Oral candidiasis is a mycotic infection of the oral cavity caused by opportunistic yeast–like fungi Candida albicans. Candidiasis of the oral cavity is manifested by hyperemia and swelling of the mucous membrane with soft or dense plaques of white plaque; dryness, burning, pain when eating; congestion, peeling and cracks of the lips. The diagnosis is based on a typical clinical picture and the identification of the pathogen by microscopic and bacteriological examination. Treatment includes the appointment of antifungal drugs (topically and orally), taking antihistamines and vitamins, immunotherapy, physiotherapy.
Oral candidiasis is a dysbiotic lesion of the oral mucosa that develops with the abundant reproduction of yeast–like fungi of the genus Candida, which are an associate of the normal human microflora. Under certain conditions, fungi can cause various pathological processes in the human body: oral candidiasis, skin candidiasis, candidiasis sepsis, etc. Candidiasis of the oral mucosa is often observed in children (during the newborn period, infants and young age), as well as in the elderly. For example, candidiasis attacks are more common in children 3-10 years old and in patients over 60 years old. Candidiasis stomatitis and glossitis are usually detected in newborns and in women after menopause.
Transmission of the causative agent of вшыуфыу is possible through physical contact with the carrier (through hands, saliva during kisses), through contaminated dishes, toys, food (especially dairy products) and water. It is possible to infect a newborn with candida fungi from the mother during childbirth, as well as during breastfeeding.
However, the mere ingestion of candida fungi on the oral mucosa is not enough for colonization and development of candidiasis. Non-attached mushrooms can be easily removed from the oral cavity with saliva and food in the gastrointestinal tract and removed from the body. In the realization of the pathogenic properties of candida fungi, the role of predisposing factors is played by the weakening or violation of the immunobiological resistance of the body, including specific and non-specific factors of local immunity, suppression of normal microflora, dysbiosis of the oral cavity.
The development of oral candidiasis is promoted by pregnancy, prematurity and hypotrophy; the presence of congenital or acquired immunodeficiency conditions (HIV infection), severe concomitant diseases (malignant tumors, tuberculosis), acute infectious processes (dysentery, diphtheria, syphilis), endocrinopathies (diabetes mellitus, hypothyroidism), metabolic diseases (iron deficiency conditions, hypovitaminosis).
Chronic gastrointestinal diseases, hyposalivation and xerostomia, low pH of saliva, low acidity of gastric juice also cause a tendency to develop oral candidiasis. In the occurrence of oral candidiasis, the age of the patient (children and the elderly), long-term treatment with antibiotics, hormonal drugs (COCs, corticosteroids), cytostatics, bad habits (smoking) are important.
The decrease in mucosal resistance and the appearance of oral candidiasis can be caused by various injuries of the mucous membrane caused by poorly fitted dentures, sharp edges of destroyed crowns of teeth, thermal or chemical burns.
Clinical manifestations of oral candidiasis are quite diverse and can be expressed in the form of yeast stomatitis (thrush), glossitis, cheilitis, angulitis. There are acute (pseudomembranous and atrophic) and chronic (hyperplastic and atrophic) clinical forms of oral candidiasis.
The most common acute pseudomembranous candidiasis of the oral cavity occurs mainly in children of the first years of life, as well as weakened and emaciated elderly people. It is characterized by the appearance of puffiness, hyperemia and milky-white curd coating on the mucous membrane of the back of the tongue, palate, cheeks and lips. Removal of plaque exposes the macerated or eroded bleeding surface of the mucosa. There is a burning sensation, soreness and difficulty in eating; children lose their appetite, become sluggish, moody. The process can spread to the larynx, pharynx, esophagus.
In the absence of treatment, thrush can turn into acute atrophic candidiasis of the oral cavity, accompanied by peeling of the epithelium, severe hyperemia, swelling and dryness of the thinned mucosa, severe pain. The back of the tongue acquires a fiery red color and shine, the filamentous papillae atrophy, the red border of the lips and the corners of the mouth are affected. Fungal plaque is absent or accumulates in deep folds, difficult to remove.
In the case of chronic hyperplastic candidiasis of the oral cavity, irregularly shaped, tightly soldered gray-white plaques and papules with a rim of hyperemia are found on the mucous membrane of the cheeks and the back of the tongue, which are not removed when scraping. Patients with this form of candidiasis are concerned about significant dryness in the oral cavity, roughness and soreness of the mucous membrane of the tongue and cheeks. The disease is usually detected in males over 30 years of age.
Chronic atrophic candidiasis of the oral cavity (stomatitis of dentures) is associated with prolonged pressure and traumatization of the mucosa. It is manifested by a local lesion of the prosthesis wearing zone in the form of a clearly defined bright erythema of the mucous membrane of the gums and palate, a small plaque, erosion of the corners of the mouth. The tongue is smooth, with papillary atrophy. Subjective sensations – pain, burning, dryness.
During the transition of candidiasis to the red border of the lips, candidiasis cheilitis develops, characterized by moderate edema, maceration and superficial peeling of the lips, painful bleeding cracks and erosions, the growth of thin grayish films and crusts. There is burning, dryness, a feeling of tightening of the mucous membrane of the lips.
