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Although many oral ulcers have similar clinical appearances, their etiologies can range from reactive to neoplastic to oral manifestations of dermatological diseases. In patients with an HIV infection, fungal diseases may cause ulceration in the oral cavity; however, there have been few studies of oral ulcerative lesions associated with Candida in patients without an HIV infection. Nevertheless, we encountered chronic oral ulcer associated with Candida among our frequent outpatients without an HIV infection. The present article reviews the causes of oral ulcers, focusing on Candida as a protractive factor for chronic oral ulcers, and it is recommended that Candida involvement be considered in diagnosis of a certain chronic oral ulcer, that remains of unknown origin even if some examinations have been performed.

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Oral ulceration is one of the common adverse effects of nicorandil in European countries. In Japan, however, only 9 cases of nicorandil-induced oral ulceration have been reported. Here, we report 3 cases of nicorandil-induced oral ulceration, one of which exhibited a unique clinical course associated with Candida infection. In this case, the initial discontinuation of nicorandil failed to ameliorate the lesion. However, the second discontinuation of the drug after the control of the Candida infection overlying the surface of the ulcer produced a favorable effect. This patient was diagnosed with nicorandil-induced tongue ulceration with Candida infection.

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OBJECTIVE: Candida-associated lesions (CALs) and burning mouth syndrome (BMS) may induce glossodynia without objective manifestations. We investigated patients with glossodynia to examine the relationship between CAL and BMS. PATIENTS AND METHODS: A visual analog scale was used to divide 95 patients with glossodynia into three groups according to intensity of pain at rest and when eating. Group A was the functional pain group; group B was the nonfunctional pain group; and group C was a mixed pain group. Antifungal treatment was scheduled for patients with suspected Candida infection by clinical, mycological, or cytological criteria. RESULTS: Culture tests and direct examination results indicated that group A had high Candida positivity (73.0% by culture and 59.5% by direct examination), and showed a good response to antifungal treatment (75.7%). Antifungal treatment was not useful in group B. This was supported by a low Candida infection rate, as determined by direct examination (3.1%). For group C, Candida positivity and antifungal treatment effectiveness were between groups A and B. Furthermore, six patients in group C showed complete remission of functional pain by antifungal treatment only. Favorable outcomes were obtained for 23 patients (10 in group B and 13 in group C), who received antidepressant treatment. CONCLUSION: These results suggested that glossodynia was Candida-associated in group A, and BMS-induced in group B, while group C contained patients with both CAL and BMS.

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BACKGROUND: Culture test and direct microscopy, which are currently used in the diagnosis of oral candidiasis, can yield false-negative results. METHODS: Forty patients with atrophic candidiasis of the tongue were evaluated. The diagnosis was confirmed by a favorable outcome consisting of tongue pain improvement and regeneration of filiform papilla after antifungal treatment in all patients. Specimens were examined by fungal culture and direct microscopy following rapid staining; the usefulness of these procedures for diagnosis was reevaluated retrospectively after treatment. RESULTS: In the culture test, 30 patients (75.0%) were positive for candidal species, most of which were confirmed to be Candida albicans. Twenty-three (57.5%) were positive for pseudohyphae of fungi on direct examination. Twenty-two (55.0%) were positive and nine (22.5%) were negative for both. With regard to the diagnosis of oral atrophic candidiasis, these examinations revealed false-negative results of 25% in the culture examination and 42.5% in the direct examination. CONCLUSION: Careful clinical observation of the patient for signs, such as prolonged disease duration, pain on eating, and no benefit from topical steroid treatment, and cytologic examination are important in the diagnosis of this disease.

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BACKGROUND: Traditionally, total atrophic tongue has been due to nutritional deficiencies, such as vitamin B12, folic acid, or iron deficiencies, and partial atrophic tongue has been well known as median rhomboid glossitis or geographic tongue. The other cause of atrophic tongue is oral candidiasis. METHODS: Forty patients with atrophic change of the tongue were examined on a relation to candidiasis. All of them complained of tongue pain on spicy or hot diet. Laboratory examinations included blood examination for diabetes and anemia, culture test and direct cytologic examination. The intensity of tongue pain was evaluated pre- and post-treatment using visual analogue scale (VAS). RESULTS: Twenty-four of 40 (60%) had pre-disposing factors of candidiasis including diabetes mellitus, malignancy, systemic steroid therapy, long-term antibiotic therapy and others in their medical history. Blood examinations revealed mild anemia and/or Fe deficiency in 5 (12.5%), mild diabetes in 4 (10.0%), both in two, while residual 29 patients (72.5%) were within reference levels. In the culture examination, candidal species were isolated in 72.5%, and almost all of them were candida albicans. The direct cytologic examination performed in 17 of 40 patients, witch revealed pseudohyphae of fungi in 14 patients (82.4%). After the antifungal treatment, the tongue pain disappeared or improved markedly in 80%. Simultaneously, the regenerative tendency of filifolm papilla of the tongue dorsum was observed in these patients. CONCLUSION: Atrophic tongue associated with pain at eating, even though it is mild atrophic change, has a high probability of being a candida-induced lesion. Long disease duration and no benefit by topical steroids are suggestive and diagnostic factors of this disease.

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The purpose of this study was to evaluate speech intelligibility after a dehiscence operation using artificial grafts for patients with speech disorders after partial glossectomy that were caused by scars resulting from the primary operation. The subjects were six men and three women, who had had a partial glossectomy for tongue cancer followed by direct closure without reconstruction. They were operated on a second time operation to mobilise the residual tongue by dividing the cicatrix. An artificial graft was applied to the wound to maintain the dehiscence. Speech intelligibility was evaluated by a standardised Japanese speech intelligibility test before, and 6 and 12 months after the second operation. The intelligibility scores significantly improved during the first 6 months after the second operation, and continued to improve slightly during the following 6 months. This study suggests that the dehiscence operation using an artificial graft could improve speech in patients after partial glossectomy.

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We report a new intermaxillary fixation (IMF) method for condylar fractures using a thermoforming plate. Fifteen cases of condylar fracture were selected and thermoforming plates were applied. The patient's recover was uneventful in all 15 cases, and the period of IMF ranged from 7 to 17 days, (mean 12) for the following 7 days IMF was used only at night together with functional jaw training during the day. The outcome was good. IMF using a thermoforming plate may be a useful technique for selected condylar fractures.

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