Question

Mr. B is an 82 year old patient who comes to the dental hygiene clinic for removal of tobacco stain resulting from 50 years of smoking two packs a day. He quit smoking several years ago but is still short of breath when he has to climb stairs or walk any distance. His physician had been treating him for asthma with a short-acting albuterol metered-dose inhaler; however, Mr.B did not get any relief from his symptoms and was becoming increasingly tired and short winded. Upon recommendation from his daughter, a health professional, he went to see a pulmonologist, who diagnosed him as having COPD. His medication was changed to a long-acting B2-agonist salmeterol and a long-acting inhaled anticholinergic agent tiotropium bromide. He had almost immediate relief of his shortness of breath and reports that his energy level increased dramatically, which is important to him because he still works as the owner of a painting business. His other medications include clopidogrel, simvastatin, and hydrochlorothiazide. His BP is 140/90, heart rate is 94, and respiratory rate is 16 breaths per minute. His oral hygiene is fair, and he wears an upper denture. Upon removal of his denture, the hygienist notes that he appears to have a fungal infection on his plate. He also complains that he has had a bad taste in his mouth since starting these medications.

Which is the most likely cause of the candidiasis and bad taste in Mr. B's mouth?
A. Antibiotic use
B. Undiagnosed diabetes
C. Immunocompromised status
D. Drug-induced xerostomia

Answer 1

The most likely cause of the candidiasis and bad taste in Mr. B's mouth is drug-induced xerostomia, which is a side effect of his medications. Smoking can also contribute to the development of candidiasis.

Step-by-step explanation:

The most likely cause of the candidiasis and bad taste in Mr. B's mouth is drug-induced xerostomia. Xerostomia is the medical term for dry mouth, which can be a side effect of certain medications. Both the long-acting B2-agonist salmeterol and the long-acting inhaled anticholinergic agent tiotropium bromide can cause dry mouth as a side effect. Dry mouth can create an environment that is favorable for the overgrowth of Candida, the fungus responsible for candidiasis. In addition, smoking can also contribute to the development of candidiasis as it weakens the immune system and disrupts the natural balance of microorganisms in the mouth. Therefore, the combination of medication-induced dry mouth and a history of smoking increases the risk of candidiasis in Mr. B's case.