Professional Documents
Culture Documents
ABSTRACT
Oral candidiasis is a common opportunistic infection of the oral cavity caused by an overgrowth of Candida
species, the commonest being Candida albicans. The incidence varies depending on age and certain
predisposing factors. Candida fungi are found almost everywhere in the environment. Some may live
harmlessly along with the abundant "native" species of bacteria that normally colonize the mouth,
gastrointestinal tract and vagina. Usually, Candida is kept under control by the body's immune defense.
Candidiasis is classified using the Lehner system. Some of the subtypes almost always occur as acute and
others chronic. Major signs and symptoms of oral candidiasis include White patches, or red lesions in oral
cavity, pruitus, and vulval erythematic, curd-like discharge from vagina. Management involves taking a
history, an examination, and appropriate antifungal treatment with a few requiring samples to be taken for
laboratory analysis. In certain high risk groups antifungal prophylaxis reduces the incidence and severity of
infections. The only prevention is Good Oral Hygiene.
KEY WORDS
Oral Cavity, Oral Candidiasis, Candida albicans and Oral Hygiene.
INTRODUCTION
Oral candidiasis is the one of the most common,
Author for Correspondence: opportunistric, treatable human fungal infection of
the oral cavity seen in all stages of life1. Oral
Lekshmi L, candiasis is also known as oral candidosis, oral
Department of Pharmaceutics, thrush, or opharyngeal candidiasis, moniliasis,
Nazreth College of Pharmacy, candidal stomatitis, muguet. It is common and
Thiruvalla, Kerala, India. under diagnosed among the elderly, particularly in
those who wear denatures and in many cases is
Email: lekshmilatha5@gmail.com avoidable with a good mouth care regimen. It is an
oral mucosal infection seen in persons with human
immunodeficiency virus (HIV), infection or
acquired immune deficiency syndrome (AIDS). It acquired from the mother's vaginal canal during
can also be a mark of systemic disease, such as birth. At very young ages, the immune system is yet
diabetes mellitus and is a common problem among to develop fully and there is no individual immune
the immunocompromised2. Oral can be a frequent response to candida species, infants antibodies to
and significant source of oral discomfort, pain, loss the bacteria are normally supplied by the
of taste, and aversion to food. Oral candidiasis is mother's breast milk.
caused by the overgrowth or infection of the oral Denture Wearing
cavity by a yeast-like fungus, Candida. Candida is Denture wearing and poor denture hygiene is
commensal organism and part of the normal oral another risk factor for both candidal carriage and
flora in about 30%-50% of the population, and is oral candidiasis. Dentures provide a relative acidic,
capable of producing opportunistic infections within moist and anaerobic environment because the
the oral cavity when appropriate predisposing mucosa covered by the denture is sheltered from
factors exist. More than 20 species of Candida, oxygen and saliva. Poorly fitting dentures may also
Candida albicans are the most common and cause minor trauma to the mucosa, which is
important causative agent of oral candidiasis. Some increase the permeability of the mucosa and
other candidia species are C tropicalis, C glabrata, increase the ability of C. albicans to invade the
Cpseudotropicalis, C guillierimondii, C krusei, C tissues. These conditions all favor the growth of C.
lusitaniae, C parapsilosis, and C stellatoidea3. albicans.
Candida albicans Dry Mouth
C. albicansis the most common fungal pathogen in Both the quality and quantity of saliva are important
humans, able to cause various Infections oral defenses against candida. Decreased salivary
(Candidiasis) that may be severe enough to kill the flow rate or a change in the composition of saliva,
host if the infection is systemic. Two important can cause the salivary hypo function or hypo
factors that affect the pathogenicity of C. albicans salivation. It is an important predisposing factor for
are the ability to switch between yeast growth and candidiasis.
filamentous growth, i.e. the hyphal switch, and the Diet
ability to form biofilms which enables C. albicans Malnutrition, malabsorption or Poor diet,
to adhere to the surface of substrates. In biofilms especially hematinic deficiencies (iron, vitamin
cells show an increased resistance to the immune B12, folic acid) can predispose to oral
system and to antifungal drugs4. candidiasis, by causing diminished host defense and
Causes epithelial integrity.
