Oral Candidiasis

Subgingival Yeasts Species Amongst Smokers and Nonsmokers With Peri-implantitis

BACKGROUND

There is a dearth of studies that have assessed yeast species in the subgingival biofilm (SB) samples collected from smokers and nonsmokers with peri-implantitis. This study assesses peri-implant clinical and radiographic profiles and yeasts species in the subgingival SB of cigarette smokers and nonsmokers with peri-implantitis.

METHODS

Participants were divided into 3 groups: group 1, cigarette smokers with peri-implantitis; group 2, nonsmokers with peri-implantitis; and group 3, nonsmokers without peri-implantitis. Information on smoking pack-years and patient demographics was collected. Implant-related parameters were retrieved from health care records. Peri-implant modified plaque and gingival indices (mPI and mGI, respectively), probing depth (PD), and crestal bone loss (CBL) were recorded. The SB samples were collected, subgingival yeasts colonisation was recorded, and yeasts species were identified. P < .05 was considered statistically significant.

RESULTS

Respectively, 22, 22, and 24 individuals were included in groups 1, 2, and 3. In group 1, cigarette smokers had a smoking history of 29.7 ± 7.9 pack-years. The PD, mPI, and mesial and distal CBL were higher in groups 1 (P < .01) and 2 (P < .01) than in group 3. The mGI was higher in group 2 (P < .01) than in groups 1 and 3. The total number of implants in groups 1, 2, and 3 were 22, 22, and 24, respectively. In group 3, implants were in function for a longer duration (12.2 ± 2.3 years; P < .05) than in groups 1 (5.6 ± 1.9 years) and 2 (5.1 ± 0.7 years). Yeasts levels in CFU/mL were higher in group 1 than in groups 2 (P < .05) and 3 (P < .05); they were also higher in group 2 than in group 3 (P < .05). Candida albicans was the most isolated yeasts species, followed by Candida tropicalis, in all groups.

CONCLUSIONS

Cigarette smokers and nonsmokers present similar peri-implant clinicoradiographic profiles, and oral yeasts (predominantly C albicans) seem to play a role in the progression of peri-implant disease in these individuals.

Peri-implant clinical profile and subgingival yeasts carriage among cigarette-smokers with peri-implant mucositis

BACKGROUND

The present observational clinical investigation is based on the hypothesis that subgingival yeast carriage (SYC) is higher in cigarette-smokers with peri-implant mucositis (PM) than non-smokers with and without PM.

OBJECTIVE

The aim was to assess peri-implant clinical profile and SYC among cigarette-smokers with PM.

METHODOLOGY

Participants were divided into four groups: Group-1-Cigarette-smokers with PM; Group-2-Cigarette-smokers without PM; Group-3-Non-smokers with PM; and Group-4-Non-smokers without PM. Information on duration and daily frequency of cigarette smoking (pack years), age, gender, familial history of smoking and most recent visit to a dentist and/or dental hygienist was collected. The following information was retrieved from healthcare records: implant dimensions, implant insertion torque, depth of insertion (credidastal or subcrestal), implant abutment connection, jaw location, implant surface characteristic, and mode of implant prosthesis retention. Peri-implant modified plaque and gingival indices (mPI and mGI), probing depth (PD) and crestal bone loss were recorded. Subgingival biofilm samples were collected, and SYC was recorded in colony forming units per milliliter (CFU/ml). P < 0.05 were considered statistically significant.

RESULTS

Eighty male individuals (20, 19, 21 and 20 individuals were included in groups 1, 2, 3 and 4, respectively) were included. The mPI was higher in Group-1 than groups 2 (P < 0.05) and 4 (P < 0.05). The mPI was higher in Group-3 than groups 2 (P < 0.05) and 4 (P < 0.05). The mGI was higher in Group-3 than groups 1 (P < 0.05), 2 (P < 0.05) and 4 (P < 0.05). The PD was higher in Group-1 than groups 2 (P < 0.05) and 4 (P < 0.05). The PD was higher in Group-3 than Groups 2 (P < 0.05) and 4 (P < 0.05). The CFU/ml were higher in Group-1 than groups 2 (P < 0.05) and 4 (P < 0.05). The CFU/ml were higher in Group-3 than groups 2 (P < 0.05) and 4 (P < 0.05).

CONCLUSION

Peri-implant soft-tissue inflammatory parameters are worse and SYC is higher in moderate smokers than light smokers with PM and non-smokers without PM.

