Infectious diseases of Oral Cavity

Question 1

Most common type of opportunistic infection?

Answer 1

Candida Albicans (70%)

Question 2

What is the local defence system for candida?

Answer 2

Innate immunity
Competition and inhibition
IgA antibodies
Anti-microbial peptides (mucins, defensins, histatins)

Question 3

Local RF for candida?

Answer 3

Xerostomia
Poor oral hygiene
Appliances
Piercings
Smoking
Irradiation
Inhaled/Topical corticosteroids

Question 4

Systemic RF for candida?

Answer 4

Neonates/ elderly
Malnutrition
Diabetes
HIV/ AIDS
Haematinic deficiency
Broad-spectrum AB
Chemotherapy
Haematological malignancy

Question 5

How do you manage candida infections?

Answer 5

Investigate predisposing factors
Oral hygiene
Topical antifungals
Systemic antifungals

Question 6

What is the topical antifungal?

Answer 6

Miconazole 20mg/g
Apply 4x a day
Use for a week after lesion heals

Question 7

What is the caution with Azoles?

Answer 7

Cannot mix with:
Warfarin (increases INR/ anticoagulant effect)
Statins (rhabdomyolysis and myopathy)

Question 8

What is the systemic antifungal?

Answer 8

Fluconazole 50mg
7 capsules

Question 9

Clinical presentation of oral candida? (white)

Answer 9

Acute pseudomembranous candidiasis
Chronic hyperplastic candidiasis

Question 10

Clinical presentation of oral candida? (red)

Answer 10

Denture related stomatitis
Acute erythematous candidiasis
Median rhomboid glossitis
Angular cheilitis

Question 11

Acute pseudomembranous candidiasis presentation?

Answer 11

White slough
Can be wiped off
Red erythematous base

Question 12

Acute pseudomembranous candidiasis diagnosis?

Answer 12

Oral rinse/ Oral swab
Topical tx
Systemic tx if topical ineffective

Question 13

Chronic hyperplastic Candidiasis presentation?

Answer 13

Speckled white/ red
Potentially malignant disorder 12%
Forms on labial commissure
Bilateral

Question 14

Chronic hyperplastic Candidiasis diagnosis?

Answer 14

Incisional biopsy with PAS (Periodic acid-Schiff stain)
Give fluconazole before biopsy

Question 15

Chronic hyperplastic Candidiasis management?

Answer 15

Manage predisposing factors
Systemic antifungal
Stop smoking
Clinical follow up with OM?GDP

Question 16

Denture related stomatitis MoA?

Answer 16

Acrylic resin and soft liners are good habitat for candidal adhesion
Denture taruma potentiates infection
Overnight use cultivates biofilm.

Question 17

Denture related stomatitis classification?

Answer 17

Newtons Classification
1. Localised inflammation
2. Generalised erythema covering denture bearing area
3. Granular type