Professional Documents
Culture Documents
DOI 10.1007/s11046-015-9933-y
Received: 11 March 2015 / Accepted: 24 August 2015 / Published online: 2 September 2015
Springer Science+Business Media Dordrecht 2015
Abstract
Introduction Oral candidiasis is one of the most
common opportunistic fungal infections of the oral
cavity in human. Among children, this condition
represents one of the most frequent affecting the
mucosa. Although most diagnoses are made based on
clinical signs and features, a microbiological analysis
is sometimes necessary. We performed a literature
review on the diagnosis of oral candidiasis to identify
the techniques most commonly employed in routine
clinical practice.
Materials and Methods A MedlinePubMed search
covering the last 10 years was performed.
Results Microbiological techniques were used in
cases requiring confirmation of the clinical diagnosis.
In such cases, direct microscopy was the method most
commonly used for diagnosing candidiasis.
Conclusion Direct microscopy appears as the
method of choice for confirming clinical diagnosis
and could become a routine chair-side technique.
Introduction
The last decade had seen a gradual increase in the
incidence of fungal infections [1]. Oral candidiasis is
one of the most common opportunistic fungal infections of the oral cavity in human. Its clinical expression is largely varied, and it has been classified into
different subtypes, as presented in Table 1 [2].
Although most fungal species live as saprophytes,
under certain conditions they can become pathogenic
and cause infectious diseases, known in animals as
mycoses. Fungi of the genus Candida cause oral
candidiasis. One hundred and fifty species of this
genus have been isolated from the oral cavity,
although 80 % of the isolates corresponded to Candida albicans [3]. All types of oral candidiasis are
found in the pediatric population where they represent
one of the most frequent mucosal disorders. Some
predisposing factors have been associated with an
increased incidence of infection in children, such as
prolonged antibiotic therapy, malnutrition, diabetes,
HIV infection and poor oral hygiene. An oral
candidiasis encountered in a young child must lead
clinician to search for an immune deficiency. Denturerelated stomatitis may also be encountered in young
patients during long-term orthodontic treatment using
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374
Subtypes
Pseudomembranous
Erythematous
Chronic
Pseudomembranous
Erythematous
Hyperplasic
Others
Angular cheilitis
Denture-related median
rhomboid glossitis
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Discussion
The occurrence of candidiasis among children is quite
high, especially in those who are medically compromised. An accurate diagnosis is essential to ensure
selection of the most suitable treatment option. In most
cases, the clinical appearance of lesions enables a
pediatric dentist to make the right diagnosis. However,
mistakes can be made differentiating candidiasis from
other clinical conditions such as bacterial gum disease
or keratosis. In such cases, further microbiological
investigation is needed. The number of recent publications on this subject reflects the interest of the
375
Recommendation
Fixation type
Authors comments
Periodic acid
Schiff stain
Yes
No data
Potassium
hydroxide
Periodic acid
Schiff stain
Giannini et al. [8]
Air dry
No data
Smitha Byadarahally
et al. [16]
Potassium
hydroxide
Krishnan [13]
Potassium
hydroxide
Alcohol fixative
Gram stain
Periodic acid
Schiff
Kumaraswamy et al.
[14]
95 % ethyl
alcohol
Coronado-Castellote
et al. [12]
No data
Potassium
hydroxide
Potassium
hydroxide
Gram stain
Periodic acid
Schiff stain
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376
Conclusion
The diagnosis of oral candidiasis is mostly based on
clinical examination. However, in some situations,
further investigations are needed to obtain a more
targeted treatment. The simplicity of the sampling
method is particularly well adapted to young patients.
The care of these patients is specific with regard to the
need to involve their parents in the process. A full
explanation of the etiology is key to obtaining parents
cooperation and finally compliance with medication.
In this respect, direct microscopic examination of the
clinical sample obtained by scraping of the affected
area with a spatula as a chair-side diagnostic method
could improve pediatric candidiasis management
(Fig. 4). Clearly, the main disadvantage of this
technique is its incapacity to differentiate between
species. Also, it should be performed by an operator
trained in microbiology, with proper material and in
close relationship with the microbiology laboratory.
Nevertheless, it remains a simple, cost-effective and
noninvasive procedure which, when used as a complementary tool alongside clinical observation, could
help to establish a correct diagnosis and guide the
clinician toward a more appropriate treatment.
Compliance with Ethical Standards
Conflict of interest
interest.
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