Oral candidosis and the therapeutic use of antifungal agents in dentistry

This paper reviews the current concepts of mycology and candidal infections as they relate to the oral cavity. Proposed classification for the presentation of oral candidosis is outlined as are examples of these topical infections, such as erythematous, pseudo-membranous and hyperplastic candidosis, as well as angular chelitis and median rhomboid glossitis. The diagnosis and principles of management of oral candidosis are discussed, the therapeutic agents available for the management of these infections are presented and a treatment protocol for the management of patients with oral candidosis is given.     

Antimicrobials as a contributory factor in oral candidosis--a brief overview.

The advent of the human immunodeficiency virus infection and the increasing prevalence of compromised individuals in the community due to modern therapeutic advances have resulted in a resurgence of opportunistic infections, including oral candidosis, which is by far the most common oral fungal infection in man. Broad-spectrum antibiotics used in the treatment of a wide range of disease conditions have also been attributed as a predisposing factor of oral candidosis. In this mini review we discuss the research findings on the relationship between antibiotics and oral candidosis and possible mechanisms of pathogenicity following such therapy.     

Antimicrobials as a contributory factor in oral candidosis – a brief overview

The advent of the human immunodeficiency virus infection and the increasing prevalence of compromised individuals in the community due to modern therapeutic advances have resulted in a resurgence of opportunistic infections, including oral candidosis, which is by far the most common oral fungal infection in man. Broad-spectrum antibiotics used in the treatment of a wide range of disease conditions have also been attributed as a predisposing factor of oral candidosis. In this mini review we discuss the research findings on the relationship between antibiotics and oral candidosis and possible mechanisms of pathogenicity following such therapy.     

The effect of miconazole on palatal candidosis induced in the Wistar rat

Autopolymerizing acrylic resin supplemented with 10 per cent miconazole nitrate was tested as a treatment for palatal candidosis as induced by Shakir et al. (1981) in the Wistar rat It was found that by fitting rats with appliances supplemented with 10 per cent(w/w) miconazole in the polymer powder, palatal candidosis could be prevented, and previously infected animals were cured after therapy for one month Rats fitted with supplemented appliances showed no adverse side-effects and tended to gain weight more rapidly than animals with unsupplemented appliances.     

Oral infections in the immunocompromised patient.

The number of immunocompromised patients is increasing because of iatrogenic immunosuppression and HIV infection. Most have T lymphocyte defects and are prone to develop persistent and severe fungal and viral infections. Oral candidosis and peri-oral herpes simplex infections are particularly common. Other oral lesions may be seen: mouth ulceration is common and periodontal health is impaired.     

Experimental oral candidosis in the mouse: microbiologic and histologic aspects

A model of oral candidosis was developed in order to investigate histologic and microbiologic aspects of this host-parasite interaction under controlled experimental conditions. Normal adult CD-1 mice were inoculated by the topical application of 10(8) Candida albicans blastospores, and oral colonization was monitored by the quantitative culturing of saliva samples and of digested oral mucosa. Tissue sections of the mucosa were examined in a kinetic study ranging from 2 h to 13 days postinoculation. We report here that oral colonization by C. albicans can be induced in normal adult mice without the use of any compromising agent and that the animals recover from this mucosal infection following a reproducible pattern. Temporal analysis of the oral histopathology showed that distinct patterns of inflammation are associated with particular stages in the development of the infectious foci. This experimental model offers a means of further investigating the host-parasite interactions involved in the onset and development of oral candidosis.     

Epithelial mitotic activity during the induction of palatal candidosis in the Wistar rat

Palatal candidosis was produced in 15 Wistar rats by fitting them with an acrylic appliance that covered the palatal mucosa and simultaneously inoculating this site with Candida albicans 3091 (serotype A). A further 15 rats were fitted with the appliance only. Five animals in each group were killed at 1, 2 and 4 weeks, 4 X 5 h after being injected with vinblastine sulphate, as were 5 normal control animals at the start of the experiment. Palatal mucosa was dissected free, fixed, sectioned and stained prior to counting the number of arrested mitotic figures in the basal epithelial layer and measuring the mean thickness of epithelium. The results were expressed as the number of mitotic figures per 1000 basal cells, per unit length of basement membrane and per square millimetre of epithelial surface. After an initial reduction in thickness, the palatal epithelium in both experimental groups became thicker than that of normal control animals, more markedly so in the animals infected with Candida albicans. Similar patterns of mitotic activity were found regardless of the reference unit used as a basis for the calculations. An initial decrease in both experimental groups was followed by a sharp and significant rise, again being more marked in the animals infected with Candida albicans.     

