Candida-induced stomatopyrosis and its relation to diabetes mellitus

Efficacy of oral nystatin treatment for patients with oral mucosal dysesthesia but without objective oral mucosal manifestations and necessity of Candida culture test before oral nystatin treatment

Background/purpose

Materials and methods

Results

Conclusion

The impact of external factors on psoriasis

Psoriasis is one of the most common chronic inflammatory skin diseases, constituting a significant health and socioeconomic problem. Despite numerous therapeutic options, the results of treatment very often remain insufficient. It is extremely important to remember that many external factors impact the effectiveness of therapy. This article discusses the importance of emollients in therapy and the influence of infectious agents and injuries on the course of psoriasis. Understanding the above-mentioned factors in the treatment of psoriasis is critical to achieve satisfactory therapeutic effects.

Burning mouth syndrome: a review of therapeutic approach

Burning mouth syndrome (BMS) is described by an intense burning sensation of the tongue or other oral areas without a clear etiopathology. The diagnosis of BMS is challenging due to variations of manifestations. The management of BMS is complicated due to the complex etiology of the disease. Many medications and treatment methods have been recommended for BMS management, but no one confirmed as the standard method. In this study, the therapeutic approaches of BMS were evaluated. The data of the article was obtained from PubMed/MEDLINE, Cochrane Library, and Web of Science. The following terms including "burning mouth syndrome", "therapy", and "treatment" were used for search in the databases. A wide range of articles about the therapeutic approach of BMS was searched and reviewed. Pharmacological and non-pharmacological approaches have been used for BMS management. Pharmacological treatments are including Capsaicin, Clonazepam, Low-dose aripiprazole, Alpha-lipoic acid, Duloxetine, Amitriptyline, Gabapentin, and Pregabalin, and ultra-micronized palmitoylethanolamide. Non-pharmacological therapies for BMS are cognitive therapy, Electroconvulsive therapy, Laser therapy, Acupuncture and auriculotherapy, Transcranial Magnetic Stimulation (rTMS), Salivary Mechanical Stimulation, and Botulinum Toxin. A detailed assessment of the etiology and pathophysiology of BMS, and having information about novel therapeutic interventions are essential for the management of BMS.

Relationship of Clinical Features with Candidal Carriage in Oral Submucous Fibrosis Patients: A Case-control Study

Background and Objectives:

Oral submucous fibrosis (OSF) is extensively prevalent in India and South-East Asia owing to the habit of arecanut (AN) use. Epithelial atrophy, hyposalivation, and immune alterations in OSF may predispose to increased Candidal carriage. Stomatopyrosis in OSF can result from multiple causes, which may also include Candidal infection. Hence, this study is aimed to assess Candidal carriage, species characterization, salivary flow rate (SFR) and its relationship with the clinical features (stomatopyrosis and mouth opening [MO]) in OSF patients alongwith the response to antifungal treatment in patients with higher Candidal carriage.

Methodology:

In this case-control study, 60 OSF patients and 30 age- and sex-matched control subjects were enrolled. SFR was assessed using modified Schirmer test. Samples for Candidal assessment were collected with the oral rinse technique and cultured. The isolated yeast species were counted and identified based on Gram staining, germ tube test, and CHROMagar. Data were analyzed with Chi-square test, Pearson's correlation test, and one-way ANOVA test.

Results:

The distribution of mean visual analog scale (VAS) score, SFR and MO was significantly varied (P < 0.001) in the study and control groups. Candida was found to be present significantly (P = 0.048) in OSF group as compared to control group. Candida albicans was the predominant species. No statistically significant association was obtained regarding Candidal isolation and SFR, burning sensation and MO in OSF patients. Only 1 patient in the study group yielded a high Candidal carriage (>400 CFU/mL) and reported relief in burning sensation (VAS score) with antifungal therapy.

Conclusions:

OSF patients yielded a significant higher oral Candidal carriage. Although it was not found to be associated directly, its role as a “cause and effect” in SFR and clinical features (stomatopyrosis and MO) of OSF cannot be ignored.

