Oral Candidal Carriage Research Articles

Oral Candida carriage in smokers and tobacco users: A systematic review and meta-analysis of observational studies

ObjectiveTo synthesize evidence from observational studies that evaluated the association between smoking and smokeless tobacco with oral Candida carriage. MethodsFollowing the PRISMA guidelines, we searched through PubMed/MEDLINE, Web of Science, Embase, and Scopus without restrictions until April 2020 for studies that assessed this association. Following study retrieval and selection, relevant data were extracted, and the risk of bias was assessed by two independent authors using the Newcastle-Ottawa Scale. A fixed-effect meta-analysis was performed due to insignificant heterogeneity between studies. ResultsWe identified 14 studies that were eligible for inclusion in this review. The pooled odds ratio (OR; six studies) for Candida carriage among smokers and non-smokers was 2.15 (95% confidence interval [CI]: 1.47, 3.14; I2 = 8%; P < 0.0001). The OR (five studies) for Candida carriage among smokeless tobacco users and non-users was 1.77 (95% CI: 1.29, 2.44; I2 = 46%; P = 0.0004). ConclusionOur findings suggest a significant relationship between smoking/smokeless tobacco users and oral Candida carriage. However, observational studies cannot clarify whether the observed epidemiologic association is a causal effect or the result of some unmeasured confounding variables. Therefore, continued efforts to measure the association between smoking and oral Candida carriage are required.

Evaluation of Candidal Carriage Among Smokers and Non-Smokers

Objectives: To determine the Candidal carriage among smokers and non-smokers and with different intra-oral sites including examination of various biotypes of Candida. Study design and setting: Cross-sectional based study conducted at Dr. Ishrat ul Ebad Khan Institute of Oral Health Sciences and Dow International Dental College, Karachi, from May 2017 till April 2018. Methodology: Comprised 100 patients (50 smokers and 50 nonsmokers) between 20 and 60 years of age. The collection was performed through sterile cotton swab to evaluate oral Candidal carriage and the colonizing Candida species using Sabouraud Dextrose Agar (SDA) and API20C AUX (BIOMERIEUX). Data was analyzed Spss version 20. Results: A total of 100 participants (50 smokers and 50 non-smokers) were evaluated for candidal carriage. The common age group was 20-30 years in both the groups, without significant difference (p-value 0.79). Frequency of candidal carriage was comparable among smokers 14 (28.0%) to non-smokers 10 (20.0%), with a statistically insignificant p-value 0.35. Based on various biotypes among smokers and non-smokers, Candida albicans was 9(18%) and 7(14%), Candida glabrata was 4(8%) and 2(4%); and Candida tropicallis was 1(2%) each for both smokers and non smokers. Dorsum of tongue harbored all prevalent biotypes i.e. Candida albicans, Candida glabrata and Candida tropicalis as statistically significant among smokers (p-value 0.04). Conclusion: Candidal carriage was comparable among smokers and non-smokers. Candida albicans and Candida glabrata were the common biotypes predominantly among smokers

Candidal carriage in saliva and subgingival plaque among smokers and non-smokers with chronic periodontitis-a cross-sectional study.

