Oral candidiasis

Last reviewed: 26 Aug 2022
Last updated: 22 Jul 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • creamy white or yellowish plaques, fairly adherent to oral mucosa
  • burning oral pain
  • cracks, ulcers, or crusted fissures radiating from angles of the mouth
More key diagnostic factors

Other diagnostic factors

  • unpleasant taste in the mouth
  • lesions on any part of the oral mucosa
  • atrophic, fiery red, flat lesions on the palate
  • patchy areas of loss of filiform papillae on the dorsum of the tongue
  • spotty red areas on the buccal mucosa
  • lesions confined to the outline of a dental prosthesis
  • dysphagia or odynophagia
  • rhomboid outline on the dorsal aspect of the tongue
  • continuous or patchy band of erythema, involving the free gingival margin
Other diagnostic factors

Risk factors

  • hyposalivation/xerostomia
  • poor oral hygiene, especially among denture wearers
  • malabsorption and malnutrition
  • advanced malignancy
  • cancer chemotherapy and radiotherapy
  • HIV infection
  • endocrine disturbance (e.g., diabetes mellitus, hypoparathyroidism, pregnancy, hypoadrenalism)
  • immunosuppressive agents (e.g., local or systemic corticosteroid therapy)
  • current or recent past use of broad-spectrum or multiple narrow-spectrum antibiotics
  • extremes of age
  • high carbohydrate diet
More risk factors

Diagnostic investigations

1st investigations to order

  • superficial smear of lesion for microscopy
More 1st investigations to order

Investigations to consider

  • biopsy of lesion
  • culture of mouth rinse sample
  • upper GI endoscopy with or without biopsy of lesions
  • urinalysis, random or fasting blood glucose, or glucose tolerance test to exclude diabetes
  • HIV antibody test
  • sialometry
  • electrolyte panel
More investigations to consider

Treatment algorithm

ACUTE

oral candidiasis

angular cheilitis

ONGOING

severely immunocompromised: prophylactic-therapy

Contributors

Authors

Fariba S. Younai, DDS
Fariba S. Younai

Professor of Clinical Dentistry

Chair, Division of Diagnostic & Surgical Sciences

UCLA School of Dentistry

Los Angeles

CA

Disclosures

FSY declares that she has no competing interests.

Peer reviewers

Joan A. Phelan, DDS

Chair of Department of Oral Pathology

New York University College Of Dentistry

New York

NY

Disclosures

JAP declares that she has no competing interests.

Giuseppina Campisi, DDS, PhD

Professor of Oral Medicine

Department of Oral Sciences

University of Palermo

Palermo

Italy

Disclosures

GC declares that she has no competing interests.

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