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4th yr- CMS- Infections > Fungal infections of the orofacial tissues > Flashcards

Fungal infections of the orofacial tissues Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

Give examples of fungal infections of the orofacial tissues

A
  1. Candida

2. Mould infections

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2
Q

Name the primary organism that causes candida

A
  1. Candida albicans is the most common

2. Candida glabrata

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3
Q

What risk factors increase candida

A
  1. smoking
  2. Dente/ orthodontic appliance wear
  3. Dry mouth
  4. Carbohydrate rich diets
  5. Immune modulating drugs
  6. Immunocompromise status
  7. Nutritional deficiency
  8. Local causes
  9. Acidic intraoral environment
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4
Q

List some immune modulating drugs that can increase risk of candida

A

Steroids like:

  1. Asthma presenter inhalers
  2. Topical creams
  3. Oral tablets
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5
Q

What can lead to Immunocompromise status

A
  1. Diabetes
  2. HIV
  3. Chemotherapy
  4. Radiotherapy
  5. Short term broad spectrum antibiotic use
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6
Q

List the different types of oral Candidosis

A
  1. Acute Pseudomembranous Candidosis
  2. Erythematous Candidosis
  3. Angular cheilitis
  4. Chronic hyperplastic Candidosis
  5. Chronic mucocutanous Candidosis
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7
Q

What is Acute Pseudomembranous Candidosis also known as

A

Thrush

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8
Q

Describe how Acute Pseudomembranous Candidosis looks

A

Creamy white plaques which may be wiped away leaving a raw looking erythematous base

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9
Q

In whom is cute Pseudomembranous Candidosis common in

A
  1. Babies or the elderly

2. Patients using broad spectrum antibiotics or steroid inhalers

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10
Q

What is Erythematous Candidosis also known as

A

Denture stomatitis

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11
Q

What is erythema a

A

Mucosal inflammation

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12
Q

What is the aetiology of Erythematous Candidosis

A

Multifactorial

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13
Q

Where is angular chelitis seen

A

At the corners of the mouth can be very sore

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14
Q

Who is at higher risk of developing chronic hyper plastic Candidosis

A

Smokers

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15
Q

Describe chronic hyper plastic Candidosis

A

It is a potentially malignant condition

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16
Q

Where does chronic hyper plastic Candidosis classically manifest

A 
Commissural mucosa (the anterior aspect of the buccal mucosa)
Possible dorsal tongue involvement
17
Q

How does chronic hyper plastic Candidosis present

A

As flat white crazed plaques

18
Q

Describe chronic mucocutaneous Candidosis

A

It is a group of overlapping syndromes that share a common clinical pattern of persistent, severe and diffuse mucocutaneous candela infections of the skin, nails and mucous membranes

19
Q

What is the unifying feature of all chronic mucocutaneous Candidosis infections

A

Hetrofenous disorder is impaired cel mediated immunity versus candida

20
Q

In whom does chronic mucocutaneous Candidosis manifest in

A

In infancy or early childhood

21
Q

How do we manage Candidosis infections

A
  1. Identify and modify risk factors
  2. Be sensitive when explaining the infection to the patient
  3. Swabs and oral rises can be useful (not routine)
22
Q

How are oral rinses does in a patient with Candidosis

A

Ask patietn to rinse around 30ml of sterilise saline for 30 seconds then wait into a time for culture and sensitivities

23
Q

What can bloods show in a patient with Candidosis

A
  1. Full blood count- anaemia
  2. Haematinics can reveal deficiencies in ferritin, B12
  3. HbA1C
  4. HIV serology
24
Q

As a dentist what should you do in a patient with Candidosis

A
  1. Identify Candidosis
  2. Explain to patietn sensitively
  3. Look for modifiable risk factors and implant appropriate management
  4. Consider prescribing antifungal medication
  5. Plan a review the patient
25
Q

Give examples of antifungal medications

A
  1. Chlorhexidene
  2. Polyenes
  3. Azoles
26
Q

What oral side effect can a patient taking Chlorhexidene have

A
  1. Discolouration teeth or dentures with long term use
  2. May experience taste disturbances
  3. dysaesthesias
27
Q

What are polyenes

A

A class of antifungals

28
Q

Give examples of polyenes

A

nystatin

amphotericin

29
Q

How is nystatin prescribed

A

Nystatin suspension is prescribed as 100,000 units or 1ml QDS for 2 weeks after food, with dentures out and no eating or drinking for 1 hour after

30
Q

How do polyenes work

A

They bind ergosterol in the fungal cell wall causing depolarisation of the cell membrane
This leads to pore formation int eh membrane leadign to lysis and cell death

31
Q

What can Amphotericin stimulate

A

Can stimulate host immune cells leadign to significant side effects

32
Q

Give examples of azoles

A
  1. Miconazole,
  2. fluconazole,
  3. itraconazole,
  4. posaconazole
33
Q

How is Miconazole prescribed

A

Miconazole gel comes a 24mg/ml 80mg tube

Apply 5ml to mouth QDS for 2 weeks

34
Q

How is Fluconazole prescribed

A

As a tablet form prescribed as 50-100mg for 14 days

35
Q

What do azoles do

A
  1. They inhibit fungal cytochrome P450 dependent enzyme 14 alpha demethylase which inhibits ergosterol synthesis
  2. Leads to depletion of ergosterol in the cell membrane of the fungus and accumulation of toxic intermediate sterols occurs
36
Q

What is mould

A

A type of function that has no chlorophyll and cannot make its own food

37
Q

How does mould get its nutrients

A

From decaying matter

38
Q

Where does mould usually invade

A

Blood vessel walls causing tissue infraction and necrosis

39
Q

Give examples of mould infections

A
  1. Zygomycosis
  2. Aspergillosis
  3. Exophalia

4th yr- CMS- Infections (4 decks)

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