Acute atrophic candidiasis presents as a red patch of atrophic or erythematous raw and painful mucosa, with minimal evidence of the white pseudomembranous lesions observed in thrush. Antibiotic sore mouth, a common form of atrophic candidiasis, should be suspected in a patient who develops symptoms of oral burning, bad taste, or sore throat during or after therapy with broad-spectrum antibiotics. Patients with chronic iron deficiency anemia may also develop atrophic candidiasis (Figure 5-16).
CHRONIC ATROPHIC CANDIDIASIS
CHRONIC ATROPHIC CANDIDIASIS
Chronic atrophic candidiasis includes denture stomatitis (denture sore mouth), angular cheilitis, and median rhomboid glossitis.
Denture Stomatitis (Denture Sore Mouth). Denture stomatitis is a common form of oral candidiasis that manifests as a diffuse inflammation of the maxillary denture-bearing areas and that is often (15 to 65% of cases) associated with angular cheilitis.
At least 70% of individuals with clinical signs of denture stomatitis exhibit fungal growth, and this condition most likely results from yeast colonization of the oral mucosa, combined with bacterial colonization.Candida spp act as an endogenous infecting agent on tissue predisposed by chronic trauma to microbial invasion.Lesions of chronic atrophic candidiasis have also been frequently reported in HIV-positive and AIDS patients.
Three progressive clinical stages of denture sore mouth have been described.The first stage consists of numerous palatal petechiae (Figure 5-17, A). The second stage displays a more diffuse erythema involving most (if not all) of the denture-covered mucosa (see Figure 5-17, B and C). The third stage includes the development of tissue granulation or nodularity (papillary hyperplasia) (see Figure 5-17, D), commonly involving the central areas of the hard palate and alveolar ridges.
Antifungal treatment will modify the bright red appearance of denture sore mouth and papillary hyperplasia specifically but will not resolve the basic papillomatous lesion, especially if the lesions have been present for more than 1 year. Antifungal therapy and cessation of denture wearing usually is advisable before surgical excision since elimination of the mucosal inflammation often reduces the amount of tissue that needs to be excised.
Yeast attached to the denture plays an important etiologic role in chronic atrophic candidiasis.The attachment of yeast to the patient’s appliances is increased by mucus and serum and decreased by the presence of salivary pellicle, suggesting an explanation for the severity of candidiasis in xerostomic patients. Rinsing the appliance with a dilute (10%) solution of household bleach, soaking it in boric acid, or applying nystatin cream before inserting the denture will eliminate the yeast. Disinfection of the appliance is an important part of the treatment of denture sore mouth. Soft liners in dentures provide a porous surface and an opportunity for additional mechanical locking of plaque and yeast to the appliance. In general, soft liners are considered to be an additional hazard for patients who are susceptible to oral candidiasis.
Denture sore mouth is rarely found under a mandibular denture. One possible explanation for this is that the negative pressure that forms under the maxillary denture excludes salivary antibody from this region, and yeast may reproduce, undisturbed, in the space between the denture and mucosa. The closer adaptation of the maxillary denture and palate may also bring the large number of yeasts adhering to the denture surface into contact with the mucosa.
Angular Cheilitis. Angular cheilitis is the term used for an infection involving the lip commissures (Figure 5-18). The majority of cases are Candida associated and respond
Three progressive clinical stages of denture sore mouth have been described.The first stage consists of numerous palatal petechiae (Figure 5-17, A). The second stage displays a more diffuse erythema involving most (if not all) of the denture-covered mucosa (see Figure 5-17, B and C). The third stage includes the development of tissue granulation or nodularity (papillary hyperplasia) (see Figure 5-17, D), commonly involving the central areas of the hard palate and alveolar ridges.
Antifungal treatment will modify the bright red appearance of denture sore mouth and papillary hyperplasia specifically but will not resolve the basic papillomatous lesion, especially if the lesions have been present for more than 1 year. Antifungal therapy and cessation of denture wearing usually is advisable before surgical excision since elimination of the mucosal inflammation often reduces the amount of tissue that needs to be excised.
Yeast attached to the denture plays an important etiologic role in chronic atrophic candidiasis.The attachment of yeast to the patient’s appliances is increased by mucus and serum and decreased by the presence of salivary pellicle, suggesting an explanation for the severity of candidiasis in xerostomic patients. Rinsing the appliance with a dilute (10%) solution of household bleach, soaking it in boric acid, or applying nystatin cream before inserting the denture will eliminate the yeast. Disinfection of the appliance is an important part of the treatment of denture sore mouth. Soft liners in dentures provide a porous surface and an opportunity for additional mechanical locking of plaque and yeast to the appliance. In general, soft liners are considered to be an additional hazard for patients who are susceptible to oral candidiasis.
Denture sore mouth is rarely found under a mandibular denture. One possible explanation for this is that the negative pressure that forms under the maxillary denture excludes salivary antibody from this region, and yeast may reproduce, undisturbed, in the space between the denture and mucosa. The closer adaptation of the maxillary denture and palate may also bring the large number of yeasts adhering to the denture surface into contact with the mucosa.
Angular Cheilitis. Angular cheilitis is the term used for an infection involving the lip commissures (Figure 5-18). The majority of cases are Candida associated and respond
promptly to antifungal therapy. There is frequently a coexistent denture stomatitis, and angular cheilitis is uncommon in patients with a natural dentition. Other possible etiologic cofactors include reduced vertical dimension; a nutritional deficiency (iron deficiency anemia and vitamin B or folic acid deficiency) sometimes referred to as perlèche; and (more rarely) diabetes, neutropenia, and AIDS, as well as co-infection with Staphylococcus and beta-hemolytic Streptococcus. More-extensive desquamative lesions affecting the full width of the lip and sometimes extending to the adjacent skin are associated with habitual lip sucking and chronic Candida infection.
Median Rhomboid Glossitis. Erythematous patches of atrophic papillae located in the central area of the dorsum of the tongue are considered a form of chronic atrophic candidiasis (Figure 5-19). When these lesions become more nodular, the condition is referred to as hyperplastic median rhomboid glossitis. These lesions were originally thought to be developmental in nature but are now considered to be a manifestation of chronic candidiasis.
Median Rhomboid Glossitis. Erythematous patches of atrophic papillae located in the central area of the dorsum of the tongue are considered a form of chronic atrophic candidiasis (Figure 5-19). When these lesions become more nodular, the condition is referred to as hyperplastic median rhomboid glossitis. These lesions were originally thought to be developmental in nature but are now considered to be a manifestation of chronic candidiasis.
