Candidiasis stomatitis

Candidiasis is an inflammatory process in the mouth of the fungal etiology.

Candidiasis is provoked by yeast-like, opportunistic fungi of the genus Candida albicans (white), which is why the disease is called a sooth-ulcer.

Types of candidal stomatitis: 

• Candidiasis of the mouth begins, as a rule, with glossitis - an inflammation of the tongue, which acquires a characteristic brilliant appearance (polished tongue) due to the pathological atrophy of the papillae linguales - receptor papillae. 

A few days later white focal patches of curdled consistency are formed on the tongue, they merge into plaques, under which there is an eroded tissue of the tongue. 

• There is a kind of candidal stomatitis, in which the papillae do not atrophy, but on the contrary, become inflamed, hypertrophied, which is diagnosed as granulomatous glossitis.
• Candidiasis, affecting the surface of the tongue, may appear as furrows, folds with a touch inside - a tongue-tied tongue.
• Candida can spread to the lips and manifest as angulus iptfectiosus - zaeda, cheilitis in the corners of the mouth.

Candidiasis is typically a "child" disease, which is more common for infants and young children, but also often for adults. The disease can develop independently or be a clinical symptom of the chronic pathology of internal organs, a decreased activity of immunity.

In the international classification of diseases ICD-10 oral candidiasis is described in the framework of A00-B99 under the heading "Some infectious and parasitic diseases": 

• B35-B49 - Mycosis.
• Q37 - Candidiasis.
• B37.0 - thrush of the oral cavity or candidal stomatitis.

[1], [2]

Causes of candidal stomatitis

It is believed that the main causes of candidal stomatitis lie in a decrease in immunity, which in turn loses its activity under the influence of various factors. The main pathogens of the oral mammal are microorganisms of the species Candida albicans, less often it is provoked by Candida krusei, Candida tropicalis, Candida glabrata and Candida parapsilosis. Candida (Candida) is considered opportunistic, as it is constantly found in the mucous membrane of the mouth, without causing any disturbances and uncomfortable sensations. Under the influence of unfavorable factors, the fungus multiplies more actively, atypically and infects nearby tissues, bypassing the barriers of protection created to protect against fungus.

The factors that cause the candida to multiply, the causes of candidal stomatitis may be: 

• Weakened, decreased activity of the immune system. This condition is typical for newborn babies, infants with unformed immunity (the 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 consequence of the absence of bacterial balance and a low level of acidic environment.
• Dysbacteriosis of the intestine.
• Infection of the baby with candida while passing through the infected generic pathways of the sick mother.
• 90% of HIV-infected patients suffer from candidal stomatitis due to systemic immunodeficiency.
• Diabetes, because a high level of glucose in the blood is a favorable environment for the reproduction of fungus.
• Excessive, uncontrolled use of medical rinses, elixirs, which provokes xerostomia (dry mucous membranes) and, as a consequence, stomatitis.
• A rare autoimmune pathology is Sjögren's syndrome, which is a combination of xerostomia and keratoconjunctivitis.
• Pregnancy, because in the body of a woman there are changes in metabolic processes, in the hormonal system. All this affects the bacterial balance of the oral cavity and will burn provoke a transient candidiasis stomatitis.
• Infringement of rules of hygiene of an oral cavity, care of a teeth.
• Non-compliance with hygiene rules when wearing dentures.
• Thrush can be a consequence of prolonged use of antibiotics, glucocorticosteroids.
• Continuous uncontrolled oral contraceptive use.
• Bad habits - smoking.
• Permanent exposure to the oral cavity by chemical, toxic substances (pesticides, benzene).
• Non-compliance with the rules of hygiene, sanitary treatment of objects, utensils.

[3], [4], [5], [6]

Symptoms of candidal stomatitis

Thrush of the oral cavity may look like a stomatitis proper, but it can manifest as glossitis (inflammation of the tongue), cheilitis or candidiasis jaundice. Symptomatology depends on the prevalence of the process, the patient's health status, and also on 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 overlooked, since they are similar to the remains of milk food. If parents try to remove white plaque on their own, ulcers appear on the mucous membrane of the mouth, and erosion.
• The child cries, as food causes painful sensations.
• Swelling of the mucosa causes difficulty in swallowing food.
• The child loses his appetite, his weight decreases.
• Candida can penetrate the intestine through the mouth and cause dyspepsia, pain in the abdomen.
• A child infected with a thrush of the mouth can infect the mother during breastfeeding. A woman with candida is affected by her breast nipples.