Background and ObjectivesStudies of gum or periodontal disease have focused mainly on bacterial pathogens. However, information related to fungal species in the saliva and subgingival mileu is particularly lacking in smokers with periodontitis. This cross-sectional study compared the prevalence of various Candida species in saliva and subgingival plaque samples of smokers and non-smokers with periodontal disease.MethodologyStudy subjects were recruited into three group—Group 1: Smokers with chronic periodontitis (N = 30), Group 2: Non-smokers with chronic periodontitis (N = 30) and Group 3: Healthy controls (N = 30). Clinical parameters recorded included plaque index (PI), gingival index (GI), periodontal probing depth (PPD) and clinical attachment loss (CAL). Saliva and subgingival plaque samples were collected from subjects from the above groups. The collected samples were processed for isolation and identification of various Candida species using CHROMagar chromogenic media. Additionally, antifungal susceptibility tests were performed for the isolated Candida species in order to assess antifungal drug resistance to fluconazole and voriconazole.ResultsPrevalence of Candida species in saliva samples was quantified as 76.6% in Group 1, 73.3% in Group 2 and 36.6% in Group 3 and statistically significant differences were observed between groups 1 & 3. Prevalence of Candida species in subgingival plaque samples was quantified as 73.3% in Group 1, 66.6% in Group 2 and 60% in Group 3 and no statistically significant differences were observed between groups. Candida albicans was the most frequently isolated species followed by Candida krusei and Candida tropicalis. A positive correlation was observed for smoking exposure, pack years and Candida colonization. A marginally significant positive correlation was observed between Candida colonization and increasing pocket depth and attachment loss. Antifungal drug resistance was mainly observed for Candida krusei in both saliva and subgingival plaque samples.ConclusionBased on the results we can conclude that oral candidal carriage is significantly increased in smokers with periodontal disease. Mechanistic studies are needed to understand the importance of Candida species in periodontal disease.

Oral colonization by Candida species in orthodontic patients before, during and after treatment with fixed appliances: A prospective controlled trial.

BackgroundOrthodontic treatment with fixed appliances is associated with changes in oral microbiota, including increased Candida colonization. The Candida fungus can cause oral lesions and infections such as candidiasis and angular cheilitis, and is harmful to both the patient and the orthodontist. Poor hygiene facilitates the colonization of these microorganisms. The key aim was to quantify the colonization of C. albicans in patients prior to beginning orthodontic treatment, and during the treatment process. Material and MethodsA total of 124 patients (43 males and 80 females) with a mean age of 19.5 years, who required treatment with metal or aesthetic (ceramic) braces, were studied. Microbiological samples were taken from the oral cavity using the swab technique throughout the treatment and cultured on a Sabouraud Dextrose Agar plate and, if positive, cultured on a CHROMagar® Candida plate. ResultsIn contrast to other published studies, no statistically significant increase in C. albicans colonization was observed during the orthodontic treatment. The fixed appliances had no influence on the presence, absence or level of colonization by C. albicans and there were no significant differences between the different appliances studied. ConclusionsOur study showed that frequency of oral hygiene measures by study participants did not affect the rate of oral carriage of Candida in a statistically significant manner. This observation contrasted with published literature, which suggests that thorough brushing is important to prevent the build-up of Candida species. Key words:Orthodontics, fixed appliances, oral microflora, Candida albicans.

Impact of Cigarette Smoke Condensate on Adhesion-Related Traits and Hemolysin Production of Oral Candida dubliniensis Isolates.

Cigarette smoke is associated with higher oral Candida carriage and possible predisposition and increased susceptibility to oral candidal infection. Candida dubliniensis is associated with oral candidosis. Candidal adherence to buccal epithelial cells (BEC) and denture acrylic surfaces (DAS), germ tube (GT) formation, cell surface hydrophobicity (CSH) and hemolysin production are pathogenic traits of Candida. The impact of exposure to cigarette smoke on the aforementioned pathogenic attributes of oral C. dubliniensis has not been studied. Hence, the impact of cigarette smoke condensate (CSC) on adhesion to BEC and DAS, GT formation, CSH and hemolysin production of 20 oral C. dubliniensis isolates after exposure to CSC for 24, 48 and 72h was ascertained. After preparation of the CSC, using an in-house smoking device, the Candida isolates were exposed to the CSC for 24, 48 and 72h, by a previously described in vitro method. Thereafter, the adhesion to BEC and DAS, GT formation, CSH and hemolysin production of C. dubliniensis isolates was investigated by hitherto described in vitro assays. Exposure to CSC significantly increased the ability of C. dubliniensis oral isolates to adhere to BEC, DAS, GT formation, CSH and produce hemolysin following 24-h, 48-h and 72-h exposure periods to CSC (P < 0.001 for all attributes tested). Exposure of oral C. dubliniensis isolates to CSC may significantly promote in vitro adhesion traits and hemolysin production of these isolates, thereby augmenting its pathogenicity in vitro in the presence of cigarette smoke.

