person susceptible to Candida infection. They alter the normal oral ecology and create conditions favorable for Candidal growth.

8.

What Other Lesions Look Similar to Oral Thrush?

- Lichen Planus.
- Leukoplakia.
- Chemical injury in the oral cavity.
- Gangrenous stomatitis.
- Genodermatoses.

9.

How to Manage Oral Thrush in Adults?

Initial removal of the underlying cause by maintaining clean dentures, removing them at night, maintaining good oral hygiene, withdrawing or changing antibiotics, discontinuing smoking, etc., must be done, followed by topical and systemic antifungal medications for seven days. Symptoms tend to disappear within five days. Chlorhexidine mouthwash can also be used regularly.

10.

Which Drug Treats Oral Thrush Effectively?

- Topical Antifungals:
Miconazole gel.
Clotrimazole.
Oral Nystatin suspension.
Amphotericin B rinse.
Mycostatin cream.
- Systemic Antifungals:
Amphotericin B.
Fluconazole.
Itraconazole (contraindicated in people taking Cisapride, Triazolam, Astemizole, and Midazolam).
Nystatin.
Ketoconazole.
- Mouthwashes:
Chlorhexidine.
Triclosan.

11.

How to Manage Oral Thrush in Toddlers?

Candidal infections in babies regress most of the time within a week or two on their own, where careful monitoring of the baby is advised. Otherwise, physicians recommend topical antifungal drops or creams to treat oral thrush in toddlers. It is advised to be applied all over the tongue and mouth with a sponge applicator.
Dr. Soheel Hussain Zargar
Dr. Soheel Hussain Zargar

Dentistry

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oral candidiasis
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