Candida stomatitis

Candidal stomatitis is an inflammatory process in the oral cavity of fungal etiology.

Candidiasis is caused by yeast-like, opportunistic fungi of the genus Candida albicans (white), which is why the disease is also called oral thrush (soor).

Types of candidal stomatitis:

• Oral candidiasis usually begins with glossitis – inflammation of the tongue, which takes on a characteristic shiny appearance (polished tongue) due to pathological atrophy of the papillae linguales – receptor papillae.

After a few days, white patches of a curd-like consistency form on the tongue; they merge into plaques, under which is eroded tissue of the tongue.

• There is a type of candidal stomatitis in which the papillae do not atrophy, but on the contrary, become inflamed and hypertrophied, which is diagnosed as granulomatous glossitis.
• Candidiasis, affecting the surface of the tongue, can manifest itself as grooves, folds with plaque inside - scrotal tongue.
• Candida can spread to the lips and manifest as angulus ipfectiosus – cracks in the corners of the mouth, cheilitis.

Candidal stomatitis is a typical "childhood" disease, which most often affects infants and small children, but also often affects adults. The disease can develop independently or be a clinical symptom of chronic pathology of internal organs, decreased immune activity.

In the international classification of diseases ICD-10, oral candidiasis is described within the framework of A00-B99 in the section “Some infectious and parasitic diseases”:

• B35-B49 – Mycoses.
• B37 – Candidiasis.
• B37.0 – oral thrush or candidal stomatitis.

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Causes of Candidal Stomatitis

It is believed that the main causes of candidal stomatitis are due to decreased immunity, which in turn loses activity under the influence of various factors. The main causative agent of oral thrush is microorganisms of the Candida albicans species, less often it is provoked by Candida krusei, Candida tropicalis, Candida glabrata and Candida parapsilosis. Candida is considered conditionally pathogenic, as it is constantly present in the oral mucosa, without causing any disorders or discomfort. Under the influence of unfavorable factors, the fungus multiplies more actively, atypically and infects nearby tissues, bypassing the protective barriers created to protect against the fungus.

Factors that provoke the proliferation of Candida, the causes of candidal stomatitis can be as follows:

• Weakening, decreased activity of the immune system. This condition is typical for newborns, infants with unformed immunity (first 2 weeks after birth, less often up to 2-3 months).
• Unformed mucous membrane of the intestinal tract, oral cavity in newborns, as a result of which there is a lack of bacterial balance and a low level of acidic environment.
• Intestinal dysbacteriosis.
• Infection of the baby with Candida when passing through the infected birth canal of a sick mother.
• 90% of HIV-infected patients suffer from candidal stomatitis due to systemic immunodeficiency.
• Diabetes, since high levels of glucose in the blood are a favorable environment for the growth of fungus.
• Excessive, uncontrolled use of medicinal rinses and elixirs, which provokes xerostomia (dryness of the mucous membranes) and, as a consequence, stomatitis.
• A rare autoimmune pathology is Sjogren's syndrome, which is a combination of xerostomia and keratoconjunctivitis.
• Pregnancy, as changes in the metabolic processes and hormonal system occur in the woman's body. All this affects the bacterial balance of the oral cavity and can provoke transient candidal stomatitis.
• Violation of oral hygiene rules and dental care.
• Failure to comply with hygiene rules when wearing dentures.
• Thrush can be a consequence of long-term use of antibiotics and glucocorticosteroids.
• Long-term uncontrolled use of oral contraceptives.
• Bad habits – smoking.
• Constant exposure of the oral cavity to chemical, toxic substances (pesticides, benzene).
• Failure to comply with hygiene rules, sanitary treatment of objects, dishes.

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Symptoms of Candidal Stomatitis

Oral thrush may look like stomatitis itself, but it may manifest as glossitis (inflammation of the tongue), cheilitis or candidal angular cheilitis. Symptoms depend on the prevalence of the process, the patient's health condition, and his age.

