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. There are three broad groupings consisting of acute candidiasis, chronic candidiasis, and angular cheilitis. Risk factors include impaired salivary gland function, drugs, dentures, high carbohydrate diet, and extremes of life, smoking, diabetes mellitus, Cushing's syndrome, malignancies, and immunosuppressive conditions. 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 prognosis is good in the great majority of cases.
Full Text
The Full Text of this article is available as a PDF (148.9 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Abu-Elteen K. H., Abu-Alteen R. M. The prevalence of Candida albicans populations in the mouths of complete denture wearers. New Microbiol. 1998 Jan;21(1):41–48. [PubMed] [Google Scholar]
- Aldred M. J., Addy M., Bagg J., Finlay I. Oral health in the terminally ill: a cross-sectional pilot survey. Spec Care Dentist. 1991 Mar-Apr;11(2):59–62. doi: 10.1111/j.1754-4505.1991.tb00815.x. [DOI] [PubMed] [Google Scholar]
- Arendorf T. M., Walker D. M. The prevalence and intra-oral distribution of Candida albicans in man. Arch Oral Biol. 1980;25(1):1–10. doi: 10.1016/0003-9969(80)90147-8. [DOI] [PubMed] [Google Scholar]
- Barkvoll P., Attramadal A. Effect of nystatin and chlorhexidine digluconate on Candida albicans. Oral Surg Oral Med Oral Pathol. 1989 Mar;67(3):279–281. doi: 10.1016/0030-4220(89)90354-x. [DOI] [PubMed] [Google Scholar]
- Barkvoll P., Hurlen B. Konvensjonell behandling av orale candidoser; enkelte fallgruber. Nor Tannlaegeforen Tid. 1989 Feb;99(4):116–119. [PubMed] [Google Scholar]
- Berdicevsky I., Ben-Aryeh H., Szargel R., Gutman D. Oral Candida in children. Oral Surg Oral Med Oral Pathol. 1984 Jan;57(1):37–40. doi: 10.1016/0030-4220(84)90257-3. [DOI] [PubMed] [Google Scholar]
- Bergmann O. J. Alterations in oral microflora and pathogenesis of acute oral infections during remission-induction therapy in patients with acute myeloid leukaemia. Scand J Infect Dis. 1991;23(3):355–366. doi: 10.3109/00365549109024323. [DOI] [PubMed] [Google Scholar]
- Blatchford N. R. Treatment of oral candidosis with itraconazole: a review. J Am Acad Dermatol. 1990 Sep;23(3 Pt 2):565–567. doi: 10.1016/0190-9622(90)70256-h. [DOI] [PubMed] [Google Scholar]
- Brassart D., Woltz A., Golliard M., Neeser J. R. In vitro inhibition of adhesion of Candida albicans clinical isolates to human buccal epithelial cells by Fuc alpha 1----2Gal beta-bearing complex carbohydrates. Infect Immun. 1991 May;59(5):1605–1613. doi: 10.1128/iai.59.5.1605-1613.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Budtz-Jörgensen E. Etiology, pathogenesis, therapy, and prophylaxis of oral yeast infections. Acta Odontol Scand. 1990 Feb;48(1):61–69. doi: 10.3109/00016359009012735. [DOI] [PubMed] [Google Scholar]
- Cumming C. G., Wight C., Blackwell C. L., Wray D. Denture stomatitis in the elderly. Oral Microbiol Immunol. 1990 Apr;5(2):82–85. doi: 10.1111/j.1399-302x.1990.tb00232.x. [DOI] [PubMed] [Google Scholar]
- Cutler J. E., Friedman L., Milner K. C. Biological and chemical characterization of toxic substances from Candida albicans. Infect Immun. 1972 Oct;6(4):616–627. doi: 10.1128/iai.6.4.616-627.1972. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Douglas L. J. Surface composition and adhesion of Candida albicans. Biochem Soc Trans. 1985 Dec;13(6):982–984. doi: 10.1042/bst0130982. [DOI] [PubMed] [Google Scholar]
- Dreizen S. Oral candidiasis. Am J Med. 1984 Oct 30;77(4D):28–33. [PubMed] [Google Scholar]
