The saliva test for Candida albicans is used to confirm the clinical diagnosis of candidiasis (synonyms: thrush, thrush mycosis, moniliasis, candidosis, candidamycosis, candidasis, candidosis) of the oral mucosa. In about 70 % of all healthy patients, and in denture wearers almost regularly, fungi can also be detected in the microbial oral flora, especially the most common representative Candida albicans. However, positive detection does not necessarily represent a pathological finding: Rather, the germs of the oral flora live in an ecological balance. Candida albicans is therefore not an obligate pathogen (necessarily leading to disease). However, if the ecosystem of the oral flora becomes unbalanced – for a variety of reasons – a pathological increase in Candida albicans occurs and the clinical symptoms of oral thrush appear. Risk factors that may result in thrush include any processes in the organism that alter or weaken the body’s defenses, thereby lowering the organism’s tolerance level to Candida albicans:
- Local conditions: Oral rhagades, mucosal coverage by prostheses.
- Tumor diseases and a resulting severely reduced general condition.
- Congenital or acquired immunodeficiencies, e.g. neutropenia (reduction of neutrophil granulocytes in the blood)
- HIV infection
- Diabetes mellitus
- Shift of the natural germ spectrum, selection of fungi by prolonged therapy with a broad-spectrum antibiotic.
- Suppression of the immune defense by immunosuppressants, for example, after organ transplantation.
- Cytostatic agents in the context of tumor diseases.
- Long-term therapy with corticosteroids, for example, inhaled asthma sprays
The thrush disease of a newborn in the first weeks of life takes a special position: if it comes under the vaginal birth or, for example, by contaminated pacifiers to the transmission of Candida albicans, the newborn still has no other oral flora that could compete with the shoot fungus. As a result, a fungal rash can quickly develop. However, it is increasingly displaced by the developing natural site flora of the mouth.
Indications (areas of application)
Due to the high percentage of healthy Candida albicans carriers, the test is not routinely used. It is used in the case of clinical findings of candidiasis, particularly if the thrush infestation has proved resistant to treatment with an antifungal agent (drug used to treat fungal infections) initially used, and the use of another antifungal agent should first be clarified by laboratory cultivation of the fungus.
Contraindications
None
Before the examination
If oral thrush cannot be clearly related to, for example, recent antibiotic therapy or local risk factors, the clinical findings should prompt the dentist to refer the patient for further investigation of the cause of the disease and to seek cooperation with the primary care physician.
The procedure
A swab is taken from the diseased mucosal area. Based on the microscopic native specimen, a microbiology laboratory makes the diagnosis of fungal infection. The differentiated diagnosis of the exact Candida species can only be made after cultivation (cultivation of the fungal culture) for several days.
After the examination
After the diagnosis is confirmed, thrush is treated with a locally acting antifungal agent (e.g., nystatin, miconazole, or amphotericin B) in the form of drops or lozenges for a period of two to several weeks until after the clinical findings have resolved. In diseases associated with weakened immune defenses, it is important to prevent thrush, which is initially confined to the oral mucosa, from spreading to the pharynx, lungs and internal organs. If necessary, an accompanying systemic antifungal permanent therapy is required, but this belongs in the hands of the general practitioner.
Possible complications
None