Denture-Related Stomatitis and Oral Candidiasis Quiz

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Questions and Answers

What are the three clinical types of denture-related stomatitis according to Newton's classification?

Type 1 is localized simple inflammation, Type 2 is generalized erythema, and Type 3 is inflammatory papillary hyperplasia.

What is a key diagnostic finding for denture-related stomatitis?

The clinical presentation of erythema and edema on the palatal mucosa covered by the denture base.

What topical treatments are commonly used for denture-related stomatitis?

Topical applications of nystatin or miconazole are commonly used.

List two systemic factors that can condition the development of candidosis.

Immunosuppression and diabetes. Signup and view all the answers

Where does angular cheilitis typically occur on the body?

Angular cheilitis occurs at the commissures or angles of the lips. Signup and view all the answers

What are the 3Ds that predispose individuals to angular stomatitis?

Denture-wearing, dry mouth, and tobacco smoking. Signup and view all the answers

Which infectious agents are most commonly associated with angular cheilitis?

Candida albicans and streptococcus aureus. Signup and view all the answers

How do nutritional deficiencies contribute to the development of angular stomatitis?

Deficiencies, especially of iron and B vitamins, can impair healing and immunity. Signup and view all the answers

What are the four classifications of oral candidiasis?

<ol> <li>Acute pseudomembranous candidosis (thrush), 2) Acute atrophic candidosis, 3) Chronic hyperplastic candidosis, 4) Chronic atrophic candidosis.</li> </ol> Signup and view all the answers

Which species of Candida is most commonly associated with oral candidiasis?

Candida albicans is the most dominant species associated with oral candidiasis. Signup and view all the answers

Name two local factors that can predispose an individual to oral candidiasis.

Xerostomia from drugs or radiotherapy and the use of dental appliances. Signup and view all the answers

What diagnostic test is essential for confirming chronic hyperplastic candidiasis?

Biopsy and histopathological examination are necessary to confirm chronic hyperplastic candidiasis. Signup and view all the answers

Describe the role of chlorhexidine in the management of oral candidiasis.

Chlorhexidine helps improve oral hygiene and possesses some anti-candidal activity. Signup and view all the answers

What is the recommended topical antifungal treatment for oral candidiasis?

Nystatin is a commonly used topical antifungal for treating oral candidiasis. Signup and view all the answers

How can individuals with oral candidiasis improve treatment effectiveness while using dentures?

Patients should leave their dentures out while topical antifungal tablets dissolve in the mouth. Signup and view all the answers

List one systemic factor that can contribute to the risk of developing oral candidiasis.

Poorly controlled diabetes mellitus is a notable systemic factor. Signup and view all the answers

What topical antifungal is recommended for treating angular stomatitis?

Miconazole is the recommended topical antifungal. Signup and view all the answers

How should a Staphylococcus infection be treated topically?

Topical antibiotics such as fusidic acid ointment or cream should be used. Signup and view all the answers

Which infection responds best to topical miconazole when present simultaneously with Staphylococcus?

A mixed infection of Candida and Staphylococcus responds best to miconazole. Signup and view all the answers

What are potential mechanical changes that may be necessary to treat angular stomatitis?

A change in dentures to correct facial contour may be necessary. Signup and view all the answers

Describe the appearance of median rhomboid glossitis.

It presents as a depapillated rhomboidal area on the tongue's dorsum, often reddish or white. Signup and view all the answers

Is median rhomboid glossitis generally painful, and how might it be discovered?

It is rarely sore and is often detected incidentally by patients or dentists. Signup and view all the answers

What histological features are commonly observed in median rhomboid glossitis?

It shows atrophic stratified squamous epithelium and a mildly infiltrated stroma. Signup and view all the answers

Is biopsy frequently indicated for the diagnosis of median rhomboid glossitis?

No, biopsy is rarely indicated as MRG is usually diagnosed clinically. Signup and view all the answers

What factors contribute to the inadequate wearing of dentures in edentulous patients?

Mechanical factors and deficiencies of haematinic such as iron, vitamin B, and folic acid contribute to inadequate denture wear. Signup and view all the answers

What is the initial sign of anemia or vitamin deficiency that may appear as angular stomatitis?

Angular stomatitis can occasionally be an isolated initial sign of anemia or vitamin B12 deficiency. Signup and view all the answers

Describe the clinical features of angular cheilitis.

Angular cheilitis typically presents as soreness, erythema, and fissuring at the mouth's angles, with features like ulceration and crusting. Signup and view all the answers

What common oral condition is associated with angular cheilitis in denture wearers?

Denture-related stomatitis is commonly associated with angular cheilitis in denture wearers. Signup and view all the answers

How can nutritional deficiencies be identified through tongue examination?