Probiotics Reduce the Prevalence of Oral Candida in the Elderly—a Randomized Controlled Trial

Overgrowth of oral yeast is a common problem among the elderly. Probiotic bacteria are known to inhibit the growth of pathogenic microbes. We tested the hypothesis that cheese containing probiotic bacteria can reduce the prevalence of oral Candida. During this 16-week, randomized, double-blind, placebo-controlled study, 276 elderly people consumed daily 50 g of either probiotic (n = 136) or control cheese (n = 140). The primary outcome measure was the prevalence of a high salivary yeast count (≥ 104 cfu/mL) analyzed by the Dentocult® method. The prevalence decreased in the probiotic group from 30% to 21% (32% reduction), and increased in the control group from 28% to 34%. Probiotic intervention reduced the risk of high yeast counts by 75% (OR = 0.25, 95%CI 0.10–0.65, p = 0.004), and the risk of hyposalivation by 56% (OR = 0.44, 95%CI 0.19–1.01, p = 0.05). Thus, probiotic bacteria can be effective in controlling oral Candida and hyposalivation in the elderly.

Distribution of Candida in the oral cavity and its differentiation based on the internally transcribed spacer (ITS) regions of rDNA

This study aimed to determine the distribution of Candida species in the oral cavity and differentiate the species based on PCR amplification, including HinfI and MspI digestion, in order to assess the effectiveness of using the rDNA region for species identification. Samples from saliva as well as palate, tongue and cheek mucosa surfaces were collected from 45 individuals, consisting of three groups: periodontal disease patients; denture-wearers; and the control group. The samples were serially diluted, spread on BHI and YPD agar plates and scored for colony-forming units (CFUs). Fifteen random candidal colonies were isolated and subjected to genomic DNA extraction, based on glass beads disruption. Four primers were used to amplify regions in the rDNA, and the ITSI-5.8S-ITSII PCR product was digested by HinfI and MspI restriction enzymes. The microbial loads on all sites of the denture-wearers were found to be significantly higher than control, while in the periodontal disease group only the microbial loads on the tongue were significantly higher than control. Meanwhile, there was no significant difference at other sites. The restriction fragment lengths of the clinical samples were compared to those of seven control species, allowing the differentiation of all seven species and the identification of 14 species from the clinical samples. The MspI restriction digest was not able to distinguish between C. albicans and C. dubliniensis, whereas the HinfI digest could not distinguish between C. tropicalis and C. parapsilosis. It was concluded that PCR-RFLP of the candidal rDNA region has potential for species identification. This study demonstrates the potential use of candidal rDNA as a means for identifying Candida species, based on genotype. The results also indicate the possibility of constructing genetic probes that target specific restriction fragments in the ITSI-5.8S-ITSII region, enabling swift and precise identification of Candida species.

Oral bacteria and yeasts in relationship to oral ulcerations in hematopoietic stem cell transplant recipients

BACKGROUND

Oral mucositis is a serious and debilitating side effect of conditioning regimens for hematopoietic stem cell transplant (HSCT). Through HSCT, the homeostasis in the oral cavity is disrupted. The contribution of the oral microflora to mucositis remains to be clarified. The aim of our study was to investigate the relationship between yeasts, bacteria associated with periodontitis, and oral ulcerations in HSCT recipients.

METHODS

This prospective observational study included 49 adult HSCT recipients. Twice weekly, oral ulcerations were scored, and oral rinsing samples were obtained. Samples were evaluated for the total bacterial load; the Gram-negative bacteria: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Parvimonas micra, Fusobacterium nucleatum, Tannerella forsythia, and Treponema denticola; and the yeasts: Candida albicans, Candida glabrata, Candida kefyr, Candida krusei, Candida parapsilosis, and Candida tropicalis using real-time polymerase chain reaction with specific primers and probes. Explanatory variables for oral ulcerations were calculated using the multilevel generalized estimated equations (GEE) technique.

RESULTS

None of the samples was positive for A. actinomycetemcomitans, while F. nucleatum was found most often (66 % of samples). C. albicans was the most isolated yeast (88 % of samples), whereas C. parapsilosis was found in only 8 % of the samples. Multivariate GEE analyses identified P. gingivalis, P. micra, T. denticola, F. nucleatum, C. glabrata, and C. kefyr as significant explanatory variables of oral ulcerations.

CONCLUSIONS

Our data indicate that P. gingivalis in particular, but also P. micra, T. denticola, F. nucleatum, C. glabrata, and C. kefyr may play a role in ulcerative oral mucositis in patients undergoing HSCT.

