International Journal of Histopathological Interpretation

REVIEW ARTICLE
Year
: 2019  |  Volume : 8  |  Issue : 1  |  Page : 6--10

Management of oral candidiasis: A review


Irfana P K1, Suganya Panneer Selvam2,  
1 Total Care Dental Clinic, Calicut, Kerala, India
2 Saveetha Dental College, Chennai, Tamil Nadu, India

Correspondence Address:
Suganya Panneer Selvam
Saveetha Dental College, Chennai, Tamil Nadu
India

Abstract

Candidiasis oral candidosis is one of the most common human opportunistic fungal infections of the oral cavity. The candidia infection may range from nonlife threatening superficial mucocutaneous disorders to invasive disseminated disease involving multiple organs. The treatment after confirmation of the diagnosis should include recognizing and eliminating the underlying causes, such as ill-fitting dentures, history of medications, immunological and endocrine disorders, nutritional deficiency states, and prolonged hospitalization. This pathology has a wide variety of treatment that has been studied until these days. After searching the latest articles about the treatment of candidiasis, it can be concluded that the incidence depends on the type of candidiasis and the virulence of the infection. Although nystatin and amphotericin b are the drugs used the most locally, fluconazole oral suspension is proving to be a very effective drug in the treatment of oral candidiasis. In certain high-risk groups, antifungal prophylaxis reduces the incidence and severity of infection. The prognosis is good in the great majority of cases.



How to cite this article:
P K I, Selvam SP. Management of oral candidiasis: A review.Int J Histopathol Interpret 2019;8:6-10


How to cite this URL:
P K I, Selvam SP. Management of oral candidiasis: A review. Int J Histopathol Interpret [serial online] 2019 [cited 2022 Nov 26 ];8:6-10
Available from: https://www.ijhi.org/text.asp?2019/8/1/6/343726


Full Text



 Introduction



The malady of oral thrush or candidiasis has been known to occur in people for more than 2,000 years. These lesions are caused by the yeast Candidia albicans. Candidia albicans is one of the components of normal oral microflora.[1],[2] An increasing incidence of the infection is associated with some predisposing factors [Table 1]. Oral candidiasis is one of the most common clinical features of those patients infected with HIV, and this manifestation is seen in up to 90% of individuals infected with HIV.[3] Clinically, there are a number of different types of oral candidiasis [Table 2]. Therefore, the choice of therapy is guided by the type of candidiasis.

Factors Predisposing for Oral Candiasisis[4]

{Table 1} {Table 2}

Types of Oral Candidiasis

 Pseudomembranous Candidiasis



This form of oral candidiasis is classically present as acute infection, though the term chronic pseudomembranous candidiasis has been used to denote recurrence cases. On the oral surfaces, the superficial component is present as white or whitish yellow creamy confluent plaques resembling milk curd or cottage cheese [Figure 1]A.{Figure 1}

 Denture Stomatitis



It is chronic inflammation of the mucosa that is typically restricted to the denture-bearing area, which is seen in association with candidiasis.[5]

 Angular Cheilitis



This form of candidiasis usually manifests as erythematous or ulcerated fissure, typically affecting unilaterally or bilaterally the commissures of the lip.[6]

 Medium Rhomboid Glossitis



Median rhomboid glossitis appears as central papillary atrophy of the tongue and is typically located around the midline of the dorsum of the tongue.[7]

 Histopathology of Oral Candidiasis



A. Fragment showed parakeratosis, acanthosis, exocytosis of polymorphonuclear leukocytes, permeating corneal layer of the epithelium, and moderately diffused perivascular inflammatory infiltrate [Figure 2]A.

B. Periodic acid Schiff stain showed the presence of Candida sp.hyphae permeating the stratum corneum [Figure 2B].{Figure 2}

 Management of Oral Candidiasis



An effective management of oral candidiasis can be achieved by adhering to and following simple guidelines:

Diagnosis through medical and dental history, clinical manifestation confirmed with laboratory tests

Correction of predisposing factors where achievable

Maintenance of proper hygiene of the oral cavity and oral prosthesis, if any

Selection of antifungal therapy based on the severity of infection and the susceptibility of candida species prevalent in that patient

 Antifungal Agents



Antifungal agents are available for the treatment of candidiasis. The choice of antifungal treatment depends on the nature of the lesion and the immunological status of the patient. There are three main antifungal drug targets in candida: the cell wall, cell membrane, and nucleic acids [Figure 3].[8]{Figure 3}

Superficial oral candidiasis in generally healthy patients can be treated topically; oral candidiasis in immunocompromised patients should be treated systemically as well as topically. Patients with persisting risk factors and relapsing candidiasis should be treated with antifungals, with the lowest risk of development or*** selection of resistant strains.[4],[9] The different drugs are listed in [Table 3].{Table 3}

 Topical Antifungals



Topical antifungals are usually the drug of choice for uncomplicated, localized candidiasis in patients with normal immune function. High levels can be achieved in the oral epithelium with topically administered antifungals. Topically administered miconazole gel is also suitable for the treatment of uncomplicated infections in generally healthy patients.[11] Repeated use of minaconazole, however, may cause a risk of development of azole-resistant strains.[12]

 Systemic Antifungal Agents



Systemic antifungals are usually indicated in cases of disseminated disease and/or in immunocompromised patients. Azoles are fungistatic drugs that inhibit the fungal enzyme lanosterol demethylase, which is responsible for the synthesis of ergosterol. Fluconazole and itraconazole are administered orally and they get secreted onto mucous membranes. The oral solution also has a topical effect.[13] The other antifungals, echinocandins, and flucytosine act through the inhibition of D-glucan synthase and DNA / protein synthesis, respectively.[14] Posaconazole is available only as an oral solution and is used in immunocompromised patients and in those resistant to other drugs.[15]

 Alternative Anticandidal Agents



Lastly, to mention, a few natural anti-yeast substances can be used as an alternative treatment. These agents with recognized activity against C. albicans included berberine containing plants, caprylic acid, grapefruit seed extract, garlic, probiotics, tea tree oil, and enteric-coated volatile oil preparations containing cinnamon, ginger, oregano, peppermint, and rosemary, propolis, and thyme.[16]

 Prevention of Oral Candidiasis



Regular oral and dental hygiene with periodic oral examination will prevent most cases of oral candidiasis; so, it is needed to make the patient aware of oral hygiene measures. Oral hygiene involves cleaning the teeth, buccal cavity, tongue, and dentures. In addition, the use of anti-candidia rinses such as Chlorhexidine or Hexedines can penetrate those areas where the brush does not. Also, there is a need to remove the dentures at night and wash them consciously, leaving them submerged in a disinfectant such as Chlorhexidine.[17]

 Conclusion



The total elimination of yeast from the body is also neither feasible nor desirable, considering that yeasts are beneficial to the body when a proper balance exists. The treatment of candida overgrowth does not seek the eradication of candida from the diet or the person, but rather a restoration of the proper balanced ecological relationship between the human and yeast.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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