Oral candidiasis - causes, symptoms and treatment

Soldatova Lyudmila Nikolaevna

Candidate of Medical Sciences, Professor of the Department of Clinical Dentistry of the St. Petersburg Medical and Social Institute, Chief Physician of the Alfa-Dent Dental Clinic, St. Petersburg

Candidiasis or, otherwise, thrush is an infectious disease, the main cause of which is infection with Candida fungi. These fungi belong to the same species as yeast and are part of the natural microflora of the vast majority of healthy people. The maximum concentration of these opportunistic microorganisms is observed in the intestines, nasopharynx, and vagina; Some fungi can also be found on the surface of the skin.

In a normal, healthy state of the body, the fungus does not cause any unpleasant symptoms. However, when the immune system is weakened and other provoking factors appear, Candida actively multiplies, resulting in discomfort, itching, burning and other manifestations of thrush. This disease can affect various tissues and organs; Candidiasis of the oral mucosa is also common.

Most often, infants suffer from this disease: according to statistics, up to 20 percent of children under the age of one year have suffered from candidiasis at least once. About 10 percent of people over 60 also suffer from symptoms of this infection. It occurs more often in women than in men; very often, signs of the disease appear in smokers. There are many other factors that contribute to the development of candidiasis in the mouth.

Causes of oral candidiasis

The main reason for the occurrence is a decrease in immune status, as a result of which the uncontrolled proliferation of microflora begins. Reduced immunity is observed in older people and infants, in patients suffering from HIV, AIDS and other diseases associated with immunodeficiency, in those who regularly expose the body to excessive stress, neglect the rules of a healthy diet and violate work and rest patterns. Risk factors include reasons such as:

• Use of medications.
  Taking antibiotics, immunosuppressants (drugs that suppress the immune system) and some other medications leads to disruption of the immune system and the natural balance of microflora in the body. Oral contraceptives, which affect hormonal levels, have a similar effect.
• Pregnancy.
  During pregnancy, a sharp and significant change in hormonal levels occurs, which can lead to a surge in the activity of pathogenic and opportunistic microflora.
• Radiation and chemotherapy.
  Often occurs in patients undergoing drug and radiological treatment for cancer.
• Injuries to mucous membranes.
  Violation of the integrity of the mucous membranes leads to loss or deterioration of the barrier function, as a result of which the fungus enters deep into the tissues, causing inflammation and other symptoms. Small, but constantly recurring injuries are especially dangerous - for example, when wearing incorrectly fitted dentures or braces.
• Overwork and stress.
  Prolonged stress of physical and mental forces leads to a deterioration in the protective function of the body. Similar consequences are caused by hypothermia or overheating, regular lack of sleep, insufficient, excessive or simply unbalanced nutrition, abuse of alcohol, nicotine, and narcotic substances.
• Hypo- and vitamin deficiency.
  May be caused by a lack of nutrients, in particular vitamins B and C.
• Somatic diseases.
  Frequent companions of candidiasis include tuberculosis, dysbacteriosis and other pathologies of the gastrointestinal tract, diseases of the adrenal glands and other endocrine glands. Candidiasis is a contagious disease. A large number of pathogenic microorganisms are transmitted through kissing and sexual contact, through the use of shared dishes, towels and other household items. Infection can also occur during childbirth (vertical transmission from mother to fetus). In addition, there is a risk of infection through contact with infected pets.

Consultation with a therapist or dentist

If you suspect that you have an oral disease that requires medical supervision, make a list of all the symptoms you have, including those that may seem unrelated to thrush: the doctor will understand whether they are important or not. Include non-medical factors in this list, such as increased stress levels and causes of anxiety. Indicate whether you are around people with weakened immune systems.

You will also need to prepare a list of all medications you take. Also, write down questions you want to ask your doctor. This will help you find out all the details you are interested in and get a comprehensive consultation, regardless of whether you have oral candidiasis or not.

The doctor may ask you clarifying questions that will allow him to narrow down the search for a diagnosis based on the symptoms he has identified and the symptoms you describe. Try to answer as openly and honestly as possible so that the doctor can quickly diagnose the disease and begin treatment without waiting for complications.

If an examination of the oral cavity does not allow the doctor to make an accurate diagnosis, he will definitely take a small sample and either examine it himself or send it to a laboratory for analysis.

If the infection has already affected not only the oral cavity, but also the esophagus, a couple of studies may be required. First, your doctor will take a swab from the back of your throat to determine what bacteria or fungi are causing your symptoms. You may then have an endoscopic examination, in which your doctor uses an endoscope (a flexible tube with a light) to look at your esophagus, stomach, and upper small intestine. This will determine how far the infection has spread.

