HJAR Mar/Apr 2025

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2025 53 erythron-leukoplakia, or oral cancer. For this reason, a biopsy should be considered. Denture-induced stomatitis is the other type of candidiasis and is present in 60% of denture wearers. It presents as an erythema- tous outline that coincides with denture- bearing areas. It can also be associated with angular cheilitis. Following topical antifun- gal therapy, improving the fit of the denture, or opening the vertical dimension of the bite is the usual treatment. Geographic tongue Geographic tongue is a benign condi- tion but has a remarkable presentation. It’s a chronic, recurring inflammatory condition of unknown etiology. The appearance con- sists of erythematous and migratory circi- nate patches that mimic a map. The lesion can persist for several days to weeks, then disappears and reappears in a different pat- tern. Association with chronic inflammatory bowel disease, psoriasis, celiac disease, HIV, atopic dermatitis, lichen planus, diabetes mellitus, lupus, and reactive arthritis have all been documented. 11 Avoidance of spicy foods, use of alcohol, and acidic foods and drinks is recommended as these can irritate areas on the tongue. Treatment is palliative, and it is self-limiting. Niki Carter, DMD, MPH Dental Director Delta Dental of Arkansas cavities. Multiple local and systemic fac- tors come into play and allow Candida to thrive. Risk factors include denture use, ste- roid inhaler use, xerostomia, endocrine dis- orders, HIV, leukemia, nutritional disorders, immune-suppressed state, radiation therapy, chemotherapy, and use of broad-spectrum antibiotics or corticosteroids. 8 Neonatal candidiasis is fairly common in the form of oral thrush or diaper rash, due to their immature immune systems. 9 Diagnosing candidiasis is usually iden- tified by clinical appearance, however, an oral smear or culture assists in confirma- tion of type. There are four types, and each has its own characteristic and presentation. These presentations are pseudomembra- nous, atrophic, hyperplastic, and denture stomatitis. The pseudomembranous is the most common type of candidiasis. This variant presents with a creamy white coating on the mucosa. This white coating can be wiped away, which reveals erythema or bleeding underneath. This condition is generally not uncomfortable. Topical antifungal therapy is the first line of treatment. The erythematous or atrophic is com- monly the result of prolonged use of steroid or antibiotics. It is red, sensitive, and causes a burning sensation. It is smooth and velvety red in appearance and is treated with topical antifungal therapy. The hyperplastic type of candidiasis is of- ten chronic and consists of white patches that cannot be removed. It often presents as an isolated plaque or speckled white nod- ules with an erythematous background. 10 Further complicating this presentation is that it can mimic oral lichen planus, frequently leave scars since they continue to recur, and can last up to six weeks.  The objective in treatment is to decrease duration, frequency, and pain. Over-the- counter topicals, rinses, and gels are avail- able for the minor aphthae, and cortico- steroids or intralesional triamcinolone are reserved for the major aphthae, which are acute and severe. 6 Since many oral ulcerations have similar presentations, a diagnosis can only be made after gathering all the necessary information, including medical history, oral examination, and duration of the lesion. A reasonable workup would include a thorough medical history review; a CBC with differential; and, for any lesion that cannot be confidently identified, a biopsy for histopathology. The histopathology will rule out malignance. The CBC should address systemic disorders such as anemia, leukemia, and hyperglycemia. More specific tests may be needed for HIV and syphilis. 7 Candidiasis: oral thrush Candidiasis is fairly common in the oral cavity. This overgrowth of fungus can be a nuisance. With changes in the oral flora, this fungal infection can be opportunistic. Sixty percent of healthy adults have been identified as having Candida in their oral