Oral candidosis: the erythematous form is the commonest and the least recognised

Oral candidosis is associated with the removable white plaque, which is however only one of its forms and not the commonest in adult denture wearers.

The pseudomembranous form, with removable white plaques leaving a reddened surface, is the one everyone recognises. It appears in newborns, the immunosuppressed, and after antibiotic therapy.

The erythematous form presents instead as simple redness, without plaques, and it is the one that goes unnoticed because it does not resemble what is expected.

Denture stomatitis is its commonest manifestation: a reddened area reproducing exactly the outline of the denture, often symptomless.

That detail of the outline is what permits diagnosis at a glance. Erythema that ends where the denture ends is no coincidence.

Angular cheilitis, with fissures at the corners of the mouth, is often candidal in origin and accompanies a reduced vertical dimension, which creates a fold where saliva pools.

Treating angular cheilitis without correcting the vertical dimension leads to continual recurrence, which is why an ointment alone rarely resolves it.

Predisposing factors should always be sought, because candidosis in a healthy adult is unusual. Uncontrolled diabetes, recent antibiotic therapy, inhaled corticosteroids, xerostomia, immunosuppression.

Inhaled corticosteroids for asthma are a frequent and readily corrected cause: rinsing the mouth after each dose suffices, an instruction many patients have never received.

Topical treatment is first choice in localised forms. Miconazole gel or nystatin suspension, held in the mouth for the stated time and not swallowed immediately.

Miconazole has a significant interaction with oral anticoagulants, and current medication must be checked before prescribing. It is the interaction most often forgotten because the product seems harmless.

Disinfecting the denture is part of the treatment, not an incidental piece of advice. The fungus colonises the acrylic, and an untreated denture reinfects the mucosa as soon as therapy ends.

In summary: the erythematous form is commonest and recognised by an outline reproducing the denture, predisposing factors must always be sought, miconazole interacts with anticoagulants, and without disinfecting the denture recurrence is certain.