Epithelial mitotic activity during the induction of palatal candidosis in the Wistar rat

Palatal candidosis was produced in 15 Wistar rats by fitting them with an acrylic appliance that covered the palatal mucosa and simultaneously inoculating this site with Candida albicans 3091 (serotype A). A further 15 rats were fitted with the appliance only. Five animals in each group were killed at 1, 2 and 4 weeks, 4·5h after being injected with vinblastine sulphate, as were 5 normal control animals at the start of the experiment. Palatal mucosa was dissected free, fixed, sectioned and stained prior to counting the number of arrested mitotic figures in the basal epithelial layer and measuring the mean thickness of epithelium. The results were expressed as the number of mitotic figures per 1000 basal cells, per unit length of basement membrane and per square millimetre of epithelial surface. After an initial reduction in thickness, the palatal epithelium in both experimental groups became thicker than that of normal control animals, more markedly so in the animals infected with Candida albicans. Similar patterns of mitotic activity were found regardless of the reference unit used as a basis for the calculations. An initial decrease in both experimental groups was followed by a sharp and significant rise, again being more marked in the animals infected with Candida albicans .     

咬合创伤诱导海马区星形胶质细胞的上调

目的：探讨咬合创伤后海马区星形胶质细胞的变化及意义。方法：通过将大鼠左侧上颌第一磨牙咬合抬高0．5mm造成咬合创伤动物模型,应用免疫荧光染色观察咬合创伤后1、3、7d、2w、4w,5w时星形胶质细胞在海马区的分布和表达变化。结果：正常大鼠海马区仅见少量星形胶质细胞,7d组星形胶质细胞数开始增加,4W时达到高峰,5W时阳性细胞数开始下降。结论：咬合创伤引起了海马区星形胶质细胞的数量增加,海马结构参与了咬合创伤反应,其CA1、CA3区与咬合创伤所致口颌面痛及痛情绪调控关系密切。     

咬合创伤诱导海马区星形胶质细胞的上调

目的：探讨咬合创伤后海马区星形胶质细胞的变化及意义。方法：通过将大鼠左侧上颌第一磨牙咬合抬高0．5mm造成咬合创伤动物模型,应用免疫荧光染色观察咬合创伤后1、3、7d、2w、4w,5w时星形胶质细胞在海马区的分布和表达变化。结果：正常大鼠海马区仅见少量星形胶质细胞,7d组星形胶质细胞数开始增加,4W时达到高峰,5W时阳性细胞数开始下降。结论：咬合创伤引起了海马区星形胶质细胞的数量增加,海马结构参与了咬合创伤反应,其CA1、CA3区与咬合创伤所致口颌面痛及痛情绪调控关系密切。     

Oral candidosis. Clinical, historical, and therapeutic features of 100 cases.

Oral candidosis is an increasingly important disease that affects a significant percentage of the population. Traditionally known as an opportunistic pathogen, the broader clinical scope of oropharyngeal candidal infections is now being recognized. The clinical and historical features of 100 patients referred for diagnosis and management of candidosis have been reviewed. The age, gender, chief complaint, medical history, medications, and clinical findings have been noted. A wide range of clinical signs and symptoms, and the rationale behind the topical and systemic antifungal therapies provided to this patient population, are discussed.     

Antimycotic agents in oral candidosis: an overview: 1. Clinical variants

The advent of the human immunodeficiency virus and the increasing prevalence of immunocompromised individuals in the community have resulted in a resurgence of opportunistic infections, including oral candidoses. Despite the availability of a number of effective antimycotics for the management of oral candidoses, therapeutic failure is not uncommon. Further, the presence of many clinical variants of oral candidosis, both new and old, may confound the unwary clinician and complicate its management. These problems have been partly circumvented by the introduction of the triazole group of antimycotics, which initially appeared to be highly effective. However, an alarming increase in organisms resistant to triazoles has been reported recently. In this paper we provide an overview of clinical variants of oral candidosis. A second paper will discuss recent advances in the usage of antimycotics in the management of this condition.     

