Oral Candidosis in the Paediatric Patient

Oral candidosis can present in childhood with recognizable mucosal changes. It may be associated with predisposing factors or suggest underlying systemic disease such as poorly controlled diabetes or an immunosuppressed state. Investigations are often required and management includes addressing predisposing factors in addition to prescribing topical or systemic antifungal therapy. CPD/Clinical Relevance: It is important for general dental practitioners to recognize oral mucosal changes related to candidal infection and refer to secondary care for further assessment when appropriate. Dent Update 2017; 44: 132–138 and secondary, where lesions affect both oral and extra-oral sites (Table 2).4 Features of the main types are discussed below. Pseudomembranous candidosis This condition is often referred to as ‘oral thrush’ and is a common form of oral candidosis in newborns and the elderly. It presents as creamy white plaques, often said to resemble milk curds, which most commonly affect the soft palate, tongue and buccal mucosa (Figure 2). A feature of pseudomembranous candidosis is that these plaques can be removed with gauze, leaving an erythematous, and sometimes bleeding, mucosal surface.3 It affects up to 5% of newborns, at any time during the first few weeks of life, as a result of a newborn’s immature immune system and vertical transmission during the passage through the birth canal.5 Predisposing factors include the use of inhaled or topical corticosteroid or immunosuppression, most notably human immunodeficiency virus (HIV) infection. It normally presents acutely with minimal symptoms but, in cases of long-term immunosuppression, a chronic pseudomembranous candidosis can develop with an associated risk of Kevin Ryan, BDS, MB, BCh, BAO, StR in Oral Medicine, Mona Agel, BDS, MJDF RCS(Eng), MSc DPH(Distinc), Locum StR in Paediatric Dentistry, Halla Zaitoun, BDS(Hons), MFDS, MPaedDent, MDentSci, FDS(Paed Dent), Consultant in Paediatric Dentistry and Anne M Hegarty, BDentSc, MSc(OM), MBBS, MFD RCSI, FDS(OM) RCS, Consultant and Honorary Senior Clinical Lecturer, Oral Medicine Unit, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield S10 2SZ, UK (Anne. [email protected]). Kevin Ryan of host immune defences.3 In the paediatric setting it is important to consider these predisposing factors as oral candidosis may reflect an undiagnosed systemic condition. Predisposing factors Factors that predispose to oral candidosis relate primarily to the host. The virulence factors unique to Candida albicans which allow it to colonize the oral mucosal surface so effectively are listed in Table 1. The factors relevant in the paediatric setting include: