Oral Candidosis (Thrush)
- ‘a disease of the diseased’
- Has a high incidence in HIV patients.
- Thrush forms soft, friable and creamy coloured plaques on the mucosa.
- They can easily be wiped off to expose an erythematous mucosa.
- Predisposing factors include Denture wearing, smoking, Antibiotic treatment, xerostomia and Immunodeficiency.
- A stained smear shows large masses of tangled hyphae, detached epithelial cells and leucocytes.
- If the cause is from use of a steroid inhaler – advise rinsing after using the inhaler
- Control of any topical antibiotic treatment can cause thrush to resolve; if this is not possible then:
- A course of NYSTATIN or AMPHOTERICIN lozenges.
- Failure to respond to these topical antifungals suggests immune deficiency.
- Caused by leakage of candida infected saliva at the angles of the mouth.
- Can be seen in denture wearers.
- Mild inflammation at the angles of the mouth.
- In patients with denture induced stomatitis inflammation frequently extends along folds of the facial skin extending from the angles of the mouth.
- These are caused by closed bite and sagging of the facial tissues with age.
- Treatment of intra oral candidosis alone causes angular stomatitis to resolve.
- If there is a co-infection with Staph aureus then local application of fuscidic acid cream may be required.
- A swab is required in some cases to establish the causative organism.
Key features and management
- Risk factors include a well fitting denture, poor denture hygiene, and keeping the denture in the mouth overnight.
- Enclosed mucosa is cut off from protective action of saliva.
- Redness of the mucosa that is sharply restricted to the area covered by the denture.
- Smear shows gram positive hyphae
- Management is by antifungal treatment.
Article by Simranjeet Kaur – Liverpool Dental Student