The causative organism is Candidia species usually Smoking
Candida albicans, C. albicans accounts for about Heavy smoking is an important predisposing factor
50% of oral candidiasis and together, C. for candidasis, but the relationships are unknown.
albicans, C. tropicalis and C. glabrata account for One hypothesis is that cigarette smoke contains
over 80% of cases. Candidiasis caused by non-C. nutritional factors for C. albicans, or that local
albicans Candida species is associated more with epithelial alterations occur that facilitate
immunodeficiency. Such as HIV/AIDS. Certain colonization of candida species.
drugs can alter the natural organisms in the mouth, Antibiotics
which can then promote the growth of Candida. Broad-spectrum antibiotics eliminates the
These include the extended use of antibiotics, competing bacteria and disrupt the normally
steroids and oral contraceptives with high estrogen balanced ecology of oral micro-organisms. Acute
content. oral candidiasis occurring due to medication
Immunodeficiency/Immunocompromise with corticosteroids or broad-spectrum
Acute pseudo membranous candidiasis occurs in antibiotics (tetracycline).
about 5% of newborn infants. Candida species are
biopsy shows candidal hyphae invading the Although this condition is also known as "denture
epithelium. Some sources use this term to describe sore mouth", there is rarely any pain. Candida is
leukoplakia lesions that become colonized associated with about 90% of cases of denture
secondarily by Candida species, thereby related stomatitis.
distinguishing it from hyperplastic candidiasis. It is Median rhomboid glossitis
known that Candida resides more readily in mucosa This is an elliptical or rhomboid lesion in the center
that is altered, such as may occur with dysplasia and of the dorsal tongue, just anterior (in front) of
hyperkeratosis in an area of leukoplakia. the circumvallate papillae. The area is depapillated,
Associated lesions reddened (or red and white) and rarely painful.
Candida-associated lesions are primary oral There is frequently Candida species in the lesion,
candidiasis (confined to the mouth), where the sometimes mixed with bacteria.
causes are thought to be multiple. For example, Linear gingival erythema
bacteria as well as Candida species may be This is a localized or generalized, linear band of
involved in these lesions. Frequently, antifungal erythematous gingivitis (inflammation of the gums).
therapy alone does not permanently resolve these It was first observed in HIV infected individuals
lesions, but rather the underlying predisposing and termed "HIV-gingivitis", but the condition is
factors must be addressed, in addition to treating the not confined to this group. Candida species are
candidiasis. involved, and in some cases the lesion responds to
Angular cheilitis antifungal therapy, but it is thought that other
Angular cheilitis is inflammation at the corners factors exist, such as oral hygiene and human
(angles) of the mouth, very commonly herpes viruses. This condition can develop
involving Candida species, when sometimes the into necrotizing ulcerative periodontitis.
terms "Candida-associated angular cheilitis", or less Chronic multifocal oral candidiasis
commonly, "monilialperlche" are used. Candida This is an uncommon form of chronic (more than
organisms alone responsible for about 20% of one month in duration) candidial infection involving
cases, and a mixed infection of C. multiple areas in the mouth, without signs of
albicans and Staphylococcus aureus for about 60% candidiasis on other mucosal or cutaneous sites. The
of cases. Signs and symptoms include lesions are variably red and/or white. Unusually for
soreness, erythema (redness), and fissuring of one, candidal infections, there is an absence of
or more commonly both the angles of the mouth, predisposing factors such as immune suppression,
with edema seen intraorally on the commisures. and it occurs in apparently healthy individuals,
Angular cheilitis is generally occurs in elderly normally elderly males. Smoking is a known risk
people and is associated with denture related factor.
stomatitis. Chronic mucocutaneous candidiasis
Denture related stomatitis This refers to a group of rare syndromes
This term refers to a mild inflammation and characterized by chronic candidal lesions on the
erythema of the mucosa beneath a denture, usually skin, in the mouth and on other mucous membranes
an upper denture in elderly edentulous individuals (i.e., a secondary oral candidiasis). These include
(with no natural teeth remaining). Some report that Localized chronic mucocutaneous candidiasis,
up to 65% of denture wearers have this condition to diffuse mucocutaneous candidiasis (Candida
some degree. About 90% of cases are associated granuloma), candidiasis-endocrinopathy syndrome
with candida species, where sometimes the terms and candidiasis thymoma syndrome. About 90% of
"candida-associated denture stomatitis, or people with chronic mucocutaneous candidiasis
Candida-associated denture induced stomatitis" have candidiasis in the mouth6.
