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Describe the difference between commnesalism and parasitism of C. albicans
- Commensalism: they obtain benefit w/out causing harm, living on oral mucosa, as harmless residents
- Parasitism: commensal organisms over grow and disease develops, disease such as Candida albicans
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List three conditions that are primarily responsible for mycotic infection.
- HIV epidemic
- increased use of therapeutic immunosuppression drugs for organ transplantation
- treatment of malignant disease
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Identify the most common example of mycotic infection of the oral cavity
Candida albicans
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What is the relationship to the host response?
Fungal and human cells have similar metabolic pathways for protein synthesis and cell division, so only a small number of unique targets for antifungal therapy have been identified, and it can be complex
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Examine agents in table 10-1, which are relevant to oral infection?
- Nystatin (in the polyenes class)
- fluconazole, Itraconazole, and clotrimazole (in the imidazoles class)
- flucytosine
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Explain the mechanisms of action for antifungal agents used in dentistry. (2)
- inhibit ergosterol synthesis
- disrupt fungal plasma membrane by binding to ergosterol
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List antifungal agents and classifications used to treat oral candida infection.
- Nystatin (polyenes class)
- Fluconazole, itraconazole, and clotrimazole (imidazoles class)
- Flucytosine (other class)
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What is the major adverse effect of systemic azole antifungals?
Hepatotoxicity
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Describe the doseforms of agents for topical application and the dosing instruction to the pt (infant, child, adult).
- They must come in contact with the fungal organisms to be affective, so must stay in the mouth for 5 to 7 minutes
- the liquid can be frozen into popcycles for kids who have a hard time with it
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What antifungal agent is given for thrush in infants? What happens if the liquid is swallowed?
- Nystatin
- It won't heal the thrush
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How is the increased caries risk managed when nystatin is used?
use of daily fluoride
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Describe the role of C. albicans in the normal flora and changes that promote the development of candidiasis
- It is a normal inhabitant of the oral cavity and other places
- Candidiasis is caused by the overgrowth of C. albicans
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List conditions that predispose an individual to develop opportunistic infections.
- acquired and therapeutic immunosuppressions: HIVD, cytotoxic drugs, corticosteroids
- endocrinopathies: diabetes mellitus, hypoparathyroidism, hypoadrenalism, pregnancy w/secondary infection of infant
- nutritional deficiencies
- high carb diet
- antibacterial agents
- qualitative and quantitative changes of salivary flow
- poor oral hygiene
- dental prostheses
- advanced age
- smoking
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Which form of candidiasis is described?
white pseudomembranes can be wiped leaving red painful mucosal surface, can affect all oral soft tissues and may be acute or chronic, found in neonates as THRUSH, immunosuppressedpts, and HIV pts
pseudomembranous candidiasis
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Which form of candidiasis is described?
appears as a red patch on palate or dorsum of tongue with loss of filiform papillae. burning sensation may be reported, often seen in HIVD, and may follow exposure to broad-spectrum antibiotics
acute and chronic erythematous candidiasis
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Which form of candidiasis is described?
persistant (chronic) white plaques, may be seen on most oral tissues. when wiped doesn't cause severe pain or bleeding. known as candidal leukoplakia, once antifungal therapy is initiated the leasion disappears. seen in association with inhaled corticosteroids used in the management of respiratory disease. least common variant
hyperplastic candidiasis
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Which form of candidiasis is described?
appears as an erythematous area beneath a denture-bearing surface. asymptomatic lesions frequently associated with poor oral hygiene and chronic wearing of dental prostheses. also seen under pontic in association with fixed prostheses.
candida-associated denture stomatitis
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Which form of candidiasis is described?
appears as an erythematous patch with loss of filiform papillae confined to the dorsal aspect of the tongue located anterior to the circumvallate papilla
median rhomboid glossitis
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Which form of candidiasis is described?
appears as erythematous fissures at the commissures of the lips, represents a mixed infection of C. albicans, and coagulase-+ stphylococcus aureus. predisposing factors can be poor oral hygiene, decrease in intermaxillary space, or nutritional deficiencies. These lesions can be more extensive especially in kids, they tend to lick their lips resulting in chapped lips
angular cheilitis
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Which of the three groups are most likely to develop pseudomembranous candidiasis?
?Immunosuppressed?
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Differentiate between primary and secondary therapies to manage oral candida infection.
- Primary line of antifungal: nystatin (mycostatin) traditional drug of first choice for tx of oral candidiasis. comes in many different forms, including losenges to dissolve, and topical agents
- Secondary line of antifungal: fluconazole, generally reserved to treat severe localized, disseminated oral candidiasis or infections in immunosuppressed individuals, or wehn candidal infections respond poorly to topical therapy
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Describe local treatment strategies to manage oral candida infections that involve the dental hygienist.
- we can aid in identifying and eliminating possible contributing factors for it including:
- meticulous oral hygiene
- management of xerostomia
- maintenance of optimally functioning and clean dental prostheses
- clean all oral tissues and all surfaces of prostheses
- a chlorhexidine rinse may be used in conjunction with antifungal agents to disinfect prosthetic devices
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Identify possible drug interactions with systemic antifungal agents and the dosing regimen suggested when an interaction is possible.
- interaction of fluconazole, ketoconazole, or itraconazole with warfarin sodium: may increase blood levels of warfarin and increase bleeding; pts must have the INR blood test
- Prolonged use of systemic antifungal drugs may potentially result in renal or hepatic dysfunction in some pts: administered with caution in pts with underlying hepatic disease takinhg other hepatotoxic meds (acetominophen)
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When nystatin is ineffective, what is the second line local agent used for candidiasis?
systemic antifungal agents, such as fluconazole, ketoconazole, or itraconazole
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Are topical antifungal agents likely to cause drug-drug interactions?
no
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Identify the most common viral infection in the oral cavity.
Infections caused by the herpes simplex virus 1 (HSV-1)
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Compare HSV-1 oral lesions in healthy and immunocommpromised individuals.
- Primary exposure: In 90% results in asymptomatic, or mildly symptomatic illness
- healthy: involves skin, lips, and intraoral mucosa bound to periosteum; lesions are fluid-filled blisters or vesicles for the skin and lips, and small pin-point ulcerations of attached gingiva.
- immunocompromised: more severe form, intraoral lesions can affect labile mucosa as well as mucosa bound to periosteum; lesions can be found in the floor of the mouth
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Identify agents used for primary therapy in complicated primary herpetic gingivostomatitis.
- acyclovir
- valacyclovir
- famciclovir (famvir)
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List the '1-day' antiviral treatment.
Valacyclovir (valtrex)
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Describe pt instructions for the various antiviral agents.
- Antivirals for HIV: caution to prevent instrument or needle sticks, antiobiotic prophylaxis is needed, warn about oral candidiasis, use oral health education, frequent maintenance prophylaxis, encourage strict plaque control
- antivirals for HBV: warn that it is highly contagious, acetominophen may be contraindicated
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Describe tx plan modifications for herpes labialis.
pts presenting for dental care with an active herpetic infection should be rescheduled, in emergency situations, isolation of the lesions during dental care will be appropriate; i.e. rubber dam
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