Association of psychotropic drugs, prevalence of denture-related stomatitis and oral candidosis

The Antifungal Efficacy of Pure Garlic, Onion, and Lemon Extracts Against Candida albicans

INTRODUCTION

The oral cavity is considered to be one of the most intricate environments in the human body. It is known to harbor commensal microorganisms that do not cause diseases, such as Candida albicans, a yeast fungus that has a carriage rate that tends to increase with age. It is worth noting that C. albicans can be readily identified within the flora of the gastrointestinal tract in 80% of healthy patients. Traditional medicine has alternatively been shown to play a key role in various health amenities with a wide spectrum anti-microbial effect against various yeast molds.

OBJECTIVES

To evaluate the antifungal efficacy of pure garlic, onion, and lemon juice extracts against C. albicans. Materials and methods: C. albicans (ATCC 10231) were sub-cultured in brain agar followed by anaerobic incubation for 48 hours at 37°C. Ten plates were used for each of the materials studied to evaluate their antifungal efficacy against C. albicans. The efficiency of commercially available fresh garlic, onion, and lemon was tested in isolation against C. albicans. One-way ANOVA and chi-square were used for comparison between the different materials. The inhibition zone was measured, and the level of statistical significance was set at ≤0.05.

RESULTS

The diameter of inhibition zones has been measured along the vertical and horizontal axis. No inhibition zones were observed for the onion and lemon extracts used in this study whereas the garlic extract exhibited inhibition zones with altered sizes (4.89 ± 0.275). A highly significant difference was observed between groups (P = 0.000) and between garlic and the other materials (P = 0.000).

CONCLUSIONS

Pure garlic showed a highly significant antifungal efficacy when compared to the onion and lemon juice extracts against C. albicans. Further studies are needed using different concentrations of onion, lemon, and lemon peel juice to confirm their antifungal efficacy in addition to their actual antimicrobial benefits.

Effects of Nystatin oral rinse on oral Candida species and Streptococcus mutans among healthy adults

OBJECTIVES

To examine the effect of Nystatin oral rinse on oral Candida species and Streptococcus mutans carriage.

MATERIALS AND METHODS

Twenty healthy adults with oral candidiasis participated in the single-arm clinical trial and received Nystatin oral rinse for 7 days, 4 applications/day, and 600,000 International Units/application. Demographic-socioeconomic-oral-medical conditions were obtained. Salivary and plaque Candida species and Streptococcus mutans were assessed at baseline and 1-week and 3-month follow-ups. Twenty-four salivary cytokines were assessed. Candida albicans isolates underwent Nystatin susceptibility test.

RESULTS

Half of participants (10/20) were free of salivary C. albicans after using Nystatin rinse. Salivary S. mutans was significantly reduced at 3-month follow-up (p < 0.05). Periodontal status reflected by bleeding-on-probing was significantly improved at 1-week and 3-month follow-ups (p < 0.05). Plaque accumulation was significantly reduced at 1-week follow-up (p < 0.05). Interestingly, the responses to Nystatin oral rinse were not associated with race, gender, age, oral hygiene practice, adherence to Nystatin rinse, or sweet consumption (p > 0.05). No C. albicans isolates were resistant to Nystatin. Furthermore, salivary cytokine eotaxin and fractalkine were significantly reduced at 3-month follow-up among participants who responded to Nystatin rinse (p < 0.05).

CONCLUSIONS

The study results indicate that oral antifungal treatment had an effect on S. mutans salivary carriage. Future clinical trials are warranted to comprehensively assess the impact of antifungal treatment on the oral flora other than S. mutans and Candida.

CLINICAL RELEVANCE

Due to the potential cariogenic role of oral Candida species, antifungal approaches shed new light on the prevention and management of dental caries from a fungal perspective.

Efficacy of Flavonoids in Combating Fluconazole Resistant Oral Candidiasis

BACKGROUND

Candida is an opportunistic fungus often present in the oral mucosa. In the compromised immune system, it may become pathogenic and cause oral candidiasis. This infection is more common with Candida albicans; though, non-albicans Candida spp also have significant relevance. Current treatment guidelines include polyenes, azoles and echinocandins, where fluconazole is the primary therapeutic option. However, both inherited and acquired resistance to fluconazole is exhaustively reported. The development of resistance has resulted in the worsening of the original and re-emergence of new fungal diseases. Thus, the development of an anti-candidiasis therapy with a satisfactory outcome is the urgent need of the hour.

