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Candida is commmensal in the oral cavity and under normal circumstances it is harmless, but in people with impaired immunity it can become aggressive and invade tissues, causing acute and chronic candidiasis. The host factors leading to candida infection include local factors like decreased salivation and wearing of dentures, and systemic factors like diabetes, old age, anaemia, HIV infection, etc. They manifest themselves as acute pseudomembranous, chronic atrophic (erythematous), chronic hyperplastic candidiasis and angular chelitis.

Acute pseudomembraneous candidiasis is the most common form, which appears as creamy white curd-like plaques on the buccal mucosa, tongue, and other mucosal surfaces of the oral cavity. Scraping of these lesions may be difficult and may leave a red or bleeding underlying surface. This should be differentiated from food debris and coated tongue.

Chronic atrophic (erythematous) candidiasis appears as a flat red lesion on the dorsal surface of the tongue and/or the hard/soft palates. The tongue may have depapillated red mucosal areas on its dorsal surface. This should be differentiated from chemical burns or trauma. Chronic hyperplastic candidiasis appears as asymptomatic white plaques or papules, sometimes against an erythematous background, on the laterodorsal surfaces of the tongue or anterior buccal mucosa, which are adherent and do not scrape off.
Angular chelitis appear as red, fissured lesions at either one or both corners of the mouth, and may appear alone or in conjunction with another form of oral candida infection.

The treatment is topical using antifungal drugs such as nystatin, clotrimazole or oral drugs such as ketoconazole, fluconazole, etc., along with control of the precipitating factor or systemic antifungal therapy depending on the severity of the infection; In fulminant cases, more aggressive parenteral antifungal treatment is required.


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Figure 1: Chronic atrophic candidiasis (denture sore mouth). Note the diffuse erythema involving the entire hard palate due to the use of the same dentures for the past 20 years.
Figure 2: Chronic atrophic candidiasis. Note the atrophic area in the hard palate and in the upper labial sulcus due to prolonged use of the same dentures for the past 16 years.
Figure 3: Chronic atrophic candidiasis. A: Note the central papillary atrophy in the dorsum of tongue. B: Note the erosive area in the palate.
Figure 4: Denture sore mouth: Edentulous patient who has dentures worn for 8 years having erythematous areas in the hard palate commonly attributed to candidal infection.
Figure 5: Central papillary atrophy of the tongue (chronic atrophic candidiasis). Note the papillary atrophy in the mid part of dorsum tongue with multiple lobular and fissured appearance.
Figure 6: Central atrophic candidiadis. Note the 2x2 cm atrophic area in the mid part of the dorsum of tongue in this 38–year-old woman.
Figure 7: Acute pseudomembranous candidiasis: Note the curdy-white flecks on an erythematous base. The white flecks can be removed by gentle rubbing or scrapping the mucosa which reveals an area of erythema.
Figure 8: Acute pseudomembranous candidiasis on the left buccal mucosa.
Figure 9: Acute candidiasis in a patient with oral submucous fibrosis.
Figure 10: Coated tongue. Note the diffuse coating on the dorsum of the tongue. Scraping from dorsum tongue showed candidial hyphae.
Figure 11: Acute pseudomembranous candidiasis.
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