To prevent the development of candidiasis, patients with partial or complete dentures should be advised to brush their dentures twice daily and to remove them during sleep, when they can be soaked in an over-the-counter denture cleansing solution or a mouthwash such as Listerine. Systemic antifungals such ketoconazole (Nizoral) or fluconazole (Diflucan) should be considered only for immunocompromised patients or those who cannot tolerate topical treatment. For patients with angular cheilitis, a nystatin ointment or clotrimazole cream applied to the affected area may be more comfortable. Nystatin rinse is more suitable for patients with xerostomia, who may find the troches difficult to dissolve, and for patients who wear dentures, who should be instructed to soak their dentures overnight in the nystatin solution in addition to receiving intraoral treatment. More widespread infection such as thrush or atrophic candidiasis should be treated with clotrimazole (Mycelex) troches or nystatin (Mycostatin) pastilles or rinse. The choice of anticandidal treatment should be based on the extent of infection. New properly fitting dentures and vitamin supplementation are the other necessary treatments. A nutritional history and evaluation for other signs or symptoms of nutrient deficiency can rule out the need for further evaluation regardless, a topical antifungal treatment should be prescribed. Although angular cheilitis is associated with some B vitamin deficiencies, it can also be caused by ill-fitting dentures, causing the collapse of the facial tissues and producing a moist environment suitable for fungal superinfection. Angular cheilitis may cause pain with wide mouth opening and will reveal erythematous, sometimes weeping tissue at the corners of the mouth. The candida infection will be evident as a bright red outline in the shape of the patient’s dental prosthesis. Atrophic candidiasis may be asymptomatic, or patients may report worsening discomfort with denture use. In addition to the more classic presentation of oral thrush, candida may colonize macerated tissue in contact with dentures (atrophic candidiasis), or in the moist regions at the labial corners (angular cheilitis). Patients may report some mouth dryness, irritation, or discomfort when swallowing, but they will not be constitutionally ill. ![]() Such patches can be scraped away with a tongue depressor or gauze, and irritated, bleeding tissue will be present beneath. Most commonly, patients will report the presence of white patches that may appear on the buccal mucosa and palate. Of note, although immunocompromised patients are at higher risk, oral candidiasis is not considered indicative of immunocompromise. Recent antibiotic use is a risk factor, as is uncontrolled diabetes and the use of inhaled corticosteroids. Other than in extremely rare cases, all are caused by Candida albicans, which is also a common colonizer of asymptomatic individuals. Oral candida infections are heterogenous in presentation. Kellerman MD, in Conn's Current Therapy 2021, 2021 Oral Candidiasis
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