- Dupont B., Graybill J. R., Armstrong D., Laroche R., Touzé J. E., Wheat L. J. Fungal infections in AIDS patients. J Med Vet Mycol. 1992;30 (Suppl 1):19–28. doi: 10.1080/02681219280000731. [DOI] [PubMed] [Google Scholar]
- Epstein J. B. Antifungal therapy in oropharyngeal mycotic infections. Oral Surg Oral Med Oral Pathol. 1990 Jan;69(1):32–41. doi: 10.1016/0030-4220(90)90265-t. [DOI] [PubMed] [Google Scholar]
- Epstein J. B., Freilich M. M., Le N. D. Risk factors for oropharyngeal candidiasis in patients who receive radiation therapy for malignant conditions of the head and neck. Oral Surg Oral Med Oral Pathol. 1993 Aug;76(2):169–174. doi: 10.1016/0030-4220(93)90199-e. [DOI] [PubMed] [Google Scholar]
- Epstein J. B., Polsky B. Oropharyngeal candidiasis: a review of its clinical spectrum and current therapies. Clin Ther. 1998 Jan-Feb;20(1):40–57. doi: 10.1016/s0149-2918(98)80033-7. [DOI] [PubMed] [Google Scholar]
- Epstein J. B., Truelove E. L., Izutzu K. T. Oral candidiasis: pathogenesis and host defense. Rev Infect Dis. 1984 Jan-Feb;6(1):96–106. doi: 10.1093/clinids/6.1.96. [DOI] [PubMed] [Google Scholar]
- Ferretti G. A., Ash R. C., Brown A. T., Largent B. M., Kaplan A., Lillich T. T. Chlorhexidine for prophylaxis against oral infections and associated complications in patients receiving bone marrow transplants. J Am Dent Assoc. 1987 Apr;114(4):461–467. doi: 10.14219/jada.archive.1987.0112. [DOI] [PubMed] [Google Scholar]
- Francis P., Walsh T. J. Current approaches to the management of fungal infections in cancer patients: Part 1. Oncology (Williston Park) 1992 Apr;6(4):81–100. [PubMed] [Google Scholar]
- Fraser V. J., Jones M., Dunkel J., Storfer S., Medoff G., Dunagan W. C. Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality. Clin Infect Dis. 1992 Sep;15(3):414–421. doi: 10.1093/clind/15.3.414. [DOI] [PubMed] [Google Scholar]
- Garber G. E. Treatment of oral Candida mucositis infections. Drugs. 1994 May;47(5):734–740. doi: 10.2165/00003495-199447050-00003. [DOI] [PubMed] [Google Scholar]
- Ghannoum M. A., Burns G. R., Elteen K. A., Radwan S. S. Experimental evidence for the role of lipids in adherence of Candida spp. to human buccal epithelial cells. Infect Immun. 1986 Oct;54(1):189–193. doi: 10.1128/iai.54.1.189-193.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Guida R. A. Candidiasis of the oropharynx and esophagus. Ear Nose Throat J. 1988 Nov;67(11):832, 834-6, 838-40. [PubMed] [Google Scholar]
- Gupta A. K., Sauder D. N., Shear N. H. Antifungal agents: an overview. Part I. J Am Acad Dermatol. 1994 May;30(5 Pt 1):677–700. [PubMed] [Google Scholar]
- Gwinnett A. J., Caputo L. The effectiveness of ultrasonic denture cleaning: a scanning electron microscope study. J Prosthet Dent. 1983 Jul;50(1):20–25. doi: 10.1016/0022-3913(83)90159-2. [DOI] [PubMed] [Google Scholar]
- Hazen K. C., Brawner D. L., Riesselman M. H., Jutila M. A., Cutler J. E. Differential adherence of hydrophobic and hydrophilic Candida albicans yeast cells to mouse tissues. Infect Immun. 1991 Mar;59(3):907–912. doi: 10.1128/iai.59.3.907-912.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Heinic G. S., Stevens D. A., Greenspan D., MacPhail L. A., Dodd C. L., Stringari S., Strull W. M., Hollander H. Fluconazole-resistant Candida in AIDS patients. Report of two cases. Oral Surg Oral Med Oral Pathol. 1993 Dec;76(6):711–715. doi: 10.1016/0030-4220(93)90039-7. [DOI] [PubMed] [Google Scholar]
- Holbrook W. P., Hjorleifsdottir D. V. Occurrence of oral Candida albicans and other yeast-like fungi in edentulous patients in geriatric units in Iceland. Gerodontics. 1986 Oct;2(5):153–156. [PubMed] [Google Scholar]
