Tipsy Dentistry: Oral Candidiasis

Tipsy Dentistry: Oral Candidiasis
Tipsy Dentistry is going to Fungal Funland to learn everything you need to know about oral candidiasis.

Skip Ahead...

📚The Fungal Funland Story

🦪A Candidiasis Clinical Pearl

🎥VIDEO: Tipsy Dentistry Goes to Fungal Funland


All You Need to Know About Oral Candidiasis

Dental Education is Boring...

...And if you are anything like us, dental school lectures were often used for online shopping and figuring out next week’s fantasy football line-up.

Plus, it doesn’t get much better when you finally have that $300k piece of paper degree in hand…Because dental CE courses ALSO can be very boring.

Which is Why You Should Get Tipsy.

Not literally. Save that for happy hour after the course is over. We mean Tipsy Dentistry🍻- a very not boring way to learn about very boring topics…looking at you candidiasis.

Here’s how it works:

  • 1️⃣A Stupid Cartoon and Video helps guide you through all you need to know about dental topics
  • 2️⃣The Information is Seared into Your Brain because it’s hard to forget that an a$$hole represents "azole" drugs.

So Let's Get to the Story...

Two sisters, Eryn and Sue, are enjoying their day at the amusement park which is of course named Fungal Funland. Eryn represents one of the main forms of candidiasis- Erythematous candidiasis...because Eryn kinda sounds like ERYY-thematous (a bit of a reach).

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Eryn represents Erythematous Candidiasis while Sue represents Pseudomembranous Candidiasis

...while Sue represents Pseu(SUE)domembranous Candidiasis.. which is a bit more obvious.

Eryn (Erythematous Candidiasis) and Sue (Pseudomembranous Candidiasis) are seen at Fungal Funland. Albert's Can Toss (C. Albicans) is seen in the background with the reminder that it's a commensal organism of the oral cavity. It's always around (Sign that says open 24/7)

🦠If we skip ahead...we can see Albert's Can Toss in the background.

The amusement park classic helps us remember the organism that causes candidiasis. Albert's Cans kinda sounds like ALBICANS....therefore helping us remember that candidiasis is caused by the C. Albicans

Albert's Can Toss (C. Albicans) is seen in the background with the reminder that it's a commensal organism of the oral cavity. It's always around (Sign that says open 24/7)

Candidiasis is actually by far the most common fungal infection in humans...

Thankfully....Albert is working hard because the fact that Albert’s cans is open 24/7 and 365 days a year reminds us that C. Albicans is a component of the normal oral microflora...

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Albert's Can Toss somewhat sounds like C. Albicans which helps us reember the organism that actually causes candidiasis

It’s working. It’s there 365 days a year 24/7.

So important to remember open 365 days 24/7 represents the fact that it’s always around in your mouth. It’s a normal component of your oral microflora....

Now...lets go back to the sisters as they enjoy their day.

Erythematous candidiasis is often associated with inhaled corticosteroid use...as represented by Eryn holding her inhaler.

And Let’s first look at Erin.

...you can see that she is holding her inhaler...

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Eryn's inhaler represents the fact that erythematous candidiasis is often associated with inhaled corticosteroid use.

Erin‘s inhaler represents the fact that erythematous candidiasis is often associated with inhaled corticosteroid use.

Erythematous candidiasis often presents as atrophic, diffuse erythema of the tongue. Represented by Eryn's bright red shirt.

Notice that both of the sisters are actually wearing a red shirt

But...

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Eryn has a red shirt on and that signifies that atrophic, diffuse erythema that often associated with erythematous candidiasis.

Which is seen very well in the clinical picture above.

You will also notice that Erin is not being very nice to her sister

...she’s sticking out her tongue.

You can see that the outside coloration is a little different compared to the middle of the tongue

Median rhomboid glossitis is an asymptomatic chronic form of candidiasis as represented by Eryn's discolored tongue

Which is great for us because it helps us remember an asymptomatic, chronic form of candidiasis known as....

Medium rhomboid glossitis.

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Eryn sticking out her tongue represents an asymptomatic, chronic form of candidiasis known as median rhomboid glossitis

And just for your knowledge, this can also be called central papillary atrophy...

Why is Sue Holding an Ice Cream Cone?...