OBJECTIVE

This review article aims to stimulate the research in establishing the synergistic efficacy of various flavonoids with fluconazole to combat the resistance and develop an effective pharmacotherapy for the treatment of oral candidiasis. Further, in this article, we discuss in detail the mechanisms of action of fluconazole, along with the molecular basis of development of resistance in Candida species.

METHOD

PubMed and other databases were used for literature search.

RESULTS

The designing of natural drugs from the plant- derived phytochemicals are the promising alternates in modern medicine. The challenge today is the development of alternative anti- oral candidiasis drugs with increased efficacy, bioavailability and better outcome which can combat azole resistance. Identifying the flavonoids with potential antifungal action at low concentrations seems to meet the challenges.

CONCLUSION

Phyto-active constituents, either alone or in combination with conventional antibiotics may be an effective approach to deal with global antimicrobial resistance. The efficacy of herbal therapy for decades suggests that bacteria, fungi, and viruses may have a reduced ability to adapt and resistance to these natural antimicrobial regimes.

Oral Cavity and Candida albicans: Colonisation to the Development of Infection

Candida colonisation of the oral cavity increases in immunocompromised individuals which leads to the development of oral candidiasis. In addition, host factors such as xerostomia, smoking, oral prostheses, dental caries, diabetes and cancer treatment accelerate the disease process. Candida albicans is the primary causative agent of this infection, owing to its ability to form biofilm and hyphae and to produce hydrolytic enzymes and candialysin. Although mucosal immunity is activated, from the time hyphae-associated toxin is formed by the colonising C. albicans cells, an increased number and virulence of this pathogenic organism collectively leads to infection. Prevention of the development of infection can be achieved by addressing the host physiological factors and habits. For maintenance of oral health, conventional oral hygiene products containing antimicrobial compounds, essential oils and phytochemicals can be considered, these products can maintain the low number of Candida in the oral cavity and reduce their virulence. Vulnerable patients should be educated in order to increase compliance.

Antimicrobial activity and inhibition of biofilm formation in vitro and on human dentine by silver nanoparticles/carboxymethyl-cellulose composites

OBJECTIVE

To evaluate the antimicrobial activity of a silver nanoparticles/carboxymethyl-cellulose (AgNPs/CMC) composite on in vitro and dentine disc heterogeneous biofilms.

DESIGN

AgNPs/CMC composite effect on normal human gingival fibroblast cells (HGF) viability was determined by the MTT reduction assay. In addition, we evaluated the antimicrobial effect of AgNPs/CMC composite on Candida albicans, Enterococcus faecalis, and Fusobacterium nucleatum growth in vitro and heterogeneous biofilms, as well as dentine disc biofilms.

RESULTS

Quasi-spherical AgNPs/CMC composites, with a mean 22.3 nm particle-size were synthesized. They were not toxic to HGF cells at concentrations tested that were antimicrobial, however they caused significant cytotoxicity (89 %, p <  0.05) at concentrations > 15 μg/mL. In vitro, they inhibited up to 67 %, 66 %, and 96 % C. albicans, E. faecalis, and F. nucleatum growth at concentrations ranging from 1.2 μg/mL to 9.6 μg/mL, as compared with untreated control. We also demonstrated significant (p <  0.05) 58 % biofilm reduction by 4.8 μg/mL AgNPs/CMC composite on human dentine discs.

CONCLUSION

AgNPs/CMC composite showed anti biofilm activity on monocultures, heterogenous cultures, and dentine discs, resulting a potentially effective alternative to prevent and eliminate infections after endodontic treatment.

Viral, bacterial, and fungal infections of the oral mucosa: Types, incidence, predisposing factors, diagnostic algorithms, and management

For millions of years, microbiota residing within us, including those in the oral cavity, coexisted in a harmonious symbiotic fashion that provided a quintessential foundation for human health. It is now clear that disruption of such a healthy relationship leading to microbial dysbiosis causes a wide array of infections, ranging from localized, mild, superficial infections to deep, disseminated life-threatening diseases. With recent advances in research, diagnostics, and improved surveillance we are witnessing an array of emerging and re-emerging oral infections and orofacial manifestations of systemic infections. Orofacial infections may cause significant discomfort to the patients and unnecessary economic burden. Thus, the early recognition of such infections is paramount for holistic patient management, and oral clinicians have a critical role in recognizing, diagnosing, managing, and preventing either new or old orofacial infections. This paper aims to provide an update on current understanding of well-established and emerging viral, bacterial, and fungal infections manifesting in the human oral cavity.

