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What is the Diabetes mellitus
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Diabetes mellitus
• Diabetes mellitus (DM) is a metabolic disorder that predisposes individuals to fungal infections,
including those related to Candida sp., due to an immunosuppressive effect on the patient.
Results show that DM patients have an increased susceptibility to Candida sp. infections which
aggravates the cases of uncontrolled hyperglycemia.
• Several factors can increase colonization of Candida species in the oral cavity such as
xerostomia, which reduces the salivary flow and is a salivary pH disorder.
Among the reasons making diabetic patients more susceptible to oral candidiasis are:-
1. high levels of salivary glucose,
2. low secretion of saliva,
3. impaired chemotaxis, and defect of phagocytosis due to poly-morpho-nuclear leukocyte
deficiency

Oral candidiasis

Oral candidiasis
is a common opportunistic infection of the oral cavity caused
by an overgrowth of candida species, particularly Candida
albicans. Numerous risk factors such as age, gender, nutrition,
oral hygiene, smoking, dentures, salivary pH disorder, and
xerostomia (dry mouth) make diabetic patients more
susceptible to oral candidiasis

Main diseases related to Candida sp. occurring with
higher incidence in patients with diabetes mellitus type
1 or type 2

most common types of Candida infection.
Candida species can infect tissues in essentially every body system,
producing a wide range of clinical manifestations -
:
is called thrush when it grows in the mouth,
shows up on skin as a red, inflamed, and sometimes scaly rash, ex:
diaper rash
causes vaginitis, commonly known as a yeast infection
causes candidal onchomycosis in the nails
 can affect the esophagus and the digestive tract
Candidal infection of the penis may result from sexual intercourse
with an infected partner

1.is called thrush when it grows in the mouth,

shows up on skin as a red, inflamed, and
sometimes scaly rash, ex: diaper rash

causes vaginitis, commonly known
as a yeast infection

causes candida onychomycosis in the
nails

can affect the esophagus and the
digestive tract

Oral candidosis

Acute candidosis
THRUSH (Pseudomembranous candidosis)
• Thrush clinically is seen as white creamy lesion or patch
seen on the tongue, palate, cheek.
• These white patches resemble curdled milk which can be
removed by scraping them with wooden spatula or with
dry gauze.
• The underlying mucosa may appear normal or
erythematous

Thrush may be initiated by
• exposure of the patient to broad spectrum antibiotic
• impairment of the patient’s immune system.
• leukemic patients
• human immunodeficiency virus (HIV)
• infant may also be affected because of their under
developed immune system.

Acute antibiotic stomatitis
• This can follow topical use of antibiotics especially tetracycline,
which can cause suppression of normal flora.
• Clinically the whole mucosa is red & sore; spot of thrush can be
present.
• Resolution may follow with removal of the antibiotic.

Chronic candidosis
Denture induced stomatitis (chronic)
This lesion is seen in patients wearing a well fitting upper denture which
cuts off the underlying mucosa from the protective action of the saliva.
This condition is characterized by varying degree of erythema, petechial
hemorrhage, localized to the denture bearing area of a maxillary removable
dental prosthesis.

• Whether this represents actual infection by C.albicans or is
simply a tissue response by the host to the various M.O. living
beneath the denture remain controversial,
• or this reaction could be due to improper design of the denture,
allergy of the denture base or inadequate curing of the denture
acrylic.

Chronic hyperplastic candidosis or candidal
leukoplakia
• This lesion characterized by the appearance of white plaque or patch
that can not be removed by scraping, such lesions are usually located
on the anterior buccal mucosa and can not clinically be distinguished
from a leukoplakia only by taking a biopsy.

•It is not clear whether this lesion is caused by
candida or candida is superimposed on preexisting
leukoplakia.
•In H&E stained section, hyphae are difficult to be
seen but by using PAS (periodic acid Schiff) stain
clearly shows the hyphae growing through the full
thickness of the keratin to the prickle cell layer.

Erythematous candidosis
This lesion clinically appears as patchy red mucosal macules
some times appear as smooth or granulated red or fissures
 this lesion mostly occur in hard palate , dorsum of the tongue and
soft palate and mostly associated with HIV-positive patients

There are varying form of erythematous candidosis :
Acute atrophic candidosis or antibiotic sore mouth .
Why???
Due to long term antibiotic therapy the patients suffer
from burning sensation which may be accompanied by a
diffuse loss of the filliform papilla of the dorsal tongue.

Median rhomboid glossitis or central papillary
atrophy
• In the past this was thought to be a developmental defect
of the tongue , but now considered as one type of candidal
infection.
• This lesion is asymptomatic as a well demarcated red
zone in the mid line of post dorsal tongue.

Angular stomatitis
 This occur in the angles of the mouth which appear as red,
fissured and scale.
 This seen typically in an older person with reduced vertical
dimension and many folds at the corner of the mouth so the saliva
tend to pool or flow in these folds keeping the area moist and thus
inducing a yeast infection.
 This may be caused by candida albicans alone or combined with
other M.O such as Staphylo-
 coccusaureus .

SYMPTOMS
OF ORAL CANDIDA

ORAL CANDIDIASIS IN THE MOUTH AND THROAT CAN HAVE
MANY DIFFERENT SYMPTOMS, INCLUDING:
 WHITE PATCHES ON THE INNER CHEEKS, TONGUE, ROOF OF
THE MOUTH, AND THROAT (PHOTO SHOWING CANDIDIASIS IN
THE MOUTH)
 REDNESS OR SORENESS
 COTTON-LIKE FEELING IN THE MOUTH
 LOSS OF TASTE
 PAIN WHILE EATING OR SWALLOWING
 CRACKING AND REDNESS AT THE CORNERS OF THE MOUTH

Risk and Prevention
Candidiasis in the mouth, throat, or esophagus is uncommon in healthy adults. People who are at
higher risk for getting candidiasis in the mouth and throat include babies, especially those younger
than 1 month of age, and people with at least one of these factors:
 Wear dentures
 Have diabetes
 Have cancer
 Have HIV/AIDS
 Take antibiotics or corticosteroids, including inhaled corticosteroids for conditions like asthma
 Take medications that cause dry mouth or have medical conditions that cause dry mouth
 Smoke
Who gets candidiasis in the mouth or throat ?

Treatment
 Candidiasis in the mouth, throat, or esophagus is usually treated with antifungal medicine.
 The treatment for mild to moderate infections in the mouth or throat is usually an antifungal
medicine applied to the inside of the mouth for 7 to 14 days.
 These medications Include clotrimazole, miconazole, or nystatin.
 For severe infections, the most common treatment is fluconazole (an antifungal
medication) taken by mouth or through a vein.

If patient does not get better after taking fluconazole, healthcare
providers may prescribe a different antifungal.
The treatment for candidiasis in the esophagus is usually fluconazole.
Other types of prescription antifungal medicines can also be used for
people who can’t take fluconazole or who don’t get better after taking
fluconazole.

Conclusion
Since using complete denture causes more susceptibility to candidal
colonization, oral candidiasis and other consequences particularly in
diabetic patients, controlling the level of serum glucose, drinking
enough water in diabetic patients with xerostomia, regularly
disinfection of denture and leaving the dentures exposed to the air at
night are the possible solutions for improving the diabetic oral health status.