Oral candidiasis

Department of Pediatric Dentistry
St Joseph Hospital

Resident’s Name: Joanne Lewis Date: July 17, 2009
Article title: Oral candidiasis in children with immune suppression: Clinical appearance and therapeutic considerations
Author(s): Catherine M. Flaitz, DDS, MS; M. John Hicks, DDS, MS, PhD, MD
Journal: Journal of Dentistry for Children
Month, Year: May-June 1999
Major topic: Oral candidiasis in immuno-suppressed children
Type of Article: review
Main Purpose: to review the clinical appearance, diagnosis, and treatment of oral candidiasis
Key points/Summary: Oropharyngeal candidiasis is of considerable importance in any condition that results in an immune suppressed state; it is particularly important in individuals with HIV infection. The development of oral candidiasis is considered to be an ominous sign, indicative of a severely depressed immune system. Oral candidiasis may present in several forms: 1.) pseudomembranous candidiasis (thrush) – white to yellow plaques overlying the oral mucosa – can be removed with gauze – symptoms include tenderness, burning, and dysphasia. 2.) erythematous (atrophic) candidiasis – marked erythematous mucosa on palate and/or dorsum of tongue – associated with broad-spectrum antibiotics and corticosteroid therapy. 3.) papillary hyperplasia – anterior hard palate, small ovoid nodules raised 2-3 mm above erythematous palatal mucosa – response to a chronic fungal infection. 4.) chronic hyperplastic candidiasis – thickened hyperkeratotic mucosa, looks like a localized area of leukoplakia – seen in long-standing fungal infections – presents on dorsum of tongue or retrocommissural region 5.) angular chelitis – seen at the commissures, may become encrusted secondary to fissuring and erosion – seen commonly in children with a lip-licking habit. 6.) median rhomboid glossitis – lesion surface varies from nodular to fissured to smooth and depapillated. Diagnosis: clinical appearance (most common), exfoliative cytology, biopsy, or culture (when lesions are resistant to anti-fungal therapy). Treatment: 1.) topical – nystatin creams, rinses, pastilles, ketoconazole cream, clotrimazole creams and lozenges, amphotericin B cream and lotion – usually have high sucrose or dextrose content, long term use may increase caries risk. 2.) prophylactic – chlorhexidine rinses. 3.) systemic – clotrimazole, ketoconazole, fluconazole, itraconazole (azole class) – side effects include – nausea, vomiting, pruritus, skin rash, abdominal discomfort, headache, abnormal liver function, drug-induced hepatitis – assess liver function at time of administration. Fluconazole and itraconazole have been more effective at treating oral candidiasis. Prophylaxis with antifungal agents in children and adolescents with HIV infection is not routinely recommended, but may be indicated on a case-by-case basis.
Assessment of article: good review.