INFECTIONS caused by Candida species of fungus comprise some of the most common oral disease conditions encountered in the practice of dentistry. In most cases, the disease may clinically present itself in several different forms. It is mainly observed as white, soft plaques overlying areas of redness on the mucosa (lining), which are removed easily, possibly revealing pinpoint areas of ulceration or sores. In infants, it is commonly referred to as thrush.
When clinical candidiasis, which is a typical yeast infection (also known as thrush), emerges, it can result from a variety of predisposing or associated factors. These factors include, but are not limited to, age extremes, malnourishment, metabolic disease (e.g. diabetes), concurrent infection with other harmful germs, antibiotic treatment, HIV infection and radiotherapy. Candida can be found in the mouths and anal regions of newborns at a rate of approximately 40%, which correlates well with vaginal carriage by the mother at the time of birth. However, the disease affects 4% to 10%. These infections appear as milky-white, curd-like plaques which are easily removed by digital rubbing and are generally evident three to seven days after birth.
With increasing age and a corresponding increase in the diversity of the germs that naturally inhabit the mouth, there appears to be a corresponding reduction in the incidence of the signs and symptoms of candidosis. This may be the result of increasing environmental competition in the oral cavity, as well as the child’s developing competence to fight off infections.
Women suffer from Candida infections four times as much as men because of hormonal factors and the greater incidence of iron deficiency among women. Notwithstanding this, the disease is also a common sign of uncontrolled diabetes. In the elderly, a major predisposing factor is the wearing of dentures. Chronic atrophic candidosis (generally known as denture sore mouth) may result from poor denture hygiene and from the denture being worn 24 hours a day. The infection appears as redness with swelling of the gums, which is generally confined to the outline of the denture. When the white patches of candidosis present in adults cannot be scraped off easily, the situation may be quite serious. The condition can be candidal leukoplakia, which is accepted as precancerous. Frequently, dentists detect such a scenario in inveterate smokers of tobacco.
Several easily recognised clinical entities have been identified in which Candida is at least circumstantially involved. One of them is angular cheilitis, which we Guyanese call “white corner”. The victim usually complains of dryness and a burning sensation at the corners of the mouth. Vitamin B deficiency may often play a role in initiating such lesions. Another case is median rhomboid glossitis. These big words describe the painless, smooth areas we sometimes accidentally discover on our tongues. The palate opposite the lesion may also be affected.
Treatment for candidiasis must be undertaken by someone who can assess the significance of the condition as it relates to the patient. A competent professional must make the diagnosis and provide treatment. Drugs available for therapy include fluconazole, clotrimazole and nystatin.
