 Hello everyone, welcome back to another session in dentistry and more. Today we have oral candidiasis or oral thresh which is also known as moneliasis or candidosis. Moneliasis it is a older name of candidiasis. Now it is known as candidiasis because it is caused by candida albicans. So let's see the details of oral candidiasis. Oral candidiasis which is caused by infection with yeast like fungus which is known as candida albicans. And there are other organisms also which causing this infection such as candida tropicalis, candida formata, candida cruzi. So it's nothing but a fungus like infection which is present in the oral cavity could be on the any part of the oral cavity. It could be on the tongue, buccal mucosa, palate or any part of the oral cavity. And this candida infection which is an opportunistic fungal pathogen which is responsible for candidiasis in humans. Which grow in several different morphological forms ranging from unicellular budding yeast to a true hyphae with parallel sidewalls. It could be in any format and basically this candida albicans is a unicellular oval shaped deployed fungus. Unicellular oval shaped and deployed fungus and it is a form of yeast. This candida albicans live as harmless organisms in the GAT and genitourin tract and are found in our almost 70% of the population. So our growth of these organisms however lead to the infection or disease. So it could be seen on not just in the oral cavity but also skin, genitals, throat, mouth and even blood. So while moving on to our topic that is oral candidiasis or oral thresh or moneliasis or candidosis, first we will start with the classification. It is basically classified as primary and secondary candidiasis. Secondary is nothing but it is a manifestation of systemic muco-cutaneous candidiasis like thymic eplasia and candida endocrinopathy syndrome. It is not very much important. So the primary oral candidiasis we have acute type, chronic, candida associated lesions and keratinized primary lesions with super infected candida. So in acute candidiasis we have pseudomembraneous and erythematous. In chronic we have hyperblastic, hyperblastic erythematous and again pseudomembraneous. Then candida associated lesions are dengiosanthomatitis, anglosanthomatitis, median rhomboclositis and keratinized primary lesions with super infected candida is leukoplugia, lycan planus or lupus erythematous and also secondary candidiasis. So what are the predisposing factors for this candida infection? The major predisposing factor is the change in oral microbial flora. That is the administration of antibiotics especially broad spectrum which creates a change in microbial flora of oral cavity and zero stomia which is secondary to any anticholinergic agents and salivary gland disease. All this could change the microbial flora of oral cavity. And the next predisposing factor is local irritation. It is due to the orthodontic appliances and various types of dentures, heavy smoking and also drug therapy also could lead to this infection like corticosteroids or cytotoxic drug or any other immunosuppressive drugs and also it is due to radiation therapy. And systemic diseases like leukemia, lymphoma, diabetes, tuberculosis, epithelial dysplasia. And malnourishment also a predisposing factor because of low vitamin A, low iron level or low pyridoxin level. It could contribute to the candida albicans infection. And age, the vulnerable age like infancy, old age and pregnancy can also a predisposing factor. Endocrine deficiency, it could be due to hypothyroidism, hypothyroidism, adhesin disease. So we will start with the pseudomembraneous canadiasis which is coming under acute classification which is also known as threshold threshold which is superficial infection of upper layer of oral mucus membrane. And the fungal growth, there will be disquamation of epithelial cells and accumulation of bacteria, keratin and necrotic tissue which is forming a pseudomembrane. And the clinical features in infamps, it could be between 6 to 10 days after birth, 6 to 10 days and infection from maternal vaginal canal. And there will be soft whitish or blueish white patches on the oral mucosa. It is mostly painless and it is removed with little difficulty. Whereas in adult, the site is roof of mouth, retromolar area, muco buckle fold. And it is most commonly seen in females than males. And the symptoms are rapid onset of bad taste and discomfort from spicy food, burning sensation and white plague like pearly white or blueish white which resemble cottage cheese or curdled milk. Cottage cheese or curdled milk. So these appearance can be seen in. Pseudomembrane is formed. On diagnosis, the chronic hyperplastic locoplegia, this is hyperplastic locoplegia can be diagnosed as firm and white letery