An investigation of the efficacy of nystatin for the treatment of chronic atrophic candidosis (denture sore mouth)

Oral candidal infections and antimycotics

The advent of the human immunodeficiency virus infection and the increasing prevalence of compromised individuals in the community due to modern therapeutic advances have resulted in a resurgence of opportunistic infections, including oral candidoses. One form of the latter presents classically as a white lesion of "thrush" and is usually easily diagnosed and cured. Nonetheless, a minority of these lesions appears in new guises such as erythematous candidosis, thereby confounding the unwary clinician and complicating its management. Despite the availability of several effective antimycotics for the treatment of oral candidoses, failure of therapy is not uncommon due to the unique environment of the oral cavity, where the flushing effect of saliva and the cleansing action of the oral musculature tend to reduce the drug concentration to sub-therapeutic levels. This problem has been partly circumvented by the introduction of the triazole agents, which initially appeared to be highly effective. However, an alarming increase of organisms resistant to the triazoles has been reported recently. In this review, an overview of clinical manifestations of oral candidoses and recent advances in antimycotic therapy is given, together with newer concepts, such as the post-antifungal effect (PAFE) and its possible therapeutic implications.

Oropharyngeal candidosis in the older patient

Colonization of the oral and pharyngeal regions by Candida spp., particularly C. albicans, is extremely common in humans, particularly in early and late life. A variety of local and systemic conditions predispose the transformation of the benign colonization to a pathological state, which may have severe local or serious systemic consequences. The finding of oropharyngeal candidosis in an older patient, therefore, merits investigation of the likely host factors responsible for the organism adopting its pathogenic behavior. This paper provides non-dental clinicians managing older patients a review of the clinical characteristics, risk factors, diagnosis, and management of oropharyngeal candidosis in older adults.

Comparison of different treatment methods for localized and generalized simple denture stomatitis

The purpose of this study was to compare the treatment effects of fluconazole, fluconazole plus chlorhexidine and the fitting of new dentures upon the treatment of denture stomatitis and 15 subjects with clinical evidence of localized simple denture stomatitis were investigated clinically and mycologically. Patients with clinical evidence of generalized simple denture stomatitis were divided into three treatment groups. The first group was given 50 mg of fluconazole tablets daily for 2 weeks. The second group were instructed to apply chlorhexidine solution to the inner surface of the denture twice a day in addition to fluconazole treatment for 2 weeks. New dentures were constructed for the third group. Patients with clinical evidence of localized simple denture stomatitis were fitted new dentures without antifungal therapy. Palatal swabs were taken from each subject before, immediately after, and 2 weeks after the end of treatment, and the samples were examined mycologically in order to identify yeast colonies. It was found that for generalized simple denture stomatitis, treatment with fluconazole plus chlorhexidine resulted in better improvement of palatal inflammation than that by either fluconazole or the fitting of new dentures without medication. Whereas fitting new dentures did not reduce inflammation in patients with generalized simple denture stomatitis, the beneficial effects of prosthetic treatment were seen in patients with localized simple denture stomatitis.

Comparison of three different treatment methods for generalized denture stomatitis

This study compared the effects of fluconazole, fluconazole plus chlorhexidine, and placing new dentures for the treatment of generalized simple denture stomatitis. Subjects with clinical evidence of generalized simple denture stomatitis were investigated clinically and myocologically. These 45 patients were divided into three groups. The first group was given 50 mg of fluconazole in tablet form once a day for 2 weeks. The second groups were instructed to apply chlorhexidine solution to the inner surface of the denture twice a day in addition to the fluconazole treatment for 2 weeks. New dentures were made for the third group. Palatal swabs and smears were taken from each subject before, immediately after, and 2 weeks after treatment and these samples were examined myocologically. It was found that for generalized simple denture stomatitis, treatment with fluconazole in conjunction with chlorhexidine resulted in greater improvement of palatal inflammation and a decrease in candidal colonization than that with fluconazole alone or making new dentures without medication.