Burning Mouth Syndrome: A Review of the Etiopathologic Factors and Management

Burning mouth syndrome (BMS) is characterized by pain in the mouth with or with no inflammatory signs and no specific lesions. Synonyms found in literature include glossodynia, oral dysesthesia, glossopyrosis, glossalgia, stomatopyrosis, and stomatodynia. Burning mouth syndrome generally presents as a triad: Mouth pain, alteration in taste, and altered salivation, in the absence of visible mucosal lesions in the mouth. The syndrome generally manifests spontaneously, and the discomfort is typically of a continuous nature but increases in intensity during evening and at night. The etiopathogenesis seems to be complex and in a large number of patients probably involves interactions among local, systemic, and/or psychogenic factors. The differential diagnosis requires the exclusion of oral mucosal lesions or blood test alterations that can produce burning mouth sensation. Management is always based on the etiological agents involved. If burning persists after local or systemic conditions are treated, then treatment is aimed at controlling neuropathic symptoms. Treatment of BMS is still unsatisfactory, and there is no definitive cure. As a result, a multidisciplinary approach is required to bring the condition under better control. The aim of this review was to discuss several aspects of BMS, update current knowledge, and provide guidelines for patient management.

A comparative study of oral candidal species carriage in patients with type1 and type2 diabetes mellitus

Context:

Diabetes mellitus can have profound effects upon the oral tissues especially in patients with poor glycemic control being prone to severe and/or recurrent infections particularly candidiasis. The main aim was to study the association between Type 1 and Type 2 diabetes mellitus and candidal carriage.

Materials and Methods:

The study design comprised of previously diagnosed 30 patients each with type 1 diabetes mellitus (Group A) and type 2 diabetes mellitus (Group B) and 30 age-, sex- and dental status-matched healthy non-diabetic individuals as controls (Group C). The saliva samples were collected and inoculated onto Sabouraud dextrose agar (SDA) and chromogenic agar culture medium. Candidal colony forming units per ml (CFU/ml) values were determined.

Statistical Analysis:

Data were analyzed by χ² test, Mann-Whitney U-test, Spearman's rank correlation and Karl Pearson's correlation coefficient.

Results:

Data analysis showed statistically significant higher positive candidal growth in Group A and Group B when compared to Group C. The CFU/ml values were significantly higher in Groups A and B as compared with Group C. Significant positive correlation of CFU/ml with fasting blood sugar level and HbA1c% in both Groups A and B was seen. Oral signs and symptoms observed in diabetics were dry mouth, burning sensation, fissuring and atrophic changes of tongue and erythematous areas, which positively correlated with candidal load.

Conclusion:

The glycemic control status of the diabetic patients may directly influence candidal colonization. The quantitative and biochemical characterization allows better insight into the study of association of diabetes mellitus and candida.

Oral Candida carriage, quantification, and species characterization in oral submucous fibrosis patients and healthy individuals

AIM

  To determine the prevalence of oral Candida carriage, candidal quantification, and various subtypes of Candida species in oral submucous fibrosis patients and healthy individuals.

METHODS

  The study comprised 30 clinically-diagnosed and -staged oral submucous fibrosis patients aged 20-40 years, and 20 age- and sex-matched controls. Buccal mucosa was sampled by sterile swab technique. Each sample was inoculated on Sabouraud's dextrose agar and CHROMagar culture media. Candida species identification was done using the KB006 Candida identification kit.

RESULTS

  Eleven (36.67%) cases in the study group, and two (10%) cases in the control group, yielded Candida on culture. The value of CFU/mL increased with an increased duration of betel quid chewing habit. All Candida-positive oral submucous fibrosis patients complained of a burning sensation. Candida albicans and Candida tropicalis were the most common species in the oral submucous fibrosis cases. Candida dubliniensis was isolated in both the study and control groups.

CONCLUSIONS

  Our observations in this study affirm that oral submucous fibrosis favors the colonization of Candida. Mucosal alterations due to the underlying disease process or betel quid chewing, coupled with other factors, might lead to candidal colonization, even in the absence of clinically-related mycotic manifestations.

A review of the ultrastructural features of superficial candidiasis

Commensal yeast Candida causes opportunistic infections ranging from superficial lesions to disseminated mycoses in compromised patients. Superficial candidiasis, the commonest form of candidal infections, primarily affects the mucosa and the skin where Candida lives as a commensal. Conversion of candidal commensalism into opportunism at the fungal-epithelial interface is still ill-defined. Nevertheless, fungal virulence mechanisms such as adhesion to epithelia, morphogenesis, production of secretory hydrolytic enzymes, and phenotypic switching are thought to contribute in the process of pathogenesis. On the other hand, host responses in terms of immunity and local epithelial responses are actively involved in resisting the fungal challenge at the advancing front of the infection. Ultrastructural investigations using electron microscopy along with immunohistochemistry, cytochemistry, etc. have helped better viewing of Candida-host interactions. Thus, studies on the ultrastructure of superficial candidiasis have revealed a number of fungal behaviors and associated host responses such as adhesion, morphogenesis (hyphae and appresoria formation), thigmotropism, production and distribution of extracellular enzymes, phagocytosis, and epithelial changes. The purpose of this review is to sum up most of the ultrastructural findings of Candida-host interactions and to delineate the important pathological processes underlying superficial candidiasis.

