Question 75

Question 1

explain oral candidiasis/leukoplakia

Answer 1

• Acute and chronic infection of the oral cavity caused by Candida species (most commonly C. albicans)
• Several patient groups are predisposed to candidal infection (pseudomembranous candidosis and erythematous candidosis infections), e.g. patients taking certain drugs, including inhaled corticosteroids, cytotoxics or broad-spectrum antibacterials, patients with diabetes, patients with nutritional deficiencies, or patients with serious systemic disease associated with reduced immunity such as leukaemia, other malignancies and HIV infection.
• Signs and symptoms – pain, bleeding, abnormal appearance:
  Acute pseudomembranous candidosis: White patches on the oral mucosa which become confluent plaques resembling milk curds. The plaques can be removed to reveal a raw erythematous base which may be painful and bleed.
  Acute erythematous candidosis: Red patches on the oral mucosa. Typically involves the dorsal surface of the tongue where it manifests as depapillated areas.
  Chronic denture stomatitis
  Chronic hyperplastic candidosis: White plaques that can’t be rubbed off. Increased risk of malignant change

Question 2

management of oral candidiaisis

Answer 2

o If patient is using a corticosteroid inhaler, advise to rinse mouth with water or brush teeth after use. Confirm good inhaler technique and potential use of spacer
o Advise pt to rinse with CHX 0.2% MW
o Prescribe antifungals (-azoles CI’d in patients taking warfarin and statins)
 Fluconazole Capsules, 50mg
* Send: 7 capsules
* Label: 1 capsule daily for 7 days
* Do not prescribe for patients taking warfarin or statins
 Miconazole Oromucosal Gel, 20mg/g
* Send: 80g tube
* Label: Apply a pea-sized amount after food four times daily
o Applied to fitting surface of denture in denture stomatitis
* Do not prescribe for patients taking warfarin or statins
* Advise patient to continue use for 7 days after lesions healed
 Nystatin Oral suspension, 100,000 units/ml
* Send: 30ml
* Label: 1ml after food four times daily for 7 days
* Can be used if -azoles are CI’d
* Advise patient to rinse suspension around mouth and then retain suspension near lesion for 5 mins before swallowing
* Advise patient to continue use for 48 hours after lesions have healed
o Investigate fungal infections in immunocompromised patients with no known explanation – refer to oral med or GMP