March 16, 2009 Oral medicine 4#

FUNGAL INFECTION
(CANDIDADIASIS (CANDIDOSIS

Candida is a yeast-like fungus. Candida species are 

common in the normal oral flora and have been reported
to be present in from 40% to 60% of the population
(candidal carriers). So the presence of candida does not
.mean you are infected with a fungal infection

They are different species of candida the most 

common which is candida albicans , although other
species (e.g., Candida tropicalis, Candida glabrata,
Candida krusei) are less commonly identified and may
cause infection, particularly in immune-suppressed and
.neutropenic patients

:Candidal carriages increased in

"Women. "due to hormonal changes○
."Individuals with blood group "O○
.High carbohydrates diet○
.Smokers○

:The host defenses

We mentions above when the pathogens are present in

the general environment or in the oral cavity it does not
mean we are infected with a disease, the pathogens
should overcome different lines of defense before it can
:affect individuals, so the host defenses are
".Oral epithelium."1st lec○
Microbial interactions. "the oral cavity is inhibited by○
different types of bacteria and they forms a normal flora, any
condition leading to absence of these normal flora will provide
space(like antibiotics intake, steroids) for more pathogenic
.(organism to occupied this space (e.g. Candida albicans

So we agreed that candida is already there among✔

normal flora but the increased with numbers of
C.albicans disappear of normal flora (spaces)
.which make you affected with fungal infections

(Saliva: (2 actions○

Dr. jumana karasneh |

 March 16, 2009 Oral medicine 4#

Non-immune: saliva by itself provides mechanical

.cleansing
Immune: by lysozyme which is damage yeast and has
.anti-bacterial effect

So People with exerostomia will lose this action✔

.and be more susceptible to fungal infection

:Immune defense○
.Cellular: T cells & phagocytes
.Humoral: IgA

So any interruption of these lines of defense like 

loss of the epi., loss of normal flora or loss of
salivary flow this will lead to overgrowth of
.candidal species

:Predisposing factors

Several predisposing factor will lead to overgrowth of

:candida which is
"Physiological factors."extremities age ○
"Local tissue trauma. "denture & poor oral hygiene ○
.Antibiotic therapy ○
"Corticosteroid therapy."particularly inhaler ○
.Reduce the immune response 
.Increase the carbohydrate in the oral cavity 

?Q .how long the symptoms will appear after we used it

It takes 2 to 3 weeks until change in the
ecosystem on the oral
Cavity or depend on the
.dose
"Malnutrition."iron-deficiency ○
.Immune defect○
Primary: genetic disease, lack of IG. Or lack of cellular
.immune response
Secondary: corticosteroid, HIV-infection or
.chemotherapy
"Endocrine disorders: "diabetes○
"Malignancies. "leukemia○
.Salivary gland hypo-function○

Dr. jumana karasneh |

 March 16, 2009 Oral medicine 4#

:Symptoms

.Most of the candida infections are a symptomatic○

.Some patient complaint from bad\altered taste○
.Nausea○
.Soreness and burning sensation○
.(Dysphagia (pharynx\ esophagus involved○
.(Hoarseness of voice (larynx involved○

:""Clinical pictures: "" signs

:white lesions.i

PSEUDOMEMBRANOUS "THRUSH"
LEUKOPLAKI

D
i
s
a
p
p
e
ars by using gauze not
.disappears

:Red lesions.ii
ERYTHEMATOUS
DENTURE -INDUCED

:Others lesions.iii
ANGULAR CHELITIS

MEDIAN RHOMBOID GLOSSITIS

Dr. jumana karasneh |

 March 16, 2009 Oral medicine 4#

Q. how I can differentiate b\w herpes labialis & angular chelitis

?""clinically
.Herpes: start as a vesicle and rupture
"A.chelitis: appears on the commissure of the lip. "angels

Clinical classification of Oral Candidosis

Lehner classification 1960s "not use
"anymore

:Acute
.Pseudomembranous✔
.Atrophic✔
:Chronic
.Atrophic✔
.Hyper-plastic✔
:The reasons of not use this classification, is due to
The pseudomembranous can last for long duration•
.particularly in immune suppression individuals
The atrophy is not help clinically cos. When you see a red•
lesion you don’t know if it's due to increased in vascularity
.or thinning of mucosa

Clinical classification of Oral Candidosis: "use

"now

:primary oral candidosis

:acute•
.Pseudomembranous✔
"Erythromatous. "appears white or red✔

:chronic•
.Pseudomembranous✔
.Erythromatous✔
.Hyperplastic✔

Dr. jumana karasneh |

 March 16, 2009 Oral medicine 4#

:candida-associated lesions•
.Denture-induced stomtitis✔
.Angular chelitis✔
.Median rhomboid glossitis✔
:secondary oral candidosis
.Manifestation of systemic mucocutanous candidosis•

:Diagnosis

.Clinical
mostly rely on it" you can give the patient antifungal"✔
and review him after 1-2 weeks if it disappears this
confirm your diagnosis. If not we need biopsy. We follow
this method for candidal leukoplakia and hyperplastic
.candidosis
.Stained smear
We take a swab from the lesion, then spread it out in✔
the slide, after that see it under the microscope. and we
can see the hyphae
.Swab & culture
We take a swab, put it✔
back in the container , send it
to the lab, to do culture and
.sensitivity test