Let’s flip over to take a look at Sue e who is also wearing a red shirt which I already mentioned represents the erythematous nature of candidiasis.

BUT here’s the big difference.

Notice that SUE is holding this ice cream cone to represent a VERY common clinical correlate that you see with candidiasis

Pseudomembranous candidiasis (Sue) is seen clinically as a white, cottage cheese like apperance that wipes off...as represented by the melting ice cream cone.

You see it in your clinical practice. You see it on board exams. It’s a high yield fact of knowledge to know.

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Pseudomembranous candidiasis has a white, cottage cheese like apperance clinically that wipes off...which is represented by ice cream falling off her tongue onto her shirt

You will notice that similar to Erin, Sue also has a medication in hand

Now she’s not holding an inhaler like Erin but she’s holding a pill bottle

That’s because the presence of pseudomembranous candidiasis often follows a course of broad-spectrum antibiotics.
Sue must have had some sort of bacterial infection lately, causing her to need to take antibiotics during her trip to the Fungal Funland

....and unfortunately she developed candidiasis as a result...

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Sue holding a pill bottle represents the fact that pseudomembranous candidiasis often presents due to the use of broad-spectrum antibiotics

An important thing to note here is that antibitoic use is not only correlated with pseudomembranous candidiasis....Eryn’s candidiasis can also show up from antibiotic use

“Antibiotic sore mouth” in both Sue and Eryn’s form is typically always an acute diagnosis.

Here's the Big Picture.

The big picture thing here again is going back to the Albert’s can toss that’s open 24/7, 365.

C. Albicans is always around....

Whenever you mess with the immune system and allow Albert’s cans to work overtime...there is a chance that candidiasis can occur.....

....Finally....one more thing I want to point out with the candid sisters...

They Didn't Put on Their Sunscreen.

The sisters got burnt...which helps us remember a common symptom of candidiasis- a mild "burning sensation"

Both sisters have been at the amusement park for far too long.

They thought they were tougher than the sun. Didn’t put on sunscreen. And that was a mistake.

Because...they are getting sunburnt.

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The sunburnt sisters remind us that a common symptom of candidiasis is mild burning mouth

Although they are going to have to lather up with aloe tomorrow, their sunburn does help us remember one of the common symptoms that patients complain about with candidiasis.

Which is a mild sensation of “burning mouth”

Let's Look at the Background of Fungal Funland

First, like I said before...

Erin and Sue both have their medical problems.

Eryn is holding the inhaler while Sue is holding the pill bottle which leads us to the fact that they both probably shouldn’t be at Fungal funland in the first place.

Eryn and Sue should have payed attention to the sign. Those with weakened immune symptoms are more likely to develop candidiasis

They completely ignored this “DO NOT ENTER” sign

Although THEY ignored it, we shouldn’t

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The "Do Not Enter if Sick" sign reminds of the fact that those who are immunocompromised are more suseptible to candidiasis.

Now if we look on the other side of our scene...

We can see that we have a kissing booth.

The kissing booth represents a "kissing lesion" which is often a clinical presenation of erythematous candidiasis

You have this rude guy trying to kiss this girl at the kissing booth. He is sticking out his tongue... Trying to make his move....

This represents a “Kissing lesion”...

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Fungal Funland's Kissing Booth represents the often-seen kissing lesion

Now you’ll see in this clinical picture here that the tongue with candidiasis often has a similar shaped presentation on the palate..... so called the kissing lesion.

Next, we have The Chronic Coaster

Now The Chronic Coaster is not JUST a  roller coaster....

But it’s also a reminder that there’s both an acute and chronic form of candidiasis

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The Chronic Coaster shows us that candidiasis is not just an acute diagnosis...but there is also a chronic form
There is both an acute and chronic form of candidisis, hence The Chronic Coaster

This roller coaster is very important because it’s story is going to give us a lot of information about some chronic forms of candidiasis...

Now to start....

First of all you can see that this coaster is looking a little sketchy.

Notice how the whole thing is red and there are cracks in the angles of the coaster.

This very nicely represents a very common form of candidiasis known as angular chelitis

The cracked, red angles of The Chronic Coaster represents a chronic form of candidiasis...angular chelitis

You can see this clinical picture here that shows the fissured, erythematous alterations of the skin at the corners of the mouth.

