A clinico-pathological and cytological study of oral candidiasis


Candidiasis of the oral mucosa arises chiefly as a re- sult of infection with Candida albicans. Many clinico- pathological analyses of macroscopic findings have been described, although the clinical findings of oral candidiasis vary considerably and the conditions are complex. The present study analyzes the distribution, clinical, cytological and histological diagnoses of oral candidiasis, associated complex diseases and the di-agnostic value of cytology. The ratio of Candida in-fection was 28.9% among 1551 study participants. Females were infected significantly more often than men (p < 0.01) and the affected age range was 60 - 79 years (61.0%, p < 0.01). The predominantly affected areas were the tongue (48.3%, p < 0.01) and gingiva (20.0%, p < 0.01), and occurrence at multiple loci was seen in 43 (9.6%) patients. The typical clinical find- ings of oral candidiasis were ulcerative/erythematous lesions (33.2%, p < 0.01) and pseudomembranous candidiasis (31.6%, p < 0.01). A histopathological dia- gnosis of candidiasis based on biopsy specimens from 26 lesions in patients with Candida infection indicated by cytology was confirmed from cultures. The break- down of a cytological to a definite diagnosis was 6 positive (SCC 4, verrucous carcinoma 1, moderate to severe dysplasia 1), 6 suspected positive (mild dyspla- sia, 2; moderate to severe dysplasia, 2; papilloma, 1 and SCC, 1) and 14 negative (epulis, 3; papilloma, 3; granulation tissue, 2; fibrosis, 2 and others, 4). Exfo-liative cytology can easily judge the presence of Can-dida species, although experience is necessary for the presumptive diagnosis of an oral mucosal disease. The application of exfoliative cytology using the Pe- riodic acid-Schiff reaction is helpful for the earlier detection of oral candidiasis with various macrosco- pic findings.

Share and Cite:

