Fungal infections of the orofacial tissues Flashcards
Give examples of fungal infections of the orofacial tissues
- Candida
2. Mould infections
Name the primary organism that causes candida
- Candida albicans is the most common
2. Candida glabrata
What risk factors increase candida
- smoking
- Dente/ orthodontic appliance wear
- Dry mouth
- Carbohydrate rich diets
- Immune modulating drugs
- Immunocompromise status
- Nutritional deficiency
- Local causes
- Acidic intraoral environment
List some immune modulating drugs that can increase risk of candida
Steroids like:
- Asthma presenter inhalers
- Topical creams
- Oral tablets
What can lead to Immunocompromise status
- Diabetes
- HIV
- Chemotherapy
- Radiotherapy
- Short term broad spectrum antibiotic use
List the different types of oral Candidosis
- Acute Pseudomembranous Candidosis
- Erythematous Candidosis
- Angular cheilitis
- Chronic hyperplastic Candidosis
- Chronic mucocutanous Candidosis
What is Acute Pseudomembranous Candidosis also known as
Thrush
Describe how Acute Pseudomembranous Candidosis looks
Creamy white plaques which may be wiped away leaving a raw looking erythematous base
In whom is cute Pseudomembranous Candidosis common in
- Babies or the elderly
2. Patients using broad spectrum antibiotics or steroid inhalers
What is Erythematous Candidosis also known as
Denture stomatitis
What is erythema a
Mucosal inflammation
What is the aetiology of Erythematous Candidosis
Multifactorial
Where is angular chelitis seen
At the corners of the mouth can be very sore
Who is at higher risk of developing chronic hyper plastic Candidosis
Smokers
Describe chronic hyper plastic Candidosis
It is a potentially malignant condition
Where does chronic hyper plastic Candidosis classically manifest
Commissural mucosa (the anterior aspect of the buccal mucosa) Possible dorsal tongue involvement
How does chronic hyper plastic Candidosis present
As flat white crazed plaques
Describe chronic mucocutaneous Candidosis
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
What is the unifying feature of all chronic mucocutaneous Candidosis infections
Hetrofenous disorder is impaired cel mediated immunity versus candida
In whom does chronic mucocutaneous Candidosis manifest in
In infancy or early childhood
How do we manage Candidosis infections
- Identify and modify risk factors
- Be sensitive when explaining the infection to the patient
- Swabs and oral rises can be useful (not routine)
How are oral rinses does in a patient with Candidosis
Ask patietn to rinse around 30ml of sterilise saline for 30 seconds then wait into a time for culture and sensitivities
What can bloods show in a patient with Candidosis
- Full blood count- anaemia
- Haematinics can reveal deficiencies in ferritin, B12
- HbA1C
- HIV serology
As a dentist what should you do in a patient with Candidosis
- Identify Candidosis
- Explain to patietn sensitively
- Look for modifiable risk factors and implant appropriate management
- Consider prescribing antifungal medication
- Plan a review the patient
Give examples of antifungal medications
- Chlorhexidene
- Polyenes
- Azoles
What oral side effect can a patient taking Chlorhexidene have
- Discolouration teeth or dentures with long term use
- May experience taste disturbances
- dysaesthesias
What are polyenes
A class of antifungals
Give examples of polyenes
nystatin
amphotericin
How is nystatin prescribed
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
How do polyenes work
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
What can Amphotericin stimulate
Can stimulate host immune cells leadign to significant side effects
Give examples of azoles
- Miconazole,
- fluconazole,
- itraconazole,
- posaconazole
How is Miconazole prescribed
Miconazole gel comes a 24mg/ml 80mg tube
Apply 5ml to mouth QDS for 2 weeks
How is Fluconazole prescribed
As a tablet form prescribed as 50-100mg for 14 days
What do azoles do
- They inhibit fungal cytochrome P450 dependent enzyme 14 alpha demethylase which inhibits ergosterol synthesis
- Leads to depletion of ergosterol in the cell membrane of the fungus and accumulation of toxic intermediate sterols occurs
What is mould
A type of function that has no chlorophyll and cannot make its own food
How does mould get its nutrients
From decaying matter
Where does mould usually invade
Blood vessel walls causing tissue infraction and necrosis
Give examples of mould infections
- Zygomycosis
- Aspergillosis
- Exophalia