Comparison of the efficacy and safety of miconazole 50-mg mucoadhesive buccal tablets with miconazole 500-mg gel in the treatment of oropharyngeal candidiasis: a prospective, randomized, single-blind, multicenter, comparative, phase III trial in patients treated with radiotherapy for head and neck cancer

BACKGROUND

Topical antifungal treatments are recommended but rarely used as first-line therapy for oropharyngeal candidiasis (OPC) in patients with cancer. Miconazole Lauriad 50-mg mucoadhesive buccal tablet (MBT) Loramyc reportedly delivered rapid and prolonged, effective concentrations of miconazole in the mouth. The objective of the current study was to compare MBT with miconazole 500-mg oral gel (MOG) in patients with head and neck cancer.

METHODS

Two hundred eighty-two patients with head and neck cancer received a 14-day treatment of either single-dose MBT or MOG administered in 4 divided doses. The primary endpoint was clinical success at Day 14, and secondary endpoints included clinical success at Day 7, clinical cure, improvement in clinical symptoms, mycologic cure, recurrence rate, and safety.

RESULTS

The success rate was statistically not inferior (P < .0001) in the MBT population to the rate observed in the MOG group (56% vs 49%, respectively; P < .0001). After adjustment for the extent of lesions and salivary secretions, a trend toward superiority was observed in favor of MBT (P = .13), particularly among patients with multiple lesions (P = .013). Results for secondary endpoints were comparable to those observed for the primary endpoint. Compliance with MBT was excellent, and >80% of patients completed treatment. Both treatments were safe.

CONCLUSIONS

The success rate of MBT Loramyc was significantly not inferior to that of MOG in the treatment of cancer patients with OPC; and, after adjusting for prognostic variables, it was more effective than MOG. MBT was well tolerated and, thus, may be recommended as first-line treatment in cancer patients who have OPC as an alternative to systemic antifungal agents. Society.

Oral candidiasis and nutritional deficiencies in elderly hospitalised patients

The prevalence of oral candidiasis and its association with malnutrition in terms of protein–energy malnutrition and mineral and vitamin depletion were evaluated in ninety-seven hospitalised older adults aged 82·1 (SD 8·6) years. Patients underwent a complete oral examination with microbiological investigation on admission to our geriatric rehabilitation unit. Patients were assessed nutritionally by evaluation of dietary intake and measurement of anthropometric variables, serum nutritional proteins, ferritin, Zn, folate, vitamins B12 and C. The prevalence of oral candidiasis was 37% (n 36); the proportion of patients with BMI <20 kg/m2 was 32% (n 31). The nutritional status of the population was studied by comparing two groups defined according to the absence (group I; n 61) or presence (group II; n 36) of oral candidiasis. The two groups did not differ on the basis of BMI and mid-arm circumference. However, group II had a smaller leg circumference, lower daily energy and protein intakes, lower albumin and transthyretin levels. Patients successfully treated with fluconazole increased their intake on day 30. The proportion of patients with hypozincaemia (<12·5 μmol/l) and vitamin C deficiency (<0·7 mg/l) was higher in group II. Treatment with antibiotics, poor oral hygiene, denture wearing, and vitamin C deficiency appeared as the most significant independent risk factors associated with oral candidiasis. The present findings show that oral candidiasis appears to be related to malnutrition and results in mucosal lesions that have a negative impact on energy intake, which may subsequently worsen nutritional status.

Risk factors associated with denture stomatitis in the United States

BACKGROUND

This study reports denture stomatitis (DS) prevalence from a large USA probability sample from the National Health and Nutrition Examination Survey, 1988-1994 (NHANES III).

METHODS

Oral examinations were performed on 3450 individuals 18-90+ years of age (mean: 59.2; SD: 0.50 years), 57.7% male and 42.3% female. Multivariable logistic regression models were fitted for DS using sociodemographic, denture quality, blood analytes, alcohol and tobacco use, history of diabetes, and current antibiotic use as covariates. Odds ratios (OR), adjusted for other covariates in each model (AOR) are presented.

RESULTS

Of 3450 removable denture wearers, 963 (27.9%) had DS. DS prevalence was associated with wearing maxillary (AOR: 6.20) and mandibular (AOR: 5.21) complete dentures continuously; smoking >/=15 cigarettes day (maxillary complete: AOR = 1.31; mandibular complete: AOR = 1.50; maxillary partial: AOR = 2.04); vitamin A deficiency (mandibular complete: AOR = 5.97; maxillary partial: AOR = 5.67; mandibular partial: AOR = 24.42). Maxillary dentures with inadequate relines had approximately half the OR of DS than those with adequate relines (maxillary complete: AOR = 0.42; mandibular complete: AOR = 0.50).

