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Fungal Infection

Candidadiasis (Candidosis)
Dent 452
Dr Jumana Karasneh
Candidal carriage
 40-60% of the population are “Candida carriers”

 Candida species: albicans, tropicalis, glabrata, …

 Candida carriage in increased in:


 Women

 Blood group O
 High carbohydrate diet
 smokers

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Host Defences
1. Oral Epithelium
2. Microbial interactions
3. Salivary non-immune defences
1. Mechanical cleansing
2. lysozyme

4. Immune defences
1. T cells & phagocytes
2. IgA
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Predisposing factors
 Over growth of Candida species due to:
 Physiological factors
 Local tissue trauma
 Antibiotic therapy (How?)
 Corticosteroid therapy (How?)
 Malnutrition

 Immune defects
 Endocrine disorders

 Malignancies
 Salivary gland hypofunction
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Symptoms

 Asymptomatic

 Bad / altered taste

 Nausea

 Soreness & burning sensation

 Dysphagia (pharynx / oesophagus involved)

 Hoarseness of voice (Larynx involved)

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Clinical Picture “Signs”

Hyperplastic
Pseudomembranous (Thrush)
Candidal Leukoplakia

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Clinical Picture “Signs”

Erythematous
Denture-induced

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Clinical Picture “Signs”

Angular chelitis Median Rhomboid


Glossitis
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Clinical classification of Oral Candidosis
Lehner classification 1960s
 Acute
 Pseudomembranous
 Atrophic

 Chronic
 Atrophic

 hyperplastic

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Clinical classification of Oral Candidosis
 Primary oral candidosis  Secondary oral candidosis
 Acute  Manifestation of systemic
 Pseudomembranous mucocutanous candidosis
 Erythematous

 Chronic
 Pseudomembranous
 Erythematous
 Hyperplastic

 Candida-associated lesions
 Denture induced stomatitis
 Angular chelitis
 Median rhomboid glossitis

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Diagnosis
 Clinical

 Stained Smear

 Swab & culture

 Biopsy

 Heamatological tests

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Diagnosis
 Clinical

 Stained Smear

 Swab & culture

 Biopsy

 Heamatological tests

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Diagnosis
 Clinical

 Stained Smear

 Swab & culture

 Biopsy stained with periodic acid Schiff (PAS)

 Other investigations:
 Haematologic

 Hormonal
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Management
 Removal of predisposing factors if possible

 Avoid/reduce smoking

 Improve oral hygiene

 Therapy
Which one to
 Systemic
choose?!
 Topical

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Topical therapy options

 Amphotericin lozenges (10 mg)

 Amphotericin suspension (100 mg/ml)

 Nystatin suspension (500.000 U/5ml) 4 /day


1-4 wks
 Miconazol cream / gel

 Nystatin cream

 Chlorhexidine mouthwash

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Systemic therapy options

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Pseudomembranous
“Thrush”
 Not common in healthy individuals
“disease of diseased”
 Plaque is made of necrotic
material, haphae, desquamated
epithelial cells.
 Should be differentiated from other
white lesions
 Could extend to pharynx &
oesophagus
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Erythematous Candidosis
 Could be acute or chronic

 Marked pain and soreness

 Could precede or follow


thrush or be isolated
 Most cases predisposed by
antibiotic or steroid
 Further inv. if couldn't confirm
diagnosis clinically
 Treatment 18
Hyperplastic Candidosis
 Always chronic

 Predisposing factors:
 Smoking
 ↓Fe & folate
 Defective cell-mediated
immunity
 Blood group secretory status

 Candidal leukoplakia (always


give antifungal prior to biopsy)
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Candida-associated
denture induced stomatitis
 Most common  Treatment should include:
 Usually not painful  Check glucose level

 Stop denture night wearing


 Predisposing factors
 OHI
 Dental appliance
 Topical antifungal
 Diabetes or ↑ carbohydrate diet

 Non significant factors


 Allergy to dental material

 Trauma
 Smoking

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Candida-associated
denture induced stomatitis

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Candida-associated
angular chelitis

 Soreness, erythema,
cracking & crusting.
 Treatment
 Candida reservoir
should be eliminated
 Correct predisposing
factors

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Candida-associated
Median rhomboid glossitis

 Midline of tongue anterior to


sulcus terminalis
 Predisposing factors
 Smoking

 Dental appliance
 Corticosteroid inhalers

 HIV infection

 Respond poorly to topical


antifungal
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Chronic mucocutaneous candidosis

 A heterogenous group of clinical


syndromes characterized by
chronic, treatment-resistant
superficial Candida infection of the
skin, nails & oropharynx

 Need referral to dermatologist

 Respond poorly to topical Trt

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References!!

 Lecture:
 Tyldesley’s oral medicine chapter 4
 Essentials of Oral medicine chapter 18

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