Efficacy of antimicrobial photodynamic therapy compared to nystatin therapy in reducing Candida colony count in patients with Candida-associated denture stomatitis: a systematic review and meta-analysis.

Parsa Firoozi,Reza Fekrazad,Nima Farshidfar

doi:10.1038/s41432-021-0208-9

Abstract

Purpose This meta-analysis assessed the efficacy of antimicrobial photodynamic therapy (aPDT) compared to conventional nystatin therapy (NYT) in reducing Candida colony count in patients with Candida-associated denture stomatitis (CADS) and critically appraised the available literature.Methods This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) updated guidelines. A literature search was performed in four electronic databases to identify relevant articles up to 15 August 2021. Randomised controlled trials (RCTs) that assessed the efficacy of aPDT compared to NYT in reducing Candida colony count in patients with CADS were investigated. The weighted mean difference (MD) and 95% confidence interval were calculated. The I2 statistic was used to determine heterogeneity at the level of α = 0.10. The Cochrane risk of bias (RoB 2) tool was used to assess the risk of bias. Certainty of the evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) ranking system.Results Only three eligible RCTs with 141 participants were included in this systematic review and meta-analysis. Based on the pooled results, NYT compared to aPDT generally performed better in reducing Candida colony count (Log10 CFU/mL) in patients' palate and patients' denture. The included studies had a moderate risk of bias and the certainty of the evidence was low.Conclusion Although still inconclusive, based on the current evidence, aPDT may be effective in reducing Candida colony count and treating CADS. Nonetheless, it does not appear to be more effective than conventional NYT in this regard. According to the limited number of included studies, more well-designed RCTs with larger sample sizes and standardised methodology should be conducted to validate this conclusion.

Highlights

Candida-associated denture stomatitis (CADS) is a fungal infection that presents in up to 70 percent of the edentulous denture wearers that leads to inflammation of the palatal mucosa under the denture 1
Mima et al compared the efficacies of antimicrobial photodynamic therapy (aPDT) to nystatin therapy (NYT) (n = 20 each) for the treatment of CADS
No statistically significant difference was shown between the Candida colony count values obtained from the aPDT and the NYT groups in all time intervals

Summary

Introduction

Candida-associated denture stomatitis (CADS) is a fungal infection that presents in up to 70 percent of the edentulous denture wearers that leads to inflammation of the palatal mucosa under the denture 1. Studies have raised several etiological factors for CADS, including long-term denture use, poor denture hygiene, immune system disorders, and hyposalivation 2. For the treatment of CADS, denture hygiene should be strengthened, proper fitness of the denture should be evaluated, and the age of denture should be taken into account 6. Patients can prevent CADS by using chlorhexidine mouthwashes, soaking denture in water, disinfecting denture with appropriate disinfectants, and removing denture during sleep. On the other hand, can prevent CADS by reviewing their patients’ dentures and replacing/relining the dentures if required 7

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Discussion

Conclusion