Types of disease

The clinical picture of oral candidiasis is classified:

• For clinical and morphological.
• With the flow.
• By localization.

Clinical and morphological is divided into:

• Hyperplastic.
• Erosive-ulcerative.
• Pseudomembranous.
• Atrophic.

The clinical picture, classified according to the course, is divided into:

• Chronic.
• Spicy.

By localization:

• Cheilitis.
• Gingivitis.
• Glossitis.
• Stomatitis.
• Tonsillitis, etc.

Based on the clinical picture, oral candidiasis comes in several types:

• Chronic hyperplastic.
• Candida infection.
• Chronic atrophic.
• Acute pseudomembranous.
• Chronic pseudomembranous.
• Acute atrophic.

Anti-thrush medications –

We have already said above that oral candidiasis is increasingly rarely caused by the subspecies Candida albicans, which responds quite well to antifungal therapy.
Increasingly, patients are being inoculated with the most pathogenic aggressive species of fungi of the genus Candida - such as C.glabrata, C.krusei and C.tropicalis, which not only show resistance to many antifungal drugs, but also more often create microbial associations with other microorganisms (staphylococci, streptococci and etc.). All this complicates the treatment of oral thrush and also contributes to the development of relapses. Therefore, the most important thing to do before treating oral thrush in adults is to conduct a cytological examination. It will not only confirm the diagnosis of “oral candidiasis,” but also determine the sensitivity of Candida fungi isolated from a particular patient to the main antifungal drugs. It is systemic antifungal drugs that will be the basis for the treatment of oral candidiasis - especially severe and moderate forms. Treatment of mild primary forms of the disease can be carried out using topical agents.

Symptoms

Infection of the oral mucosa by Candida fungus can take various forms, each of which has its own characteristics of symptoms. The most common forms of the disease are candidal angulitis, glossitis, cheilitis, and stomatitis. There are both acute and chronic forms of the disease.

• Pseudomembranous acute candidiasis is the most common form and most often occurs in infants and the elderly. This form is characterized by the appearance of severe swelling and hyperemia (redness) of the mucous membranes. In addition, a characteristic whitish coating forms on the surface of the lips, palate, back of the tongue and the inside of the cheeks. If the plaque is scraped off, the surface of the mucous membrane underneath will be macerated (softened) or ulcerated and bleeding. In this case, patients complain of pain, burning or itching in the mouth; Eating becomes very difficult. Very often the process spreads to the esophagus and pharynx.
• Acute atrophic candidiasis of the oral mucosa usually develops due to the lack of adequate treatment. The upper part of the mucous membranes (epithelium) is exfoliated, the mucous membrane becomes thin, red or, on the contrary, swollen. The patient’s tongue and the corners of the lips also acquire a bright red color; the papillae on the tongue atrophy and smooth out. The plaque is absent or is found only in hard-to-reach places.
• Hyperplastic chronic candidiasis is characterized by the formation of a large number of papules and plaques of irregular or round shape. They are located close to each other on the mucous membrane of the tongue and cheeks and often become soldered and fused. Around each such formation there is a thin rim of reddened, inflamed tissue. It is difficult to scrape off or otherwise remove such a plaque. The oral cavity becomes dry and rough; When chewing, speaking, and even at rest, patients experience significant discomfort and pain. It should be noted that this disease most often affects men over 30 years of age.

The main cause of the chronic atrophic type is constant injury to the mucous membranes, for example due to wearing a prosthesis. Symptoms of the disease are localized in the affected area. Redness of the mucous membrane occurs (often along the contour of the lesion), plaque forms, pain and burning occur, and the membranes become dry.

Symptoms of oral thrush in children and adults

In some cases, symptoms of oral candidiasis may not appear immediately: sometimes they can appear completely unexpectedly. Here are some telltale signs that you may have oral thrush:

• White, curdled plaques in any part of the mouth
• Unusual pain with normal movements of the tongue and jaw
• Plaques bleed when rubbed
• Cracks and redness in the corners of the lips (more often when wearing dentures)
• Dry mouth
• Marked loss of sense of taste when eating or drinking

Although thrush most often develops in the most easily visible areas of the mouth, lesions can also occur in the esophagus. This makes it difficult to swallow or a feeling that food is stuck in the throat. This occurs in the most severe cases, and if you have any of these symptoms, you should contact your dentist or GP immediately.