2. Adults: 

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

3. Complications that can cause thrush of the mouth: 

• Decreased body weight.
• Infection of the intestine, esophagus.
• Dyspepsia, a defecation disorder.
• The inflammatory process of the larynx.

Symptoms of candidal stomatitis depend on the form of the disease - acute or chronic. Acute form of thrush is the rapid formation of visible cheesy plaque in the entire 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 candidiasis of the oral cavity, the symptomatology is less pronounced and localized in the tongue or gums, moving periodically throughout the cavity.

Candidiasis of stomatitis in children

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

In addition to insufficient immune protection, the factor that promotes reproduction of fungi is milk nutrition - both breast milk and artificial mixtures.

The milk environment is the most favorable opportunity for nutrition and distribution of candida, which belongs to yeast-like microorganisms.

Symptoms of a thrush of a mouth at the child are clearly visible are a red mucous membrane of cavity, curdled, white local raids. The kid becomes capricious, cries, refuses food, loses weight, practically does not sleep.

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

Treatment of thrush of the mouth in children is primarily associated with strengthening immunity and eliminating a possible bacterial root cause - infection or a virus. Treatment of the oral cavity is carried out according to the recommended by the doctor scheme, usually prescribed alkaline rinses, small mouth children grease with a weak solution of iodinol. Treatment should be continued even when the symptoms are neutralized, that is, the raid disappears. The fixing course of therapy lasts no more than a week, it helps 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 candidiasis process. The main treatment is to strengthen the immune system, vitamin preparations and nutrition.

Parents need to monitor the hygiene of the oral cavity of the child, you need to carefully handle toys, dishes, in a word everything that the child can pull in his mouth or touch with his hands. Also, the rules of sanitation and hygiene directly affect all adults who come into contact with the baby. Pets, however it was difficult, should be removed from the room where the child is.

[7], [8]

Candidiasis of stomatitis in newborns

In infants thrush is characterized by a special intensity and acute form of the flow of the process. Candidial stomatitis in newborns can be caused by infection in the process of childbirth, when the child passes the infected birth canal, but also factors may be reduced immune protection, violation of basic rules of hygiene in the home where the newborn is. Rarely the cause of thrush infant becomes the use of antibiotics, usually similar treatment is performed in serious congenital pathologies in hospital under the supervision of medical staff. Accordingly, candidiasis is virtually eliminated or its signs are recognized quickly and the disease is docked.

Pediatricians note that premature infants, children with a lack of body weight, suffer from thrush twice as often as healthy babies.

Candidial stomatitis in newborns is manifested in total, in the entire oral cavity - on the gums, tongue, larynx, cheeks. The first sign is reddening of the mucous membrane, just on the same day, there appears a raid characteristic for thrush, which can bleed and cause pain. The kid refuses to eat, constantly cries, loses weight, does not sleep. In the systemic process, the acute form of candidiasis may increase body temperature, develop intoxication and a very serious condition requiring immediate hospitalization. In addition, the danger is represented by sores that hide under the raids, it is an open path for infection not only in the oral cavity, but also in the entire body of the baby.

Treatment of thrush infants is carried out at home, less often - in the hospital. Parents need careful compliance with hygiene rules, that is, systematic treatment of breast nipples during breastfeeding, bottles and nipples with artificial feeding. Affected areas of the mouth are lubricated with solutions of antiseptics, antimycotic drugs prescribed by the doctor. Self-medication, the use of alternative drugs in the treatment of newborn babies is not only unacceptable, but also fraught with dangerous, sometimes irreversible consequences.

In addition to treating the baby therapy can be exposed and the mother, who is often a disease provoking the disease

Treatment of candidiasis of the mouth in an infant continues for at least a month, all medical recommendations should be performed in full even when the symptoms of thrush disappear.

[9], [10], [11], [12], [13]

Candidiasis stomatitis in adults

Earlier it was believed that thrush of the oral cavity - this is a purely childhood disease, formed against a background of reduced immunity. Currently, dentists and therapists are reviewing this version, as the activity and frequency with which candidal stomatitis in adults began to occur increases several fold.