CONCLUSIONS

Denture stomatitis prevalence is associated with the amount of tissue covered by dentures, low vitamin A levels, cigarette smoking, and constant denture wear.

Fluconazole mouthrinses for oral candidiasis in postirradiation, transplant, and other patients

OBJECTIVE

Oral candidiasis is associated with multiple local and systemic factors. Morbidity and deaths, in high-risk patients, may be prevented by recognition and adequate management. Fluconazole is a systemic antifungal medication that demonstrated clinical advantages in rinsing before swallowing. The purpose of the present study was to evaluate the clinical efficacy of fluconazole aqueous mouthrinses to treat oral candidiasis.

METHODS

Ten women and 9 men diagnosed with oral candidiasis used fluconazole (2 mg/mL) aqueous solution 3 times per day as a rinse and-spit topical treatment. The outcome was assessed after 1 week of treatment.

RESULTS

Complete symptomatic and clinical relief was noted in 94% of the patients, and a mycologic cure was documented in all but 1 patient. No side effects were reported. Oral rinses with fluconazole suspension may be useful to manage patients with dry mouth or those who have difficulties in swallowing caused by oral candidiasis.

CONCLUSIONS

Further double-blind studies are needed to establish the optimal treatment regimen and the usefulness of fluconazole mouthrinses in patients with different risk factors for infection.

A comparative study of the efficacy and safety of fluconazole oral suspension and amphotericin B oral suspension in cancer patients with mucositis

This randomized study compared the efficacy and safety of fluconazole suspension with that of amphotericin B suspension in patients with head and neck cancer who were suffering from candidiasis during cancer treatment with radiotherapy and/or chemotherapy. A total of 123 evaluable patients received 50 mg fluconazole once daily and 120 evaluable patients received 0.5 g amphotericin B thrice daily for 7-14 days depending on clinical response. A positive culture result was obtained in 121 of 264 (46%) patients; Candida albicans was most common. At the end of treatment, fluconazole and amphotericin B were equivalent (CI(90) of -10.7 to +14.9) in terms of clinical cure and improvement, but the rate of mycologic cure was higher for fluconazole (48%) than amphotericin B (35%). The incidence of adverse events was 39% for fluconazole and 44% for amphotericin B. Fluconazole suspension appeared effective and safe.

The influence of aging on oral health and consequences for taste and smell

Oral diseases that are commonly seen in older adults can impair chemosensory function. Many stomatological conditions are preventable and treatable, yet unmanaged, they can cause significant morbidity and a diminished quality of life. Importantly, many oral diseases are not necessarily an inevitable consequence of growing old, and are frequently attributed to systemic diseases and their treatment. Although gustation may undergo mild age-related decrements, olfaction declines dramatically with greater age. The oral-facial region is intimately involved in the sensations of taste and smell, and diseases affecting this region in an older person could adversely affect an already compromised chemosensory system. Older adults with impaired taste and/or smell should be thoroughly evaluated for oral and pharyngeal diseases. It is reasonable to expect that a healthy adult can grow older with good oral health and function, and can continue to experience the hedonic pleasures of taste and smell associated with eating and drinking.

Human salivary histatins: promising anti-fungal therapeutic agents

Histatins constitute a group of small, cationic multifunctional proteins present in the saliva of human and some non-human primates. The most significant function of histatins may be their anti-fungal activity against Candida albicans and Cryptococcus neoformans. Histatins have been extensively studied at both the protein and gene levels. The structure-function relationship of histatins with respect to their candidacidal activity has also been studied by means of recombinant histatin variants, as well as by chemically synthesized histatin fragments. The mechanism of histatins' action on Candida albicans is not clear, but it appears to be different from that of azole-based anti-fungal drugs which interrupt ergosterol synthesis. During the past 20 years, fungal infections have become more prevalent as a result of the emergence of AIDS, as well as, paradoxically, modern medical advances. The toxicity of current anti-fungal medicine, the emergence of drug-resistant strains, and the availability of only a few types of anti-fungal agents are the major disadvantages of current anti-fungal therapy. Therefore, the importance of the search for new, broad-spectrum anti-fungals with little or no toxicity cannot be overemphasized. The following properties make histatins promising anti-fungal therapeutic agents: (1) They have little or no toxicity; (2) they possess high cidal activities against azole-resistant fungal species and most of the fungal species tested; and (3) their candidacidal activity is similar to that of azole-based antifungals. Current research efforts focus on the development of improved histatins with enhanced cidal activity and stability, and of suitable and effective histatin delivery systems. These and other approaches may help to outpace the growing list of drug-resistant and opportunistic fungi causing life-threatening, disseminating diseases. The histatins with improved protective properties may also be used as components of artificial saliva for patients with salivary dysfunction.