While waiting for treatment, you can relieve pain, if any, on your own. Eat unsweetened yogurt or take probiotics containing lactobacillus acidophilus. Neither one nor the other is a medicine in the literal sense of the word, but it can help restore normal microflora. If the infection persists, your doctor will likely prescribe you to take an antifungal or antibiotic.

How does the disease manifest in children?

In children, the disease occurs in an acute form and is accompanied by the appearance of redness and swelling in the oral mucosa. The child sleeps poorly, may have no appetite, and becomes tearful.

The disease can occur in children for the following reasons:

• Weakening of the immune system.
• Infection during breastfeeding.
• Transmission of the fungus during childbirth.
• Infection through household items.

If the disease is not diagnosed and treated in a timely manner, a whitish coating resembling cottage cheese will soon appear in the child’s mouth, and in an advanced stage, ulcers will appear, which are accompanied by bleeding and cause severe pain in children.

Diagnostics

To make an accurate diagnosis, a combination of several methods is used - from a simple examination and questioning of the patient for complaints to laboratory methods, such as culture, microscopic examination of biomaterial, analysis of the degree of contamination of the oral cavity with fungal mycelium.

Oral candidiasis is accompanied by a number of characteristic external signs, in particular the formation of plaque, bad breath, ulceration and hyperemia of the mucous membranes. However, laboratory methods make it possible to accurately determine the type of pathogen and exclude the possibility of a secondary infection, which may affect the nature and duration of treatment.

Differential diagnosis is used to separate cases of candidiasis from aphthous stomatitis, leukoplakia, lichen ruber, streptococcal infection and other infectious pathologies of the oral cavity.

Diagnosis of candidiasis

The study is based on the isolation and identification of a species of fungus of the genus Candida. Currently, there are about 150 species, differing in morphological and biochemical properties. The most common fungus is C. albicans, accounting for up to 80% of cases of candidiasis of the digestive tract and up to 70% of genital infections. Before prescribing treatment, it is also necessary to determine the sensitivity of the isolated strain to antimycotics (antifungal medications): amphotericin B, voriconazole, itraconazole, fluconazole, flucytosine.

Microscopic diagnostics

1. Microscopy of a smear is taken from the area of ​​the affected mucosa. Allows for comparative characterization of blastospores and pseudomycelia. During the study, fixed and native preparations that stain microorganisms are used. To increase the information content, pseudomycelia of cells are treated with dyes. The contrast in staining of microorganisms makes it easy to distinguish candida from other forms, including bacteria, under a microscope.

2. Bacterial culture allows you to identify the causative agent of infection and determine its concentration. The analysis is used to monitor the effectiveness of treatment, as well as to identify the sensitivity of candida fungi to various antimycotics.

Diagnostics by ELISA and PCP

1. Enzyme-linked immunosorbent assay (ELISA) is based on the determination of antibodies that are produced by the immune system in response to foreign substances in the blood. This technique allows you to identify the pathogen and the degree of its development, establishing whether the disease occurs in an acute or chronic stage.

2. Polymerase chain reaction (PCR) is a highly sensitive test that allows you to directly detect the infectious agent. Thanks to it, it is possible to differentiate Candida fungi with pseudomycelium from those that do not have it. These data are important for subsequent interpretation of results and deeper diagnosis.

How to treat oral candidiasis?

Treatment is carried out using local and general, specific and symptomatic remedies. Among the main goals of therapy are the elimination of foci of infection in the oral cavity (sanitation), treatment of diseases that accompany candidiasis and are risk factors, and stimulation of the body's defenses. The total duration of treatment is usually at least 7-10 days.

As a means of local therapy, rinses are used - using solutions of boric acid, soda, sodium tetraborate. For a longer and more effective effect, such products can be used in the form of applications - moistening a cotton swab or bandage with the solution.

Nystatin for oral candidiasis is used to combat the main cause of the disease - a fungal infection. Treatment of candidiasis in the mouth may also include the use of other antimycotic (antifungal) drugs - for example, levorin ointment. The best effect is achieved by using several drugs, alternating them for several days.

Antifungal drugs are also prescribed for systemic therapy - in this case, medications for oral candidiasis and other infections such as Lamisil, Diflucan, Levarin, Nizoral, etc. are taken orally. In the most severe cases of the disease, the treatment regimen includes taking immunomodulatory drugs, as well as the use other agents that have a stimulating effect on the immune system and help strengthen the body’s own defenses.

An equally important task is to protect against additional fungal and bacterial infections that can join the Candida infection and complicate the course of the disease. For this purpose, rinses with antiseptic solutions - fucorcin, iodinol and others.

