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Candidiasis

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oral pathology

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Candidiasis

  1. 1. Oral Candidiasis Deepak K Gupta
  2. 2. • Also known as moniliasis or thrush or candidosis • Caused by the infection with yeast like fungus Candida albician. • Other causative organism may be Candida tropicalis, Candida famata, Candida krusei www.facebook.com/notesdental
  3. 3. Classification • Primary Oral Candidiasis – ACUTE • Pseudomembranous • Erythematous – CHRONIC • Hyperblastic • Erythematous • Pseudomembranous – CANDIDA ASSOCIATED LESSION • Denture stomatitis • Angular stomatitis • Median rhomboid glositis – Keratinized primary lesion super infected with candida • Leukaplakia • Lichen planus • Lupus erythematous • Secondary candidiasis – Manifestation of Systematic mucocutaneous candidiasis – thymic aplasia and candida endocrinopathy syndrome www.facebook.com/notesdental
  4. 4. www.facebook.com/notesdental
  5. 5. Predisposing Factor • Change in oral microbial flora – Administration of antibiotics specially broad spectrum – Xerostomia secondary to anticholinergic agents – Salivary gland disease • Local Irritation – Denture, orthodontic appliance – Heavy smoking www.facebook.com/notesdental
  6. 6. Predisposing Factor • Drug therapy – Corticosteroid or cyto-toxic drug or immunosuppressive drug – Radiation therapy • Other systemic disease – Leukemia – Lymphoma – Diabetes – Tuberculosis – Epithelial dysplesia www.facebook.com/notesdental
  7. 7. Predisposing Factor • Malnutrition status – Low serum vit A – Pyridoxine – Iron level • Age • Infancy – Pregnancy – Old age www.facebook.com/notesdental
  8. 8. Predisposing Factor • Endocrine deficiency – Hypoparathyroidism – Hypothyroidism – Addison’s disease • Others – Tight fitting garments – Indwelling catheter www.facebook.com/notesdental
  9. 9. Pseudomembranous candidiasis • Thrush • Superficial infection of upper layer of oral mucous membrane • Fungal growth – desquamation of epithelial cell and accumaltion of bacteria, keratin and necrotic tissue forming pseudomembrane www.facebook.com/notesdental
  10. 10. Clinical features: Infants – 6th and 10th day after birth – Infection from maternal vaginal canal – Soft white/bluish whit, adherent patches on oral mucos – Painless – Removed with little difficulty www.facebook.com/notesdental
  11. 11. Clinical features : Adult – Site : roof of mouth, retromolar area, Mucobuccal fold – Sex: female – Prodromal symptom : rapid onset of bad taste and discomfort from spicy food – Burnig sensation – White plaque • pearly white or bluish white – resemble cottage cheese or curdled milk • Composed of tangled mass of hyphae, yeast, desquammated epithelial cell and debris • Easily wiped out – erythematous/atrophic area which is painful www.facebook.com/notesdental
  12. 12. Diagnosis • White lesion which can be scraped off easily • Diffrential diagnosis – Plaque from lichen planus – Leukolplakia – Chemical burn – Gangrenous stomatitis www.facebook.com/notesdental
  13. 13. Acute atrophic candidiasis • Antibiotics sore mouth • It may be squeal of pseudomembranous candidiasis after white patch has been shed off • AIDS patient • Prolonged drug therapy • Topical steroid • Broad spectrum antibiotics • Denture wearers www.facebook.com/notesdental
  14. 14. Clinical feature • Any site but mainly involves tongue or area facing prosthesis • Red or erythematous • Vague pain or burning sensation • Careful examination – white thickened foci that can be rubbed off www.facebook.com/notesdental
  15. 15. Diagnosis • Erythematous area with diminished host resistance • Differential diagnosis – Chemical burn – Drug reaction – Syphilitic mucus patches – Necrotic ulcer and gangrenous stomatitis – Traumatic ulcer www.facebook.com/notesdental