Atypical clinical manifestation of mucoepidermoid carcinoma in the palate

A 62-year-old woman sought treatment for a red macule in her hard palate. Examination of the oral cavity revealed an ovoid-shaped erythematous macule on the right side of the hard palate. The patient was edentulous and used a poorly adapted maxillary denture. The initial diagnosis was chronic atrophic candidosis and trauma; however, when the lesion did not heal following removal of the prosthesis and application of topical antifungal medication, an incisional biopsy was performed, resulting in a final diagnosis of low-grade mucoepidermoid carcinoma. The patient was referred to a head and neck surgeon and the tumor was excised.     

实验性创伤对牙髓和牙周组织影响的研究

为了探讨创伤持续时间与牙髓、牙周组织变化间的关系，作者对４４只大鼠的下颌磨牙制造了实验性创伤，利用组织病理学和软射线的研究方法，观察不同实验期受创伤大鼠磨牙的牙髓、牙周组织变化，并与软射线片进行对照分析。结果表明，牙髓组织随创伤时间延长而病变逐渐加重；牙周组织受到长期创伤后呈现适应性变化，牙周组织的病变部位与软射线片显示的牙周变化部位相应。本研究结果为创伤性牙髓炎和根尖周炎的病因、病理提供了实验依据。     

实验性He创伤对牙髓和牙周组织影响的研究

为了探讨Ｈｅ创伤持续时间与牙髓、牙周组织变化间的关系，作者对４４只大鼠的下颌磨牙制造了实验性Ｈｅ创伤，利用组织病理学和软射线的研究方法，观察不同实验期受创伤大鼠磨牙的牙髓、牙周组织变化，并与软射线片进行对照分析。结果表明，牙髓组织随Ｈｅ务时间延长而病变逐渐加重；牙周组织受到长期Ｈｅ创伤后呈现适应性变化，牙周组织焦吩一软射线片显示的牙周变化部位相应。本研究结果为Ｈｅ创伤性牙髓炎和根尖周炎的病因，病理     

Candida-associated denture stoma titis. Aetiology and management: A review. Part 2. Oral diseases caused by candida species

Certain systemic conditions and/or defects in the immune system may predispose the host to oral candidal infection and the commonest form of oral candidosis is candida-associated denture stomatitis. Until recently there has been controversy concerning the aetiology of the disease. Although some earlier investigators linked denture stomatitis with trauma or bacterial infection, others had isolated Candida albicans from the mouths of patients with the condition. Current studies indicate that denture stomatitis lesions are associated with the detection of candida species while other factors such as denture hygiene, trauma, systemic diseases and deficiencies of the immune system may be involved.     

Candida-associated denture stoma titis. Aetiology and management: A review. Part 2. Oral diseases caused by candida species

Certain systemic conditions and/or defects in the immune system may predispose the host to oral candidal infection and the commonest form of oral candidosis is candida-associated denture stomatitis. Until recently there has been controversy concerning the aetiology of the disease. Although some earlier investigators linked denture stomatitis with trauma or bacterial infection, others had isolated Candida albicans from the mouths of patients with the condition. Current studies indicate that denture stomatitis lesions are associated with the detection of candida species while other factors such as denture hygiene, trauma, systemic diseases and deficiencies of the immune system may be involved.     

口腔念珠菌病患者唾液溶菌酶水平的研究

目的：了解唾液溶菌酶水平与口腔念球菌感染的关系。方法：以正常人群作对照，用琼脂糖含菌平板法测量口腔念珠菌病患者混合唾液溶菌酶含量。结果：口腔念球菌感染者唾液溶菌酶含量高于非感染者对照组。     

平阳霉素对血管内皮细胞急性损伤后酶活性变化的实验研究

目的：探讨平阳霉素损伤血管内皮细胞的机制,为临床应用提供组织学依据。方法：选用成年Wistar大白鼠42只（其中6只为正常对照）,经肠系膜静脉分别注入平骒霉素（24只）或鱼肝油酸钠（12只）后,分别于注药后0．5,1,2,4,8,24h,切取肝脏组织,通过酶组化染色法测定肝窦内皮细胞的5’－核苷酸酶,肝细胞的琥珀酸脱氢酶（SDH）及乳酸脱氢酶（LDH）活性,结果：注入药液后,肝窦内皮细胞的5’－核苷酸酶,肝细胞的SDH和LDH活性随时间逐渐下降,其中平阳霉素组下降较轻微,结论：平阳霉素和鱼肝油酸钠都可对血管内皮细胞产生损伤,损伤的性质一样,均为非特异性,但平阳霉素损伤程度轻微,而鱼肝油酸钠严重。