As an alternative, you can use ASEPTA antiseptic mouth rinse, which contains the active ingredients chlorhexidine and benzydamine. Both of these substances have broad antimicrobial effects. Regular use of ASEPTA rinses also has a pronounced anti-inflammatory effect and helps not only eliminate unpleasant symptoms, but also reduce the risk of complications.

Symptoms of oral candidiasis in infants and nursing mothers

If you have oral thrush, your baby may have difficulty feeding or become fussier and more irritable than before. The manifestation of thrush will most likely be white plaques in the child’s mouth. Mothers should closely monitor their baby's oral health because candidiasis is transmitted through breastfeeding, and if this happens and the baby recovers, the mother may inadvertently infect him again.

As a breastfeeding mother, look out for the following signs and symptoms:

• Itchy, tender, or unusually red nipples
• Shiny or peeling skin around the alveoli
• Unusual pain during or between feedings
• Severe, stabbing chest pain

If white plaques appear in your or your child's mouth, contact your doctor or dentist immediately. Do not delay a visit to the doctor if symptoms of candidiasis occur in older children or adolescents, since the underlying disease against which thrush developed may be diabetes.

Because there are two people to treat at once, your doctor may use a special strategy, such as prescribing two different antifungal medications to begin with: a cream for your breasts and a different medication for your baby.

If you are breastfeeding, use breastfeeding pads to prevent fungus from getting on your clothes. Do not buy liners with plastic membranes, as they will only encourage the growth of fungus. Reusable pads (and, of course, the bra itself) should be washed in hot water and bleach to help prevent infection from spreading.

If you not only breastfeed your baby, but also bottle-feed him, and also give him a pacifier, wash all items that come into contact with the baby’s mouth every day in a solution of equal parts water and vinegar. After washing, allow items to air dry to prevent fungus from growing. All parts of the breast pump need to be treated in the same way, especially its removable parts.

Disease prevention

Preventive measures are aimed at improving the condition of the microflora. These include:

• Proper oral hygiene.
• A thoughtful diet with a high amount of protein foods and reduced consumption of foods containing glucose.
• Quitting smoking and alcoholic beverages.
• Timely examination by the attending dentist for the prevention, diagnosis and treatment of the disease.
• Avoid taking medications, such as antibiotics, without first consulting your doctor.
• If the patient has dentures, then one of the preventive measures will be their regular treatment in a special solution.

Sources:

1. The role of anti-inflammatory rinse in the treatment of periodontal diseases (L.Yu. Orekhova, A.A. Leontyev, S.B. Ulitovsky) L.Yu. OREKHOVA, Doctor of Medical Sciences, Prof., Head of Department; A.A. LEONTIEV, dentist; S.B. ULITOVSKY, Doctor of Medical Sciences, Prof. Department of Therapeutic Dentistry of St. Petersburg State Medical University named after. acad. I. P. Pavlova
2. Report on clinical trials to determine/confirm the preventive properties of commercially produced personal oral hygiene products: mouth rinse "ASEPTA PARODONTAL" - Solution for irrigator." Doctor of Medical Sciences Professor, Honored Doctor of the Russian Federation, Head. Department of Preventive Dentistry S.B. Ulitovsky, doctor-researcher A.A. Leontiev First St. Petersburg State Medical University named after academician I.P. Pavlova, Department of Preventive Dentistry.
3. Study of the clinical effectiveness of treatment and prophylactic agents of the Asepta line in the treatment of inflammatory periodontal diseases (A.I. Grudyanov, I.Yu. Aleksandrovskaya, V.Yu. Korzunina) A.I. GRUDYANOV, Doctor of Medical Sciences, Prof., Head of Department I.Yu. ALEXANDROVSKAYA, Ph.D. V.Yu. KORZUNINA, asp. Department of Periodontology, Central Research Institute of Dentistry and Maxillofacial Surgery, Rosmedtekhnologii, Moscow

Lifestyle and Home Remedies for Oral Thrush

At the initial stage of candidiasis, good oral hygiene will help contain the development of the disease - brushing your teeth twice a day and at least daily use of dental floss will contribute to the timely removal of food debris and plaque from the surface of the teeth, from the interdental spaces and along the gum line. Instead of regular mouthwash, use a solution that requires a teaspoon of salt and a glass of warm water. Rinse your mouth with this solution for two minutes; After this, the solution must be spat out.

Oral candidiasis is a contagious disease that can spread to internal organs and cause serious harm to them, making it impossible for you to eat normally (if the esophagus, stomach and intestines are affected). If you suspect you have one or more of the symptoms of oral thrush, contact your dentist immediately for an accurate diagnosis. By identifying candidiasis early, your doctor can relieve symptoms and stop the infection.