Page 15 - IDX-DecisionTree-Booklet-Digital

Step 2b

Targeted Therapeutic Management
(Medium or High Levels)

Candida albicans:
• Initiate topical antifungal therapy (nystatin suspension 5 mL
QID × 7–14 days or clotrimazole troches).
• For extensive or persistent cases, consider systemic fluconazole
(100 mg QD × 7–14 days).
• Clean and disinfect dentures or appliances daily; manage
xerostomia and carbohydrate intake.

Pseudomonas aeruginosa:

• Perform mechanical debridement with antiseptic irrigation
(chlorine dioxide, povidone-iodine, or sodium hypochlorite).
• Focus on peri-implant or ulcerative sites.

• Reinforce hygiene and evaluate for systemic risks
(immunocompromise, chronic antibiotic use).
• Systemic antibiotic therapy only if clinically warranted in
consultation with the physician.

Streptococcus mutans:

• Apply professional fluoride varnish and prescribe
high-fluoride toothpaste (1,000–5,000 ppm).

• Recommend xylitol gum/lozenges and dietary
counseling to limit cariogenic exposure.
• Use pH-neutralizing or remineralizing agents
(calcium phosphate or hydroxyapatite pastes).
• Allow 4–6 weeks of healing and biofilm
stabilization before re-evaluation.