Use of a new assay technique for quantification of antifungal activity of nystatin incorporated in denture liners

Denture-induced stomatitis with concurrent candidal infection is the most commonly encountered intraoral abnormality among individuals who wear dentures. The institutionalized elderly demonstrate increased susceptibility and could benefit from its management with a fungicidal denture liner. As an integral part of the prosthesis, the efficacy of the fungicidal liner would be independent of patient compliance and/or nursing involvement and would provide a predictable therapeutic modality. In this study a "slant agar assay" was developed to evaluate the in vitro antimycotic activity of Visco-gel and Lynal liners impregnated with various concentrations of nystatin over a 14-day period in nonaqueous and aqueous environments. The results were as follows: preparations incorporating higher concentrations of nystatin resulted in greater inhibition of Candida albicans growth; Visco-gel liner-nystatin preparations exhibited a greater fungicidal activity than equivalent Lynal preparations; loss of potency by all of the reline-nystatin preparations consisted of an initial rapid loss between days 0 and 2, followed by a plateau during which the preparations gradually continued to lose inhibitory activity; and 1 million units of nystatin were necessary to maintain an adequate level of antifungal activity in an aqueous environment, where the liners demonstrated decreasing antifungal activity proportional to the duration of exposure to water.

Comparative trial of fluconazole and amphotericin in the treatment of denture stomatitis

The efficacy of fluconazole and amphotericin in the management of denture stomatitis was investigated in a comparative trial. Patients were assessed clinically, hematologically, and mycologically at the time of entry into the study and at 1, 4, and 12 weeks thereafter. A total of 29 patients were selected at random to receive 50 mg of fluconazole daily for 14 days; 30 patients were selected to receive amphotericin lozenges and cream for 28 days. Clinical response rates were similar in both treatment groups throughout the study. The best mycologic response was noted after 1 week whereas the best clinical response was observed after 4 weeks. Clinical evidence of relapse and recurrence at 12 weeks was a common finding irrespective of treatment. Side effects were uncommon in both groups.

Oral candidal infection and denture stomatitis: a comprehensive review

Denture stomatitis rarely occurs without at least one predisposing factor that lowers patient resistance. A new disinfection technique for dentures and oral tissue may eliminate topical or anti-fungal drug use.

Treatment of angular cheilitis. The significance of microbial analysis, antimicrobial treatment, and interfering factors

This prospective study evaluated the significance of microbial analysis and antimicrobial treatment for the cure of angular cheilitis. Furthermore, various etiologic factors were investigated for their relative effect on the healing process. The study included 1) an open trial with 50 patients infected by Candida albicans and/or Staphylococcus aureus, and 2) an intraindividual comparison of eight patients with bilateral lesions infected by Candida albicans as the only detected pathogen. After a base-line examination the patients received ointments containing nystatin and/or fusidic acid, on the basis of the outcome of an initial microbial analysis. The patients were evaluated clinically, photographed, and examined for microorganisms at different time intervals. Ninety-six per cent of the patients who participated in the open trial had no sign of infection after 42 days of treatment. Lesions in the double-blind study, treated with nystatin, were healed after 28 days, whereas lesions that received placebo persisted throughout the treatment period. Increasing age, dry skin, and extended skinfolds at the corner of the mouth were factors closely related to the length of the healing process.

Recurrence of angular cheilitis

The incidence of recurrence of angular cheilitis following a successful antimicrobial treatment was studied in 48 patients. Clinical assessments including a microbial examination were carried out 8 months and 5 yr after termination of treatment. Eighty percent of the patients reported recurrence of their angular cheilitis on one or more occasions during the observation period. Patients with cutaneous disorders associated with dry skin or intraoral leukoplakia had an increased incidence of recrudescence. Neither the presence of denture stomatitis nor the type of microorganisms isolated from the original lesions of angular cheilitis, i.e. Candida albicans and/or Staphylococcus aureus, were associated with the number of recurrences. The present observations indicate that treatment of the majority of patients with angular cheilitis should be considered in a longer perspective than previously supposed, due to the short lasting therapeutic effects of the antimicrobial therapy.