Symptoms of candidal stomatitis:

1. Small children:

• White, cheesy plaques in the mouth, on the tongue. In newborns, the first signs of thrush are often missed, as they are similar to the remains of dairy food. If parents try to remove the white plaque themselves, ulcers and erosions appear on the oral mucosa.
• The child cries because eating causes pain.
• Swelling of the mucous membrane causes difficulty swallowing food.
• The child loses his appetite and his weight decreases.
• Candida can enter the intestines through the mouth and cause dyspepsia and abdominal pain.
• A child infected with oral thrush can infect the mother during breastfeeding. In women, candida affects the nipples of the breast.

2. Adults:

• A burning sensation in the mouth, first in the larynx.
• A characteristic whitish-yellow coating on the oral mucosa.
• Redness of the oral cavity.
• Bleeding of the mucous membrane during plaque removal.
• Atypical taste (metallic).
• Loss of taste when eating food.
• Chronic thrush causes dryness of the oral mucosa and pain when swallowing food.

3. Complications that oral thrush can cause include:

• Weight loss.
• Infection of the intestines, esophagus.
• Dyspepsia, bowel disorder.
• Inflammatory process of the larynx.

Symptoms of candidal stomatitis depend on the form of the disease - acute or chronic. Acute thrush is the rapid formation of a visible cheesy plaque throughout the oral cavity (ulcers, mucous membranes, gums, larynx, cheeks). Under the plaque, the mucous membrane is affected by ulcers, inflamed, hyperemic. In the chronic form of oral candidiasis, the symptoms are less pronounced and localized on the tongue or gums, periodically moving throughout the entire cavity.

Candidal stomatitis in children

The mucous membrane of the mouth of children is more vulnerable, vulnerable, in addition, due to the immaturity of many immune functions, opportunistic microflora is also not fully developed. Due to the age-related imperfection of local immune protection, this factor contributes to the fact that candidal stomatitis in children is a common disease.

In addition to insufficient immune protection, a factor that promotes the proliferation of fungi is dairy nutrition - both breast milk and artificial formulas.

A milk environment is the most favorable environment for the nutrition and spread of Candida, which is a yeast-like microorganism.

Symptoms of oral thrush in a child are clearly visible - this is a red mucous membrane of the cavity, cheesy, white local plaque. The baby becomes capricious, cries, refuses to eat, loses weight, practically does not sleep.

Candidal stomatitis in children, as a rule, is very acute, the chronic form of thrush is more typical for adults. Diagnosis of candidiasis is not difficult, since the signs are visible at the first examination. However, a smear from the cavity or pharynx may be needed for microscopic clarification of the causative agent of the disease. Additional tests or procedures are also possible if the child suffers from concomitant pathologies, since thrush is not always a primary disease, it can join existing inflammatory processes.

Treatment of oral thrush in children is primarily associated with strengthening the immune system and eliminating the possible bacterial root cause - infection or virus. Oral cavity treatment is carried out according to the scheme recommended by the doctor, alkaline rinses are usually prescribed, for small children the mouth is lubricated with a weak solution of iodinol. Treatment should be continued even when the symptoms are neutralized, that is, the plaque disappears. The consolidating course of therapy lasts no more than a week, it helps to minimize the risk of relapse and is mandatory. The use of antifungal drugs, antimicrobial agents for children is undesirable, they are prescribed only in case of acute symptoms and systemic candidal process. The main treatment is immune-boosting agents, vitamin preparations and good nutrition.

Parents are required to monitor the child's oral hygiene, toys, dishes, in a word, everything that the child can put in his mouth or touch with his hands must be carefully treated. Also, the rules of sanitization and hygiene directly concern all adults who come into contact with the baby. Pets, no matter how difficult it is, must be removed from the room where the child is.

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Candidal stomatitis in newborns

In infants, thrush is particularly intense and acute. Candidal stomatitis in newborns can be caused by infection during childbirth, when the child passes through an infected birth canal, but factors can also include reduced immune protection, violation of basic hygiene rules in the home where the newborn is. Rarely, the cause of thrush in an infant is the use of antibiotics, usually such treatment is carried out for serious congenital pathologies in hospital conditions under the supervision of medical personnel. Accordingly, candidiasis is practically excluded or its signs are recognized quickly and the disease is stopped.