Kuyama, K. , Sun, Y. , Taguchi, C. , Endo, H. , Wakami, M. , Fukumoto, M. , Ito, T. and Yamamoto, H. (2011) A clinico-pathological and cytological study of oral candidiasis. Open Journal of Stomatology, 1, 212-217. doi: 10.4236/ojst.2011.14033.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Kuyama, K., Fifita, S.F., Mastumoto, T., Endo, H., Takahashi, H., Kato, T., Uehara, T. and Yamamoto, H. (2005) Clinico-cytological study of oral candidiasis. The Journal of the Japanese Society of Clinical Cytology, 44, 132-138.
[2] Barnes, L., Eveson, J.W., Reichart, P. and Sidransky, D. (2005) Pathology and genetics of head and neck tumours. IARC Press, Lyon.
[3] Samaranayake, L.P., Keung, L.W. and Jin, L. (2009) Oral mucosal fungal infections. Periodontology 2000, 49, 39-59. doi:10.1111/j.1600-0757.2008.00291.x
[4] Zegarelli, D.J. (1993) Fungal infections of the oral cavity. Otolaryngologic Clinics of North America, 26, 1069- 1089.
[5] Samaranayake, L. (2009) Commensal oral candida in Asian cohorts. International Journal of Oral Science, 1, 2-5. doi:10.4248/IJOS.08006
[6] Scully, C., El-Kabir, M. and Samaranayake, L.P. (1994) Candida and oral candidosis: A review. Critical Reviews in Oral Biology & Medicine, 5, 125-157.
[7] Carrard, V., Haas, A., Rados, P., Filho, M., Oppermann, R., Albandar, J. and Susin, C.(2011) Prevalence and risk indicators of oral mucosal lesions in an urban population from South Brazil. Oral Diseases, 17, 171-179. doi:10.1111/j.1601-0825.2010.01712.x
[8] Ergun, S., Cekici, A., Topcuoglu, N., Migliari, D.A., Külek?i, G., Tanyeri, H. and Isik, G. (2010) Oral status and Candida colonization in patients with Sj?gren’s syndrome. Medicine Oral, Pathogia Oral y Cirgía Bucal, 15, e310-e315.
[9] Motta-Silva, A.C., Aleva, N.A., Chavasco, J.K., Armond, M.C., Fran?a, J.P. and Pereira L.J. (2010) Erythematous oral candidiasis in patients with controlled type Ⅱ diabetes mellitus and complete dentures. Mycopathologia, 169, 215-223. doi:10.1007/s11046-009-9240-6
[10] Da Silva, P.M., Acosta, E.J., De Rezende, P.L., Graeff, M., Spolidorio, D.M., Almeida, R.S. and Porto, V.C. (2011) Microscopical analysis of Candida albicans biofilms on heat-polymerised acrylic resin after chlorhexidine gluconate and sodium hypochlorite treatments. Mycoses, 23, epub ahead of print.
[11] Awano, S., Ansai, T., Takata, Y., Soh, I., Akifusa, S., Hamasaki, T., Yoshida, A., Sonoki, K., Fujisawa, K. and Takehara, T. (2008) Oral health and mortality risk from pneumonia in the elderly. Journal of Dental Research, 87, 334-339. doi:10.1177/154405910808700418
[12] Majorana, A., Bardellini, E., Flocchini, P., Amadori, F., Conti, G. and Campus, G. (2010) Oral mucosal lesions in children from 0 to 12 years old: ten years’ experience. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology & Endodontics, 110, e13-e18. doi:10.1016/j.tripleo.2010.02.025
[13] Arnrup, K., Lundin, S.A. and Dahll?f, G. (1993) Analysis of paediatric dental services provided at a regional hospital in Sweden. Dental treatment need in medically compromised children referred for dental consultation. Swedish Dental Journal, 17, 255-259.
[14] Bánóczy, J., Rigó, O. and Albrecht, M. (1993) Prevalence study of tongue lesions in a Hungarian population. Community Dentistry and Oral Epidemiology, 21, 224-226. doi:10.1111/j.1600-0528.1993.tb00761.x
[15] Sedgley, C.M., Samaranayake, L.P., Chan, J.C. and Wei, S.H., (1997) A 4-year longitudinal study of the oral prevalence of enteric gram-negative rods and yeasts in Chinese children. Oral Microbiology and Immunology, 12, 183-188. doi:10.1111/j.1399-302X.1997.tb00377.x
[16] Masipa, J.N., Hauman, C.H. and Raubenheimer, E.J. (1992) Oral carriage of Candida species in patients visiting the Medunsa Dental Clinic. The Journal of the Dental Association of South Africa, 47, 407-409.
[17] Jainkittivong, A., Aneksuk, V. and Langlais, R.P. (2002) Oral mucosal conditions in elderly dental patients. Oral Diseases, 8, 218-223. doi:10.1034/j.1601-0825.2002.01789.x
[18] De Oliveira, C.E., Gasparoto, T.H., Dionísio, T.J., Porto, V.C., Vieira, N.A., Santos, C.F. and Lara, V.S. (2010) Candida albicans and denture stomatitis: Evaluation of its presence in the lesion, prosthesis, and blood. International Journal of Prosthodontics, 23, 158-159.
[19] Akpan, A. and Morgan, R. (2002) Oral candidiasis. Postgraduate Medical Journal, 78, 455-459. doi:10.1136/pmj.78.922.455
[20] Schaller, M., Korting, H.C., Sh?fer, W., Bastert, J., Chen W. and Hube, B. (1999) Secreted aspectic proteinase (Sap) activity contributes to tissue damage in a model of human oral candidosis. Molecular Microbiology, 34, 169-180. doi:10.1046/j.1365-2958.1999.01590.x
[21] Kay, L.W. (1976) Corticosteroids in diseases of the oral mucosa. International Dental Journal, 26, 405-410.
[22] Fukushima, C., Shimoda, T., kawano, T., Tomari, W.S., Mitsuta, K., Obase, Y., matsuo, N., Matsuse, H. and Kohno, S. (2001) Effects of amphotericin B gargles on oral colonization of Candida albicans in asthmatic patients on steroid inhalation therapy. Respiration, 68, 465-470. doi:10.1159/000050552
[23] Senpuku, H., Sogame, A., Inosita, E., Tsuha, Y., Miyazaki, H. and Hanada, N. (2003) Systemic diseases in association with microbial species in oral biofilm from elderly requiring care. Gerontology, 49,301-309. doi:10.1159/000071711
[24] Abaci, O., Ualiki-Uztan, A., Ozturk, B., Toksavul, S., Ulusoy, M. and Boyacioglu, H. (2010) Determining Candida spp. incidence in denture wearers. Mycopathologia, 169, 365-372. doi:10.1007/s11046-010-9275-8
[25] Budtz-J?rgensen, E., Mojon, P., Banon-Clément J.M. and Baehni, P. (1996) Oral candidosis in long-term hospital care: comparison of edentulous and dentate subjects. Oral Diseases, 2, 285-290.
[26] Walker, D.M. and Arendorf, T. (1990) Oral candidosis. In: Samaranayake, L.P. and MacFarlane, T.W., Eds., Candidal Leukoplakia, Chronic Multifocal Candidosis and Median Rhomboid Glossitis, Butterworth, London, 184- 199.
[27] Bánóczy, J. (1977) Follow-up studies in oral leukoplakia. Journal of Maxillofacial Surgery, 5, 69-75. doi:10.1016/S0301-0503(77)80079-9
[28] Lipperheide, V., Quindós, G., Jiménez, Y., Pontón, J., Bagán-Sebastián, J.V. and Aguirre, J.M. (1996) Candida biotypes in patients with oral leukoplakia and lichen planus. Candida biotypes in leukoplakia and lichen planus. Mycopathologia, 134, 75-82. doi:10.1007/BF00436868
[29] Davies, A.N., Brailsford, S.R., Beighton, D., Shorthose, K. and Stevens, V.C. (2008) Oral candidosis in community-based patients with advanced cancer. Journal of Pain and Symptom Management, 35, 508-514. doi:10.1016/j.jpainsymman.2007.07.005
[30] Jainkittivong, A., Aneksuk, V. and Langlais, R.P. (2010) Oral mucosal lesions in denture wearers. Gerodontology, 27, 26-32. doi:10.1111/j.1741-2358.2009.00289.x
[31] Zakout, Y.M., Salih, M.M., and Ahmed, H.G. (2011) Frequency of Candida species in Papanicolaou smears taken from Sudanese oral hormonal contraceptives users. Biotechnic & Histochemistry, 14, epub ahead of print.
[32] Loss, R., Sandrin, R., fran?a, B.H., De Azevedo-Alanis, L.R., Grégio, A.M., Machado, M.?. and Lima, A.A. (2011) Cytological analysis of the epithelial cells in patients with oral candidiasis. Mycoses, 54, e130-135. doi:10.1111/j.1439-0507.2009.01857.x
[33] Vogt, F.C. (1979) The incidence of oral candidiasis with use of inhaled corticosteroids. Ann Allergy, 43, 205-210.

Copyright © 2021 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.