Oral mucosal fungal infections

This review has provided an overview of variants of oral mucosal candidiasis and current therapeutic techniques followed by an outline of the rare oral mycoses and their management. The advent of the HIV infection and the increasing prevalence of compromised individuals in the community as a consequence of surgical and medical advances have resulted in a resurgence of opportunistic infections, including oral candidiasis and other rare mycoses that were once considered exotic. It is now recognized that oral candidiasis may present in many clinical guises, including the classic white lesion of thrush as well in as nondescript, red mucosal lesions that may confound the unwary clinician. Other mycotic diseases, such as aspergillosis, cryptococcosis, histoplasmosis and mucormycosis, may manifest intra-orally, both as primary lesions and as secondary manifestations of systemic disease. Periodontal manifestations of mycotic diseases are rare. If at all, such lesions may present as erythematous areas as in linear gingival erythema and rarely as ulcerations in exotic mycoses. Most of the oral mycoses respond well to either topical or systemic therapy with the polyenes or azoles. In general, the management of oral fungal infections has been revolutionized by the triazole group of drugs, fluconazole and itraconazole, although recent reports indicate an alarming increase of resistant organisms, in particular to fluconazole.