Candidiasis, Oral



  • Candida is a fungus
  • Candidiasis is an opportunistic infection
  • Infection of oral mucosa with any species of Candida
  • Up to 80% of isolates are Candida albicans (most common), Candida glabrata, and Candida tropicalis
  • Candida normally present as oral flora in 30–50% of the healthy population
  • Rates of carriage increase with age
  • Variations include:
    • Pseudomembranous (thrush)
    • Chronic and acute atrophic candidiasis
    • Angular cheilitis
    • Hyperplastic candidiasis
  • More common in neonates, elderly, and immunosuppressed individuals
  • Usually benign course in healthy patients
  • More likely to be recurrent and a non-albicans species in immunocompromised patients
  • May represent an early manifestation of AIDS in HIV-infected patients
  • Typically localized
  • Risk factors for systemic infection:
    • HIV—most common oral manifestation
    • Diabetes
    • Hospitalization
    • Immunosuppressive therapy
    • Malignancy
    • Neutropenia
    • Organ transplantation
    • Prematurity


  • Usually overgrowth of C. albicans from alterations in intraoral environment
  • May be medication induced—commonly antimicrobials, inhaled or systemic steroids, chemotherapy, immunosuppressive agents
  • Alterations or impairment of salivary flow:
    • Anticholinergic or psychotropic medications
    • Sjögren disease
    • Head or neck radiation
  • Presence of dentures or other orthodontics:
    • Occurs in up to 50–65% of denture wearers
    • Common etiology for chronic atrophic candidiasis
  • Interruption of epithelial barrier (cheek biting)
  • Endocrinopathies (diabetes, hypothyroidism)

Pediatric Considerations
  • Acute pseudomembranous candidiasis (thrush) is common in infancy likely because of immune system immaturity and lack of mature oral flora
  • Initial presentation may be feeding difficulty secondary to dysphagia
  • May have concurrent Candida diaper rash
  • Consider maternal treatment if breastfeeding:
    • Maternal breast colonization may be cause for persistent thrush
    • Query maternal nipple pain, burning, itching, or cracked skin

Geriatric Considerations
  • Candida organisms are normally present as oral flora from 65–88% of elderly or those in long-term care facilities
  • Dentures can lead to Candida overgrowth
  • Angular cheilitis more common in the elderly secondary to facial wrinkling

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