Oral health and Candida carriage in socioeconomically disadvantaged US pregnant women

BackgroundDespite the well-documented associations between poor maternal oral health and increased risk for adverse birth outcomes and dental caries in children after birth, prenatal oral health care is under-utilized, especially among the underserved population. In addition, oral Candida has recently been suggested as a potential culprit for children’s dental caries, with evident maternal contributions. Therefore, this study aimed to obtain epidemiological data on the oral health and oral Candida carriage in a cohort of underserved US pregnant women, and reveal factors associated with their oral Candida carriage.MethodsDemographic-medical-oral hygiene practice data were collected. Comprehensive oral examination was conducted. Caries status and plaque index were recorded. Oral samples (saliva, plaque and swab) were processed to identify Candida species and Streptococcus mutans by culturing-dependent and -independent methods. Multiple logistic regression analyses were used to identify factors associated with oral Candida carriage and caries severity.ResultsEighty-two socioeconomically disadvantaged women (48 pregnant and 34 non-pregnant) were enrolled. More pregnant women (79.1%) had > = 1 untreated decayed tooth when compared to their non-pregnant counterparts (47.1%) (p = 0.01). The average number of decayed teeth in pregnant and non-pregnant women was 3.9 and 3.1 (p > 0.05). Caries severity was positively associated with race (African American vs. white), plaque index and salivary Candida albicans level. C. albicans was the most predominant/abundant Candida strain, with cheek and tonsil as the most common colonized sites. The detection of C. albicans was 56%/56% in saliva and 40%/47% in plaque of the pregnant and non-pregnant groups, respectively. Study women’s oral Candida carriage is positively associated with hypertension [p = 0.03, odds ratio = 14.47(1.28, 163.51)], decayed teeth number [p = 0.04, odds ratio = 1.31 (1.01,1.69)] and salivary S. mutans level [p = 0.03, odds ratio = 4.80 (1.18–19.43)].ConclusionsSocioeconomically disadvantaged US women are in need of improved prenatal oral health, a large proportion of them have untreated decayed teeth and high carriage of oral Candida. Due to the observed significant association between the decayed teeth number and oral Candida carriage, providing oral health care during pregnancy (including limiting decayed teeth) will not only improve women’s oral health, but also present as a promising approach to reduce oral Candida carriage in women.

ORAL CANDIDA CARRIAGE INCLUDING SPECIATION, BIOFILM PRODUCTION AND CORRELATION WITH OCCURRENCE OF DENTAL CARIES IN STUDENT POPULATION

The study was done to establish oral carriage of Candida, speciation, assay biofilm production and correlate the oral Candida carriage with occurrence of dental caries in students. Swab samples from oral cavity were collected from 206 students and were cultured for yeasts. Isolated yeasts were identified and detected for Biofilm production. Results: Overall Candida carriage was found in 90 of the 206 students (75 with caries). The rate of Candida carriage in students with caries (64%) was significantly higher as compared to overall carriage in students (43.7%). A total of 123 Candida strains were isolated including C albicans (63%), C tropicalis (23 %), C. parapsilosis (6 %), C. glabrata (4 %) and C. krusei (4 %). Biofilm production by C albicans was less frequent (42. 85%) than that by non-C albicans (63.33 %). and was significantly higher in students with caries than from without caries. Conclusion: We found a significant risk of dental caries with oral Candida carriage rates in student population. Candida albicans was the most common species isolated. Biofilm production was implicated in Candida virulence and was more important for non- C.albicans than C.albicans strains to establish infections.

Oral candidal carriage correlates with CD4+ cell count but not with HIV and highly active antiretroviral therapy status.