If the kids have almost no local immunity, then in adults the condition of the oral cavity is controlled by saliva containing microbacteria to maintain the balance of the microflora. As soon as the composition of saliva changes under the influence of taking antibiotics, hormonal preparations, as a result of diseases of internal organs, systems, with viruses or infections, a wonderful opportunity for candida appears uncontrollably.

Candidiasis of the mouth of adults rarely occurs in acute form, more often it manifests itself in the form of chronic foci in the form of white raids on the gums, tongue, cheeks or larynx. Under the foci of white plaque, an eroded surface is hidden, removing white precipitates can cause bleeding and pain. The acute form of candidiasis is characterized by severe burning sensation in the mouth, sore throat, inability to swallow food, loss of taste sensations. The chronic course of thrush is typical of stomatitis, which develops as a complement, a concomitant disease to the underlying pathology - diabetes, hepatitis, stomach ulcer or the most serious disease - HIV. Candida stomatitis in adults is diagnosed without difficulty, as well as other types of stomatitis, as the signs of the disease are visually determined.

Thrush of the oral cavity in adults is treated for at least a month with the help of a complex of drugs, both local and internal. Lung forms can be treated at home, outpatient, acute stomatitis as a consequence or complication of the underlying pathology is treated in the hospital, which is rare.

Usually in the treatment of stomatitis caused by fungi, immunostimulating drugs, vitamins are used. In addition, a local mouth rinse is appointed for gentle removal of deposits and sanitation. Fungi such as decoction of sage, chamomile, oak bark can also have an effect, but as an auxiliary, they do not replace the main treatment. Rinse with soda solution can bring temporary relief, but at the present time such a method is considered ineffective and outdated. Bacterial flora of the oral cavity is neutralized by modern drugstores prescribed by the dentist or therapist (Hexoral, Mycosyst, Stomatophyte, Orungal and others). Antimicrobials such as Flucanazole and its analogs are rarely used, only in the case of severe stomatitis, which affects the entire oral cavity, including the lower larynx. Typically, candidal stomatitis in adults is treated with local means, nutrition, vitamin therapy and personal hygiene. Strengthening the immune system, cleanliness and regular care for teeth and oral cavity - this is the guarantee of prevention and reducing the risk of thrush development.

[14], [15], [16], [17], [18], [19]

Diagnosis of candidal stomatitis

Diagnose thrush of the mouth is quite simple because of its visual symptomatic manifestation. However, any doctor in his practice uses the 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, which describes in detail the candidiasis of stomatitis in all its manifestations. Dentists use the classifier Arievich: 

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

In the course of the process, the diagnosis of candidal stomatitis determines such forms: 

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

Candidiasis also differs in degree of lesion and can be as follows: 

• Superficial candidiasis stomatitis.
• Deep candida stomatitis.

By prevalence, localization: 

• Focal candidiasis.
• Generalized candidiasis.

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

• Microscopic examination of the smear from the oral cavity.
• Characteristics of the plaque - stain, plaque, actually plaque, papule, open erosion.
• Quantitative analysis of the degree of colonization of the oral cavity.
• Identification of cultures obtained as a result of the study.
• Rarely an intradermal allergy test is performed on Candida antigen.
• Rarely - serological examination and histology, mainly in adults with a history of history - HIV, AIDS, tuberculosis.

[20], [21],

Which doctor treats candidal stomatitis?

If the first signs of thrush are revealed by the parents of a newborn baby, the question is which doctor treats candidal stomatitis does not occur, of course the treating pediatrician. In more adult children, the first examination is also conducted by a district doctor, a pediatrician, who is more likely to refer the child to the dentist and immunologist, since the external manifestations of stomatitis are the prerogative of dentistry, and internal causes are most often associated with reduced immunity. Also in the treatment of stomatitis can include and advice infektsionista, allergist, less often - a dermatologist.

As a rule, candidal diseases of the oral cavity are treated by a dentist, therapist and immunologist. This applies to adults and children, except for newborns, whose treatment is handled by a neonatologist.

