Oral cavity pain or discomfort are caused by candidiasis, herpetic or aphthous ulceration, periodontal disease, and tumours. Often the diagnosis can be made by simple inspection and appropriate treatment initiated without further investigation. Systemic oral therapy of herpes simplex ulceration and candidiasis is preferred for reasons of efficacy and ease of use. Recurrence is common and if frequent, maintenance therapy may be required rather than the short treatment of each occurrence. Maintenance therapy may be more likely to induce resistance.
About one third of patients develop oesophageal disease. The likelihood of candidiasis is so high that a therapeutic trial with a systemic antifungal agent is indicated before considering further investigation. If symptoms fail to respond, or recur despite adequate maintenance therapy, endoscopy is performed to exclude herpes simplex, cytomegalovirus and other causes of oesophageal ulceration including malignant lesions.
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