The occurrence of oropharyngeal candidiasis (OPC) may be influenced by oral candidal carriage (OCC). Although OPC is strongly associated with low CD4+ cell count (400-700cells/mm3 ) and a lack of highly active antiretroviral therapy (HAART), the effect of these two parameters on OCC is debatable. We investigated the oral candidal carriage, species diversity, antifungal susceptibility and the association of OCC with CD4+ cell count and HAART. Oral candidal isolates from 120 HIV+ patients (60 receiving and 60 not receiving HAART) and 60 healthy controls were quantified, and their species determined using standard culture and biochemical methods, followed by antifungal susceptibility testing using the agar dilution method. The OCC was significantly higher in HIV+ patients; Candida albicans was the most frequently isolated species in both groups, followed by Candida tropicalis. Candidal density carriage correlated significantly with CD4+ cell count, but not with HIV and HAART status. Among the isolates from HIV+ patients, 35.4% showed reduced susceptibility to fluconazole. HIV status results in significantly elevated rates of OCC Calbicans remains the predominant pathogen, although other species are emerging rapidly. Resistance to fluconazole is on the rise, and more efficient treatment strategies need to be implemented.

Type 2 diabetes mellitus and oral Candida colonization: Analysis of risk factors in a Sri Lankan cohort

Aims: Oral candidiasis is a major oral manifestation of uncontrolled diabetes mellitus, and a number of cofactors are associated with the pathogenesis of this infection. Here, we describe the prevalence of oral Candida in a Sri Lankan cohort of type 2 diabetes mellitus and risk factors that predispose them to this common fungal infection.Methods: A case–control study was conducted in 250 diabetics with type 2 diabetes and 81 nondiabetic controls. Clinical and demographic data were collected using an interviewer administered questionnaire, and patient records. Oral rinse samples were collected to determine the candidal carriage, and the resultant yeast growth was quantified and speciated using multiplex-PCR and phenotypic analyses. Chi-square test (χ2 test) and Fisher exact test were used for the determination of the significant relationships between risk factors and oral candidiasis.Results: The oral prevalence of Candida species among both groups was similar (81%) although a significantly higher proportion of diabetics (32.8%) yielded >2000 CFU/mL of yeasts compared with only 12.3% of the healthy controls (p < .05). Significant associations were noted between oral candidal carriage amongst diabetics, and (i) denture wearing, (ii) female gender and (iii) cigarette smoking (all, p < .05). Amongst both groups, C.albicans was the most common Candida species isolated followed by C. parapsilosis, C. tropicalis and C. glabrata.Conclusions: The oral infestation of Candida in our Sri Lankan cohort of diabetics is significantly higher than their healthy counterparts, and co-carriage of multiple yeast species is a common finding in the study population. As there are no previous such reports of the latter phenomenon particularly from the Asian region it is noteworthy, mainly in view of the recent data on the emergence of drug-resistant yeast species the world over.

Oral Candidal carriage and associated risk indicators among adults in Sakaka, Saudi Arabia

BackgroundCandida is a ubiquitous organism in nature which inhabits the oral cavity as part of the normal microbial flora. The oral carriage of Candida is perpetuated by several predisposing factors.MethodsThis cross-sectional study was designed to investigate the carriage rate of Candida among 104 voluntary adults at the college of medicine - Jouf University. The concentrated oral rinse technique using Sabouraud Dextrose agar medium supplemented with 0.05% Chloramphenicol was used to isolate Candida. The relative factors affecting the colonization of Candida and the concentration of each type were also determined.ResultsCandida species were isolated from the oral cavity of 45 (43.4%) subjects. Of these 55.6% were identifies as C. albicans as determined by the Vitek 2 compact system. Other Candida species were represented by C. glabrata (11.1%), C. krusei (11.1%), C. dubliniensis (8.9%), C. parapsilosis (6.7%), C. tropicalis (4.4%), and C. famata (2.2%). Subjects with very poor plaque status, severe gingivitis and diabetes had significantly (P = 0.001) high concentration of Candida spp.ConclusionPlague, severe gingivitis, and diabetes were found to be significantly associated with higher Candida colonization.