Biopsy stained with

.(periodic acid Schiff (PAS

Dr. jumana karasneh |

 March 16, 2009 Oral medicine 4#

Other investigation:"used only when we

".removed causes but still we have fungal inf
.Hematological•
.Zinq○
.Iron-deficiency○
.Hormonal•
.Hypothyroidism○
.Diabetes○

:Management

.Removal of predisposing factors if possible 

.Avoid \ reduced smoking 
.Improve oral hygiene 
:Therapy 
.Systemic•

"Topical. "4\day 1-4\wks•

Dr. jumana karasneh |

 March 16, 2009 Oral medicine 4#

!?Q. which one to choose

We need to consider while prescribe anti fungal the

compliance of the patient, (e.g. you have a patient in
60 y.o. having complete denture with fungal infection,
he'll never follow what you said, if you tell him to put
antifungal gel in his denture 5-6 time daily), the patient
prefer to take a pill 1-2 a day. And we always go for
.topical cos. it has a less systemic effect

:Note
It is contraindication when you prescribe chlorhexidine mw. With
.nystatin
.Suspension and lozenges are not affective in exerostomia

"Pseudomembranous "THRUSH

Not common in health○

individuals "disease of a
"diseases
Could be an early signal of
diabetes, immune suppression
.or malignancies
Plaque is made of necrotic○
.material, haphae, desquamated epithelial cells
Should be differentiated b\w○
from other white Could
extend to pharynx &
.esophagus

,,,Pic, From book

Dr. jumana karasneh |

 March 16, 2009 Oral medicine 4#

A, Acutely painful pseudomembranous candidiasis of the

palate. B, Signs and symptoms were controlled after 200 mg
.ketoconazole daily for 3 days

:Erythematous Candidosis

Could be acute or○

.chronic
Marked pain and○
.soreness
Could precede or○
follow thrush or be
.isolated
Most cases are○
predisposing by
.antibiotic or steroid
Farther inv. If you○
.couldn't confirm diagnosis clinically
.Treatment○

Dr. jumana karasneh |

 March 16, 2009 Oral medicine 4#

spacer used to This is the

prevent the contact of steroid with oral mucosa, it
.was short to improve the inhaler
,,,Pic. From book
A and B, Erythematous candidiasis controlled after a 1-week course
.(of fluconazole (100 mg/d

H
y
p
e
r
p
l
:astic candidosis

Most commonly seen in the corner of the○

.mouth
.Always chronic○
:Predisposing factors○
Smoking
.Decrease Fe & folate
Defective cell-mediated
.immunity
Blood group secretory status.
""we'll talk later

Dr. jumana karasneh |

 March 16, 2009 Oral medicine 4#

Candidal leukoplakia. (always given antifungal prior○

.(to biopsy
Cos. Sometimes in very sever condition of candidosis
.we have dysplastic feature on the cells

,,,Pic from book

Dr. jumana karasneh |

 March 16, 2009 Oral medicine 4#

Hyperplastic candidiasis, that was mistaken for leukoplakia, was completely reversed with
400 mg
ketoconazole daily for 1 week in a patient with xerostomia caused by head and neck
.radiation therapy
Because of constant recurrences, the patient was maintained and controlled using nystatin
troches
U) dissolved orally up to 3 times a day. A, Before treatment; B, after 3 days of 100,000 )
.treatment

Candida-associated
denture induced stomatitis

.Most common○
"Usually not painful. "although it's red○
:Predisposing factors○
".Dental appliance. "ortho ✔
.Diabetes or increase carbohydrates diet✔
:Not significant factors○
.Allergy to dental material✔
.Trauma✔
.Smoking✔
:Treatment should include ○
.Check glucose level✔
"Stop denture night wearing. "main cause✔
.OHI✔
.Topical antifungal✔

:THE REFERENCES
.The record(1
.The slide(2
.Essentials 0f oral medicine(3

,,,Compimento

\Done by

Dr. jumana karasneh |

 March 16, 2009 Oral medicine 4#

WORDS IN MEMO
I WOULD LIKE TO TAKE THIS APPORTUNITY TO THANKS ALL OF
YOU WITH MY HEART, AND I'M DEEPLY HONERS TO BE ONE OF A
GREAT PEOPLE, A WONDERFUL DENTISTS, A MARVELOUS
BROTHERS, I'LL NEVER SEEN B4,,, REALLY I THANKS ALLAH AND
PRAY 4 THAT TO KEEP US AS A FAMILY LIKE ALWAYS, STRONG
OUR FRIENDSHIP AND TO MAKE US A SAFE A MORAL A FAMOUSE
.…DENTISTOO

,,,FOR YOU GIRLS

&‫ سكينة الفريدو)البحرينية‬- (‫ نور النجار)احلى كيكة‬-MORE THAN KIND WOMAN) )‫شهد‬
share the same crazy ‫ جمانة شمساه‬-‫ زينب بيكاسو‬-(‫ فرح )اسم على مسمى‬-(KOOL
-(‫ نور بني هاني )مبروك‬-(!!!‫ سناء الديمي)اخذت الدواء؟‬-(‫( ( –جمانه تيسير)عسوول‬idea
...-‫ لمياء حسن‬-(‫ شيرين)واتقلب‬-‫ ربى‬- ‫رهام )ميلد سعيد( – هبة زيدية‬

Dr. jumana karasneh |