Microscopia directa

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a removable material [4, 5]. In the adult population,

wearing of prosthetic denture is also a predisposing

factor, as well as smoking and xerostomia. While this

pathology occurs more rarely among children and

teenagers, methods of diagnosis and treatment havebeen proposed [6, 7]. The diagnosis of oral candidiasis

is often done with clinical symptoms [7], mostly for

acute pseudomembranous cases (Fig. 1). However,

due to its clinical variability, microbiological tech-

niques are often necessary to confirm the diagnosis

and establish a differential diagnosis with other

diseases, such as oral lichen planus or leucoplasia,

especially in acute erythematous candidiasis (Fig. 2),

or in cases characterized by resistance to antifungal

drugs [8]. Several approaches are used to isolate and

identify Candida species, including direct microscopyof smears, stains and cultures, as well as PCR [9].

Recent advances in optical devices offered dental

practitioners the opportunity to equip their surgeries

with powerful optical microscopes for direct

microscopic examination. The procedure involves

taking a representative sample from the infected siteby exfoliative cytology, which is transferred on glass

slide for microscopic examination. Ideally, it is treated

with potassium hydroxide (KOH), Gram stain or

periodic acid–Schiff (PAS) stain. The KOH clears

organic material from the background, making the

fungi stand out, as clear blastoconidia, hyphae or

pseudohyphae in the case of Candida infection. With

Gram staining, hyphae and yeasts will appear dark

blue, whereas they will be red to purple on PAS-

stained specimens [10].

We aimed to study the recent literature andinternational policies regarding the diagnosis and

monitoring of oral candidiasis in children and adoles-

cents using direct microscopy, in order to define the

interest for a pediatric dentist to use these technics.

Materials and Methods

A PubMed search was performed using the following

key words: «oral AND candidiasis AND diagnosis».

This review respected the Prisma checklist. The keywords were validated by the Medical Subject Heading

(MeSH) dictionary, and the Boolean operator «AND»

was used to relate them. All systematic reviews,

clinical trials and meta-analyses were considered in

this review.

We identified a total of 63 articles from which we

selected 11 after analysis, all of which were reviews.

The excluded publications fell outside the scope of the

present study.

Table 1 Clinical classification of oral candidiasis

Type Subtypes

Acute Pseudomembranous

Erythematous

Chronic Pseudomembranous

Erythematous

Hyperplasic

Others Angular cheilitis

Denture-related median

rhomboid glossitis

Fig. 1 Acute pseudomembranous candidiasis in a 7-year-old

boy

Fig. 2 Erythematous tongue candidiasis in a child

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and numbers of isolates with reduced azole susceptibility.

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3. Coronado-Castellote L, Jiménez-Soriano Y. Clinical and

microbiological diagnosis of oral candidiasis. J Clin Exp

Dent. 2013;5(5):e279–86.

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Assoc. 1992;123:46–51.

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10(1):25–31.

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Scully C. Denture-related stomatitis: identification of aeti-

ological and predisposing factors—a large cohort. J Oral

Rehabil. 2007;34:448–55.

7. Figueiral MH, Fonseca PA, Lopes MM, Pinto E, Pereira-

Leite T, Sampaio-Maia B. Effect of denture-related stom-

atitis fluconazole treatment on oral Candida albicans sus-ceptibility profile and genotypic variability. Open Dent J.

2015;9:46–51.

8. Giannini PJ, Shetty KV. Diagnosis and management of oral

candidiasis. Otolaryngol Clin N Am. 2011;44:231–40.

9. Aguirre-Urı́zar JM. Oral candidiasis. Rev Iberoam Micol.

2002;19:17–21.

10. Muzyka BC, Epifanio RN. Update on oral fungal infections.

Dent Clin N Am. 2013;57(4):561–81. doi:10.1016/j.cden.

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11. StooplerET, Sollecito TP. Oralmucosaldiseases: evaluation

and management. Med Clin N Am. 2014;98(6):1323–52.

12. Coronado-Castellote L, Jiménez-Soriano Y. Clinical and

microbiological diagnosis of oral candidiasis. J Clin Exp

Dent. 2013;5(5):e279–86.

13. Krishnan PA. Fungal infections of the oral mucosa. Indian J

Dent Res. 2012;23:650–9.

14. Kumaraswamy KL, Vidhya M, Rao PK, Mukunda A. Oral

biopsy: oral pathologist’s perspective. J Can Res Ther.

2012;8:192–8.

15. Laurent M, Gogly B, Tahmasebi F, Paillaud E. Oropha-

ryngeal candidiasis in elderly patients. Geriatr Psychol

Neuropsychiatr Vieil. 2011;9(1):21–8.

16. Byadarahally Raju S, Rajappa S. Isolation and Identification

of Candida from the Oral Cavity. ISRN Dent.

2011;2011:487921. doi:10.5402/2011/487921.

17. Saint-Jean M, Tessier MH, Barbarot S, Billet J, Stalder JF.

Oral disease in children. Ann Dermatol Venereol.

2010;137(12):823–37.

18. Farah C, Lynch N, McCullough M. Oral fungal infections:

an update for the general practitioner. Aust Dent J.

2010;55:48–54.19. Thompson GR 3rd, Patel PK, Kirkpatrick WR, Westbrook

SD, Berg D, Erlandsen J, Redding SW, Patterson TF.

Oropharyngeal candidiasis in the era of antiretroviral ther-

apy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.

2010;109(4):488–95.

20. Marty M, Bonner M, Vaysse F. Observation of trichomon-

ads infection in a child with periodontitis by direct micro-

scopy at the dental office. Parasitology. 2015;142:1440–2.

Mycopathologia (2015) 180:373–377 377

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http://dx.doi.org/10.1016/j.cden.2013.07.002http://dx.doi.org/10.1016/j.cden.2013.07.002http://dx.doi.org/10.5402/2011/487921http://dx.doi.org/10.5402/2011/487921http://dx.doi.org/10.1016/j.cden.2013.07.002http://dx.doi.org/10.1016/j.cden.2013.07.002

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