Oral Candidal Carriage Among Patients with Oral Squamous Cell Carcinoma: A Case-Control Study

Introduction: Etiology of oral squamous cell carcinoma is multifaceted. The established risk factors include tobacco, alcohol, and immunodeficiency states with infections gaining an importance. Candida species has been implicated in oral squamous cell carcinoma (OSCC). The present study aims at determining the prevalence of Candida species in the saliva of patients with OSCC and healthy cohorts. Materials and Methods: Unstimulated saliva was collected from patients with OSCC (n = 90) and age and sex matched healthy subjects (n = 170). The samples were inoculated onto sabouraud dextrose agar and incubated for a week. The isolates were enumerated using a colony counter. The isolates were identified using standard phenotypic methods. The significance of oral candidal carriage was calculated using chi-square test. Odds and risk ratio was calculated using pearson’s chi-square test. Result: Oral candidal carriage were present in 70% of patients with oscc, while healthy cohorts had a prevalence of 20%. The oral candidal carriage among OSCC patients in comparison to healthy cohorts was highly significant. (p = 0.0001). C. albicans and non-albicans Candida were equally distributed in the OSCC group. Colony-forming units were high among patients with oscc. Significant odds and risk ratio was observed for the prevalence of Candida species among OSCC (p

Oral Candidal Carriage Among Patients with Oral Potential Malignant Disorders: A Case-Control Study

Objective: To determine the prevalence of Candida species in the saliva of patients with clinically suspected oral potentially malignant disorders (OPMD) and healthy cohorts. Material and Methods: Unstimulated saliva was collected from patients with OPMD (n=100) and age and sex matched healthy subjects (n=170). The samples were inoculated onto Sabouraud Dextrose Agar and incubated for a week. The colonies of the isolates were enumerated using a colony counter. The isolates were identified using standard phenotypic methods. The significance of oral candidal carriage was calculated using Independent T test. Odds and Risk ratio was calculated using Pearson’s Chi-square test. Results: Oral candida carriage was present in 51% of patients with OPMD while healthy cohorts had a prevalence of 20.6%. A good statistical significance was observed for the prevalence of oral candidal carriage for patients with OPMD in comparison to healthy cohorts (p=0.013). Significant Odds and risk ratio was observed for the prevalence of Candida species among OPMD. Majority of the isolates in both groups were C. albicans . Colony forming units were high among patients with OPMD. Conclusion: A significant association of oral candidal carriage to oral potentially malignant disorders in comparison to healthy cohorts was observed. Candidal species may be potent risk factor for transition of OPMD to oral Squamous Cell Carcinoma.

Correlation of Blood Glucose Levels, Salivary Glucose Levels and Oral Colony Forming Units of Candida albicans in Type 2 Diabetes Mellitus Patients

The study aims to correlate salivary glucose, blood glucose levels and oral colony forming units of Candida albicans and to evaluate whether saliva can be used as noninvasive means to measure glycemic status in type II diabetics without the need for the invasive procedure. The study included 100 type II diabetic patients (group I) of both genders with age 40 years and above and100 healthy patients (group II), age and sex matched with the study group. Group I includes uncontrolled and controlled diabetics as groups IA and IB, respectively. Salivary glucose measurement was done using the enzymatic colorimetric method and blood glucose levels measured by doing venepuncture and centrifuged. The oral candidal carriage was calculated by incubation in Sabouraud's dextrose agar supplemented with chloramphenicol and incubated aerobically for 48 hours. To compare the mean values Z test was applied. To determine the relationship between two variables Pearson's correlation coefficient was used. The salivary glucose levels showed a significant correlation with blood glucose levels. The salivary candida carriage was higher in uncontrolled as compared to controlled diabetics and healthy individuals. Positive correlation was obtained between salivary glucose and blood glucose in diabetics and candidal carriage has a positive correlation with blood glucose levels. This salivary glucose and blood glucose levels correlation confirms its use to find glycemic status in diabetic patients. The positive correlation of salivary glucose with blood glucose shows that it can be utilized as a noninvasive tool for monitoring glycemic status in diabetic patients.