With mycotic congestion, mucosal maceration occurs in the corners of the mouth on both sides, dry cracks with thickened roller-like edges and thin gray scales. When opening the mouth, cracks bleed, cause pain. Candidiasis of the oral cavity can occur in isolation or combined with damage to other mucous membranes and skin; under unfavorable conditions and improper treatment, it can turn into generalized candidiasis with damage to internal organs, the development of candidiasis sepsis.
The diagnosis of candidiasis is based on the presence of characteristic complaints and clinical manifestations, the results of laboratory studies (microscopic examination of scraping, quantitative analysis of the degree of contamination of the oral cavity, sowing for candidiasis with determination of sensitivity to drugs). Examination of the oral mucosa at the dentist allows you to identify typical candidiasis lesions. If necessary, consultations are held with a therapist, pediatrician, infectious disease specialist, allergist-immunologist, endocrinologist.
Candidiasis of the oral cavity is confirmed by the detection of Candida fungi in the form of budding cell forms and pseudomycelia filaments during survey microscopy of stained smears from the affected areas of the mucosa. Isolation of candida fungi from the oral mucosa during sowing on nutrient media from 100 to 1000 CFU is interpreted as a possible sign of candidiasis. If necessary, serological studies are carried out – intradermal allergy test for Candida antigen, determination of antibodies to candida IgG / IgA and PCR diagnosis of scraping. With recurrent candidiasis of the oral cavity, the blood glucose level is examined to exclude diabetes mellitus.
Oral candidiasis should be differentiated from the flat and verrucose forms of leukoplakia, lichen planus, allergic and chronic aphthous stomatitis, desquamative glossitis, streptococcal congestion, actinic cheilitis, herpes simplex, syphilitic papules, lip eczema, etc.
Complex treatment of candidiasis includes local and general methods: treatment and sanitation of the oral cavity, treatment of concomitant diseases, increased immune protection factors. For the local treatment of oral candidiasis, alkalizing rinses and applications are used (solutions of baking soda, boric acid, sodium tetraborate in glycerin, clotrimazole), lubrication with antifungal ointments (nystatin, levorin and decamine). For the best effect, 2-3 different antimycotic drugs are alternated during the day with replacement after 2-3 days with new ones.
It is recommended to treat the oral cavity with solutions of fucorcin, lugol, and iodinol. From 4-5 days from the start of therapy, it is possible to use keratoplastic agents (vitamins A and E, rosehip oil, sea buckthorn oil). Careful treatment of dentures and orthodontic structures is shown. For the general effect on the causative agent of oral candidiasis, antifungal agents are prescribed orally (fluconazole, terbinafine ketoconazole, amphotericin B, levorin). Antihistamines are used to reduce allergic manifestations. With oral candidiasis, physiotherapy is effective – electrophoresis with potassium iodide, UV, laser therapy. In severe cases of oral candidiasis, complex immunotherapy is necessary.
The course of treatment of oral candidiasis lasts at least 7-10 days after the disappearance of all clinical manifestations; in the chronic form, the courses are repeated to prevent relapses. Oral candidiasis therapy includes, if possible, the cancellation or reduction of the dose of antibiotics, corticosteroids; treatment of concomitant diseases. For patients with oral candidiasis, it is important to have a full diet with a decrease in the amount of simple carbohydrates, taking vitamins of group B, PP, C. With recurrent candidiasis, prosthetics are necessary to return the height of the bite.
Prognosis and prevention
The prognosis for mild oral candidiasis is favorable, relapses do not occur; with a moderate form, the probability of relapses exists; with severe, a transition to a chronic infection with the development of candidal sepsis is possible.
Prevention of oral candidiasis includes health promotion and hardening of the body, proper nutrition, sanitation of the oral cavity, compliance with the rules of personal and general hygiene, timely detection and treatment of dysbiosis, inadmissibility of self-medication with medications, compliance with sanitary and hygienic regime at food industry enterprises and medical institutions. It is important to eliminate the foci of candida infection in pregnant women and proper hygienic care of infants.
- Cross L.J., Williams D.W., Sweeney C.P., Jackson M.S., Lewis M.A., Bagg J. Evaluation of the recurrence of denture stomatitis and Candida colonization in a small group of patients who received itraconazole // Oral Surg Oral Med Oral Pathol Oral Radiol Endod. — 2004; 97: 351-358.link
- Goins R.A., Ascher D., Waecker N., Arnold J. Moorefield EComparison of fluconazole and nystatin oral suspensions for treatment of oral candidiasis in infants // Pediatr Infect Dis J. — 2002; 21(12): 1165-1167.link
- Collins C.D., Cookinham S., Smith J. Management of oropharyngeal candidiasis with localized oral miconazole therapy: efficacy, safety, and patient acceptability // Patient Prefer Adherence. — 2011; 5(): 369-374.
- Koks C.H., Crommentuyn K.M., Mathôt R.A., Mulder J.W., Meenhorst P.L., Beijnen J.H. Prognostic factors for the clinical effectiveness of fluconazole in the treatment of oral candidiasis in HIV-1-infected individuals // Pharmacol Res. — 2002; 46(1): 89-94.
- Kuriyama T, Williams D.W., Bagg J., Coulter W.A., Ready D., Lewis M.A. In vitro susceptibility of oral Candida to seven antifungal agents // Oral Microbiol Immunol. — 2005; 20: 349–53.
- Stamford Skin Centre. Angular Cheilitis. — 2020. link