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Oral candidal infections are medically treated with antifungal agents. In the fungal cell membrane, steroid ergosterol is the target of the antifungals on the market, but similarity with the human cell membrane may cause host toxicity and unintended reactions. Management of oral candidiasis depends on several factors, some are host-sensitive parameters, systemic diseases and drug exposure, and others are infection-sensitive parameters, duration of the infection and the virulence of the infecting Candida species. Treatment failure might be associated with acquired or native azole resistance in particular in patients with recurrent oral candidiasis. This risk can be reduced if different types of antifungal drugs are used over time or are combined. This chapter focuses on antifungal treatment of the medically compromised patient with oral candidiasis by highlighting the advantages and disadvantages of different antifungals.

Oral candidiasis is a common opportunistic oral infection in humans caused by overgrowth of Candida species, in particular Candida albicans. Clinically it usually presents as pseudomembranous or erythematous candidiasis. It may be asymptomatic or associated with local discomfort, dysgeusia and xerostomia. The most common risk factors for oral candidiasis include treatment with antibiotics, poor oral hygiene, tobacco smoking, denture wearing and salivary gland hypofunction. A large number of diseases as well as their treatment including diabetes, cancer and cancer therapy, HIV infection and treatment with immunosuppressants are associated with oral candidiasis. In immunocompromised patients, the localized oral infection can spread through the bloodstream or upper gastrointestinal tract leading to severe infection with increased morbidity and mortality. This chapter focuses on Candida as commensal oral microorganism, the clinicopathological aspects in medically compromised patients and diagnostic methods available regarding oral candidiasis.

Saliva plays an important role in the maintenance of oral health and regulation of the oral microbiota. Saliva lubricates the oral hard and soft tissues, dilutes food detritus and bacteria and enhances the clearance of microorganisms and dietary carbohydrates from the oral cavity. Saliva also provides antimicrobial activity via numerous proteins and peptides including lactoferrin, lactoperoxidase, lysozyme, statherin and histatins. This chapter focuses on the oral microbiota in patients suffering from salivary gland hypofunction due to Sjogren’s syndrome, radiotherapy of tumours in the head and neck region, cancer chemotherapy and intake of medications. Despite the different causes of salivary gland hypofunction, these patient groups show some similarities regarding the composition of the oral microbiota with increased colonisation of oral pathogens associated with dental caries (Streptococcus mutans and Lactobacillus species) and oral mucosal infections, especially Candida albicans.