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Chronic Candidiasis Investigation — MFDS Part 1 MCQ

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ModerateOral MedicineChronic Candidiasis InvestigationMFDS Part 1

A 24-year-old presents with a third clinically confirmed episode of oral candidiasis within 9 months. They do not wear dentures, smoke, have xerostomia or use inhaled corticosteroids, and they have not recently taken antibiotics. Which pair of investigations is most appropriate to identify an occult predisposing condition?

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Correct answer: D — Combined HIV antigen–antibody test and HbA1c

The correct answer is D. Recurrent oral candidiasis in a young adult without an evident local or medication-related precipitant should prompt investigation for systemic predisposition. SDCEP identifies diabetes and diseases associated with reduced immunity, including HIV infection, as important risk factors. NICE also classifies unexplained oral candidiasis as an HIV indicator condition for which testing should be offered. HbA1c assesses for previously unrecognised diabetes, while a combined HIV antigen–antibody test addresses an important acquired immunodeficiency. Bitewing or pulp testing, periodontal assessment, orthodontic records and bruxism or temporomandibular joint assessment may be indicated for their respective dental conditions, but they do not adequately investigate the occult systemic causes suggested by this presentation.

Reference: Scottish Dental Clinical Effectiveness Programme. Management of Acute Dental Problems, section 4.17: Candidal Infection (Oral Thrush). 2013. https://www.sdcep.org.uk/media/ixlpeakb/sdcep-madp-guidance-march-2013.pdf