- Kanbe T., Li R. K., Wadsworth E., Calderone R. A., Cutler J. E. Evidence for expression of the C3d receptor of Candida albicans in vitro and in vivo obtained by immunofluorescence and immunoelectron microscopy. Infect Immun. 1991 May;59(5):1832–1838. doi: 10.1128/iai.59.5.1832-1838.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Klotz S. A., Smith R. L. A fibronectin receptor on Candida albicans mediates adherence of the fungus to extracellular matrix. J Infect Dis. 1991 Mar;163(3):604–610. doi: 10.1093/infdis/163.3.604. [DOI] [PubMed] [Google Scholar]
- Kwon-Chung K. J., Lehman D., Good C., Magee P. T. Genetic evidence for role of extracellular proteinase in virulence of Candida albicans. Infect Immun. 1985 Sep;49(3):571–575. doi: 10.1128/iai.49.3.571-575.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lucas V. S. Association of psychotropic drugs, prevalence of denture-related stomatitis and oral candidosis. Community Dent Oral Epidemiol. 1993 Oct;21(5):313–316. doi: 10.1111/j.1600-0528.1993.tb00782.x. [DOI] [PubMed] [Google Scholar]
- Lumbreras C., Cuervas-Mons V., Jara P., del Palacio A., Turrión V. S., Barrios C., Moreno E., Noriega A. R., Paya C. V. Randomized trial of fluconazole versus nystatin for the prophylaxis of Candida infection following liver transplantation. J Infect Dis. 1996 Sep;174(3):583–588. doi: 10.1093/infdis/174.3.583. [DOI] [PubMed] [Google Scholar]
- MacFarlane T. W., Helnarska S. J. The microbiology of angular cheilitis. Br Dent J. 1976 Jun 15;140(12):403–406. doi: 10.1038/sj.bdj.4803773. [DOI] [PubMed] [Google Scholar]
- MacPhail L. A., Hilton J. F., Dodd C. L., Greenspan D. Prophylaxis with nystatin pastilles for HIV-associated oral candidiasis. J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Aug 15;12(5):470–476. doi: 10.1097/00042560-199608150-00005. [DOI] [PubMed] [Google Scholar]
- Manning D. J., Coughlin R. P., Poskitt E. M. Candida in mouth or on dummy? Arch Dis Child. 1985 Apr;60(4):381–382. doi: 10.1136/adc.60.4.381. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Milne L. J., Crompton G. K. Beclomethasone dipropionate and oropharyngeal candidiasis. Br Med J. 1974 Sep 28;3(5934):797–798. doi: 10.1136/bmj.3.5934.797. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Morgan R., Tsang J., Harrington N., Fook L. Survey of hospital doctors' attitudes and knowledge of oral conditions in older patients. Postgrad Med J. 2001 Jun;77(908):392–394. doi: 10.1136/pmj.77.908.392. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ninane J. A multicentre study of fluconazole versus oral polyenes in the prevention of fungal infection in children with hematological or oncological malignancies. Multicentre Study Group. Eur J Clin Microbiol Infect Dis. 1994 Apr;13(4):330–337. doi: 10.1007/BF01974614. [DOI] [PubMed] [Google Scholar]
- Odman P. A. The effectiveness of an enzyme-containing denture cleanser. Quintessence Int. 1992 Mar;23(3):187–190. [PubMed] [Google Scholar]
- Ohman S. C., Jontell M. Treatment of angular cheilitis. The significance of microbial analysis, antimicrobial treatment, and interfering factors. Acta Odontol Scand. 1988 Oct;46(5):267–272. doi: 10.3109/00016358809004776. [DOI] [PubMed] [Google Scholar]
- Penhall B. Preventive measures to control further bone loss and soft tissue damage in denture wearing. Aust Dent J. 1980 Dec;25(6):319–324. doi: 10.1111/j.1834-7819.1980.tb03889.x. [DOI] [PubMed] [Google Scholar]
- Peterson D. E. Oral candidiasis. Clin Geriatr Med. 1992 Aug;8(3):513–527. [PubMed] [Google Scholar]