appearance which is difficult to rub. Differential diagnosis includes lichen planus, hairy locoplegia and other bacterial infection. And there is one peculiar disease which is known as IED reaction. IED reaction, it is nothing but a secondary response characterized by localized or generalized sterile vesicopapular rash. Vesicopapular rash, the presence of vesicopapular rash. And which is believed to be allergic response of Candida and Dijon. Because of this Candida and Dijon, if there is vesicopapular rash which is known as IED reaction. And next we have in chronic format that is chronic atrophic candidiasis. Chronic atrophic. Before we study chronic hyperplastic, chronic atrophic candidiasis is nothing but denger stomatitis. Denger stomatitis is all of us know. It is a manifestation of erythematous candidiasis which is found under complete denger or partial dengers mostly under palate. Appearance is speckled, curd like white lichens and there will be patchy distribution, soreness and dryness of mouth. So it appears as bright red palatal tissue with edema and granular appearance. There will be sharp outline of this redness. And the multiple pin point 4K of hyperemia usually seen in maxilla, 4K of hyperemia. So we can diagnose it as erythematous area under complete denger. Differential diagnosis could be erosive lichen planus, allergic reaction due to denger base. So all these are the common types of oral candidiasis. Now let us move on to the treatment of oral candidiasis. So we can go for a topical treatment. This is topical, topical and systemic one. Usually 7 days treatment we follow and oral symptoms usually disappears in 2-5 days. And the relapse is common because of this underlying immunodeficient. So since if you are not treating the immunodeficiency problem, the relapse is very common. And we need to remove the causal factor. So many candidiasis can be controlled by removing the causal factor such as ill-fitting dentures or changing the antibiotics or withdrawing the antibiotics. Or ask the patient to clean the denger using an anti-fungal agent. So in topical treatment which is preferred because it is less systemic absorption and effective as it depends entirely on patient's complaints. So that is the problem since it is not going in systemic circulation and it is less side effect but the patient complains is very much important for its effectiveness. So the most common one is clotrimazole. Clotrimazole is the most commonly used topical agent which is antibacterial as well as anti-fungal property. We give 10 milligram tablet, 10 mg tablet which is available in water 5 times a day. 10 mg tablet of clotrimazole 5 times a day or 1 percentage Genshin violet, 1 percentage Genshin violet which is not ideal why because there will be unesthetic staining properties. So most commonly used clotrimazole 10 mg tablet 5 times a day which is available in water. Or we can also go for nystatin which is around 2 lakh unit. We can apply for 5 times a day which is dissolved in mouth. Also 1 lakh unit 5 times a day or oral rinse in 20 ml of water. Or we can use AM4 thyracin B which is 0.1 mg or 5 to 10 ml oral rinse which can be used thrice a day. And we can go for a combination like triamcinolone, nystatin for angular chelates and for acute atrophic candidates we can think about tetracycline and amphotocyan B. A combination of these two we can use. In acute atrophic candidates tetracycline along with amphotocyan tetracycline and in angular chelates we can think of nystatin along with triamcinolone. Triamcinolone we can think of. And also we have nystatin cream. Nystatin cream which is 1 lakh unit which is placed under the tongue for 3 times a day. And also we have oral rinse format 3 times a day. And idokinol is an antifungal and antibacterial agent which is combined with corticoceroids. And it can be used for angular chelates, idokinol. So we have topical in method clotrimazole, genitian violet, nystatin, amphotocyan B, microstatin and idokinol. Tetracycline and triamcinolone can be used as a combination. In systemic methods we have nystatin 250 mg 3 times a day for 2 weeks. Then followed by once per day for the next 3 weeks. Then we have ketokinazole which is 200 mg with foot once a day. And there should be liver side of it so continuous monitoring is required. And also we can think of itracanazole 100 or 200 mg capsule twice a day for 2 weeks. And also flucanazole 100 mg twice a day for 2 weeks. So all these can be used as a treatment regimen as it could be topical or systemic. So we have learned about the classification, each clinical features and diagnosis and differential diagnosis. Then in detail about the treatment part which includes topical and systemic. So I will come up with a new topic in the industry and more. Thank you.