Journal of Dental Pathology and Medicine
Open Access

Oral candidiasis; Thrush; Candida albicans; Oral hygiene; Antifungal treatment; Immunocompromised; Diagnosis

Oral candidiasis, also known as thrush, is a common fungal infection of the oral cavity, primarily caused by an overgrowth of Candida species [1]. The most prevalent species responsible for this infection is Candida albicans, although other species such as Candida glabrata and Candida tropicalis can also contribute to oral infections [2]. Candida is a normal inhabitant of the human microbiota, but when there is an imbalance or a weakened immune system, it can proliferate and lead to infection. Oral candidiasis can affect individuals of all ages, from infants to elderly adults, and is particularly common among those with compromised immune systems [3, 4].

This article aims to provide an in-depth understanding of oral candidiasis, including its causes, risk factors, clinical features, diagnostic methods, and treatment strategies [5]. We also discuss preventive measures to reduce the risk of this condition and improve overall oral health.

Pathophysiology of oral candidiasis

The pathogenesis of oral candidiasis involves the overgrowth of Candida species in the oral cavity, which typically remains in a balanced state with other microorganisms under healthy conditions [6].

Conditions such as HIV/AIDS, cancer, diabetes, and organ transplants can weaken the immune system, making individuals more susceptible to opportunistic infections like oral candidiasis [7]. Patients undergoing chemotherapy or long-term use of immunosuppressive medications are also at high risk.

Antibiotic treatment, especially broad-spectrum antibiotics, can alter the oral microbiota, killing beneficial bacteria that keep fungal growth in check. This disruption provides an opportunity for Candida to overgrow.

Inadequate oral care can lead to the accumulation of food particles, bacteria, and fungi in the mouth, creating an environment conducive to Candida growth [8]. Hormonal fluctuations during pregnancy, menstruation, or due to the use of oral contraceptives can increase the risk of developing oral candidiasis.

Reduced saliva production, whether from certain medications, dehydration, or underlying medical conditions, can foster an environment that promotes fungal overgrowth.

Poorly controlled diabetes can increase glucose availability in the mouth, which feeds the fungi, thus promoting their growth.

Clinical presentation

Oral candidiasis is characterized by the development of white, creamy lesions in the mouth. These lesions are most commonly found on the tongue, inner cheeks, gums, and roof of the mouth. In addition to visible lesions, patients may experience:

The lesions may cause discomfort, particularly when eating or drinking, which can affect a person’s quality of life. As the infection progresses, patients may experience dysphagia (difficulty swallowing) due to the presence of lesions in the throat [9]. The mucosal tissues beneath the lesions may become inflamed, leading to redness and swelling. A sensation of dryness or a cottony feeling may accompany the infection, which is often a result of reduced saliva production. In some cases, oral candidiasis may lead to a temporary loss of taste. Cracking at the corners of the mouth may occur as a secondary manifestation of the infection [10].

In severe cases, oral candidiasis may spread to other parts of the body, such as the esophagus, leading to esophageal candidiasis, which can cause painful swallowing and esophageal inflammation.

Diagnosis

The diagnosis of oral candidiasis is typically made through clinical evaluation. A healthcare provider will examine the oral cavity for characteristic signs, such as white patches that can be scraped off, revealing an underlying red or inflamed mucosa.

To confirm the diagnosis and rule out other conditions, laboratory tests may be necessary:

A sample from the lesion is often taken and examined under a microscope to detect Candida species.

A culture of the lesion can help identify the specific species of Candida involved in the infection, which can guide treatment choices.

In immunocompromised patients, blood tests may be used to assess the presence of systemic Candida infections.

In rare cases, if the diagnosis is uncertain, a biopsy may be conducted to confirm the presence of Candida and rule out other causes of lesions.

Treatment of oral candidiasis

Treatment of oral candidiasis generally involves antifungal medications. The choice of treatment depends on the severity of the infection, the underlying health condition of the patient, and the specific Candida species involved.

For mild cases, topical antifungal treatments, such as nystatin oral suspension, clotrimazole troches, or miconazole gel, are often effective. These medications are applied directly to the affected area in the mouth.

In moderate to severe cases, or when the infection is resistant to topical treatments, systemic antifungal medications such as fluconazole or itraconazole may be prescribed.

