Candidal infections of the oral cavity

1. Candidal Infections of the
Oral Cavity
Dr. Arsalan Wahid Malik
M. Phil (Oral Pathology) Dip.(Orthodontics)
ِ‫يم‬ ِ‫ح‬َّ‫ر‬‫ال‬ ِ‫من‬ْ‫ح‬َّ‫ر‬‫ال‬ ِ‫هللا‬ ِ‫م‬ْ‫س‬ِ‫ب‬

2. Candidal Species of Oral Cavity
 Candida albicans
 Candida tropicalis
 Candida pseudotropicalis
 Candida glabrata
 Candida krusei
 Candida parapsilosis

3. Candida Carriers
50% of normal population harbour C.albicans
as a normal oral commensal
 C.albicans resides on the posterior dorsum of
tongue
 C.albicans more frequent in females

4. Predisposing Factors for Oral Candidosis
 Physiological
 Antibiotics
 Corticosteroids
 Local irritations
 Malnutrition
 Immunity
 Hormonal disorders
 Tumors
 Salivary glands hypofunction

5. Predisposing Factors for Oral Candidosis
• Physiological- Old age, Infancy, Pregnancy
• Antibiotics- Broad spectrum, Topical/Systemic
• Corticosteroids- Topical, Systemic, Inhalers
• Drugs- Contraceptive pills, tricyclic
antidepressants, cytotoxic
• Local irritations- Dentures, Oral hygiene, Smoking

6. Predisposing Factors for Oral Candidosis
• Malnutrition -Iron and Folate deficiency
• Immunity- AIDS, HIV
• Hormonal disorders- D.M, Addison's disease
• Tumors- Leukemia, Kaposi sarcoma, Lymphomas
• Salivary glands hypofunction- Radiation, Drugs,
• Syndromes - Sjogren's, BMS

7. Who are at Special Risk?
• Newborn babies
• Adults with diabetes or other metabolic disturbance.
• People undergoing antibiotic or chemotherapy
treatment
• Xerostomia
• High carbohydrate diet
• People with poor nutrition
• Denture wearers
• People with an immune deficiency
• Smokers
• Hospitalized patients

8. Candidal lesion associated with
Denture induced stomatitis
 Angular cheilitis
 Median rhomboid Glossitis

9. Classification of Oral Candidosis
1. Primary Oral Candidosis (Group 1)
1. Acute form
1. Pseudomembranous
2. Erythematous
2. Chronic form
1. Pseudomembranous
2. Erythematous
3. Hyperplastic
2. Secondary Oral Candidosis (Group 2)
– Oral manifestations of systemic
mucocutaneous candidosis

10. Classification of Oral Candidosis
Primary Oral Candidosis (Group 1)
• Pseudomembranous
• Erythematous
• Hyperplastic
Acute
Chronic
Acute
Chronic
Chronic

11. Investigations of Candida Infections
Swab Smear Oral rinse Biopsy
Pseudomembranous
+ +
-
+ -
Erythematous
+ +
-
+ -
Hyperplastic
+
-
+
-
- +
Denture stomatitis
+ + + -

12. Other Investigations
• Tests of immune functions
• Endocrine functions
• Nutritional deficiencies test

13. Diagnosis of Oral Candidosis
• Identification of pseudohyphae in stained
smears from the lesion
• Staining by periodic acid Schiff (PAS)
• Culture and sensitivity on Sabouraud’s
medium

15. Management of Primary Oral Candidosis
Rx (Topical):
• Amphotericin (10mg)
(Dissolve 1-tab in mouth 4-times daily as lozenge)
OR
• Nystatin pellets (100 000 units)
(Dissolve slowly in mouth after meals Q.I.D for 01- months
period)
Rx (Systemic):
• Fluconazole (tab. 50-100 mg) daily for 2-3 weeks
OR
• Itraconazole (tab. 150 mg) daily for 2-weeks

16. Preventive measures for Oral Candidosis
• Patients with
• HIV +ve
• Cancer chemotherapy
• Immunosuppressive therapy
• Prolonged antibiotic therapy

17. Classification of Oral Candidosis

18. Pseudomembranous Candidosis
(Thrush, Moniliasis)
CLINICAL FEATURES:
Soft, white to yellow, elevated plaques, that are easily
wiped off leaving an erythematous, eroded, or
ulcerated surface which is tender
SITE:
Oral mucosa, Pharynx, Oesophagus, Trachea

20. Comparison of Pseudo membranous
lesions with White lesions
• Pseudomembrane can be easily wiped off and
the area left behind is red and bleeding.
• This is a test to differentiate the white patch of
pseudomembrane from the patch of white lesions

21. Erythematous Candidosis
1. Acute
2. Chronic
CAUSE:
• Imbalance in the oral flora produced by
antibiotics and Corticosteroids

22. Acute Erythematous Candidosis
CAUSE:
Increased population of lactobacilli causes a
decrease in pH, which diminishes the Candida
population and this in turn results in the reduction
of lactobacillus population. When the lactobacilli
are destroyed by antibiotic therapy then the
Candida organisms flourish.

23. Acute Erythematous Candidosis
CLINICAL FEATURES:
• NO pseudomembrane
• Widespread erythema and
soreness of mucosa
• Generalized burning
sensation,
• Diffuse red oral and perioral
tissue
• Painful Mucosa
• Epithelium THIN and ATROPHIC

24. Hyperplastic Candidosis
• Chronic Keratotic Candidosis/ Candidal
leukoplakia
• characterized histologically by parakeratosis and
chronic intraepithelial inflammation with fungal
hyphe invading the superficial layer of epithelium
• It’s a Premalignant lesion
• More common in smokers
• Excessive keratinization

25. Hyperplastic Candidosis:
CLINICAL FEATURES:
• Buccal mucosa
• Commissures of lip
• Bilateral
• Raised , Irregular, Palpable
• White plaque, hard and
rough to touch
• Speckled or Nodular

26. Hyperplastic Candidosis:
• Excessive
keratinization
• The white patch
cannot be peeled off
• Diagnosis is
confirmed by biopsy
• Organism is identified
with routine
Hematoxylin and
Eosin stains OR
periodic acid-Schiff
stain

27. Hyperplastic Candidosis:
TREATMENT:
• Nystatin (topical
application) 6-times
daily for 14-days
• Surgical stripping
which may recur
• Close follow up of
these type of
patients

28. Candidal lesion associated with
Angular cheilitis
• Erythema and
cracking at angle
of mouth

29. Candidal lesion associated with
Median rhomboid Glossitis
• Depapillation on
midline of dorsum of
tongue
• Rhomboid shaped
• Surface is red, white
or yellow