Nutritional deficiencies may be indicated by a depapillated tongue in iron deficiency and a glossy red tongue in folate deficiency. Signup and view all the answers

What is a key management step for treating angular cheilitis?

A key management step includes eliminating underlying systemic predisposing factors and treating any infections. Signup and view all the answers

What role does candidiasis play in angular cheilitis, particularly for denture wearers?

Candidiasis can cause angular cheilitis, especially in denture wearers where it may thrive beneath the dentures. Signup and view all the answers

What preventive measure is recommended to reduce recurrence of angular cheilitis?

Preventing recurrence of angular cheilitis involves eliminating the organism from its reservoir and treating underlying conditions. Signup and view all the answers

What is the recommended management for individuals with erythematous candidiasis in HIV disease?

Management includes stopping tobacco habits and initiating antiretroviral treatment. Signup and view all the answers

What are the characteristic lesions of chronic hyperplastic candidiasis?

Chronic hyperplastic candidiasis presents as persistent white patches, often seen as raised lesions on the oral mucosa. Signup and view all the answers

How is median rhomboid glossitis typically treated?

No treatment is necessary for median rhomboid glossitis unless it is nodular, in which case it may be removed for evaluation. Signup and view all the answers

What is the significance of the 'thumbprint lesions' in the diagnosis of erythematous candidiasis?

Thumbprint lesions are irregular erythematous macules and patches found on the central palate indicative of erythematous candidiasis. Signup and view all the answers

What are the histological features characterizing chronic hyperplastic candidiasis?

It is characterized histologically by parakeratosis and chronic intraepithelial inflammation with fungal hyphae. Signup and view all the answers

What systemic antifungal medication is typically indicated for patients with chronic hyperplastic candidiasis?

Systemic fluconazole is usually indicated for chronic hyperplastic candidiasis. Signup and view all the answers

What is the significance of biopsy in diagnosing candidal leukoplakias?

Biopsy is essential to distinguish candidal leukoplakias from other lesions and to check for possible epithelial dysplasia. Signup and view all the answers

What factors contribute to the development of chronic hyperplastic candidiasis?

Major contributing factors include vitamin deficiency and generalized immune suppression. Signup and view all the answers

In which demographic does candidal leukoplakia predominantly occur?

Candidal leukoplakia is primarily found in adults. Signup and view all the answers

What factors influence the prognosis of candidal leukoplakias?

Prognosis is influenced by risk factors such as tobacco and alcohol use, whether the lesion is speckled or homogeneous, and the presence and degree of epithelial dysplasia. Signup and view all the answers

What treatment was reported for chronic hyperplastic candidosis?

The treatment for chronic hyperplastic candidosis involved the systemic antifungal agent, fluconazole. Signup and view all the answers

What distinguishes chronic mucocutaneous candidiasis (CMC) from other candidal conditions?

CMC is characterized by persistent, severe, and diffuse candidal infections affecting the skin, nails, and mucous membranes. Signup and view all the answers

What are the primary approaches to therapy for chronic mucocutaneous candidiasis?

The main treatment strategies for CMC include prolonged antifungal therapy and attempts to address the underlying immune defect. Signup and view all the answers

Study Notes

Candidiasis Overview

Candidiasis encompasses a group of yeast-like fungal infections affecting skin and mucous membranes.
Oral candidiasis, specifically, is categorized into four types: acute pseudomembranous (thrush), acute atrophic (erythematous), chronic hyperplastic, and chronic atrophic (erythematous).

Predominant Oral Species

C. albicans is the most frequent oral species, followed by Candida tropicalis, Candida glabrata, Candida parapsilosis, Candida krusei, and other Candida species (less common).
Some Candida species are rare and transient.

Predisposing Factors

Local factors: xerostomia (dry mouth), caused by medications or radiotherapy, antibiotic therapy (particularly broad spectrum), corticosteroids, heavy smoking, and dental appliances.
Systemic factors: poorly controlled diabetes mellitus, extremes of age, nutritional deficiencies (iron, vitamin B12, folic acid), immunosuppressive drugs (corticosteroids, cytotoxic chemotherapy), and immunodeficiency (hereditary or acquired, like HIV).

Diagnostic Tests

Smear and stain: a sample from the affected area is stained using Gram's stain or PAS (periodic acid-Schiff) to visualize Candida hyphae.
Culture: swabs and oral rinses are cultured to identify the specific Candida species.
Biopsy and histopathology: a biopsy examination allows for confirming chronic hyperplastic candidiasis and checking for dysplasia (precancerous changes).

Management of Candidiasis

Lifestyle modifications: avoiding or reducing smoking, treating local predisposing causes (like xerostomia), and improving oral hygiene (chlorhexidine has anti-candidal activity).
Topical antifungals: medications like nystatin and miconazole gel are often applied to the affected areas, frequently placed on dentures.
Systemic antifungals: fluconazole is for treating resistant cases.
Prophylactic antifungals: necessary for patients with HIV, cancer chemotherapy, immunosuppressive therapy, or prolonged antibiotic use.

