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Self-Study Course Four Course 2015 self-study course four course The Ohio State University College of Dentistry is a recognized provider for ADA CERP credit. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to the Commission for Continuing Education Provider Recognition at www.ada.org/cerp. The Ohio State University College of Dentistry is approved by the Ohio State Dental Board as a permanent sponsor of continuing dental education. ABOUT this FREQUENTLY asked COURSE… QUESTIONS… Q: Who can earn FREE CE credits? . READ the MATERIALS. Read and review the course materials. A: EVERYONE - All dental professionals in your office may earn free CE . COMPLETE the TEST. Answer the credits. Each person must read the eight question test. A total of 6/8 course materials and submit an questions must be answered correctly online answer form independently. contact for credit. SUBMIT the ANSWER FORM Q: What if I did not receive a ONLINE. You MUST submit your confirmation ID? answers ONLINE at: A: Once you have fully completed your us http://dentistry.osu.edu/sms-continuing-education answer form and click “submit” you will be directed to a page with a . RECORD or PRINT THE unique confirmation ID. phone CONFIRMATION ID This unique ID is displayed upon successful submission Q: Where can I find my SMS number? of your answer form. 614-292-6737 A: Your SMS number can be found in the upper right hand corner of your ABOUT your monthly reports, or, imprinted on the toll free back of your test envelopes. The SMS FREE CE… number is the account number for 1-888-476-7678 your office only, and is the same for everyone in the office. TWO CREDIT HOURS are issued for Q: How often are these courses fax successful completion of this self- available? study course for the OSDB 2015-2016 614-292-8752 biennium totals. A: FOUR TIMES PER YEAR (8 CE credits). CERTIFICATE of COMPLETION is used to document your CE credit and e-mail is mailed to your office. [email protected] . ALLOW 2 WEEKS for processing and mailing of your certificate. The Ohio State University College of web Dentistry is an American Dental dentistry.osu.edu/sms Association (ADA) Continuing Education Recognized Provider (CERP). Page 1 ORAL CANDIDIASIS 2015 The purpose of this course is to review the types of oral candidiasis and how they present to better help clinicians and the dental team recognize and course treat all patients. In addition to reviewing the common types and presentations, this course will review the symptoms, differential diagnoses, four treatment options and contraindications, and answers to a few commonly asked patient questions. Case 2 CASE STUDIES A 43 year-old woman with a Case 1 noncontributory medical history presented for a routine dental A 67 year-old woman presented to treatment. The dentist noticed the dentist with a 6 month history of “white and red lesions” on the a midline palatal ulcer. The patient hard palate. The patient reported reported wearing her denture 24 that her husband told her she hours a day. The long-standing ulcer sleeps with her tongue pushed to was causing the patient pain, but the roof of her mouth. The patient she still continued to wear her also had a three week history of a dentures around the clock. An “cut” near her left commissure, evaluation of the oral mucosa but otherwise was unaware of any revealed red patches on the palate lesions. The dentist consulted and a somewhat rough area on the with an oral pathologist, and an posterior portion of the denture. exam revealed a red area in the The patient was also taking central portion of the dorsal numerous medications which tongue, angular cheilitis, and a contributed to dry mouth. The oral “kissing lesion” on the hard palate. mucosa and the denture were The white areas were thought to written by swabbed and cultured, and showed be slight hyperkeratosis caused by ashleigh n. briody, dds positive for Candida albicans. The the chronic rubbing of her palate patient was treated with with her tongue while sleeping. edited by Clotrimazole troches and advised to The culture was positive for ross white, bs soak her denture in a diluted bleach Candida albicans. solution at night, during the rachel a. flad, bs antifungal treatment. After three weeks, the patient reported that the release date ulcer had healed and she was no October 26, 2015 longer experiencing any discomfort. last day to take the course at no charge November 20, 2015 last day course is Multifocal Dr. Ashleigh Briody, available for credit Candidiasis The Ohio State University College December 31, 2017 with Central of Dentistry Papillary Longstanding Ulcer Dr. Ashleigh Briody, Atrophy The Ohio State on the Posterior University College Hard Palate of Dentistry Page 2 Case 4 The patient was prescribed 100 mg of Fluconazole for one week, after stating she did not like the oral A 27 year-old black female presented to oral troches (Mycelex) and had trouble remembering pathologists