Oral candidosis (thrush) is a common clinical problem seen in
various groups of patients. Oral thrush can appear as the typical
white plaques, but this is not the only clinical presentation.
More commonly, denture stomatitis is seen in patients wearing
either partial or complete dentures. Angular cheilitis, redness
and cracking at the corners of the mouth, is also common in these
patients. In the case of oral candidosis, there is generally either
a local or systemic factor that predisposes the patient to this
disease. Candidosis is aptly called the disease of the diseased
whether this represents a local disturbance or a systemic condition.
An important point to note is that the presence of oral thrush
merely signals the presence of a predisposing factor, which in
itself should be identified and treated.
Oral lichen planus is a common skin condition that affects the
oral tissues. It is caused by an immune-mediated defect in the
tissues, and generally affects older individuals. It can take
on several clinical presentations from white lines on the buccal
mucosa, to ulcerated, red lesions on the tongue and gums.
Histopathology is very helpful in the final diagnosis, and the
lesions are managed with the use of topical or systemic corticosteroids
or other immunomodulatory agents, depending upon the severity
of the lesions.
Ulcers can be present in the mouth for several reasons. They can
result from local trauma to the oral tissues, or represent a more
systemic problem such as immune defects. One particular type of
ulceration is known as recurrent aphthous ulcers (RAU). These
ulcers are generally small in size, but are very uncomfortable.
They come and go on a regular basis, and last between 7-10 days.
These ulcers cause considerable functional morbidity and so their
correct diagnosis and management with corticosteroid anti-inflammatory
creams and ointments to help reduce the discomfort and the duration
of the ulcer is a significant patient service. The aims of treatment
therefore are both to treat individual lesions and inhibit new
lesion formation and this is achievable in most patients.
Dry mouth (xerostomia) is a direct result of the lack of saliva
and its protective effects. Some patients become xerostomic because
of the medications they may be taking or post-radiotherapy, while
others may be suffering from immune-related problems such as Sjogrens
syndrome. This latter group require careful ongoing review to
intercept the development of other auto-immune disease as well
as the small number who will develop lymphoma.
The reason for the dry mouth must be determined first, and this
is followed by outlining a suitable management strategy to help
the patient overcome their dryness and to protect the oral tissues
including the teeth. Several commercially available products can
be used. Patients may also require the use of sialogogues to stimulate
salivary flow and lifestyle modification where appropriate.