Candida-associated denture stomatitis in type 2 diabetes mellitus

OBJECTIVE

To describe the clinical appearance of Candida-associated denture stomatitis (DS) in subjects with type 2 diabetes (T2DM). The relationships between the types of DS, oral complaints and associated conditions were assessed in terms of glycemic control as determined by glycated hemoglobin (HbA1c) measurements.

MATERIALS AND METHODS

Demographic and clinical data were obtained from questionnaires and oral examinations of 110 edentulous patients with T2DM and 50 control subjects.

RESULTS

Type II DS commonly occurred in diabetics (57.3% vs 30%; p=0.002) together with DS related oral complaints (60.9% vs 24%; p<0.001) compared with controls. Burning sensation of the mouth (BS) was the most common complaint. Dryness of the oral mucosa (DOM) (50.9% vs 6%; p<0.001), angular cheilitis (26.4% vs 8%; p=0.01) and glossitis (27.3% vs 6%; p=0.003) occurred more frequently in diabetics. Oral complaints and associated conditions of DS coincided with elevated HbA1c levels (p<0.001). Diabetics with extensive type of inflammation had higher HbA1c levels than type I/III DS subjects (p<0.001).

CONCLUSIONS

Diffuse type of inflammation was associated with T2DM. BS and DOM were the most common oral complaints. Inadequately controlled diabetes with Candida-associated DS was linked to a high incidence of an extensive type of inflammation, oral complaints and associated conditions.

"Burning tongue" and "burning tip": the diagnostic challenge of the burning mouth syndrome

OBJECTIVE

To investigate the clinical features of burning mouth syndrome (BMS) in a large cohort of patients and to correlate them with the results of tongue biopsy.

METHODS

We screened 98 patients complaining of oral burning pain for at least 6 months. Forty-two patients were excluded after screening for contact sensitivity to dental materials, food allergies, tongue injuries, malignancies, connective tissue and metabolic disorders, oral infectious diseases, vitamin deficiencies, and other systemic diseases known to cause neuropathy. Fifty-six patients underwent neurologic examination and assessment of pain intensity, depression, anxiety, quality of sleep, and quality of life. Tongue biopsy with the quantification of epithelial nerve fibers (ENF) was performed in 51 patients.

RESULTS

Compared with 9 healthy participants (4.13+/-1.85 SD), epithelial innervation density was significantly reduced in 38 patients (1.35+/-1.46 SD; P<0.0001) and normal in 13 patients (6.1+/-2.19 SD). The clinical features differed in the two groups: patients with reduced ENF density complained of pain in the whole tongue, lips, hard palate, and alveolar ridges, reported dysgeusia and xerostomia in 29% of cases (P<0.001), and 24% of them were depressed. Patients with normal innervation complained of pain on the tip of the tongue, reported dysgeusia and xerostomia in 7.7% of cases, and 54% of them were depressed (P<0.017).

DISCUSSION

The diagnostic criteria for BMS are not defined yet and the relationship with depression and anxiety is debated. We proposed a biopsy-supported approach for the diagnosis. Our study shows that BMS can present with two distinct clinical pictures and that tongue biopsy can contribute to the assessment of the diagnosis. Mood disorders occur frequently and should be considered when approaching patients and treatment options. These observations could help physicians in identifying patients with BMS and addressing them with the appropriate diagnostic work-up and treatment.

Oral burning sensation: prevalence and gender differences in a Japanese population

BACKGROUND

Burning mouth syndrome (BMS) is characterized by an oral burning sensation (OBS) in the tongue or other oral mucous membrane in the absence of any clinical abnormal findings. It frequently affects middle-aged and aged women. Although there are many oral disorders with OBS besides BMS, the prevalence of OBS is unclear.

AIM

To investigate the prevalence of OBS and analyze the gender differences in a Japanese population.

METHODS

The study subjects were 2599 dental patients in two dental offices in Tokyo, Japan. The prevalence of OBS was investigated using a questionnaire.

RESULTS

The mean ages of the subjects were 42.7 +/- 13.8 (mean +/- SD) years of age in male and 40.1 +/- 15.4 (mean +/- SD) years of age in female. The prevalence of OBS "at present" was 2.8% of 1310 male subjects and 3.2% of 1289 female subjects. There was no statistically significant difference between them for each decade. The prevalence including "at present" and "in the past" were 9.3% in male subjects and 10.8% in female subjects; this difference was not statistically significant.

