Urban legends series: oral candidosis

Abstract

Candida species (spp) are commensal yeast that can only instigate oral infection (oral candidosis - OC) when there is an underlying predisposing condition in the host. We investigated four controversial topics on OC: (i) How can a microbiological determination of OC be made as Candida spp. are commensal yeasts and not all of them form hyphae or pseudohyphae during infection? (ii) Is median rhomboid glossitis (MRG) a manifestation of candidal infection? (iii) Can candidal infection cause palate papillary hyperplasia (PPH)? (iv) What is the best therapeutic treatment for denture-associated erythematous stomatitis (DAES)? Results from extensive literature searches, including a systematic review, suggested the following: (i) the diagnosis of OC merely on the basis of the presence of yeasts is an oversimplification of a complex process. No convincing evidence of a single test or method better able to discriminate the transition from candidal saprophytism to pathogenicity has been reported in the literature; (ii-iii) conclusive evidence of a direct aetiopathogenic relationship between MRG and PPH and candidal infection has not been found; and (iv) only limited evidence is available for any DAES treatment, thus making it impossible to make strong therapeutic recommendations.

Median Rhomboid Glossitis

“…Although there are several studies and hypotheses about the origin of MRG, the importance of Candida to the etiology of this lesion is still controversial because embryological, anatomical, and traumatic factors, and a mixed microbiota may favor the appearance of Candida (Scully et al, 1994 ;Manfredi et al, 2013 ). This would explain why the administration of antifungal therapy is suffi cient to achieve clinical improvement in some cases and not in another (Samaranayake et al, 2009 ;Manfredi et al, 2013 ).…”

“…This would explain why the administration of antifungal therapy is suffi cient to achieve clinical improvement in some cases and not in another (Samaranayake et al, 2009 ;Manfredi et al, 2013 ).…”

Denture stomatitis – a clinical update

“…It is now deemed acceptable to leave dentures to dry out overnight as firstly, organisms that inhabit the biofilm do not survive prolonged drying out, and secondly, there is no evidence that leaving dentures to dry out overnight will cause the acrylic to warp. 24 Improved denture hygiene is key to treating all types of DS and patients must understand the importance of their own denture hygiene regime. The use of a sonic bath filled with suitable cleaning solution can also be beneficial, and these are relatively inexpensive for the patient to purchase.…”

In-vitro Analysis of Antifungal Activity of Epigallocatechin-Gallate: Preliminary Study

“…Three primary oral manifestations (acute and chronic pseudomembranous erythematous and chronic hyperplastic candidosis) are recognised together with some Candida-associated lesions (denture stomatitis also called denture-associated erythematous stomatitis -DAES, angular cheilitis, median rhomboid glossitis -MRG-and linear gingival erythema) (1-7). The incidence of drugresistant species is increasing dramatically (8,9); furthermore, in recent years higher incidences of non-albicans (usually considered the almost exclusive cause of candidosis) species of Candida have been reported (10), thus increasing necessity of wide-spectrum drugs (7). Common antifungal drugs such as polyenes and azoles have strong antifungal activity but they also show side effects (II), and, as stated, antimycotic-resistant Candida species have appeared (12,13).…”