(CADIS), are used. Some sources state that this is
by far the most common form of oral candidiasis.
Available online: www.uptodatereseachpublication.com November December 412
Lekshmi L et al. / International Journal of Research in Pharmaceutical and Nano Sciences. 4(6), 2015, 409 - 417.
day for 2-3 weeks. Main side effects are nausea, Yogurt
vomiting and headache. It interacts with Incorporate yogurt with live-acting cultures into
anticoagulants and this drug is contraindicated in your diet to boost the level of healthy bacteria in
pregnancy, liver and renal disease your mouth. Swish the yogurt about your mouth and
Itraconazole then refrain from eating or drinking anything
It is one of the broad spectrum antifungal agents shortly afterwards.
and contraindicated in pregnancy and liver disease. Thorough Cleaning
The dosage of the drug is 100 mg capsule once a If you wear dentures 23 and have thrush, cleaning
day for 2 weeks. The main side effects are nausea, your mouth and dentures each night is a must. Make
neuropathy and rashes. sure to soak your dentures in a cleaner overnight.
Treatment for pregnant women Rinse them well after removing from the
Because many of the drugs used to treat fungal solution24and before placing back into your
infections can be toxic to the developing fetus, only mouth15.
topical treatments-such as creams - are used when
ever possible11,12. PREVENTION
The risk of getting oral thrush can be reduced by
LIFESTYLE AND HOME REMEDIES13 following the advice outlined below.
To ease the pain, discomforts, and inconvenience of Oral hygiene
oral thrush, consider the following home remedies: Your chances of getting oral thrush are
Practice Good Oral Habits reduced if you keep your mouth clean and
Brushing 22 at least twice a day and flossing at least healthy. You can do this by,
once can cut down on the amount of time you have Rinsing your mouth after meals
to suffer an oral thrush infection. Make sure to Visiting your dentist regularly for check-ups
frequently replace your toothbrush until the Eating a healthy balanced diet
infection is gone14. Keeping your dentures clean
Natural Home Remedies for Oral Thrush Brushing your teeth twice a day with a
Mix equal parts of a tincture consisting of liquorice, toothpaste that contains fluoride
myrrh, and Echinacea. Use one teaspoon of this
Flossing regularly
remedy as a mouthwash that is taken with water
Using a mouthwash as part of your routine.
every three to four hours.
Denture hygiene
Saltwater Rinses
If you wear dentures clean them every night before
Add teaspoon of salt into one cup of warm water.
you go to bed. They can be done by brushing them
After the salt has dissolved, swish the rinse in your
with warm, soapy water and scrubbed with a
mouth and then spit out.
nailbrush on the non-polished side of the dentures.
Anti-Fungal Home Mouthwashes
Dentures can then be soaked in any liquid that can
Blend warm water, cider vinegar and a pinch of salt
be used to sterilize babies bottles. However,
to create a home remedy that fights fungus. Swish
products containing bleach should not be used on
the wash around the mouth, making sure to reach all
dentures that contain metal. You should visit your
corners. Use it as a gargle for the throat.
dentist to correct dentures that do not fit properly.
Garlic and Onions
This can also reduce the risk of oral thrush and
Tap into the antifungal power of onions and garlic,
soreness underneath the dentures.
which can help kill candida in the mouth. Increase
Smoking
the amount of garlic used in your diet to eliminate
Smoking encourages yeast in your mouth to grow
yeast infection. Onions also help heal the white
and increases your chance of getting oral thrush.
patches (lesions) found in the mouth.
Please cite this article in press as: Lekshmi L et al. Oral candidiasis - Review, International Journal of
Research in Pharmaceutical and Nano Sciences, 4(6), 2015, 409-417.