Accepted Manuscript

Oral thrush,

Dr. Tanay Chaubal MDS , Dr. Ranjeet Bapat MDS

PII: S0002-9343(18)30397-8
DOI: 10.1016/j.amjmed.2018.04.020
Reference: AJM 14648

To appear in: The American Journal of Medicine

Received date: 28 March 2018

Revised date: 2 April 2018
Accepted date: 2 April 2018

Please cite this article as: Dr. Tanay Chaubal MDS , Dr. Ranjeet Bapat MDS , Oral thrush, , The Amer-
ican Journal of Medicine (2018), doi: 10.1016/j.amjmed.2018.04.020

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 ACCEPTED MANUSCRIPT

Title: Oral thrush

Authors:

Dr. Tanay Chaubal a, Dr. Ranjeet Bapat a

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MDS (Periodontology and Oral Implantology), Division of Clinical Dentistry, School of

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Dentistry, International Medical University, Kuala Lumpur, Malaysia, Zip code – 57000.

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E-mail:

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Dr. Tanay Chaubal – tanayvc@gmail.com

Dr. Ranjeet Bapat - ranjeetbapat@gmail.com

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Corresponding Author:

Dr.Ranjeet Bapat,
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Address: International medical university,126- Jalan jalil perkasa 19, Bukit Jalil,57000

Kuala lumpur, Malaysia

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Mobile no: +60173446970

E-mail: ranjeetbapat@gmail.com
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Source of financial support or funding: None

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Conflict of interest statement: None

Author Contributions: All authors had access to the data and were involved in writing the
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manuscript.

1) Dr. Tanay Chaubal – conception of study, acquisition of data and drafting of article.

2) Dr. Ranjeet Bapat – acquisition of data and final guarantor of article.

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Article Type – Clinical communication to the editor

Keywords: Oral thrush

Running title: Oral thrush

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To the Editor:

A 54-year-old male patient presented with a chief complaint of burning sensation of

mandibular right gingiva and alveolar ridge on eating spicy food. The intensity of the burning

sensation has increased since last 3 months. The patient has suffered from diabetes mellitus for 3

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years and was on oral hypoglycemic agent metformin (500 mg/day). Intraoral examination

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revealed a presence of a raised, creamy white lesion on the mandibular right gingiva and alveolar

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ridge with “cottage cheese” appearance (Figure, Black arrows). The white lesion could be

scrapped, leaving an erythematous area which was painful. The patient was not under any

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antibiotics, corticosteroids and other immunosuppressants. Primary testing with Polymerase
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chain reaction showed a negative result for HIV. The HbA1c test result was 7.2% indicating that

the diabetes mellitus was in an uncontrolled state. Smears from the scrapings of the lesion were
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strongly periodic acid Schiff stain positive. To rule out precancerous and cancerous lesions a

biopsy was performed which revealed hyperplastic epithelium, candidial hyphae penetrating the
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stratum spinosum and chronic inflammatory cells in lamina propria. Based on the clinical

picture, laboratory tests, smear test and biopsy, a final diagnosis of Oral thrush
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(pseudomembranous candidiasis) was made. For systemic therapy, he was referred to

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endocrinologist who modified the dosage of oral hypoglycemic along with diet alterations

leading to an HbA1c level of 5.4%. For oral therapy, he was advised to use nystatin at doses of
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100 000 IU/ml [5ml, 4 times daily] and amphotericin-b at 50mg [5ml, 3 times per day]. 3-month

recall of the patient revealed completely healed gingiva.

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Oral thrush also known as oral candidosis, oral candidiasis, moniliasis, oral mycosis,

oral yeast infection, or Candidal stomatitis is a common opportunistic oral Candida infection that

develops in the presence of one of several predisposing conditions. Predisposing conditions

include drugs, smoking, diabetes mellitus, malignancy, dentures and immunosuppressive

conditions.1 Candidal species are relatively common inhabitant of the oral cavity, gastrointestinal

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tract, and vagina of clinically normal persons. Oral thrush is caused by an overgrowth of the

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superficial fungus Candida albicans which is a common inhabitant of the oral cavity but, in the

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presence of predisposing factors it has an ability to transform to a pathogenic hyphal form. 2

Prevalence of oral candidiasis in diabetic patients is 13.7 to 64%.3 Oral thrush forms soft, friable,

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and creamy lesions on the mucosa that can be wiped off, leaving an erythematous painful
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surface. The buccal mucosa, palate, and tongue are common locations for oral thrush. Diagnosis

of oral thrush is based on clinical features, smear examination and biopsy. Management of oral
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thrush includes topical antifungal agents, removal of predisposing factors and adequate oral

hygiene.
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References:

1) Rautemaa R, Ramage G. Oral candidosis-clinical challenges of a biofilm disease. Crit

Rev Microbiol 2011; 37(4):328-336.

2) Laura Coronado - Castellote, Yolanda Jiménez - Soriano.

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Clinical and microbiological diagnosis of oral candidiasis. J Clin Exp Dent 2013; 5(5):

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e279–e286.

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3) Belazi M, Velegraki A, Fleva A, et al. Candidal overgrowth in diabetic patients: potential

predisposing factors. Mycoses 2005; 48(3):192–196.

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Figure captions

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Figure – Raised creamy white lesion in the mandibular right gingiva and alveolar ridge with

cottage cheese appearance (Black arrows) - single column fitting.

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