Candidasis

Question 1

Organism responsible for candidasis?

Answer 1

Candida Albicans

Question 2

Candida albicans is a dimorphic fungus with 2 states which are…?

Answer 2

Vegetative state ( healthy person )
Active state
-Fungus in hyphal form, with ability to invade superficial layers of mucosa

Question 3

What are the general factors that play a role for candida infection to develop

Answer 3

Host immune status
Oral mucosal environment
Strain of C. Albicans

Question 4

Infection rates are higher in patients with…

Answer 4

diabetes
alcoholism
malnutrution
HIV infection

Question 5

Candida is classified into 2 categories

Answer 5

Acute
chronic

Question 6

Acute pseudomembranous candidasis ( thrush ) —> CF

Answer 6

non-adherent plaques on oral mucosa tongue dorsum and palate
soft, friable
looks like cottage cheese
easily scraped off
diffuse underlying red mucosa

Question 7

Acute erythematous candidasis CF

Answer 7

More common than pseudomembranous candidasis
Whitish component not a prominent feature

Focal/diffuse loss of papillae on tongue
DIffuse erythema of oral mucosa

Painful

Shortly after gving broad spectrum ABS
Xerostomia

Question 8

How can the prescription of broad spectrum antibiotics result in acute erythematous candidasis?

Answer 8

Antibiotics suppress normal competing commensal organisms in mouth resulting in fungal overgrowth

Question 9

DDx erythematous candidiasis

Answer 9

Vitamin B/folate deficiency
iron deficiency anemia
syphilitis glossitis

Question 10

Symptoms acute pseudomembranous candidasis

Answer 10

Asymptomatic
Burning sensation of the mucosa
Bitter taste

Question 11

General differences between chronic and acute candidasis lesions

Answer 11

Acute occurs more rapidly and associated with antibiotics
while chronic is long standing ( immunosuppresion related )

Question 12

Difference between acute and chronic pseudomembranous candidiasis

Answer 12

Acute is rapid and occurs within a short duration
Usually due to broad spectrum candidasis
Chronic has a slow onset, long standing and usually is due to immunologic issues

Question 13

Chronic erythematous candidasis may present as ?

Answer 13

Angular cheilitis
- skin folds at commissures
- erythema, erosion /fissuring
- crusting

associated with older patients with non-functional dentures, loss of vertical dimension of occlusion
saliva accumulates in skin folds
areas kept moist
secondary colonization by C. Albicans

Denture stomatitis

Cheilocandidiasis
more extensive than angular

Median rhomboid glossitis
chronic multifocal candidasis

Question 14

CF of chronic erythematous candidiasis — Median Rhomboid Glossitis

Answer 14

Central papillary atrophy of tongue
anterior to circumvallate papillae
smooth lobulated and painless

Congenital lack of langerhans cells in particular area

Question 15

Chronic hyperplastic candidasis CF

Answer 15

Often found on anterior buccal mucosa
Tongue dorsum
Adherent rough white plaque
cannot rub off

usually middle aged men who smoke

Question 16

DDx of chronic hyperplastic candidiasis

Answer 16

leukoplakia

Question 17

Diagnosis of Chronic hyperplastic candidasis

Answer 17

Incisional biopsy ,even if we see lesion with candida organisms in superficial layer it can still be leukoplakia

Question 18

Treatment chronic hyperplastic candidasis

Answer 18

Antifungal treatment

Question 19

Chronic Mucocutaneous candidiasis importance in dentistry

Answer 19

It may present as endocrine-candidiasis syndrome
Auto-immune polyendocrinopathy candidiasis ectodermal dystrophy syndrome
Auto-immune polyendocrinopathy syndrome type 1

Question 20

Chronic mucocutaneous candidiasis is associated with which endocrinopathies

Answer 20

DM
Hypoparathyroidism
Hypoadrenocorticism
Hypothyroidism

Question 21

Treatment Chronic mucocutaneous candidiasis

Answer 21

Controlled with continuous systemic antifungals

Question 22

Diagnosis of angular chielitis, cheilocandidiasi, gingival erythema,denture stomatitis, MRG?

Answer 22

They are all clinical diagnosis

Question 22

Diagnosis of angular chielitis, cheilocandidiasi, gingival erythema,denture stomatitis, MRG?

Answer 22

They are all clinical diagnosis

Question 23

Diagnosis pseudomembranous candidiasis

Answer 23

Smear biopsy for a PAS stain , a clincal diagnosis can be made as well

Question 24

Diagnosis hyperplastic candidasis

Answer 24

incisional biopsy indicated, even if hyphae present, the candidiasis may super impose the underlying leukoplakia. patient should be treated with anti fungals. If lesions disappears —> no leukoplakia

Question 25

What types of smear biopsys are indicated for candidiasis

Answer 25

Histo chemical stains like PAS ( periodic acid schiff ) or GMS ( Grocott Gomori Methenamine silver )

Question 26

Management of candidiasis

Answer 26

Diagnosis

Removal load of fungal components
- Good OH ( tongue brushing/scraping )
- Good denture hygiene
Appropriate anti-fungal

Address predisposing factors

Prevent reoccurences

Question 27

Appropriate Anti-Fungals for Candidiasis

Answer 27

Nystatin - polyene agent
nystatin suspension 1:100 000
4ml 4x a day for 10-14 days
Hold in mouth as long as possible
Dont rinse/eat for 60 minutes

Miconazole ( angular cheilitis )
Imidazole agent 20 mg
4x

Clotrimazole ( angular cheilitis )
Imidazole agent
10mg lozenges
5x

Amphotericin B
10mg lozenges
dissolve in mouth
4x

Chlorhexidine
complementary mouth wash
rinse 10ml for 2min
2x
not within 30minutes of tooth brushing or anti-fungal agent