From the Guidelines
Oral candidiasis should be treated with antifungal medications, such as clotrimazole troches or nystatin suspension, to alleviate gum pain and prevent further complications. According to the clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America 1, for mild disease, clotrimazole troches at a dosage of 10 mg 5 times daily or nystatin suspension at a concentration of 100,000 U/mL and a dosage of 4–6 mL 4 times daily are recommended.
Key Considerations
- For moderate to severe disease, oral fluconazole at a dosage of 100–200 mg (3 mg/kg) daily for 7–14 days is recommended 1.
- Good oral hygiene practices, such as brushing teeth gently twice daily, flossing daily, and rinsing with warm salt water, can help soothe gum pain and prevent the spread of infection.
- Removing dentures at night and cleaning them thoroughly can also help prevent the recurrence of oral candidiasis, especially in cases of denture-related candidiasis 1.
Treatment Approach
- The treatment approach should be based on the severity of the disease, with mild cases being treated with topical antifungals and more severe cases requiring systemic antifungal therapy.
- It is essential to note that chronic suppressive therapy is usually unnecessary for patients with HIV infection, but if required, fluconazole at a dosage of 100 mg 3 times weekly is recommended 1.
- In cases where symptoms do not improve within a week of treatment, or if the patient has a weakened immune system, professional dental or medical care should be sought to evaluate for underlying conditions and determine the best course of treatment.
From the Research
Oral Candidiasis and Gum Pain
- Oral candidiasis is a common opportunistic infection that can cause gum pain and other symptoms 2, 3, 4, 5, 6.
- The infection can range from superficial mucocutaneous overgrowths to invasive bloodstream infections with a high mortality rate 2.
- Various fungal strains, including C. tropicalis, C. glabrata, C. krusei, and others, can cause oral candidiasis 2.
- Antifungal agents, such as polyenes, azoles, and echinocandins, are available to treat oral candidiasis 2, 3, 4.
Treatment Options
- Topical antifungal drugs, such as nystatin and miconazole, are commonly used to treat oral candidiasis 3, 4.
- Fluconazole is an effective systemic treatment for oral candidiasis that does not respond to topical treatment 3, 4, 6.
- Other systemic treatment alternatives, such as itraconazole, voriconazole, and posaconazole, are also available 3.
- Echinocandins, such as anidulafungin and caspofungin, can be used intravenously to treat oral candidiasis 3.
Management of Oral Candidiasis
- Topical treatment methods are the first line of therapy for oral candidiasis, especially for the pseudomembranous and erythematous variants 5.
- Patients with dental prostheses should be advised to disinfect the prosthesis routinely during the candidal treatment period 5.
- A disinfecting solution of equal parts of hydrogen peroxide and water or 2% chlorhexidine gluconate solution can be used to disinfect dental prostheses and oral hygiene aids 5.
- Systemic therapy should be employed for the treatment of more resistant forms of oral candidiasis or those that do not respond to topical therapy 5.