Podcast
Questions and Answers
What is the most common organism associated with oral candidosis?
What is the most common organism associated with oral candidosis?
Which of the following is a predisposing factor for oral candidosis?
Which of the following is a predisposing factor for oral candidosis?
What is indicative of acute pseudo-membranous candidosis (thrush)?
What is indicative of acute pseudo-membranous candidosis (thrush)?
Which antifungal medications are commonly used for oral candidosis management?
Which antifungal medications are commonly used for oral candidosis management?
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What histological feature is associated with thrush?
What histological feature is associated with thrush?
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Which condition is characterized by inflammation associated with denture wear?
Which condition is characterized by inflammation associated with denture wear?
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Which patient population is more likely to present with neonatal thrush?
Which patient population is more likely to present with neonatal thrush?
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What is a management step for acute pseudomembranous candidosis?
What is a management step for acute pseudomembranous candidosis?
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What is the mechanism of action for azoles in antifungal therapy?
What is the mechanism of action for azoles in antifungal therapy?
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Which of the following azoles is known to have high CNS penetration?
Which of the following azoles is known to have high CNS penetration?
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What side effect is commonly associated with Amphotericin B?
What side effect is commonly associated with Amphotericin B?
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Which azole is primarily used in the treatment of intestinal fungal infections?
Which azole is primarily used in the treatment of intestinal fungal infections?
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Which antifungal drug is not well absorbed when taken orally?
Which antifungal drug is not well absorbed when taken orally?
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What is a characteristic sign of angular stomatitis?
What is a characteristic sign of angular stomatitis?
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Which of the following treatments is recommended for denture induced stomatitis?
Which of the following treatments is recommended for denture induced stomatitis?
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What pathology is observed in chronic hyperplastic candidosis?
What pathology is observed in chronic hyperplastic candidosis?
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Which condition is associated with a low CD4 cell count, commonly seen in HIV positive patients?
Which condition is associated with a low CD4 cell count, commonly seen in HIV positive patients?
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What is the primary treatment for angular stomatitis when associated with oral candidosis?
What is the primary treatment for angular stomatitis when associated with oral candidosis?
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What is one consequence of the overuse of topical antibiotics in the mouth?
What is one consequence of the overuse of topical antibiotics in the mouth?
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Which antifungal drug primarily works by binding to ergosterol in fungal cell membranes?
Which antifungal drug primarily works by binding to ergosterol in fungal cell membranes?
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What might be a necessary treatment for angular stomatitis related to anemia?
What might be a necessary treatment for angular stomatitis related to anemia?
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Study Notes
BDS IV Oral Candidiasis
- Oral candidiasis is a fungal infection in the oral cavity
- Key speaker is Prof. Mohamed Al Ismaili, Head of Oral Surgery
- Learning objectives include classification of oral candidal infections, anti-fungal medication discussion (indications, contraindications, drawbacks), and referral criteria.
Candida
- Candida is a yeast-like fungus commonly found in the oral cavity
- Candida albicans is the most commonly cultured type, associated with disease and opportunistic overgrowth
Opportunistic Mycosis
- Some fungi are normal commensals (e.g., in the mouth, gut, vagina).
- Usually balanced by other microorganisms (like lactobacilli)
- Can become problematic with compromised immune responses (e.g., AIDS, antibiotic use, chemotherapy, radiation, alcoholism).
Predisposing Factors
- Immunodeficiency (e.g., DM, AIDS)
- Immunosuppression (e.g., steroid inhalers)
- Anemia
- Broad-spectrum antibiotics
- Xerostomia (dry mouth)
- Denture wearing
- Smoking (increased risk of thrush)
Classification
-
Acute:
- Acute pseudo-membranous candidosis (thrush)
- Acute antibiotic stomatitis
-
Chronic:
- Denture-induced stomatitis
- Chronic hyperplastic candidosis
- Chronic mucocutaneous candidosis
- Erythematous candidosis
Acute Pseudomembranous Candidosis (Thrush)
- Characterized by easily scraped-off, creamy patches on an erythematous mucosa (e.g., in the oropharynx).