CONCLUSION

These findings fail to demonstrate a female predilection for OBS.

Burning mouth syndrome: etiology

The Burning Month Syndrome (BMS) is an oral mucosa pain - with or without inflammatory signs - without any specific lesion. It is mostly observed in women aged 40-60 years. This pain feels like a moderate/severe burning, and it occurs more frequently on the tongue, but it may also be felt at the gingiva, lips and jugal mucosa. It may worsen during the day, during stress and fatigue, when the patient speaks too much, or through eating of spicy/hot foods. The burning can be diminished with cold food, work and leisure. The goal of this review article is to consider possible BMS etiologies and join them in 4 groups to be better studied: local, systemic, emotional and idiopathic causes of pain. Knowing the different diagnoses of this syndrome, we can establish a protocol to manage these patients. Within the local pain group, we must investigate dental, allergic and infectious causes. Concerning systemic causes we need to look for connective tissue diseases, endocrine disorders, neurological diseases, nutritional deficits and salivary glands alterations that result in xerostomia. BMS etiology may be of difficult diagnosis, many times showing more than one cause for oral pain. A detailed interview, general physical examination, oral cavity and oropharynx inspection, and lab exams are essential to avoid a try and error treatment for these patients.

Management of burning mouth syndrome: systematic review and management recommendations

Primary burning mouth syndrome (BMS) is a chronic, idiopathic intraoral mucosal pain condition that is not accompanied by clinical lesions or systemic disease. There is some uncertainty whether this condition should be referred to as a disease, a disorder, or a syndrome but there are insufficient data to justify any change in taxonomy at present. BMS occurs most often among women and is often accompanied by xerostomia and taste disturbances. More recently a neuropathological basis has been proposed so that BMS may be regarded as an oral dysesthesia or painful neuropathy. However, our incomplete understanding of the epidemiology, etiology, pathophysiology, and lack of diagnostic criteria are barriers to critical investigation and selection of effective treatments. There is only limited evidence to guide clinicians in the management of patients with BMS. Treatable secondary causes should be investigated before diagnosing primary BMS. Topical clonazepam and cognitive therapy have been proven efficacious in some patients. Emerging evidence supports the effectiveness of the antioxidant, alpha lipoic acid, with further studies of this agent being warranted. Additional research into mechanisms, diagnostic criteria, and randomized controlled interventional studies are needed.

Síndrome da boca ardente: etiologia

A Síndrome da Boca Ardente (SBA) é caracterizada por dor na cavidade oral, com ou sem sinais inflamatórios, mas sem lesões específicas. Acomete geralmente mulheres na faixa etária entre 40 a 60 anos. A dor é do tipo queimação, de intensidade moderada a severa, sendo a língua o local mais acometido, podendo haver sensação dolorosa também em gengivas, lábios e mucosa jugal. Pode haver piora da intensidade dolorosa no decorrer do dia, nos estados de tensão, fadiga, ao falar muito, à ingestão de alimentos picantes e/ou quentes e melhora com alimentos frios, trabalho e distração. O objetivo desta revisão é contemplar as possíveis etiologias da SBA, agrupando-as em 4 grandes grupos para que melhor possam ser estudados: dor oral de causa local, sistêmica, emocional e idiopática. Sabendo dos diagnósticos diferenciais da síndrome, estabelecemos um protocolo para o manejo destes pacientes. Dentre as etiologias de dor bucal local, deve-se pesquisar as de causa dentária, alérgicas e infecciosas. Para as causas sistêmicas, pesquisar doenças do tecido conectivo, doenças endócrinas, neurológicas, deficiências nutricionais e as alterações das glândulas salivares que levam à xerostomia. A etiologia da SBA pode ser de difícil diagnóstico, muitas vezes com mais de um fator causando dor na boca. A realização de anamnese detalhada, exame físico geral, inspeção minuciosa da cavidade oral e orofaringe, além de exames laboratoriais são de fundamental importância, para evitar que o tratamento dos pacientes com esta síndrome, seja baseado em tentativa e erro.

Diabetes mellitus as a contributory factor in oral candidosis

It has been reported that poor glycaemic control predisposes to oral candidal infection in diabetic patients. For instance, the carriage of Candida species and the density of candidal growth in the oral cavity is frequently claimed to be increased in patients with diabetes mellitus. However, the validity of these observations remains controversial. Hence, we review and discuss here the clinical data in the literature on the relationship between diabetes and oral candidal carriage and infection, and possible mechanisms associated with its pathogenicity.