Maintaining good oral hygiene is essential in the management of oral candidiasis. Brushing teeth regularly, cleaning dentures, and using antifungal mouthwashes can help eliminate fungal growth.

Addressing any underlying health conditions, such as diabetes or HIV, is crucial for preventing recurrent infections. Controlling blood sugar levels in diabetic patients and adjusting immunosuppressive therapies in patients with autoimmune disorders can help reduce the frequency of oral candidiasis.

Reducing sugar and refined carbohydrate intake can limit the food sources available to Candida, thus helping to prevent overgrowth.

Prevention

Preventing oral candidiasis involves several key strategies, including:

Brushing teeth twice a day, flossing regularly, and using antibacterial mouthwash can prevent the accumulation of plaque and fungi.

Visiting the dentist regularly for professional cleaning and checkups can help prevent infections.

Smoking can increase the risk of oral candidiasis and worsen symptoms. Quitting smoking reduces the likelihood of developing oral fungal infections.

Proper management of underlying conditions such as diabetes and HIV can help prevent oral candidiasis.

Conclusion

Oral candidiasis is a common fungal infection that can affect people of all ages, particularly those with compromised immune systems or poor oral hygiene. Early diagnosis and treatment are essential to prevent complications and improve patient outcomes. By adhering to appropriate antifungal therapy and adopting preventive measures such as proper oral hygiene and the management of underlying conditions, patients can reduce their risk of developing oral candidiasis and ensure optimal oral health. 

1. Alguacil-Ramos AM, Portero-Alonso A, Pastor-Villalba E, Muelas-Tirado J, Díez-Domingo J, et al. (2019) Rapid assessment of enhanced safety surveillance for influenza vaccine.Public Health 168: 137-141.

Indexed at, Google Scholar, Crossref

2. Tennant RK, Holzer B, Love J, Tchilian E, White HN (2019) Higher levels of B-cell mutation in the early germinal centres of an inefficient secondary antibody response to a variant influenza haemagglutinin.Immunology 157: 86-91.

Indexed at, Google Scholar, Crossref

3. Marshall C, Williams K, Matchett E, Hobbs L (2019) Sustained improvement in staff influenza vaccination rates over six years without a mandatory policy.Infect Control Hosp Epidemiol 40: 389-390.

Indexed at, Google Scholar, Crossref

4. Odun-Ayo F, Odaibo G, Olaleye D (2018) Influenza virus A (H1 and H3) and B co-circulation among patient presenting with acute respiratory tract infection in Ibadan, Nigeria.Afr Health Sci 18: 1134-1143.

Indexed at, Google Scholar, Crossref

5. Havlickova M, Druelles S, Jirincova H, Limberkova R, Nagy A, et al. (2019) Circulation of influenza A and B in the Czech Republic from 2000-2001 to 2015-2016.BMC Infect Dis 19: 160.

Indexed at, Google Scholar, Crossref

6. Yang L, Chan KP, Wong CM, Chiu SSS, Magalhaes RJS, et al. (2019) Comparison of influenza disease burden in older populations of Hong Kong and Brisbane: the impact of influenza and pneumococcal vaccination.BMC Infect Diz 19: 162.

Indexed at, Google Scholar, Crossref

7. Nagase H, Moriwaki K, Kamae M, Yanagisawa S, Kamae I (2009) Cost-effectiveness analysis of oseltamivir for influenza treatment considering the virus emerging resistant to the drug in Japan.Value Health 12: 62-75.

Indexed at, Google Scholar, Crossref

8. Nshimyumukiza L, Douville X, Fournier D, Duplantie J, Daher RK, et al. (2016) Cost-effectiveness analysis of antiviral treatment in the management of seasonal influenza A: point-of-care rapid test versus clinical judgment.Influenza Other Respir Viruses 10: 113-121.

Indexed at, Google Scholar, Crossref

9. Kumar S, Henrickson KJ (2012) Update on influenza diagnostics: lessons from the novel H1N1 influenza A pandemic.Clin Microbiol Rev 25: 344-361.

Indexed at, Google Scholar, Crossref

10. Teo J, Di Pietro P, San Biagio F, Capozzoli M, Deng YM, et al. (2011) VereFlu: an integrated multiplex RT-PCR and microarray assay for rapid detection and identification of human influenza A and B viruses using lab-on-chip technology.Arch Virol 156: 1371-1378.

Indexed at, Google Scholar, Crossref