Prevalence of fungal infections in the oral and maxillofacial region: a 50-year experience from a dental school in Thailand

Abstract

OBJECTIVES: Although superficial fungal infections of the oral and maxillofacial region are common, deep fungal infections remain unfamiliar. We investigated the prevalence of fungal infections in this location in Thailand from specimens examined in the Department of Oral and Maxillofacial Pathology over a 50-year period. MATERIALS AND METHODS: Cases diagnosed as fungal infections in our archive were selected. Demographic data, risk factors, clinical and radiographic features, clinical differential diagnoses and treatments were analyzed. RESULTS: Of 22,070 biopsied specimens, 41 cases (0.19%) were fungal infections in this location. The prevalence increased in the last decade. Approximately 71% were candidiasis, while 29% constituted deep infections including mucormycosis, aspergillosis and histoplasmosis. Fungal infections predominantly affected elderly individuals (mean age: 62.1 years). Both superficial and deep types exhibited a female predominance with a ratio of 1:3.8 and 1:3, respectively. About 60% of patients were associated with risk factors, namely, betel quid chewing, diabetes mellitus and human immunodeficiency virus infection. Clinically misdiagnosed chronic hyperplastic candidiasis as erythroleukoplakia/lichen planus, and deep fungal infections as osteomyelitis/oral squamous cell carcinoma were frequently observed. All candidiasis were treated with topical antifungal drugs, while mucormycosis and histoplasmosis required systemic antifungal therapy. CONCLUSIONS: Fungal infections constituted less than 1% among biopsied specimens. The majority of fungal infections were clinically misdiagnosed. Currently, histopathologic examinations using proper special stains play a vital role to achieve a definite diagnosis. CLINICAL RELEVANCE: Unfamiliarity with deep fungal infections in the oral and maxillofacial region among oral healthcare personnel may lead to misdiagnosis and inappropriate treatment. Awareness of fungal infections in this area must be encouraged.