oral surgery presentation

1. Oral candidiasis
Muhammad Ansar khan

2. Introduction
• It is the most prevalent opportunistic infection in the oral cavity .
• Caused by candida ablicans.
• Exact pathogenesis unknown but caused by local and general
predisposing factors .

4. Predisposing factors
• Weakened immune system
• Xerostomia
• Nutritonal defeciency
• Antibiotic use
• Radiation therapy or chemotherapy
• Dentures
• Diabetes
• Smoking
• Other medical conditions like sjogren syndrome

5. Pseudomembranous candidosis
• It presents clinically as white plaques on oral mucosa that can be
rubbed off.
• On removal erythematous mucosa appears which is called thrush.
• It is superficial infection of outer layers of epithelium.
• Also present as burning sensation and pain.
• Multiple eroded areas in the oral cavity ,in children it can be painless.

7. Atrophic candidosis
• It presents as red patch on mucosa.
• Erythematous raw and painful mucosa.
• Antibiotics sore mouth also presents as atrophic candidosis.
• It presents as
• Oral burning
• Bad taste
• Patients wit iron deficiency anemia may also develop atrophic
candidosis.

9. Hyperplastic candidosis
• Also known as Candidal leukoplakia associated with chronic infection
of oral mucosa.
• More likely to occur in smoker.
• It can lead to epithelial neoplasia.
• It presents as a fixed white patch at the commissures of the
mouth,other areas like palate may also be effected but tongue less
effected.

11. Candida associated lesions
• Candida associated denture stomatitis
• Angular cheilitis
• Median rhomboid glossitis

12. Angular cheilitis associated with candida
• A candidal infection of the corners of the mouth, with crusted red raw
fissures that are sore and easily bleed when the mouth is opened
wide.
• Over exposed to
saliva

13. Candida associated denture stomatitis
• Mild erythema or redness under the denture.
• The redness is only associated with denture wearing areas.
• Usually no complaint of pain.
• Common in denture wearers.
• Bad hygiene or diabetes can be predisposing factors.
• Candida accumulation under denture causes increase enzymatic
activity which leads to decrease ph and causes inflammation.
• It can be pinpoint lesions,diffuse or granular.

15. Candida associated median rhomboid
glossitis
• Area of depapillation on medline of the dorsum of tongue .
• Classically rhomboid shape hence the name
• The surface may be red ,white or yellow in appearance.
• It is mostly caused by candida in chronic debilitating disease.
• The tongue also becomes deeply fissured.

17. Chronic mucocutaneous candidosis
• Chronic mucocutaneous candidiasis (CMC) refers to a heterogeneous
group of disorders characterized by candidosis of the oral cavity,skin
and fingernails may occur with or without generalized disease
process.
• The lesions in CMC are initially thrush like but eventually resemble
hyperplastic candidosis.
• The skin also consist of widespread infection of skin and scalp.
• Lesions of lips also occurs

19. Investigations
• Clinical examination of the lesion
• Swab my be collected from the area
• Culture test
• Biopsy i.e lesion not responding to treatment
• Blood test

21. Treatment
• Predisposing factors should be identified.
• The underlying condition responsible for candiasis should be treated.
• The first step in treatment of candisos is topical antifungals like
amphotericin and nystatin.
• In severe condition systemic Fluconazole and itraconazole may be
used.

23. Carcinoma in situ
• Occurs in skins ,mucous membranes and oral cavity.
• Early carcinoma in situ of the oral cavity is a slightly elevated grey-
white plaque either well defined or which blends in gradually with
surrounding mucosa.
• Also presents as redened mucosa or ulcerated areas.

24. • It’s common site is Floor of mouth ,tongue and lips.
• It has combined features of leukoplakia and erytroplakia.
• Common in smokers.
• Common in elderly with male predilection.
• Epithelial dysplasia don’t cross connective tissue.
• Most severe premalignant lesion.

25. Histological features
Dysplastic epithelial cells which don’t cross connective tissue.
• Also called intraepithelial dysplasia.
• Keratin may or may not be present but if present will be parakeration
• Indiviual cell keratinization or keratin petals rare.
• Loss of orientation and polarity of cells.

26. Treatment
• Avoid aggravating habits, for example, quit smoking.
• Surgical excision
• CO2 laser — excision or vaporisation
• Oher options include retinoids (acitretin or isotretinoin),
photodynamic therapy.
• Follow up.