- Phillips P., Zemcov J., Mahmood W., Montaner J. S., Craib K., Clarke A. M. Itraconazole cyclodextrin solution for fluconazole-refractory oropharyngeal candidiasis in AIDS: correlation of clinical response with in vitro susceptibility. AIDS. 1996 Oct;10(12):1369–1376. doi: 10.1097/00002030-199610000-00009. [DOI] [PubMed] [Google Scholar]
- Powderly W. G., Finkelstein D., Feinberg J., Frame P., He W., van der Horst C., Koletar S. L., Eyster M. E., Carey J., Waskin H. A randomized trial comparing fluconazole with clotrimazole troches for the prevention of fungal infections in patients with advanced human immunodeficiency virus infection. NIAID AIDS Clinical Trials Group. N Engl J Med. 1995 Mar 16;332(11):700–705. doi: 10.1056/NEJM199503163321102. [DOI] [PubMed] [Google Scholar]
- Rex J. H., Rinaldi M. G., Pfaller M. A. Resistance of Candida species to fluconazole. Antimicrob Agents Chemother. 1995 Jan;39(1):1–8. doi: 10.1128/aac.39.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Riipi L., Carlson E. Tumor necrosis factor (TNF) is induced in mice by Candida albicans: role of TNF in fibrinogen increase. Infect Immun. 1990 Sep;58(9):2750–2754. doi: 10.1128/iai.58.9.2750-2754.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rodu B., Carpenter J. T., Jones M. R. The pathogenesis and clinical significance of cytologically detectable oral Candida in acute leukemia. Cancer. 1988 Nov 1;62(9):2042–2046. doi: 10.1002/1097-0142(19881101)62:9<2042::aid-cncr2820620928>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
- Saltarelli C. G., Gentile K. A., Mancuso S. C. Lethality of Candida strains as influenced by the host. Can J Microbiol. 1975 May;21(5):648–654. doi: 10.1139/m75-093. [DOI] [PubMed] [Google Scholar]
- Samaranayake L. P. Nutritional factors and oral candidosis. J Oral Pathol. 1986 Feb;15(2):61–65. doi: 10.1111/j.1600-0714.1986.tb00578.x. [DOI] [PubMed] [Google Scholar]
- Schuman P., Capps L., Peng G., Vazquez J., el-Sadr W., Goldman A. I., Alston B., Besch C. L., Vaughn A., Thompson M. A. Weekly fluconazole for the prevention of mucosal candidiasis in women with HIV infection. A randomized, double-blind, placebo-controlled trial. Terry Beirn Community Programs for Clinical Research on AIDS. Ann Intern Med. 1997 May 1;126(9):689–696. doi: 10.7326/0003-4819-126-9-199705010-00003. [DOI] [PubMed] [Google Scholar]
- Shay K., Truhlar M. R., Renner R. P. Oropharyngeal candidosis in the older patient. J Am Geriatr Soc. 1997 Jul;45(7):863–870. doi: 10.1111/j.1532-5415.1997.tb01517.x. [DOI] [PubMed] [Google Scholar]
- Silverman S., Jr, Luangjarmekorn L., Greenspan D. Occurrence of oral Candida in irradiated head and neck cancer patients. J Oral Med. 1984 Oct-Dec;39(4):194–196. [PubMed] [Google Scholar]
- Slutsky B., Buffo J., Soll D. R. High-frequency switching of colony morphology in Candida albicans. Science. 1985 Nov 8;230(4726):666–669. doi: 10.1126/science.3901258. [DOI] [PubMed] [Google Scholar]
- Smith D., Midgley J., Gazzard B. A randomised, double-blind study of itraconazole versus placebo in the treatment and prevention of oral or oesophageal candidosis in patients with HIV infection. Int J Clin Pract. 1999 Jul-Aug;53(5):349–352. [PubMed] [Google Scholar]
- Sobel J. D., Muller G., Buckley H. R. Critical role of germ tube formation in the pathogenesis of candidal vaginitis. Infect Immun. 1984 Jun;44(3):576–580. doi: 10.1128/iai.44.3.576-580.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stafford G. D., Arendorf T., Huggett R. The effect of overnight drying and water immersion on candidal colonization and properties of complete dentures. J Dent. 1986 Apr;14(2):52–56. doi: 10.1016/0300-5712(86)90051-5. [DOI] [PubMed] [Google Scholar]