Oropharyngeal candidiasis: a review of its clinical spectrum and current therapies

With the increased use of antibiotics and immunosuppressive agents, oropharyngeal candidiasis is becoming more common. This infection is also associated with such advances in medical management as chemotherapy and organ transplantation and with human immunodeficiency virus infection. Various topical and systemic agents are available to treat patients with candidiasis, but optimal management can be elusive. Treatment of uncomplicated oropharyngeal candidiasis in the immunocompetent patient involves selecting a particular formulation of a topical medication based on oral conditions, length of contact time, and taste, texture, and cost of the medication. Treatment of severe oropharyngeal candidiasis, particularly in patients with a compromised immune system, is often more difficult, and relapses are common. Reports of resistance to systemic agents, particularly in patients needing recurrent therapy, are increasing. Amphotericin B, long used as an intravenous agent, is now available as an oral suspension that may offer therapeutic benefits comparable to those of systemic therapy without the toxicity associated with systemic absorption.

Studies of the mechanism of human salivary histatin-5 candidacidal activity with histatin-5 variants and azole-sensitive and -resistant Candida species

Histatins are a group of small, cationic, antifungal peptides present in human saliva. A previous molecular modeling analysis suggested structural similarity between the Phe14-His15 and His18-His19 dipeptide sequences in histatin-5 (Hsn-5; a 24-amino-acid polypeptide) and the sequence of miconazole (one of the azole-based antifungal therapeutic agents), implying that the mechanisms of killing of Candida albicans by these two molecules may be similar. To further elaborate on this observation, we have produced two variants of Hsn-5 in which Phe14-His15 or His18-His19 dipeptide sequences were replaced by Ala-Ala (F14A/H15A and H18A/H19A) to eliminate the phenyl and imidazole rings of the side chains and assessed their candidacidal activities against C. albicans. In addition, we tested azole-resistant C. albicans and Candida glabrata strains for their susceptibilities to Hsn-5. Analysis of the purified recombinant proteins for their candidacidal activities indicated that both variants were significantly less effective (the molar concentrations required to kill half of the maximum number of cells [ED50s], approximately 67 and approximately 149 microM for F14A/H15A and H18A/H19A, respectively) than the unaltered Hsn-5 (ED50, approximately 8 microM) at killing C. albicans, suggesting that the two dipeptide sequences are important for the candidacidal activity of Hsn-5. Assessment of the candidacidal activity of Hsn-5 with the well-characterized azole-resistant strains of C. albicans and C. glabrata, however, suggested that the mode of action of histatins against Candida is distinct from that of azole-based antifungal agents because Hsn-5 kills both azole-sensitive and azole-resistant strains equally well.

Growth patterns of Candida albicans in relation to radicular dentin

Candida albicans is the most common fungal pathogen isolated from the oral cavity. The role of this organism as an endodontic pathogen is poorly understood.

OBJECTIVES

The aim of this study was to observe the interaction of C. albicans with root canal walls and the growth patterns of this microorganism in relation to radicular dentin.

STUDY DESIGN

Fifteen root sections were infected with C. albicans grown in calf serum and incubated for various periods. The sections were fixed in glutaraldehyde, split into two halves, and evaluated by scanning electron microscopy.

RESULTS

Blastospores and hyphal structures were observed on the root canal walls of all specimens. Filamentous hyphal form was dominant in 5-day specimens. Most of the hyphae and blastospores showed penetration into dentinal tubules. The body of germinating mother cells and hyphae demonstrated collapsed cell walls as a result of vacuole formation.

CONCLUSIONS

With this invasive affinity to dentinal structures, C. albicans may be considered a dentinophilic microorganism.

In vitro antifungal resistance of oral Candida albicans strains in non-AIDS patients

Some cases of oral candidosis are refractory to antifungal treatment. This might be related to development of resistant Candida strains, but susceptibility testing is not standardized and not routinely available, and information related to this problem is scarce in non-AIDS patients. In this study, the in vitro antifungal resistance of oral Candida albicans strains was evaluated. The strains were obtained from a cohort of 72 HIV-negative patients with oral yeast carriage and clinical complaint. Laboratory identification revealed C. albicans in 93% of cases. None of these oral C. albicans isolates showed in vitro resistance to polyenes, but they showed varying resistance levels to fluorocytosine and azoles. This study confirms the usefulness of standardizing susceptibility testing so that it could be routinely available and of realizing a mycological diagnosis including an antifungigram when oral candidosis is suspected, whenever antifungal treatment with azoles is planned.