A clinico-pathological and cytological study of oral candidiasis

Candidiasis of the oral mucosa arises chiefly as a result of infection with Candida albicans. Many clinicopathological 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 diagnostic value of cytology. The ratio of Candida infection 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 findings of oral candidiasis were ulcerative/erythematous lesions (33.2%, p < 0.01) and pseudomembranous candidiasis (31.6%, p < 0.01). A histopathological diagnosis of candidiasis based on biopsy specimens from 26 lesions in patients with Candida infection indicated by cytology was confirmed from cultures. The breakdown of a cytological to a definite diagnosis was 6 positive (SCC 4, verrucous carcinoma 1, moderate to severe dysplasia 1), 6 suspected positive (mild dysplasia, 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). Exfoliative cytology can easily judge the presence of Candida species, although experience is necessary for the presumptive diagnosis of an oral mucosal disease. The application of exfoliative cytology using the Periodic acid-Schiff reaction is helpful for the earlier detection of oral candidiasis with various macroscopic findings.