White Lesion Of the Oral Mucosa Part 5

Candidal infection, with the exception of neonates , usually does not become evident in healthy persons.
Intact mucous membranes prevent candidal infection.
When host’s local or systemic defence mechanism are weak, commensal or acquired candidal organism becomes pathogenic.

1.Use of antibiotics,especially broad-spectrum, excessive use of antibacterial mouth rinses,or xerostomia.
2.Chronic local irritants (dentures/orthodontic appliances)
3.Administration of corticosteroids (aerosolized inhalant and topical agents are more likely to cause candidiasis than systemic administration)
4.Poor oral hygiene
6.Infancy or old age
7.Immunologic deficiency:
Congenital or childhood (chronic familial mucocutaneous candidiasis +- endocrine candidiasis syndrome { hypoparathyroidism , hypoadrenocorticism} and immunologic immaturity of infancy.)
Acquired or adult (diabetes , leukemia , lymphomas and AIDS)

Iatrogenic ( from cancer chemotherapy , bone marrow transplantation , and head and neck radiation)
Malabsorption and malnutrition
Recent studies have indicated that a small percentage of persons prone to disseminated candidiasis lack an alpha-2-globulin anticandidal factor in their serum and others lack a specific lysosomal enzyme called myeloperoxidase in their leucocytes

Atrophic (Erythematous)
-Antibiotic stomatitis
-Denture sore mouth
-Angular cheilitis
-Median rhomboid glossitis
-Candidal leukoplakia
-Papillary hyperplasia of the palate
-Median rhomboid glossitis (nodular)
Syndrome associated
-Familial +/- endocrine candidiasis syndrome
-Myositis (thymoma associated)
Generalized (diffuse)
Immunocompromise (HIV) associated

Common form predominantly seen in otherwise healthy neonates or severely debilitated & chronically ill patients.
In neonates, oral lesions start between the sixth and tenth day after birth.
Infection is contracted from the maternal vaginal canal where candida albicans flourishes during pregnancy.
Maternal antibodies transferred through the placenta to the fetus are believed to play a role in protecting the infant against thrush.
It is believed that the immunity is produced by immunoglobulin IgG which can cross the placenta &not by IgA and IgM which do not cross the placental barrier.
In healthy adults acute pseudomembranous candidiasis of oral mucosa is uncommon.
Seen in persons on long term, broad spectrum antibiotics or those with immunodeficiency states,
Superficial infection of the outer layers of the epithelium.
Refers to the semi-adherent, whitish, yellowish, soft and creamy, slightly elevated, pseudomembranous, drop-like or confluent patches or plaques, resembling milk curds.
Removal of the plaques by gentle rubbing or scraping reveals an area of erythema or even shallow ulceration .
The intraoral lesions are generally painless and can be removed with little difficulty .
May involve the entire oral mucosa or localized areas where normal cleansing mechanism are poor.
Prodromal symptoms: rapid onset of a bad taste and loss of taste discrimination .
Burning sensation of the mouth & throat may also precede
Symptoms of this type in a patient receiving broad-spectrum antibiotics are strongly suggestive of thrush or other forms of oral candidiasis
Possible complication of oropharyngeal thrush is the involvement of the adjacent mucosa , particularly those of the upper respiratory tract and the esophagus.
The combination of oral and esophageal candidosis is particularly prevalent in HIV-infected patients .
Patients with immunodeficiencies such as those suffering from AIDS or hematologic malignancies , are also susceptible
Candida albicans is most commonly found in thrush.
Severity and refractoriness of candida infection to treatment possibly depend more on the site of involvement and on predisposing factors than on properties of the infecting species.
Diagnosis is made on the basis of the appearance
Microscopic identification of the organism in large numbers in smears (PAS) and /or tissue cultures .

The differential diagnosis of thrush includes:
Food debris
Habitual cheek bite
White sponge nevus

Nystatin and amphotericin B may be used as specific treatment for oral pseudomembranous candidasis.
Search for an underlying predisposing systemic factors

Uncommon and poorly understood condition associated with corticosteroids and topical or systemic broad spectrum antibiotics or HIV disease.
The clinical presentation is characterized by erythematous areas generally on the dorsum of the tongue, palate, or buccal mucosa.
Painful erythematous lesions with minute white plaques are characteristic features of acute atrophic candidiasis.
Resembles erosive lichen planus and erythroplakia.
White plaques in acute atrophic candidasis are removable on digital pressure , a diagnostic feature.
Lesions on the dorsum of the tongue present as depapillated areas.
Red areas are often seen in the palate in HIV disease.
There can be associated angular stomatitis.

Parakeratinized epithelium is atrophic in areas.
A few fungi may be seen in superficial epithelium layers (special stains to demonstrate)
Microabscesses may be seen in the superficial epithelial layers occasionally.

Withdrawal or change of antibiotic use if feasible.
Topical application of antifungal agents
Nystatin or amphotericin B topical application are commonly used preparation.
Mysteclin elixir containing both tetracycline and amphotericin B may also prove to be beneficial