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

Oral candidiasis 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 older age group wearing dentures. Though there are several Candida species, Candida albicans is most commonly associated with it.

Clinical Presentation:

It presents as 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 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 palate and upper edentulous ridge of the maxillae. It is also called as denture stomatitis.

Causes:

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 deficiency 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 it. Moreover, the flow of saliva decreases, and there is also a decrease in pH. These factors result in the growth of Candida species, particularly Candida albicans.

• Smoking: Smokers are at high risk. They usually develop 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 due to autoimmune diseases like Sjogren's syndrome are at risk of developing candidiasis.

Diagnosis:

Clinical examinations followed by investigations are usually done to diagnose this condition. Usually, the scrapping of lesion exposes the erythematous red surface beneath which distinguishes 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.

Management:

The management requires multipronged strategy depending upon the cause. The various strategies are:

• Topical antifungals in case there are no systemic manifestations. For example, using topical antifungal cream 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 is used in certain circumstances. It is usually prescribed as a two-week therapy based on clinical and other findings.
• Vitamins supplementations are given in case there is a deficiency.
• Treatment of the underlying disease.

Prevention:

Several preventive measures can be taken to prevent the infection. These are:

1. Susceptible patients to visit the dentist after two to three months for a general checkup.
2. Older people to remove dentures for some time, particularly during the night.
3. Washing dentures after eating.
4. Complete cessation of smoking in susceptible cases.
5. Vitamin supplementation by proper diet among older adults, undernourished, and medically compromised patients.
6. Use of prophylactic mouthwash like Hexidine on the recommendation of a registered dentist to prevent the growth of fungus in high-risk patients.

Remember: "Prevention is always better than cure."