Prevalence of Candida albicans in primary endodontic infections associated with a higher frequency of apical periodontitis in type two diabetes mellitus patients

To identify the prevalence of C. albicans in primary endodontic infections of type two diabetes mellitus (T2DM) patients and compare their clinical and radiographical characteristics with a non-diabetic control group, establishing the possible relationship between primary endodontic infection, T2DM, and C. albicans, since diabetes mellitus (DM), influences the development, course, and response to the treatment of apical periodontitis, but the presence of Candida albicans (C. albicans) has not been considered before. A total of 120 patients were selected and divided into two groups: 60 T2DM diagnosed patients and 60 non-diabetic controls. A clinical examination and radiographic analysis were performed to establish a periapical index score (PAI). Root canal samples were taken. Deoxyribonucleic acid (DNA) was extracted, and specific primers were used to identify C. albicans by polymerase chain reaction (PCR). A twofold increase in the prevalence of C. albicans in T2DM patients was observed in contrast to control patients (p = 0.0251). Sixty-five percent of T2DM patients with positive C. albicans scored a ≥ 3 PAI, while only 27% of the patients without C. albicans had a ≥ 3 PAI score (p = 0.0065). Long-term DM patients presented C. albicans more frequently (p < 0.0001). In this study, long-term T2DM patients carried C. albicans in their root canals more frequently when having a primary endodontic infection. Furthermore, this C. albicans presence seems to be related to a higher frequency of apical periodontitis.

Understanding the importance of oral health in psychiatric patients

Dental disease and psychiatric illness are among the most prevalent health problems in the Western world. While the dental needs of mentally ill people are similar in type to those in the general population (Markette et al, 1975) there is some evidence that patients suffering from mental illness are more vulnerable to dental neglect and poor oral health (Stiefel et al, 1990; Armstrong, 1994). Sims (1987) reports that physical health problems are more common in psychiatric patients. They seem to be poorly recognised by psychiatrists, and oral health is no exception (Hede, 1995). Oral health is an important aspect of quality of life which affects eating, comfort, speech, appearance and social acceptance (Nordenram et al, 1994).

Prevalence of Candida albicans and non-albicans on the tongue dorsa of elderly people living in a post-disaster area: a cross-sectional survey

Background

Candida species are normal commensal organisms of the mouth. However, they can cause oral mucosal and severe systemic infections in persons with reduced immune function, which is common in the very elderly. In post-disaster areas, the number of elderly residents rapidly increases due to the outflow of younger generations. Hence, we examined the prevalence of Candida albicans and non-albicans in association with oral and systemic conditions, life style, medications, and living conditions.

Methods

This study was performed in 2014. Participants of this study were 266 community dwellers aged 60 years or older in Otsuchi town, which was severely damaged by the Great East Japan Earthquake and Tsunami in 2011. Oral specimens were collected from tongue dorsa by swabbing. After 48 h incubation on CHROMagar™ medium, C. albicans and non-albicans were identified by the morphology and pigmentation of the colonies. Oral and systemic health check-ups were performed to assess the following: number of remaining teeth and periodontal status, oral hygiene, use of dentures, obesity, hypertension, hyperlipidemia, and hyperglycemia. A questionnaire addressed lifestyle, medications, and living conditions. Using the variables above, the relative factors involved in the colonization and the amounts of each type of Candida were determined.

Results

C. albicans and non-albicans were detected in 142 (53.4%) and 63 (23.7%) participants, respectively. Multinomial logistic regression analyses revealed that the significant factors of colonization by C. albicans were “having decayed teeth” and “relocation from home”. Factors related to non-albicans colonization were “age over 80 years”, “number of remaining teeth”, “use of dentures”, and “obesity”. On the contrary, none of the parameters were related to the amount of non-albicans in the carrier, and the amount of C. albicans was significantly associated with “number of teeth” and “hypertension”.

Conclusions

Prevalence-related factors differed between C. albicans and non-albicans colonization. In addition, other than oral status, systemic and living conditions affected the prevalence of both C. albicans and non-albicans in elderly people living in a post-disaster area.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-017-0342-0) contains supplementary material, which is available to authorized users.

A study of factors contributing to denture stomatitis in a north Indian community

Factors like oral and denture hygiene, presence of saliva, age of the denture, and degree of colonization with Candida albicans are to be evaluated as local contributing factors for causing denture stomatitis. 100 patients aged 30 to 70 years were selected for the study. Among these, 70 patients were labeled test group showing signs of stomatitis and 30 patients as control group as they showed no inflammatory signs. Clinical tests included oral and denture hygiene evaluation, salivary measurements, and age of the dentures, and microscopic investigations were done. Results showed no significant differences between the two groups in terms of saliva, oral and denture hygiene habits, and denture age. Test group showed stomatitis in patients who were wearing dentures for 5 to 10 years compared to control group who were wearing dentures for 10 years and above. Denture age was proportional to Candida colonization and not to degree of inflammation. Significant differences were found in Candida colonization of the fitting surface of the denture between stomatitis and control groups. Poor denture hygiene habits are the most prominent contributing factor for denture stomatitis and colonization.

