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Oral Care in Cancer Therapy: Oral Care During Cancer Therapy

This second segment of the six-part series of oral complications in cancer treatment deals with fungal infections, most commonly candidiasis.

See also:

Oral Care in Cancer Therapy Part 1: Oral Care Pre-Head & Neck Cancer Treatment
Oral Care in Cancer Therapy Part 3: Oral Care During Cancer Therapy

Candidiasis or condidosis is an overgrowth of a commensal organism. The infection usually involves C. albicans, but C. krusei, dublinensis and torolopsilosis are also seen. It is important to note that resistance has been noted to medications by Candida spp.

Etiology

  1. Due to systemic immune effects
    • Extremes of age
    • Malnutrition
    • Cytotoxic CT
    • Immune T-cell defects (HIV, diabetes, leukaemia, lymphoma, immunosuppressive drugs)
    • Anaemia, neutropenia
  2. Due to local factors
    • Hyposalivation
    • Dental appliances
    • Tobacco
    • Broad-spectrum antibiotics
    • Corticosteroids

Symptoms

  • Pain/burning sensation
  • Taste changes
  • Difficulty opening mouth wide (angular cheilitis)
  • Difficulty swallowing (pharyngeal involvement)

Management

Essentially, management follows the fundamental oral care principles as outlined by CCO such as keeping the oral cavity and tissues moist, tobacco cessation, keeping a neutral pH in the oral and using a bland baking soda/salt mouth rinse. The following outline other considerations.

Topical

  • No combo rinses (NEORCC #3), dilution factor
  • Nystatin 100,000u/ml, soak dentures as well
  • Clotrimazole, miconazole
  • Consider CHX rinses

Systemic

  • Fluconazole

Prophylactic use when using steroids

 

 

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