Case Report
A Case of Amyotrophic Lateral Sclerosis Prevented Oral Candidiasis by Oral Care with Neonisin-e® Oral Gel
2023 Volume 27 Issue 2 Pages 143-149
Details
2023 Volume 27 Issue 2 Pages 143-149
Introduction: The oral condition of dependent persons can deteriorate, leading to oral candidiasis due to insufficient oral care. Herein, we report a patient with amyotrophic lateral sclerosis (ALS) and poor oral hygiene in whom oral candidiasis may have been suppressed by oral care using Neonisin-e®-containing oral gel (Ne gel).
Case: A 64-year-old man had developed ALS 16 years ago and was using an electric wheelchair. He was referred to hospital dentistry for manufacturing a prosthesis for dysphagia. At his first visit, his oral hygiene was found to be poor and white pseudomembrane formation was observed on the buccal mucosa and tongue. Oral candidiasis was suspected, which could have been caused by poor oral hygiene, as well as a history of diabetes and long-term antibiotic usage. Antifungal medication was started for 6 days and oral hygiene instructions were given by a dental hygienist.
Course: The patient managed his oral hygiene himself as he lived alone. He was able to hold a toothbrush; however, he was not able to move it correctly because of ALS and so used an electric toothbrush. The plaque control record (PCR) at his first dental visit was 58.3%, indicating poor oral hygiene. In order to maintain a good oral condition without oral candidiasis, oral hygiene instructions were given to him by a dental hygienist, who also recommended using Ne gel. The white pseudomembrane disappeared after using the antifungal agent.
Oral candidiasis did not recur during the period of oral care with the Ne gel. Recurrence of oral candidiasis was observed on days 42 and 106, a period of oral care without the Ne gel because the patient chose not to use it then. However, from day 7 to the final visit, the PCR was 20% or less and the oral hygiene was maintained well.
Discussion: In this case, oral candidiasis was probably suppressed by oral care using Ne gel. After oral hygiene instructions were given by the dental hygienist, oral hygiene was maintained well, but oral candidiasis recurred during the period when Ne gel was not used. Therefore, oral care using Ne gel may prevent the recurrence of oral candidiasis and reduce the need for frequent administration of antifungal agents.