Pediatricians note that premature babies and children with low birth weight suffer from thrush twice as often as healthy babies.

Candidal stomatitis in newborns manifests itself totally, in the entire oral cavity - on the gums, tongue, larynx, cheeks. The first sign is reddening of the mucous membrane, literally on the same day a plaque characteristic of thrush appears, which can bleed and cause pain. The baby refuses to eat, constantly cries, loses weight, does not sleep. With a systemic process, an acute form of candidiasis, body temperature may rise, intoxication and a very serious condition may develop, requiring immediate hospitalization. In addition, ulcers that are hidden under plaque are dangerous, this is an open path for infection not only of the oral cavity, but also of the entire body of the baby.

Treatment of thrush in infants is carried out at home, less often - in a hospital. Parents are required to carefully observe the rules of hygiene, that is, systematic treatment of the nipples of the breast during breastfeeding, the bottle and nipple during artificial feeding. The affected areas of the mouth are lubricated with solutions of antiseptics, antifungal drugs prescribed by the doctor. Self-medication, the use of folk remedies in the treatment of thrush in newborns is not only unacceptable, but also fraught with dangerous, sometimes irreversible consequences.

In addition to treating the baby, the mother, who is often the source of the disease, may also undergo therapy.

Treatment of oral candidiasis in an infant lasts at least a month; all doctor's recommendations should be followed in full even when the symptoms of thrush disappear.

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Candidal stomatitis in adults

Previously, it was believed that oral thrush is a purely childhood disease that develops against the background of reduced immunity. Currently, dentists and therapists are reconsidering this version, since the activity and frequency with which candidal stomatitis in adults began to occur increases several times.

If babies have practically no local immunity, then in adults the condition of the oral cavity is controlled by saliva containing microbacteria to maintain the balance of microflora. As soon as the composition of saliva changes under the influence of antibiotics, hormonal drugs, as a result of diseases of internal organs, systems, viruses or infections, Candida has an excellent opportunity to multiply uncontrollably.

Oral candidiasis in adults rarely occurs in an acute form, more often it manifests itself in the form of chronic foci in the form of white plaque on the gums, tongue, cheeks or larynx. Under the foci of white plaque there is an eroded surface, removal of white discharge can cause bleeding and pain. Acute candidiasis is characterized by a strong burning sensation in the mouth, sore throat, inability to swallow food, loss of taste. Chronic thrush is typical for stomatitis, which develops as an addition, a concomitant disease to the main pathology - diabetes, hepatitis, stomach ulcer or the most serious disease - HIV. Candidal stomatitis in adults is diagnosed without difficulty, like other types of stomatitis, since the signs of the disease are visually determined.

Oral thrush in adults is treated for at least a month using a combination of drugs, both local and internal. Mild forms can be treated at home, on an outpatient basis, acute stomatitis as a consequence or complication of the underlying pathology is treated in a hospital, which is rare.

Usually, immunostimulants and vitamins are used to treat stomatitis caused by fungi. In addition, local mouth rinses are prescribed for gentle plaque removal and sanitation. Herbal decoctions such as sage, chamomile, and oak bark can also have an effect, but as an auxiliary remedy, they do not replace the main treatment. Rinsing with a soda solution can bring temporary relief, but at present, this method is considered ineffective and outdated. Bacterial flora of the oral cavity is neutralized by modern pharmaceutical drugs prescribed by a dentist or therapist (Geksoral, Mikosist, Stomatofit, Orungal, and others). Antimicrobial drugs such as Fluconazole and its analogues are rarely used, only in the case of a severe form of stomatitis, which affects the entire oral cavity, including the lower parts of the larynx. As a rule, candidal stomatitis in adults is treated with local remedies, proper nutrition, vitamin therapy and personal hygiene. Strengthening the immune system, cleanliness and regular care of teeth and oral cavity are the key to prevention and reducing the risk of developing thrush.

