Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London, W1G 8YS. email@example.com. Priority will be given to letters less than 500 words long. Authors must sign the letter, which may be edited for reasons of space. Readers may now comment on letters via the BDJ website (www.bdj.co.uk). A 'Readers' Comments' section appears at the end of the full text of each letter online.
Sir, I was discussing a new diagnosis of asthma with a patient and found myself struggling to walk the line between patient-centred advice and opportunistic health prevention. The prevalence of asthma in the UK is approximately one in 11 children and one in 12 adults.1 In 2016, the British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) published new guidelines on its management.2 A key update in the guidance is the emphasis that individuals should no longer be on a short acting beta-2 agonist as a primary form of treatment; instead the early use of inhaled corticosteroids (ICS) has been highlighted. With up to 5.4 million people2 now potentially requiring ICS, the question on whether asthma patients should be routinely informed about preventing and recognising oral candidiasis becomes more pertinent.
In our experience during training, both in hospital and in primary care, the discussion of the risk of developing oral candidiasis is neglected. A recent study demonstrated that in the 4–11-year age group of ICS users, the incidence of oral candidiasis ranges from 0.8% to 3.2%,3 which has been corroborated with previous evidence.4 An adverse event which occurs in 1–10% of patients taking the drug is deemed as a common adverse side effect of the drug,5 and the General Medical Council recommends that such effects should be discussed with the patient prior to prescription.6 Treatment of oral candidiasis and its complications requiring treatment bears a cost to the NHS.
Dental professionals on deep examination of the mouth often spot the first signs of candidiasis, and are also responsible for advising treatment. We believe there is scope for targeted opportunistic health promotion in patients taking inhaled corticosteroids for both doctors and dental professionals. During the discussion of past medical history and drug history, where a patient mentions a history of asthma or ICS use, we believe discussion of good oral hygiene practice following the use of ICS as well as a quick examination of the oral cavity would be of benefit to prevent and identify candidiasis.