at the dental clinic for evaluation of to take the troches five times per day. The patient oral mucosal lesions. The patient’s medical returned for routine treatment and no evidence of history was indicative for systemic lupus yeast was found. erythematosus with kidney involvement and the patient was taking several immunosuppressive Case 3 medications, including Prednisone, Hydroxychloraquine (Plaquenil), and A 70 year-old white male presented to the dental Mycophenolate (CellCept). The intraoral clinic with a six month history of a sensitive oral examination revealed numerous white plaques mucosa. His medical history signified that he had resembling curdled milk that wiped off with a liver transplant and that he had been taking gauze ,while the underlying mucosa was red and antirejection drugs – including corticosteroids and tender. The patient complained of pain when tacrolimus – for many years. He stated that he had eating and drinking. An exfoliative cytology was not been able to eat any spicy or hot-temperature performed and the results showed candidal foods for several months. He and his wife were hyphae admixed with epithelial cells. very frustrated with his symptoms, since he could only eat very bland food. The additional oral examination revealed red lesions at the commissures consistent with angular cheilitis, a very smooth tongue (atrophic tongue), erythematous tissue on his palate, and alveolar mucosa consistent with denture stomatitis. Pseudomembranous Dr. Ashleigh Briody, Candidiasis in and The Ohio State Immunocompromised University College of Dentistry Patient Due to the patient’s severely immunocompromised status and complex medical history, the primary care physician was Denture Dr. Ashleigh Briody, The advised of the results and the patient was placed Stomatitis Ohio State University on preventative regimen of 100 mg of College of Dentistry Fluconazole daily. Summary A culture was performed, which came back positive for Candida, and the patient was placed As shown in these cases, proper diagnosis and on Clotrimazole troches (Mycelex). A systemic treatment of candidiasis will improve a patient’s antifungal medication, such as Fluconazole, was symptoms. Candidiasis can present in obvious or determined to conflict with one of his anti- very subtle ways. As the dental team, recognition rejection medications: tacrolimus. The patient was of the variations are very important because the also instructed to use over-the-counter oral cavity is our area of expertise. Many other Clotrimazole antifungal cream in the corners of his medical professionals are not familiar with the mouth and/or to lick the corners of his lips while different oral presentations of candidiasis, dissolving the oral troche. therefore patients go undertreated. This can result in delayed healing of wounds and Page 3 discomfort in a patient who would otherwise be the infection can cause the lesion to appear more cured by administration of antifungals. troublesome than normal. ORAL CANDIDIASIS OVERVIEW Disease Spectrum & Presentation Oral candidiasis is a fungal infection of the top The disease spectrum for candidiasis widely varies layer of the oral mucosa caused by Candida from an asymptomatic carrier state to life albicans. This very common dimorphic yeast threatening disseminated candidiasis. The exists in two forms: yeast (unicellular) and hyphal treatment for the spectrum of candidiasis also (multi-cellular). In the yeast form, the fungus is ranges from topical antifungal to very potent commensal with the host, but when the oral intravenous medications. Typically, oral conditions change, the yeast can transform into candidiasis is a very superficial infection and will the hyphal form, which is pathogenic. Up to 50% require minimal medication for resolution. of patients can have yeast as part of their normal However, in cases of the severely oral flora, with no signs or symptoms of disease. immunocompromised, the fungus can deeply Numerous factors and conditions can contribute invade the tissue and, if untreated, the disease to the development of an oral candidiasis can result in death. infection: immune status, oral mucosal environment, and the virulence of the Candida Oral candidiasis presents in a number of ways – strain. Previously, candidiasis was thought to only including pseudomembranous candidiasis, occur as an opportunistic infection in patients erythematous candidiasis, denture stomatitis, who were inflicted with other diseases, such as hyperplastic candidiasis, and angular cheilitis. those that modify immune status. Candida is The most recognizable form of candidiasis – acute commonly seen in newborns, the elderly, and pseudomembranous candidiasis, also known as those individuals who are immunocompromised. thrush – presents as a white cottage cheese-like However, it can also be seen in otherwise healthy plaque on the buccal mucosa, palate, or dorsal individuals.
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