- Often associated with angular cheilitis or angular stomatitis
- Affects infants, elderly, and immunocompromised individuals
- Neonatal thrush is due to immune system immaturity and birth canal infection
Thrush Pathology
- Smear reveals many Gram-positive hyphae
- Histology shows hyphae invading superficial epithelium, proliferative inflammation, and neutrophils are present ( acute inflammation cells are neutrophils + basophils + esinophils + monocytes + macrophage )
- chronic inflammation cells are Monocytes + macrophage + lymphocytes + plasma cells + fibroblast )
Thrush Management
- Remove the cause (e.g., stop topical antibiotics)
- Control local causes
- Use Nystatin or Amphotericin lozenges
- Address systemic issues if thrush persists (e.g., immunodeficiency, anemia, HIV)
- Systemic fluconazole (1000mg OD x 2 weeks)
Acute Antibiotic Stomatitis
- Frequent or excessive use of antibiotics suppresses normal oral flora
- Results in generalized erythematous and sore oral mucosa
- May show thrush
- Resolves with antibiotic withdrawal or topical antifungal assistance
Angular Stomatitis
- A characteristic sign of candidiasis, with infected saliva leakage at the mouth corners.
- Can be associated with thrush, denture wearers, and chronic hyperplastic candidosis
- Iron deficiency anemia
- Co-infection with Staphylococcus aureus and Beta-hemolytic streptococci are possible.
- Treatment: Treat intra-oral candidal infection and topical fusidic acid cream ( fusidic acid is against staphylococcus aureus )
Denture-Induced Stomatitis
- Deprivation of the underlying mucosa from salivary protective action
- Trauma from occlusion
- Asymptomatic erythema area, possible in conjunction with angular stomatitis
- More common in smokers
- Denture care and hygiene are important to treat this
Denture-Induced Stomatitis: Pathology
- Gram-stained smear shows candidal hyphae and yeast forms
- Histology shows acanthosis and chronic inflammation
- acanthosis : a thickening of the epidermis and elongation of the rete ridges due to thickening of the spinous layer
Denture-Induced Stomatitis: Management
- Improving denture hygiene
- Removing occlusal trauma
- Soaking the denture in 0.1% hypochlorite or 0.2% chlorhexidine overnight
- Topical Miconazole gel on denture fitting surface twice daily
- Treating underlying systemic issues (e.g., anemia).
- Systemic fluconazole, if unresponsive to local treatments
Erythematous Candidosis
- Patchy red mucosal macules due to Candida albicans (often in HIV positive patients with low CD4 counts).
- Affects the hard palate, soft palate, and tongue dorsum
- Linear gingival erythema (this is in attached gingiva without involving papilla) , potential for desquamating gingivitis (will involve both attached gingiva and papilla)
- Treatment: Itraconazole
Chronic Hyperplastic Candidosis
- White, folded plaques behind mouth angles.
- Associated with smokers, poor denture hygiene
- Hyphae invasion of the parakeratin layer
Median Rhomboid Glossitis
- Rhomboid-shaped, erythematous patch on midline dorsal tongue.
- Usually asymptomatic.
- Epithelial hyperplasia with neutrophils in the parakeratin layer.
Antifungal Drugs
-
Polyenes: (e.g., Amphotericin B, Nystatin)
- Work on cell membranes, altering ergosterol function and leading to cell membrane disruption
- Amphotericin B is given intravenously or topically (poor oral absorption); not well-tolerated but effective in systemic infections.
- Nystatin is topical only.
-
Azoles: (e.g., Ketoconazole, Miconazole, Fluconazole, Itraconazole)
- Inhibit ergosterol synthesis.
- Often preferable to polyenes for oral infections
- Fluconazole is well-tolerated and commonly prescribed for systemic candidosis; high CSF penetration.
- Miconazole and Ketoconazole are often prescribed topically.
- Itraconazole has poor absorption and does not cross the blood-brain barrier, so it is less-preferred for CNS issues.
- Imidazoles (e.g., Ketoconazole, Miconazole, Fluconazole, Itraconazole) are frequently used, due to their fungistatic action against fungi and dermatophytes, and their resistance to changes in 14-demethylase.
-
miconazole and fluconazole interact with warfarin and with statins (myopathy )
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Description
This quiz focuses on oral candidiasis, a fungal infection in the oral cavity. Led by Prof. Mohamed Al Ismaili, the quiz covers classification, antifungal medications, and the impact of various predisposing factors. It aims to enhance understanding of opportunistic mycosis and its management in dental practice.
