Clinical Appearance of Oral Candida Infection and Therapeutic Strategies

Abstract

Candida species present both as commensals and opportunistic pathogens of the oral cavity. For decades, it has enthralled the clinicians to investigate its pathogenicity and to improvise newer therapeutic regimens based on the updated molecular research. Candida is readily isolated from the oral cavity, but simple carriage does not predictably result in development of an infection. Whether it remains as a commensal, or transmutes into a pathogen, is usually determined by pre-existing or associated variations in the host immune system. The candida infections may range from non-life threatening superficial mucocutaneous disorders to invasive disseminated disease involving multiple organs. In fact, with the increase in number of AIDS cases, there is a resurgence of less common forms of oral candida infections. The treatment after confirmation of the diagnosis should include recognizing and eliminating the underlying causes such as ill-fitting oral appliances, history of medications (antibiotics, corticosteroids, etc.), immunological and endocrine disorders, nutritional deficiency states and prolonged hospitalization. Treatment with appropriate topical antifungal agents such as amphotericin, nystatin, or miconazole usually resolves the symptoms of superficial infection. Occasionally, administration of systemic antifungal agents may be necessary in immunocompromised patients, the selection of which should be based upon history of recent azole exposure, a history of intolerance to an antifungal agent, the dominant Candida species and current susceptibility data.

Efficacy of Propolis on the Denture Stomatitis Treatment in Older Adults: A Multicentric Randomized Trial

“…In our study, thirty-eight patients reported sleeping with the dentures, among a total of forty. This habit is harmful because the contact of the contaminated surface of the denture with the palatal mucosa is continuous, favoring the reduction of salivary flow and the development of denture stomatitis [2, 8, 36–38]. Studies show that only the drug treatment of the patient is not effective, and disinfection of the denture surface is necessary.…”

Commensal and pathogen: Candida albicans

“…It is only painful form of candidiasis. (1,11) Lesions on dorsum of tongue result in loss of papilla. Differential diagnosis includes denture stomatitis, erythema migrans, erythroplakia and anemia.…”

“…It can also occur in association with iron and folate deficiencies and with defective cell mediated immunity. (1) Other forms of candidiasis Denture stomatitis: It is chronic inflammation of mucosa mainly restricted to denture area, so also known as chronic atrophic candidiasis. It is seen in 50-65% of patients wearing dentures.…”

“…(27,28) Smoking: Smoking increases risk of oral candidiasis by various mechanisms such as localized alteration in epithelium, smoking along with denture friction changes mucosal surface, suppression of local immunity, elevation of glycosylated hemoglobin and smoking also increases adrenaline levels, thus indirectly affecting blood glucose level. (1,29,30) Systemic factors Age: Extremes of age may also increase risk of oral candidiasis due to reduced immunity. (31) Nutritional status: Deficiency of iron reduces fungistatic action of transferrin and other iron dependent enzymes.…”

“…Severity of candida infection is variable, ranging from non life threatening superficial mucocutaneous lesions to invasive disseminated infection involving multiple body organs. (1) It was found that Candida albicans isisolated from the oral cavity of 45% neonates, 45%-65% of healthy children, 30%-45% of healthy adults,50%-65% of people who wear removable dentures, 65%-88% of people those are under acute and long term care facilities, 90% of patients with acute leukaemia undergoing chemotherapy, and 95% of HIV patients. (2)(3)(4)(5)(6)(7)(8) Candida albicans causes 4 th most common nosocomial infection with mortality rate of 39% in year 1995 and it is 3 rd most common nosocomial infection in ICUs with mortality rate of 47%.…”