Candidiasis, Dry Mouth, and Dentures.

If you notice that there is a white coating or redness (which can be painful or not) on your tongue, roof of your mouth, or the inside of your cheeks it is possible you have candidiasis. It is important to be evaluated by a medical professional to test for the condition.

Why Did I Get Candidiasis?

Wearing dentures and having dry mouth can often be a perfect storm for fungal infections in the mouth.

The oral cavity is very similar to the stomach in that it contains naturally-existing “good” and “bad” bacteria all of which are kept under control when there is a healthy environment. Whenever there is a disruption to this balance, that is when problems can begin. 

Saliva in the mouth serves as both, a mechanical-cleansing function and as defense against bad bacteria because it includes antibodies (Immunoglobulin A) and enzyme components (such as lysozyme and lactoperoxidase) (1). When there is less saliva (hyposalivation which is experienced as dry mouth), the defense system of the body goes down and disease has a better opportunity to become established.

65% of denture users experience denture-related stomatitis (aka candida-associated denture stomatitis) (4) This condition is more likely to happen to patients who do not remove dentures at night. By keeping the dentures in all the time an ideal environment is created for candida to thrive (moist, acidic, oxygen-deprived).

The candida organisms can attach to the denture itself (which is often made from polymethylacrylate). It the denture is not cleaned properly the fungus will continue to grow and cause complications.

Loose and badly fitting dentures can also cause damage to the tissues which support them. As a result candida and other bacteria are able to invade more easily.

When dentures become worn the height of the top and bottom denture decreases below normal which causes the deepening of the folds in the corners of the mouth where fungus and bacteria can accumulate and grow very easily. This is called angular chelitis. 

What is Candidiasis:

Albicans is the organism which is largely responsible for candidiasis which is a yeast/fungal infection. About 35-50% of humans possess C. albicansas part of their normal oral flora (5)Some studies suggest this figure reaches 90%.

There are three types of candidiasis. 

  • Acute pseudomembranous candidiasis also called “thrush” and is considered the “classic form” It is characterized by a white slough which can be wiped away. It usually appears on the tongue, roof of the mouth and the inside of the cheek. (2)
  • Erythematous (atrophic) candidiasis is when the oral mucosa appears as a red, raw-looking lesion. (3) It is often associated with inhalation steroids (used for treatment of asthma). Acute erythematous candidiasis usually occurs on the top the tongue in individuals taking long term corticosteroids or antibiotics. Chronic erythematous candidiasis occurs in patients wearing dentures.
  • Hyperplastic or “plaque-like” candidiasis, “nodular candidiasis” usually occurs on the inside of the cheeks and looks like thrush except it cannot be rubbed off with tissue. It is the least common form of candidiasis (3)

 

Predisposing factors

-      Endoctine disorders (diabetes

-      Immunosuppression (HIV/AIDS, chemotherapy)

-      Some antibiotics

-      Nutritional deficiencies

-      Dentures

-      Corticoid inhalers

-      Dry Mouth

-      High sugar diet

 

What are the treatment options?

Oral candidiasis can be treated in most cases with topical anti-fungal drugs such as Nystatin, Miconazola, Amphotericin B.

Lesions may need to be surgically removed especially if they recur. (6)

It is important to identify and treat underlying medical conditions which will help prevent recurrent candida infections. 

For patients what are immunocompromised, such as those with HIV/AIDS or who are undergoing chemotherapy, oral or intravenous administration of anti-fungal medication may be indicated.

Patients who experience candidiasis due to steroid inhalation or antibiotic use should talk to their doctor about alternative types of medications. With inhaled corticosteroids it is helpful to rinse mouth with water after the administration of the medication. (7)

How do I take care of my dentures?

It is important to take dentures off at night to allow the tissues to recover and re-oxygenate.

There are various denture-cleaning techniques which should be discussed with your dentist as each one is appropriate for the specific materials which are used in the denture, as some can be damaging. These solutions include sodium hypochlorite, chlorohexidine and vinegar (acetic acid).

Read More: 7 Best Dry Mouth Remedies

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References:

  1. Scully C Oral and Maxillofacial Medicine : the basis of diagnosis and treatment(3rd ed.). Edinburgh: Churchill Livingstone. pp. 254–267. (2013). 
  2. Greenberg MS, Glick M, Ship JA. Burket's oral medicine(11th ed.). Hamilton, Ont.: BC Decker. pp. 79–84. (2008)
  3. Rhodus, NL "Treatment of oral candidiasis"(PDF). Northwest Dentistry. 91(2): 32–3. (Mar–Apr 2012). 
  4. Salerno, C; Pascale, M; Contaldo, M; Esposito, V; Busciolano, M; Milillo, L; Guida, A; Petruzzi, M; Serpico, R "Candida-associated denture stomatitis"(PDF). Medicina Oral, Patologia Oral y Cirugia Bucal. 16(2): e139–43. (Mar 1, 2011). 
  5. Bouquot, Brad W. Neville, Douglas D. Damm, Carl M. Allen, Jerry E. Oral & maxillofacial pathology(2. ed.). Philadelphia: W.B. Saunders. pp. 189–197. (2002). 
  6. Shah, N; Ray, J. G; Kundu, S; Sardana, D "Surgical management of chronic hyperplastic candidiasis refractory to systemic antifungal treatment". Journal of Laboratory Physicians. 9 (2): 136–139. (2017). 
  7. Anne Field, Lesley Longman William R Tyldesley Tyldesley's Oral medicine(5th ed.). Oxford: Oxford University Press. pp. 35–40. (2003). 

 

 

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