Emerging fungal infections among children: A review on its clinical manifestations, diagnosis, and prevention

The incidence of fungal infections is increasing at an alarming rate, presenting an enormous challenge to healthcare professionals. This increase is directly related to the growing population of immunocompromised individuals especially children resulting from changes in medical practice such as the use of intensive chemotherapy and immunosuppressive drugs. Although healthy children have strong natural immunity against fungal infections, then also fungal infection among children are increasing very fast. Virtually not all fungi are pathogenic and their infection is opportunistic. Fungi can occur in the form of yeast, mould, and dimorph. In children fungi can cause superficial infection, i.e., on skin, nails, and hair like oral thrush, candida diaper rash, tinea infections, etc., are various types of superficial fungal infections, subcutaneous fungal infection in tissues under the skin and lastly it causes systemic infection in deeper tissues. Most superficial and subcutaneous fungal infections are easily diagnosed and readily amenable to treatment. Opportunistic fungal infections are those that cause diseases exclusively in immunocompromised individuals, e.g., aspergillosis, zygomycosis, etc. Systemic infections can be life-threatening and are associated with high morbidity and mortality. Because diagnosis is difficult and the causative agent is often confirmed only at autopsy, the exact incidence of systemic infections is difficult to determine. The most frequently encountered pathogens are Candida albicans and Aspergillus spp. But other fungi such as non-albicans Candida spp. are increasingly important.

Properties and applications of calcium hydroxide in endodontics and dental traumatology

Calcium hydroxide has been included within several materials and antimicrobial formulations that are used in a number of treatment modalities in endodontics. These include, inter-appointment intracanal medicaments, pulp-capping agents and root canal sealers. Calcium hydroxide formulations are also used during treatment of root perforations, root fractures and root resorption and have a role in dental traumatology, for example, following tooth avulsion and luxation injuries. The purpose of this paper is to review the properties and clinical applications of calcium hydroxide in endodontics and dental traumatology including its antibacterial activity, antifungal activity, effect on bacterial biofilms, the synergism between calcium hydroxide and other agents, its effects on the properties of dentine, the diffusion of hydroxyl ions through dentine and its toxicity. Pure calcium hydroxide paste has a high pH (approximately 12.5-12.8) and is classified chemically as a strong base. Its main actions are achieved through the ionic dissociation of Ca(2+) and OH(-) ions and their effect on vital tissues, the induction of hard-tissue deposition and the antibacterial properties. The lethal effects of calcium hydroxide on bacterial cells are probably due to protein denaturation and damage to DNA and cytoplasmic membranes. It has a wide range of antimicrobial activity against common endodontic pathogens but is less effective against Enterococcus faecalis and Candida albicans. Calcium hydroxide is also an effective anti-endotoxin agent. However, its effect on microbial biofilms is controversial.

Oral health of adults with serious mental illnesses: a review

(A) To assess the prevalence of suboptimal oral health in adults with SMI in studies published in 1971-2009; (B) To describe approaches that promote oral health among adults with SMI. A total of 57 randomized, quasi-randomized, cross-section, and cohort studies from samples of 38-4,769 mental health consumers are identified through database, journal, and Internet searches (Cochrane, FASTSTATS, PUBMED, WHO.int). Selected studies are inclusive for the sample, reported statistical power, and external validity. Oral health adverse outcomes (xerostomia, sialorrhoea, dental caries, extracted teeth, malocclusion, periodontal disease, edentulous, oral cancer) are considered as measurable outcomes. This review suggests a substantial prevalence of suboptimal oral health (61%) among individuals with serious mental illnesses. The following outcomes are mostly met: xerostomia, gross caries, decayed teeth, and periodontal disease. Poor oral hygiene, higher intake of carbonates, poor perception of oral health self-needs, length of psychotropic treatment, and less access to dental care determine suboptimal oral health among this population. Further replication of this research should generate gender-wise ethnic cohorts, including detailed observations of environmental factors, and medical problems that contribute to suboptimal oral health. This review highlights the importance of bridging dental health education to psychiatric rehabilitation programs.

