Management of Patients with Oral Candidiasis

Sensitive parameters
Topical
Systemic
 
Polyenes
Azoles
Azoles
Difficult compliance
+
Complicating systemic disease/condition
+
+
Risk of drug-drug interactions
+
Azole insusceptibility
+
Treatment expense
+
+ Advantage, − disadvantage

13.4 Specialist Treatment

Second-generation azoles such as voriconazole and posaconazole are spared for specialist settings and selected patients with life-threatening candidiasis or severe immunocompromising conditions. Intravenous antifungal therapy with amphotericin B, echinocandins, and pyrimidines for oral candidiasis may be indicated in seriously medically compromised patients and should only be done in specialist settings.

13.5 Management of Patents with Oral Candidiasis

Management of oral candidiasis depends on several factors; some are host-sensitive and others are infection-sensitive parameters (Table 13.2).

Table 13.2

Relevant factors for management of patents with oral candidiasis
Host-sensitive parameters
1. Predispositions for oral candidiasis
Local
Systemic
2. Health and medical status of the patient affecting drug metabolism
Chronic diseases
Drug exposure
Infection-sensitive parameters
1. Classification of infection
Duration of infection (acute/chronic)
Primary/secondary/tertiary infection
Sporadic/recurrent
Clinical manifestations
2. Candida species
Susceptibility to antifungals
Resistance to antifungals

13.5.1 Host-Sensitive Parameters

Host-dependent parameters are very important factors when managing oral candidiasis. Identification of predisposing factors is crucial for successful treatment outcome (Table 13.3). If the underlying causes are not eliminated or identified, the chance of relapse is high.

Table 13.3

Local and systemic predisposing factors and conditions
 
Background
Intervention
Local
Poor oral hygiene
Instruction, motivation, and follow-up of oral hygiene procedures
High-carbohydrate diet
Information, motivation, and follow-up
Salivary gland hypofunction caused by medications, head and neck radiotherapy, or systemic diseases like Sjögren’s syndrome
Stimulation of functional salivary gland tissue with sugar-free pastilles or chewing gum, substitution of drug if possible
Mucosal traumas
Identify cause and eliminate
Mucosal diseases
Diagnostic workup, information, treatment, and follow-up
Topical steroid
Instruction in appropriate behaviour
Tobacco
Tobacco counselling, smoking cessation
Systemic
Immune deficiency (acquired or idiopathic)
Diagnostic workup and intervention.
Often need for multidisciplinary cooperation
Systemic diseases
Nutritional deficiency
The drug formulation is relevant in patients with special needs, e.g. topical formulation in patients with dysphagia and capsules in patients with reduced compliance. Patients with hyposalivation cannot dissolve pastilles and lozenges.
The health and medical status of the patient is important as the choice of antifungals depends on whether the patient can eliminate the drug in order to avoid toxic or adverse reactions. Moreover, knowledge of the patient’s drug intake is vital as severe drug-drug interactions with the antifungals can be relevant (Table 13.1 and 13.4).

Table 13.4

Central host- and infection-sensitive parameters regarding the management of patients with chronic oral candidiasis with antifungals
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Host factors
Infection factors
 
Administration
Drug
Formula
Dosage
Diseases
Drug interaction
Classification
In-sensitive Candida species
Comments
Topical
Clotrimazole
Cream 1 %
2–3 dailycontinues until 10 days after lesions healed
Perioral *
>12 years of old
Miconazole
Cream 2 %
2 dailycontinues until10 days afterlesions healed
+
Perioral *
+
 
Ketoconazole
Cream 2 %
1–2 dailycontinues untilsome daysafter lesionshealed
Liver monitoring
+
Perioral
+
 
 
Oral gel
2.5 ml × 4daily in 4–6weeks
+
Intraoral
+
Blockage of airway in neonatal children
Nystatin
Oral suspension 100,000 IE/ml
1 ml × 4 dailyin 4–6 weeks
Intraoral
 
Pastille 100.000 IE/unit
After meals x 4 daily 4 weeks
Intraoral
Not if hyposalivation
Amphotericin B
Lozenge 10 mg
4 times daily for 4 weeks
Intraoral
Not if hyposalivation
Fluconazole
Oral suspension 10 mg/ml
50–100 mg daily for 4 weeks
Dosis↓ reduced renal function
+
Multi-focal infection
+
 
Feb 14, 2016 | Posted by in General Dentistry | Comments Off on Management of Patients with Oral Candidiasis
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