Candidosis
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.


Lichen Planus
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
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
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.

 

  2005 Oral Medicine and Pathology