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Oral candidiasis, a frequent and important fungal condition of the oral cavity is caused by Candida
species. There are few local factors that make the oral tissues susceptible to Candida infection. These
factors include acid saliva, xerostomia, night use of prosthetic dentures, tobacco, carbohydrate rich-
diets and patients that receive radiotherapy and chemotherapy in maxillofacial structures. Maintenance
of oral hygiene and early diagnosis of this condition is very important.
INTRODUCTION:
Oral candidiasis is one of the common fungal infection There are three general factors which helps the Candida
affecting the oral mucosa. These lesions are caused by albicans infection to develop in the patients body. They
the yeast Candida albicans. Candida albicans are one of are:
the components of normal oral microflora and around
30% to 50% people carry this organism. Rate of carriage 1. Immune status of the patient
increases with age of the patient. Candida albicans are 2. Oral mucosal environment
recovered from 60% of dentate patients mouth over the 3. Strain of Candida albicans
age of 60 years. There are nearly five types of candida
species which are seen in the oral cavity (Gravina et al. The main factors which increase susceptibility of oral
2007). candidiasis are (Akpan and Morgan, 2002).
They are,
i. Immunosuppression
1. Candida albicans ii. Endocrinopathies
2. Candida tropicalis iii. Nutritional deficiencies
3. Candida krusei iv. Malignancies
4. Candida parapsilosis v. Dental prosthesis
5. Candida guilliermondi vi. Epithelial alteration
vii. High carbohydrate diet
Among these five types, Candida albicans are commonly viii Infancy and old age
seen in the oral cavity. Candida albicans is a dimorphic ix. Poor oral hygiene
fungus that causes severe opportunistic infections in x Heavy smoking
humans (Molero et al., 1998). An interesting feature of
Candida albicans is its ability to grow in two different Xerostomia: Saliva contains IgA which inhibits binding of
ways, reproduction by budding, forming an ellipsoid bud, Candida albicans to mucosal surfaces. It also provides a
and in hyphal form, which can periodically fragment and flushing action which removes Candida albicans from oral
give rise to new mycelia, or yeast-like forms (Cutler, cavity. In case of xerostomia both these actions are
2001). Yeast is innocuous and hyphal forms are absent because of lack of saliva production, so chances
of candidiasis is more in oral cavity. Xerostomia is also
associated with invasion of host tissue (Figure 1).
Scholarly Journals International
Scholarly J. Med. 27
2. Culture (Figure 2)
3. Tissue biopsy significant drug interaction or side effects. (Figure 3)
ID reaction: It is a secondary skin response which is a Amphotercin B: This drug is available as Lozenge
localised or generalized sterile Vesicullopapular rash. (Fungilin 10mg) and oral suspension 100mg/ml which is
These rashes resolve with treatment to be applied 3 to 4 times daily. Amphotericin-B inhibits
the adhesion of Candida to epithelial cells. The side
effect of the drug is nephrotoxicity.
Management
Clotrimozole: This drug decreases fungal growth by
Always continue the treatment for 2 weeks after inhibiting the synthesis of ergosterol. It is not indicated for
resolution of the lesions. When the topical therapy fails systemic infection. This drug is available in Creams and
then one has to start systemic therapy because failure of Lozenge 10mg. main side effects of this drug is
drug response is the initial sign of underlying systemic unpleasant mouth sensation, increases liver enzyme
disease. Follow-up appointment after 3 to 7 days is levels, nausea and vomiting.
important to check the effect of drugs. Main Goals of
treatment are (Parihar, 20111),
1. To identify & eliminate possible contributory factors Second line of treatment:
2. To prevent systemic dissemination
3. To eliminate any associated discomfort The second lines of treatment are used for severe,
4. To reduce load of candida localized, immunosuppressed patients and patients who
Treatment options are mainly categorized in to two lines, respond poorly to primary line of treatment. Drugs mainly
primary & secondary line of treatment used in second line of treatment are, (Pappas, 2004).
1. Ketoconazole
Primary line of treatment: 2. Fluconazole
3. Itraconazole
Nystatin is the drug of choice as a primary line of
treatment. Usually for the mild and localized candidiasis Ketoconazole: It blocks ergosterol synthesis in fungal
this primary line of treatment is used other drugs includes cell membrane and is absorbed from the gastro intestinal
Clotrimazole which can be taken as is Lozenges and tract and metabolized in the liver. The dosage is 200-400
Amphotercin B as oral suspension (Pappas, 2004). mg tablets once or twice daily for 2 weeks. Side effects
are nausea, vomiting, liver damage and also it interacts
Nystatin: It is another drug which can be used as a with anticoagulants.
primary line of treatment. It is available as cream & oral
suspensions. It is to be applied four times a day and Fluconazole: This drug inhibits fungal cytochrome P450
allowed to act approximately for two minutes in the oral sterol C-14 alpha demethylation. It is used in
cavity and then it is to be swallowed. There is no oropharyngial candidosis and dosage is 50 100mg
Scholarly Journals International
Rao 30
capsule once a day for 2-3 weeks. Main side effects are Akpan, A, Morgan, R 2002). Oral candidiasis-Review. Postgrad. Med.
J., 78:455459
nausea, vomiting and headache. It interacts with
Cutler, JE (1991). Putative virulence factors of Candida albicans.
anticoagulants and this drug is contraindicated in Annual Rev. Microbiol., 45:187218
pregnancy, liver& renal disease Dangi, YS, Soni, ML, Namdeo, KP (2010). Oral candidiasis: a review.
Inter. J. Pharm. Sci., 2: 36-41
Gravina, HG, de Morn, EG, Zambrano, O, Chourio, ML, de Valero, SR,
Itraconazole: It is one of the broad spectrum antifungal
Robertis, S, Mesa L (2007). Oral Candidiasis in children and
agents and contraindicated in pregnancy & liver disease. adolescents with cancer. Identification of Candida.spp Med Oral Patol
The dosage of the drug is 100 mg capsule once a day for Oral Cir Bucal, 12: E419-23.
2 weeks. The main side effects are nausea, neuropathy & Greenberg, MS, Glick, M, Ship, JA (2008). Burkets Oral Medicine. 11th
edn , BC Decker Inc. India, pp. 79
rashes. Molero, G, Orejas, RD, Garca, FN, Monteoliva, L, Pla, J, Gil, C, Prez,
MS, Nombela, C (1998). Candida albicans: genetics, dimorphism and
pathogenicity. Internatl microbial., 1:95106
CONCLUSION Pappas, PG, Rex, JH, Sobel, JD, Filler, SG, Dismukes, WE, Walsh, TJ,
Edwards, JE (2004). Guidelines for Treatment of CandidiasisCID, 38:
161-89
The prognosis of oral candidiasis is good when the Parihar, S Oral Candidiasis- A Review . WebmedCentral
predisposing factors associated with this infection are DENTISTRY.2011; 2: WMC002498
eliminated. When the systemic predisposing factors arise Salerno, C, Pascale, M, Contaldo, M, Esposito, V, Busciolano, M,
Milillo, L, Guida, A, Petruzzi, M, Serpico, R (2011). Candida-
even patient with primary candidiasis are also at risk. In associated denture stomatitis. Med Oral Patol Oral Cir. Bucal., 16
most of the cases oral candidiasis is a cause of :e139-43.
secondary superficial infection which can easily be Webb, BC, Thomas, CJ, Willcox, MD, Harty, DW, Knox, KW (1998).
resolved with antifungal therapy. Candida-associated denture stomatitis. Aetiology and management:a
review. Part 3. Treatment of oral candidosis. Aust. Dent. J., 43:244-9.
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