Which Specialist Should Treat Oral Candida
Primary care clinicians can and should initiate treatment for oral candidiasis in most cases, with referral to a qualified dental professional reserved only for complicated oral conditions and infections. 1
Primary Care Management
Most cases of oral candidiasis can be effectively managed by primary care clinicians without specialist referral. The American Society of Clinical Oncology and American Cancer Society guidelines explicitly state that primary care clinicians should consider systemic fluconazole and/or localized therapy with clotrimazole troches to treat oral fungal infections. 1
Initial Treatment Approach by Primary Care
For mild oral thrush: Primary care clinicians should prescribe clotrimazole troches 10 mg five times daily for 7-14 days, or nystatin suspension (100,000 U/mL, 4-6 mL four times daily) for 7-14 days. 2, 3
For moderate to severe oral thrush: Oral fluconazole 100-200 mg daily for 7-14 days is the most effective first-line treatment and can be prescribed by primary care clinicians. 2, 3
For fluconazole-refractory cases: Primary care clinicians can escalate to itraconazole oral solution 200 mg daily for 7-14 days (64-80% response rate), or consider voriconazole 200 mg twice daily for 14-21 days. 2
When to Refer to a Dental Professional
Referral to a qualified dental professional is indicated only for complicated oral conditions and infections, not for routine oral candidiasis. 1 This includes:
Denture-related candidiasis requiring specialized denture management: Proper denture hygiene and disinfection are mandatory in addition to antifungal therapy for definitive cure. 2, 3
Persistent or recurrent infections despite appropriate antifungal therapy: When standard treatment fails and underlying oral pathology needs evaluation. 1
Complex oral lesions with uncertain diagnosis: When clinical presentation is atypical or diagnosis is unclear. 4
Common Clinical Pitfalls
Do not reflexively refer all oral candidiasis cases to specialists: The vast majority can be managed effectively in primary care with appropriate antifungal therapy. 1
Do not treat based on culture results alone: Candida species are normal oral flora, and positive cultures without clinical symptoms do not warrant treatment. 5
Do not discontinue therapy prematurely: Complete the full 7-14 day course even if symptoms resolve quickly to prevent recurrence. 3
Address underlying predisposing factors: Identify and eliminate causes such as ill-fitting dentures, corticosteroid use, immunosuppression, or antibiotic therapy. 6