Treatment of candidal stomatitis in adults

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

Treatment of candidal stomatitis in adults includes such activities, methods, methods: 

• Dose reduction or withdrawal of drugs potentially provoking candidiasis. If the patient's state of health does not cause danger, antibiotics, cytostatics, glucocorticoids as a factor that causes candidal stomatitis can be abolished.
• Mandatory treatment of chronic diseases of internal organs and systems, as primary factors provoking candidiasis, and as co-morbidities.
• Antimicrobial treatment, which involves the appointment of Lamizil, Nystatin, Nizoral, Levorin, Diflucan, Orungal or other similar drugs, both for internal use and externally.
• Prophylactic rinsing with a weak solution of furacilin, orasept and other solutions. Perhaps the use of phyto-products - from the bark of oak, broth of chamomile, calendula, sage.
• Necessarily appointed dietary food, excluding starchy foods, sweet dishes. It is also necessary to reduce the use of carbohydrates - potatoes, cereals, bread, confectionery and bread.
• B vitamins, ascorbic acid, rutin are prescribed.
• Antihistamines may be prescribed as an additional treatment.
• As a reinforcing effect of the treatment, the treatment is always prescribed treatment of caries, periodontal disease and other dental diseases.

In the treatment of thrush of the oral cavity there is no single scheme that would be universal and guaranteed a reliable result. This is due to a rather complex and variative mechanism of development of candidal stomatitis, its propensity to recur.

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

Treatment of candidal stomatitis in children

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

Therapy of thrush in a newborn and children under the age of one and a half years is a systematic treatment of the oral cavity, which often, up to 6-8 times a day is sanitized with a solution of pimafucin, antifungal agents, including ointments, oral administration. The drug, dosage and method of application is prescribed by the doctor, self-medication in relation to small children, as well as for adults, not only will not bring benefits, but can provoke serious complications or translate candidal stomatitis into chronic form. Older children show resorption of tablets that reduce the bacterial background by normalizing the microflora of the oral cavity, strengthening the immune system. These 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.

Antifungal preparations of internal purpose (oral) to children try not to appoint, however in a stage of an exacerbation of a candidiasis, at a grave condition they can be applied, including injection.

Treatment of candidal stomatitis in children is impossible without the participation of parents who are required to sanitize the mouth of a newborn baby or to control the mouth rinse with older children. Children older than 5-7 years can be sanitized mouth with a solution of furatsilina, with the help of Miramistin, Rivanol, Stomatidin, Oracept. Children from 3 years of age are shown resorption of Imudon, Pharingospet in dosage and mode prescribed by a doctor.

Local treatment of thrush of the mouth is also in the blurring of white spots (aphthae) with oxolin ointment or other remedy recommended by the pediatrician.

From the nutrition of the child exclude sharp, acidic dishes, which can have an irritating effect on the mucous membrane. Confinement is limited to sweets, starchy foods, flour and confectionery, the menu should be enriched with vitamins and dishes rich in protein (meat, fish).

All the items that the child can bring to the mouth - toys, pacifier, spoon and so on, should be regularly treated (wash, boil).

Prevention of candidal stomatitis

Like any other disease, thrush of the oral cavity is easier to prevent than treat later. In addition, candidal stomatitis is prone to recurrence under certain conditions, which must be eliminated.

Prevention of candidal stomatitis is as follows: 

• The oral cavity needs regular care and sanitation. In addition, that every day you need to brush your teeth, you need to rinse your mouth, better after each meal. You should use special rinses, dental floss, decoctions of medicinal herbs. 
• Patients with stomatitis after diagnosis of the disease (preferably with its first signs) should change the toothbrush and carefully handle personal utensils. Dental prostheses that need to be sanitized in any case, with stomatitis, require particularly careful care, as a rule, they are placed in the chlorhexidine solution for the night or use the Polydent, the Efferodent. 
• All, and not only those who suffer from candidal stomatitis, should use only individual personal care items - 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 get Candida in the process of giving birth (passing through the birth canal).
• After the birth of the child, the mother must carefully process the bottles, nipples, everything that gets into the baby's mouth, including her own breasts (nipples).
• Do not use the same bottle without treatment for 1-1.5 hours. A container with a milk mixture, more precisely its top - a nipple, standing in the air, can become a breeding ground for bacteria that "love" the milky medium.
• A child who is breastfed on breastfeeding naturally has 3 times less stomatitis than "artificial" ones.

Summarizing, it can be noted that the prevention of thrush oral cavity - these are the two main rules: 

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

These standard rules concern many diseases, including candidal stomatitis, which develops quickly enough, and is treated much longer.