Sometimes this is associated with decreased VDO in edentulous patients....

What happens saliva gets caught in the corner of the mouth and it’s a perfect breeding ground for fungal infections...

And speaking of fungal infections...we have been only been talking about fungal infections but in the case of angular chelitis we also need to talk about bacteria.

Angular chelitis is not only a fungal infection, but also in the majority of cases involves bacteria

Now if you look really closely at this roller coaster you’ll see that there’s these little bugs surrounding the frame.

This is a great reminder telling us that not only does angular chelitis involve a fungus but the majority of the time it also involves bugs...AKA bacteria.

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In the majority of cases, angular chelitis also involves a baterial infection which is represented by bugs crawling around the cracked frame of the red Chronic Coaster

Let's talk about treatment while we’re at it...

These construction workers are up here trying to figure out what to do with this cracked roller coaster...

As you probably guessed these workers are going to represent appropriate prescription for treatment of angular chelitis...

The Construction workers (which of course starts with the letter "C") represents the common prescription for candidiasis...clotrimazole

The contruction workers starting with a C....stands for clotrimazole....conveniently also starting with a C...

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The construction workers represent a common prescription for angular chelitis...clotrimazole

You may tell your patient to apply to the affected areas four times a day for two weeks...

And this is actually the same thing as athlete’s foot cream so you can usually just tell your patient to pick it up over the counter....

Again, this clotrimazole is important because it has an anti-bacterial component of it that will take care of those bugs crawling around the frame of the roller coaster.

Finally, just a quick clinical pearl that your patients will appreciate...

Often...this angular chelitis hurts...and when it hurts patients are naturally inclined to put something like vaseline or chapstick on the corners of their mouth....

Vaseline and chap stick acttually just causes problems when it comes to the treatment of angular chelitis. Get your patients some clotrimazole instead

But what they are actually doing is just sealing in the infection and delaying healing.

So get them the clotrimazole instead and tell them to stop using vaseline and chapstick...

Even more of the Chronic Coaster Explaining Candidiasis

Now there’s still a lot going on with this roller coaster here you can see that there’s a couple riders enjoying their day at the amusement park so let’s zero in on a couple of them....

First of all you have this poor guy... it looks like he just got a nice pair of dentures made and apparently they didn’t have enough retention because they are flyiing off the chornic coaster.

Dentures wearers are suseptible to a chronic form of candidiasis...chronic denture stomatitis

While this is a bummer for him, it does help us remember another form of chronic candidiasis which is convenient because he is riding...THE CHRONIC COASTER after all

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The dentures flying off the chronic coaster remind us that a chronic from of candidiasis is chronic denture stomatitis

You can see in the clinical picture above there is distinct outline of where the denture sits

Often when you talk to the patient about this and ask, “are you taking your denture out at night.” They are going to respond with something like, “I’m supposed to take it out at night?”

Yes. Yes you are.

Next...we have this other guy here that looks like he’s drinking some alcohol on the roller coaster

Those with xerostomia have an increased prevalence of candidiasis

But actually he is drinking water...

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Those with xerostomia are more likely to develop candidiasis- symbolized by The Chronic Coaster rider drinking water 

And the reason that he is riding The Chronic Coaster is because patients that suffer from xerostomia have an increased prevalance of erythematous candidiasis.

And Finally...the Pharmacology to Treat Candidiasis

I already talked about the treatment of angular chelitis with the construction workers and the chronic coaster... but let’s talk about the treatments of the other presentations of candidiasis

For that....we are going focus on this guy in line for Albert’s Can toss

And frankly he is looking a little pissed.

He’s waiting in line for his turn and just not being patient. Causing a scene. Demanding that he to to the front of the line

Some people would call him a AZOLE....

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The AZOLE saying "I want my turn stat" symbolizes common pharmaceuticals to treat candidiasis: Drugs such as fluconazole and clotrimazole and NySTATin

Yes an AZOLE

Even though he is being an azole it helps us remember that drugs that end with AZOLE such as the already mentioned clotrimazole and fluconazole are drugs that conquer those fungal infections.

He’s also saying...”I want my turn. STAT!” which helps us remember another common drug for the treatment of candidiasis being Nystatin


Video: Tipsy Dentistry Goes to Fungal Funland