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Oral Thrush

  • Tanay Chaubal
    Affiliations
    Periodontology and Oral Implantology, Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
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  • Ranjeet Bapat
    Correspondence
    Requests for reprints should be addressed to Ranjeet Bapat, MD, International Medical University, No 126, Jalan Jalil Perkasa 19, 57000 Kuala Lumpur, Malaysia.
    Affiliations
    Periodontology and Oral Implantology, Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
    Search for articles by this author
      A 54-year-old male patient presented with a chief complaint of burning sensation of the mandibular right gingiva and alveolar ridge on eating spicy food. The intensity of the burning sensation had increased over the previous 3 months. The patient has suffered from diabetes mellitus for 3 years and was on oral hypoglycemic agent metformin (500 mg/day). Intraoral examination revealed the presence of a raised, creamy white lesion on the mandibular right gingiva and alveolar ridge, with a ‘cottage cheese’ appearance (Figure 1, black arrows). The white lesion could be scraped, leaving an erythematous area that was painful. The patient was not receiving any antibiotics, corticosteroids, or other immunosuppressants. Primary testing with polymerase chain reaction showed a negative result for human immunodeficiency virus. The HbA1c test result was 7.2%, indicating that the diabetes mellitus was in an uncontrolled state. Smears from the scrapings of the lesion were strongly periodic acid–Schiff stain positive. To rule out precancerous and cancerous lesions, a biopsy was performed, which revealed hyperplastic epithelium, candidal hyphae penetrating the stratum spinosum, and chronic inflammatory cells in the lamina propria. On the basis of the clinical picture, laboratory tests, smear test, and biopsy, a final diagnosis of oral thrush (pseudomembranous candidiasis) was made. For systemic therapy, the patient was referred to an endocrinologist, who modified the dosage of oral hypoglycemic along with diet alterations, leading to an HbA1c level of 5.4%. For oral therapy, the patient was advised to use nystatin at doses of 100,000 IU/mL (5 mL, 4 times daily) and amphotericin-b 50 mg (5 mL, 3 times per day). Three-month recall of the patient revealed completely healed gingiva.
      Fig 1
      Figure 1Raised creamy white lesion in the mandibular right gingiva and alveolar ridge with cottage cheese appearance (black arrows).
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