OralCandidacarriage among cigarette‐ and waterpipe‐smokers, and electronic cigarette users

The aim of this cross-sectional study was to compare oral Candida carriage among cigarette- and waterpipe-smokers, electronic cigarette (E-Cig) users, and never-smokers. Demographic data and information regarding smoking and vaping were collected using a questionnaire. Number of missing teeth and unstimulated whole salivary flow rate (UWSFR) were recorded. Oral Candida samples were collected and identified using concentrated oral rinse culture technique and PCR, respectively. Level of significance was set at p<0.05. Thirty-four cigarette-smokers (Group-1), 33 waterpipe-smokers (Group-2), 30 E-Cig users (Group-3), and 32 never-smokers (Group-4) were included. All were male participants with comparable mean ages. In groups 1, 2, 3, and 4, oral Candida carriage rate was 100%, 100%, 83.3% and 50%, respectively. The most commonly isolated oral yeast species in all groups was C.albicans. C.albicans carriage was significantly higher in groups 1 (p<0.05), 2 (p<0.05), and 3 (p<0.05) than Group-4. Data stratification for age, missing teeth, and UWSFR showed no significant difference in oral yeasts carriage in groups 1, 2, and 3. Oral C.albicans carriage was significantly higher among cigarette- and waterpipe-smokers and E-Cig users than never-smokers. No significant differences were identified among groups in the oral carriage of other Candida species.

Oral Candida colonization in patients with chronic periodontitis. Is there any relationship?

BackgroundCandida can be implicated in the pathology of chronic periodontitis. AimsTo analyze the oral Candida carriage in patients suffering from chronic periodontitis (CP) and its correlation with the severity of this condition. MethodsMicrobiological samples were taken from 155 patients using the oral rinse (OR) technique and by using paper points in the periodontal pockets (GPP). These patients were divided into 3 groups: 89 patients without CP (control), 47 with moderate CP, and 19 with severe CP. Samples were cultured in a Candida chromogenic agar for Candida. Species were identified by microbiological and molecular methods. ResultsCandida was isolated in the OR of 45 (50.6%), 21 (44.7%), and 11 (57.9%) patients, respectively, and in the GPP of 32 (36%), 14 (29.2%), and 10 (42.6%) patients from the control, moderate CP and severe CP groups, respectively. Candida was isolated more frequently and in a greater burden in OR than in GPP (p<0.01). Candida albicans was the most prevalent species. GPP of patients with CP had poor fungal biodiversity (p<0.01). ConclusionsColonization by Candida was present in the samples of patients without CP, and with both moderate and severe CP. Nonetheless, patients with severe CP had a higher rate of Candida colonization, especially by C. albicans.

Candida species in patients with oral dysesthesia: A comparison of carriage among oral disease states

Oral dysesthesia (burning mouth syndrome) is characterized by a burning-like sensation of the oral mucosa. The etiology of this disorder is still unknown, however, associations with oral fungal carriage have been proposed and applied clinically. The aim of the this study was to compare oral Candida carriage in patients with oral dysesthesia with Candida carriage in patients with other commonly diagnosed oral diseases to clarify the relationship between Candida and oral dysesthesia. In total, 441 patients in total including 79 patients diagnosed with oral dysesthesia were included in this study. A retrospective analysis of mycological investigations undertaken in patients with clinically diagnosed oral dysesthesia compared with other oral conditions was undertaken. Oral carriage of Candida was found in 63.3% (50 of 79) of patients with oral dysesthesia. The frequency of carriage and oral load of Candida were not significantly increased in patients with oral dysesthesia relative to the other conditions assessed. Patients with clinical signs of fungal infection or xerostomia presented with increased carriage of Candida. There is no association between oral dysesthesia and the presence or load of oral Candida.

Association of Oral Candidal Carriage, Candidiasis, and Periodontal Disease with the Degree of Glycemic Control in Type I and Type II Diabetes Mellitus

Association of Oral Candidal Carriage, Candidiasis, and Periodontal Disease with the Degree of Glycemic Control in Type I and Type II Diabetes Mellitus

Salivary metals, age, and gender correlate with cultivable oral Candida carriage levels