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Diagnosis of candidal stomatitis

Diagnosing oral thrush is quite simple due to its visual symptomatic manifestation. However, any doctor in his practice uses generally accepted norms and classification of the disease. As a rule, the diagnosis is made according to ICD-10, but there is also a specific systematization that describes in detail candidal stomatitis in all its manifestations. Dentists use the Arievich classifier:

1. Yeast stomatitis in children – thrush.
2. Yeast stomatitis and glossitis.
3. Candidal cheilitis.
4. Candidal erosion of the corners of the mouth.

According to the course of the process, the diagnosis of candidal stomatitis determines the following forms:

1. Acute form of candidiasis.
2. Pseudomembranous candidiasis is thrush.
3. Atrophic candidiasis.
4. Chronic candidal stomatitis.
5. Hyperplastic candidiasis.

Candidiasis also varies in the degree of damage and can be as follows:

• Superficial candidal stomatitis.
• Deep candidal stomatitis.

By prevalence, localization:

• Focal candidiasis.
• Generalized candidiasis.

In order to determine more precisely the type and course of oral thrush, sometimes it is enough to collect anamnesis and perform a primary visual examination. But in practice, doctors quite often use the following diagnostic methods:

• Microscopic examination of a smear from the oral cavity.
• Characteristics of plaque: spot, plaque, plaque itself, papule, open erosion.
• Quantitative analysis of the degree of contamination of the oral cavity.
• Identification of cultures obtained as a result of the study.
• Intradermal allergy testing for Candida antigen is rarely performed.
• Rarely – serological testing and histology, mainly in adults with a complicated medical history – HIV, AIDS, tuberculosis.

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What kind of doctor treats candidal stomatitis?

If the first signs of thrush are detected by the parents of a newborn child, the question of which doctor treats candidal stomatitis does not arise, of course, the attending pediatrician. In older children, the first examination is also carried out by a local doctor, a pediatrician, who will most likely refer the child to a dentist and immunologist, since external manifestations of stomatitis are the prerogative of dentistry, and internal causes are most often associated with reduced immunity. Also, the treatment of stomatitis may include a consultation with an infectious disease specialist, allergist, and less often a dermatologist.

As a rule, oral candidiasis is treated by a dentist, therapist and immunologist. This applies to both adults and children, with the exception of newborns, who are treated by a neonatologist.

Treatment of candidal stomatitis in adults

Treatment of oral thrush depends on the type, form and extent of the fungal disease. The condition that ensures effective treatment of candidal stomatitis in adults is the precise determination of the cause and pathogen, since adult patients can be carriers of not only Candida albicans, which is typical for candidiasis, but also other types of microorganisms. In addition, concomitant diseases of the digestive system, endocrine pathologies (diabetes) can reduce and slow down the effectiveness of antifungal therapy. That is why the treatment of candidiasis is always comprehensive, with the prescription of drugs for external use and for internal use.

Treatment of candidal stomatitis in adults includes the following measures, methods, and techniques:

• Reducing the dose or discontinuing medications that potentially provoke candidiasis. If the patient's health condition does not pose a threat, antibiotics, cytostatics, and glucocorticoids can be discontinued as a factor causing candidal stomatitis.
• Mandatory treatment of chronic diseases of internal organs and systems, both as primary factors provoking candidiasis and as concomitant diseases.
• Antimicrobial treatment, which involves the administration of Lamisil, Nystatin, Nizoral, Levorin, Diflucan, Orungal or other similar drugs, both for internal and external use.
• Preventive rinsing with a weak solution of furacilin, Orasept and other solutions. It is possible to use herbal decoctions - from oak bark, decoction of chamomile, calendula, sage.
• A dietary diet is mandatory, excluding starchy foods and sweet dishes. It is also necessary to reduce the consumption of carbohydrates - potatoes, cereals, bread, confectionery and bread.
• Vitamins of group B, ascorbic acid, and rutin are prescribed.
• Antihistamines may be prescribed as adjunctive treatment.
• As a measure to support the effectiveness of treatment, treatment of caries, periodontal disease and other dental diseases is necessarily prescribed.

