Etiology, pathogenesis, therapy, and prophylaxis of oral yeast infections

Etiologic factors in oral candidosis are immature antimicrobial host defenses, acquired suppression of immune defense mechanisms (AIDS, immunosuppressive or radiation therapy), or changes of the environmental conditions of the oral cavity (antibiotics, dentures, epithelial changes). After colonization and adhesion of Candida to the epithelial surface the subsequent mucosal lesion is due to tissue destruction by potent proteolytic enzymes or toxins and an inflammatory response to Candida antigens. Topical antimycotic treatment with nystatin, amphotericin B, or miconazole is important especially to prevent spread of the infection. Chronic Candida infections require long-term antifungal therapy, and patient compliance may be difficult to obtain. In denture stomatitis colonization of the fitting denture surface by Candida should be controlled by, for example, using a chlorhexidine solution as a denture disinfectant. However, recurrences are frequent if the local or the systemic predisposing conditions are not corrected. Fluconazole, a new bis-triazole, may be important for long-term treatment of immunocompromised patients.