ABSTRACT Background: Little is known about the normal range of metal levels in unstimulated saliva, nor whether these might impact Candida carriage in healthy individuals. Both are important in determining which populations are at risk for candidiasis, as the availability of metal ions can influence the growth and pathogenesis of Candida albicans. Objective: We quantified salivary metals of healthy individuals to determine the correlation with C. albicans oral colonization. Design: Unstimulated whole saliva was collected from healthy adults and plated to determine fungal carriage, and metal content was measured using ICP-mass spectrometry (ICP-MS). Results: Zinc was most abundant, followed by iron, copper, manganese, and nickel. Cultivable oral Candida carriage was found in 48% of people. Total protein levels did not differ in salivas from donors with or without carriage. However, innate fungicidal activity was increased in donors with carriage; correlations between levels of several metals were stronger in salivas with fungal carriage, indicating a shift in the oral environment. Concentrations of copper and manganese, as well as age and gender, were significantly predictive of carriage levels in a multiple regression model. Conclusions: Salivary copper and manganese content along with age and gender could be used as a predictive metric for individuals that are more susceptible to Candida overgrowth.

Improving practice guidelines for the treatment of denture-related erythematous stomatitis: a study protocol for a randomized controlled trial

BackgroundDenture-related erythematous stomatitis (DES) is a chronic biofilm-mediated disease, affecting one in every three complete denture wearers. Antifungals are the treatment most commonly prescribed by oral health professionals, based on the belief that colonization by Candida spp. is the main cause of DES. However, high recurrence rates and adverse effects are commonly observed, prompting the need for practice guidelines regarding treatment. Results from our pilot study demonstrate that palatal brushing can reduce the palatal inflammation and potentially associated Candida carriage without any need for antifungal therapy. The objective of this study is to validate these pilot results by means of a randomized controlled trial (RCT) and provide a practice guideline for clinicians.Methods/designA pragmatic, two-parallel-arm, multicenter RCT will be conducted in Canada, Brazil, and Chile. Fifty-two adult complete denture wearers presenting with moderate to severe DES will be allocated randomly to two groups: the Intervention arm will consist of palatal brushing and standard oral and denture hygiene measures, while the Control arm will include only standard oral and denture hygiene measures. The study outcome will be the oral Candida carriage. Participants will be assessed at baseline, and at 3 and 6 months post intervention. Descriptive, bivariate, and mixed models with repeated measures will be performed following the intention-to-treat principle.DiscussionThis pragmatic RCT will serve to provide a clinical practice guideline regarding the use of preventive measures in the treatment of biofilm-mediated oral diseases. Moreover, it will have a great impact on reducing the harm of antifungal overtreatment on patients suffering from DES.Trial registrationClinicalTrials.gov, NCT02686632. Registered on 15 February 2016.

Oral candidal speciation, virulence and antifungal susceptibility in type 2 diabetes mellitus.

To determine the oral candidal carriage (OCC), activity of virulent factors and fluconazole susceptibility in subjects with type 2 diabetes mellitus (T2DM) and investigate their association with HbA1c measurements. A cross sectional study was conducted on 100 diabetics and 100 healthy volunteers. The virulence was assessed by measuring the phospholipase activity and proteolysis index. Fluconazole susceptibility was performed using the gradient diffusion method. The OCC, virulence factors and antifungal susceptibility were correlated with patients' HbA1c measurements. The OCC and candidal density carriage was significantly higher in diabetics. Candida albicans (C. albicans) was the most frequently isolated species followed by Candida tropicalis (C. tropicalis). Relatively uncommon species, Candida lusitaniae (C. lusitaniae) and Candida lipolytica (C. lipolytica) were isolated from the diabetics. Prevalence of virulence factor, proteinase, was greater in diabetic group (p<0.05). Reduced fluconazole susceptibility was noted among the isolates from diabetics; however it was not statistically significant (p=0.593). Except one, all the susceptible-dose dependent and resistant isolates were Candida no-albicans (C. non-albicans). C. albicans remains the predominant pathogen in diabetics, although other species are on the rise. Compared to control group, the isolated species from T2DM group had higher proteinase activity. Resistance to fluconazole was considerably greater among the C. non-albicans isolates from T2DM group. These findings warrant effective treatment modalities to reduce the occurrence of oropharyngeal candidiasis.