Oral Ulceration

When there is a decrease in the host resistance to infection, some predisposing factor is usually present and should be sought out. Possibilities include infancy, pregnancy, decreased salivary flow, denture, poorly controlled diabetes, hypoparathyroidism, hypoadrenocorticism, malnutrition, immunosuppression including AIDS, underlying malignancy, and lymphoreticular disorders such as agranulocytosis, leukemia, lymphoma, etc.

Oral candidiasis usually presents with profuse creamy white plaques, which cover any portion of the mouth, rub off easily, leaving a bright red, raw, bleeding surface. In some cases it may present as a brightly erythematous mucosa with only scattered white plaques. Chronic hyperplastic cadidiasis is the form of the disease that presents clinically as a leukoplakic lesion that does not rub off the underlying mucosa. A biopsy is necessary to differentiate this form of candidiasis from other forms of leukoplakia. Although the diagnosis may be made primarily on the clinical features alone, cytologic smears are helpful in confirming it. This may easily be done by making a smear of the suspected lesion on a glass slide, adding a drop of 20% potassium hydroxide, and examining the slide for the typical hyphae. Oral Candida infection is usually treated with various topical antifungal preparations. The use of systemic antifungal therapy such as Fluconazole or Itraconazole may be initiated under specialist supervision.