Acute Pseudomembranous Candidiasis (Thrush)

Definition: Candida albicans accumulates on the oral mucosa, causing a characteristic white-fleck appearance resembling a bird.
Causes: observed in healthy individuals when oral microflora is altered by antibiotics, corticosteroids, or xerostomia. Frequently complicates corticosteroid inhaler use.

Symptoms and Clinical Features

Creamy white lesions on the tongue, inner cheeks, and sometimes on the roof of the mouth, gums, and tonsils.
Lesions resemble cottage cheese and can sometimes be painful or bleed slightly when touched.
Severe cases, lesions can spread to the esophagus, causing difficulty swallowing or the feeling of food getting stuck.

Tests and Diagnosis

Diagnosis is typically made by observing the visible lesions.
Microscopic examination of a sample is occasionally used to confirm.
More serious cases may require throat cultures, endoscopic examinations, or barium swallows.

Treatment and Drugs

Treatment goals are to prevent fungal spread and balance gut bacteria.
Children: adding unsweetened yogurt and antifungal medications.
Infants and nursing mothers: mild topical antifungal medications or oral creams.
Healthy adults: using unsweetened yogurt, acidophilus capsules/liquids, or antifungal medications.
Weakened immune systems: antifungal medications in various forms (lozenges, tablets, or swish-and-swallow liquids).

Atrophic (Erythematous) Candidiasis

Characterized by red lesions.
In some cases, can precede or be a consequence of pseudomembranous candidiasis.
Related conditions include denture-related stomatitis, antibiotic-induced stomatitis, and median rhomboid glossitis, especially in HIV infection.

Mild inflammation and erythema beneath dentures, typically complete upper dentures.
Erythematous area restricted to the denture-wearing zone.
Rare complications include angular stomatitis and papillary hyperplasia of the palate.
Classification (Newton's types) into localised inflammation or pinpoint erythema (type 1), a more diffuse erythema involving parts of or entire denture-covered mucosa (type 2), and a granular type of inflammation commonly affecting the hard palate and alveolar ridge (type 3).

Clinical assessment—inspection of erythema and oedema on the palatal mucosa under dentures.
Confirmation via a smear of the palate (periodic acid-Schiff stain) may reveal Candida.

Address any underlying systemic issues.
Correct any mechanical factors (e.g., denture fit).
Apply topical antifungals (nystatin, miconazole).
Systemic antifungals (fluconazole) in severe cases.

Median Rhomboid Glossitis (MRG)

Characterised by a depapillated, typically reddish- or white-colored, painless, well-defined, rhomboidal area in the middle of the tongue's surface.
Uncommon and typically found in adults.

Diagnosis of MRG

Generally a clinical diagnosis.
Biopsy might be necessary in certain cases for confirming the diagnosis.

Treatment of MRG

No treatment is usually necessary.
Antifungal therapy (topical or systemic) may help reduce inflammation related to Candida infection.

Erythematous Candidiasis in HIV Disease

Uncommon finding.
Observed as irregular erythematous patches generally on the tongue's surface, hard palate, or buccal mucosa.
May also present as 'thumbprint' lesions in the palate region.

Diagnosis of Erythematous Candidiasis in HIV Disease

Often diagnosed clinically.
Rarely, smears or culture might be required if unsure based on the clinical evaluation.

Chronic Hyperplastic Candidiasis (Candidal Leukoplakia)

Persistent white lesion on the commissures of the oral mucosa.
Associated with Candida albicans and systemic co-factors like vitamin deficiency or immune suppression.
Without treatment, some lesions may show dysplasia, potentially progressing into carcinomas.

Diagnosis of Chronic Hyperplastic Candidiasis

Clinically the lesion can be identified.
A biopsy can distinguish it from other white lesions. Candida hyphae are confirmed using periodic acid-Schiff (PAS) stain.
Additional investigation to check for dysplasia is required.

Treatments and Prognosis of Chronic Hyperplastic Candidiasis

Treatment strategies include systemic anti-fungal therapy (fluconazole).
Overall prognosis and risk factor of progression to a carcinoma vary. Possible variables include lesion characteristic and degree of dysplasia.

Chronic Mucocutaneous Candidiasis (CMC)

CMC is a serious condition that represents a group of overlapping syndromes, characterized by persistent, widespread, and often severe infections with Candida that affect the skin, nails, and mucous membranes.

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Description

Test your knowledge on denture-related stomatitis and oral candidiasis. This quiz covers Newton's classification, key diagnostic findings, common treatments, and risk factors associated with these conditions. Gain insight into the infectious agents and nutritional deficiencies that impact oral health.