  16. 16. Chronic hyperplastic candidiasis • Candidal leukoplakia • Firm adherent white patches • Predominantly in men of middle age or above – heavy smokers • Site: cheek, lip and tongue • Appearance: firm and white leathery plaque www.facebook.com/notesdental
  17. 17. Clinical features • Persist without any pain for years • Doesn’t rubs off with lateral pressure • Slightly white to dense white with cracks and fissures occasionally • Vague border – epithelial dysplasia www.facebook.com/notesdental
  18. 18. Diagnosis • Firm and white leathery appearance which is difficult to rub • Diffrential diagnosis – Lichen planus – Hairy leukoplakia – Superficial bacterial infection – microscopic culture www.facebook.com/notesdental
  19. 19. Id Reaction • Secondary response characterized by localized or generalized sterile vesicopapular rash that is believed to be allergic response – candida antigen (monoloids) www.facebook.com/notesdental
  20. 20. Chronic atrophic candidiasis • Also known as Denture stomatitis • Manifestation of Erythematous candidiasis • Found under complete denture or partial denture – mostly under the palate • Speckeled curd like white lesion – patchy distribution • Soreness and dryness of mouth www.facebook.com/notesdental
  21. 21. Clinical sign • Bright red palatal tissue – edematous and granular • Sharply outline of redness • Multiple pinpoint foci of hyperemia usually involving the maxilla www.facebook.com/notesdental
  22. 22. Diagnosis • An erythematous are under complete denture • Diffrential diagnosis – Allergic reaction due to denture base – Erosive lichen planus – Dermatitis herpetiform www.facebook.com/notesdental
  23. 23. Treatment of oral Candidiasis • Topically or systematic • 7 days treatment • Oral symptoms disappears in 2-5 days • Relapse common – underlying immunodeficiency • Removal of causative factors – Ill fitting denture – Withdrawal or change of antibiotics – Proper cleaning of denture and use of antifungal agent www.facebook.com/notesdental
  24. 24. Topical treatment • Preferred – less systemic absorption • Effectiveness depends – entirely on patient compliance • Clotrimazole – antibacterial as well as antifungal property – 10 mg tablets – soluble in water – 5times a day • 1% genitian violet • Not ideal – causes unaesthetic staining www.facebook.com/notesdental
  25. 25. Topical Treatment • Nystatin – 2,00,000 unit Oral pastille – 5 times a day – dissolved in mouth – 1,00,000 unit oral suspension – 5 times a day – oral rinse in 20 ml of water • Amphotericin B – 0.1 mg/ml, 5- 10 ml oral rinse and expectorated – tds – Elixir containing tetracycline and amphotericin B – acute atrophic candidiasis – Triamcinolene + Nystatin - angular cheilitis www.facebook.com/notesdental
  26. 26. Topical Treatment • Mycostatin cream – 1,00,000 placed under tongue – tds – Oral rinse - tds – Adsorbable corticosteroid and antibiotic agent + mycostatin cream – accelerates symptomatic relief • Idoquinol – Antifungal and antibacterial property – Combined with corticosteroid – effective in angular chelitis www.facebook.com/notesdental
  27. 27. Systemic Treatment • Nystatin – 250 mg tds – 2 week followed by 1 troche per day for 3rd week • Ketaconazole – 200 mg tab with food, OD – Liver side effect – so continous monitoring needed in long term dose. – Acidic environment for absorption www.facebook.com/notesdental
  28. 28. Systemic Treatment • Itraconazole – 100/200 mg capsule – b.d. for 2 week • Fluconazole – 100 mg – o.d. for 2 week – Effective prophylactic agent www.facebook.com/notesdental
  29. 29. Reffrences • Shafer’s Textbook of Oral Pathology, 6th edition • Textbook of Oral medicine, Anil Govindrao Ghoom, 2nd edition • Burkitt’s Oral medicine, 11th edition www.facebook.com/notesdental
  30. 30. THANKS…… Like, share and comment on https://www.facebook.com/notesdental http://www.slideshare.net/DeepakKumarGupta2 www.facebook.com/notesdental

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