There is no single scheme in the treatment of oral thrush that would be universal and guarantee a reliable result. This is due to the rather complex and variable mechanism of development of candidal stomatitis, its tendency to recurrence.

Etiotropic drugs and their dosage are selected individually, taking into account the form of candidiasis, the age of the patient and the degree of damage to the oral cavity.

Treatment of candidal stomatitis in children

Treatment of candidal stomatitis in children can last from two weeks to several months, depending on the degree of damage to the oral cavity and the prevalence of the fungal disease.

Therapy for thrush in newborns and children under one and a half years of age consists of systematic treatment of the oral cavity, which is often, up to 6-8 times a day, sanitized with a solution of pimafucin, antifungal agents, including ointments, for oral use. The drug, dosage and method of administration are prescribed by a doctor, self-medication in relation to small children, as well as for adults, will not only not bring benefits, but can provoke serious complications or transfer candidal stomatitis to a chronic form. Older children are shown the resorption of tablets that reduce the bacterial background by normalizing the microflora of the oral cavity, strengthening the immune system. Such means include the polyvalent drug Imudon, which is able to activate the processes of phagocytosis and increases the level of lysozyme and protective immunoglobulins in saliva.

They try not to prescribe antifungal drugs for internal use (oral) to children, however, in the acute stage of candidiasis, in severe conditions, they can be used, including by injection.

Treatment of candidal stomatitis in children is impossible without the participation of parents, who must sanitize the mouth of a newborn baby on their own or control mouth rinsing in older children. Children over 5-7 years old can sanitize the mouth with a solution of furacilin, with Miramistin, Rivanol, Stomatidin, Orasept. Children from 3 years old are shown the resorption of Imudon, Faringospet in the dosage and regimen prescribed by the doctor.

Local treatment of oral thrush also involves lubricating the white spots (aphthae) with oxolinic ointment or another remedy recommended by the pediatrician.

Spicy and sour dishes, which can irritate the mucous membrane, are excluded from the child's diet. Sweets, starchy foods, flour and confectionery products are limited, the menu should be enriched with vitamins and dishes rich in proteins (meat, fish).

All objects that a child can bring to his mouth – toys, pacifiers, spoons, etc. – should be regularly processed (washed, boiled).

Prevention of candidal stomatitis

Like any other disease, oral thrush is easier to prevent than to treat later. In addition, candidal stomatitis tends to recur under certain conditions that need to be eliminated.

Prevention of candidal stomatitis is as follows:

• The oral cavity requires regular care and sanitation. In addition to brushing your teeth daily, you need to rinse your mouth, preferably after each meal. You should use special rinses, dental floss, and herbal decoctions.
• Patients with stomatitis after diagnosis of the disease (preferably at the first signs) should change their toothbrush and carefully clean their personal utensils. Dentures, which need to be sanitized in any case, need especially careful care in case of stomatitis, as a rule, they are placed in a chlorhexidine solution at night or use Polident, Efferodent.
• Everyone, not just those who suffer from candidal stomatitis, should use only individual personal hygiene items – a toothbrush, cup, fork, spoon, cosmetics (lipstick), and so on.

Prevention of candidal stomatitis in newborns should begin in the womb:

• A pregnant woman should treat any vaginal inflammatory pathology, especially infectious, since the baby can become infected with Candida during childbirth (passage through the birth canal).
• After the birth of the baby, the mother must carefully clean bottles, nipples, everything that goes into the baby's mouth, including her own breast (nipples).
• You cannot use the same bottle without processing it for 1-1.5 hours. The container with the milk mixture, or rather its top – the nipple, standing in the air can become a breeding ground for bacteria that “love” the milk environment.
• A child who is breastfed suffers from stomatitis 3 times less often than a child who is formula fed.

To summarize, it can be noted that the prevention of oral thrush consists of two basic rules:

• Active immunity.
• Compliance with the rules of personal and general hygiene.

These standard rules apply to many diseases, including candidal stomatitis, which develops quite quickly and takes much longer to treat.