Candidal Infections

Usually caused by candida albicans.

Predisposing factors include :

• Depressed cell mediated immunity (e.g. diabetes)
• Interference with normal microbial flora by the use of antibiotics
• Iron deficiency
• Denture wearing
• Xerostomia
• Corticosteroid inhalers
• Elderly
• Local factors e.g. trauma

CLASSIFICATION

Acute pseudomembranous candidosis (thrush )

White flecks that wipe off to leave a red raw surface

Acute pseudomembranous candidosis of the palate

Acute atrophic candidosis

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Chronic atrophic candidosis of the tongue

Chronic hyperplastic candidosis

Commonly on the buccal mucosa just inside the commissure of the mouth and does not wipe off.

Mainly in middle aged male smokers and has a malignant potential.

May not respond to antifungals.

Consider referral for biopsy

Denture induced stomatitis

Common condition

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AETIOLOGY

Candidal infection associated with poor denture hygiene

PRESENTATION

Uniform erythema underneath the denture bearing. Generally it is asymptomatic

TREATMENT

• Improvement in denture hygiene (soaking in weak bleach or chlorhexidine)
• Concurrent antifungal therapy (e.g. nystatin pastilles or miconazole gel)

Angular cheilitis

AETIOLOGY

Combined staphylococcal, streptococcal and candidal infection involving the tissues at the angle of the mouth.

It is often with an underlying precipitating factor such as iron deficiency and often seen with denture induced stomatitis.

PRESENTATION

Red, cracked macerated skin at the angles of the mouth, often with a yellow crust.

TREATMENT

• Miconazole gel which is active against all three infecting organisms which should be continued for up to 10 days following clinical resolution of the lesion.
• Correction of any underlying factors should also be carried out (eg. correct anaemia, correct occlusal vertical dimension of dentures)

Angular cheilitis