Effects of psychological stress and fluoxetine on development of oral candidiasis in rats

Psychological stress has been found to suppress cell-mediated immune responses that are important for limiting the proliferation of Candida albicans. Fluoxetine has been observed to reduce negative consequences of stress on the immune system in experimental and clinical models, but there are no data on its effects on oral candidiasis. We designed experiments to evaluate the effects of fluoxetine on the development of oral candidiasis in Sprague-Dawley rats exposed to a chronic auditory stressor. Animals were submitted to surgical hyposalivation in order to facilitate the establishment and persistence of C. albicans infection. Stress application and treatment with drugs (placebo or fluoxetine) were initiated 7 days before C. albicans inoculation and lasted until the end of the experiments, on day 15 postinoculation. Establishment of C. albicans infection was evaluated on days 2 and 15 after inoculation. Tissue injury was determined by the quantification of the number and type (normal or abnormal) of papillae on the dorsal tongue per microscopic field. A semiquantitative scale was devised to assess the degree of colonization of the epithelium by fungal hyphae. Our results showed that stress exacerbates C. albicans infection in the tongues of rats. Significant increases in Candida counts, the percentage of the tongue's surface covered with clinical lesions, the percentage of abnormal papillae, and the colonization of the epithelium by hyphae were found in stressed rats compared to the nonstressed ones. Treatment with fluoxetine significantly reversed these adverse effects of stress. Besides the psychopharmacological properties of fluoxetine against stress, it has consequences for Candida infection.

Erythematous oral candidiasis in patients with controlled type II diabetes mellitus and complete dentures

Diabetes mellitus (DM) is a systemic condition characterized by a deficient sugar metabolism, which affects the immune system and favors the development of yeasts. The aim of the present study was to perform biochemical, morphological, exoenzyme analyses of Candida species and the molecular identification (DNA) of C. albicans in patients with type II diabetes mellitus. The exoenzyme quantification was compared to non-diabetic patients as controls. Two hundred and seventy-four patients who make use of complete dentures were evaluated, 28 of whom had diabetes and erythematous oral candidiasis. Other thirty patients presented the same clinical feature but without diabetes. Samples were isolated for biochemical identification (auxonogram), morphological identification (production of germ tubes) and PCR molecular identification (DNA). The capability of the Candida samples in producing phospholipases and proteinases was also determined. The diabetic patients had a greater diversity of Candida species (Fischer's exact test, P = 0.04). The production of proteinases by C. albicans in patients with diabetes was greater than in the control group (unpaired "t" test P < 0.003). However, there was no difference between groups for phospholipase production (unpaired "t" test P > 0.05). It was concluded that patients with controlled DM exhibited systemic conditions predisposing C. albicans proteinase increased production.

Evaluation and treatment of oral candidiasis in HIV/AIDS patients in Enugu, Nigeria

INTRODUCTION

Oral candidiasis is one of the common diseases seen in HIV/AIDS patients. It is rare if CD4+ cell counts are above 500 microl. Outbreaks are more common as the count drops to 100 microl. It may be more difficult to treat when CD4+ cell counts fall below 50 microl.

MATERIALS AND METHODS

A retrospective review of 112 HIV/AIDS patients with lesions in the mouth, head, and neck seen at the oral and maxillofacial surgery units of two public hospitals in eastern Nigeria was carried out between 2000 and 2003. The focus was on oral candidiasis patients. Twenty-nine of these patients, made up of 11 males and 18 females, had oral candidiasis. To compare the action of two drugs, namely, nystatin (a topical antifungal drug) and ketoconazole (a systemic antifungal drug), we treated 15 of the patients with nystatin in the first 2 years and the remaining 14 with ketoconazole in the following 2 years.

RESULTS AND DISCUSSION

Amongst the 15 patients treated with topical drugs, 7 (46.7%) had complete remission, 2 (13.3%) had partial response, 4 (26.7%) remained stationary, and 2 (13.3%) died. Out of the 14 cases treated with systemic drugs, 11 (78.6%) had complete remission, 2 (14.3%) had partial response, and 1 (7.1%) died.

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.

Oral candidosis in patients with removable dentures

The prevalence of Candida species with and without denture-related stomatitis were evaluated in 167 Jordanian patients. The study revealed that 47 (28%) of the patients with denture-related stomatitis were colonized with Candida species (clinical group). Candida albicans was responsible for most cases of denture-related stomatitis (72%), and it was the only species capable of secreting aspartic proteinases. The study also indicated that candidal colonization was not influenced by predisposing haematological deficiencies, as both the clinical and control patient groups showed comparable haematological parameters and the differences were not significant (P > 0.05). All Candida species isolates were 100% susceptible to amphotericin B, while these isolates were less susceptible (25-75%) to fluconazole.

Oral health and treatment needs of institutionalized chronic psychiatric patients in Israel

The aim of the study was to examine the oral health and treatment needs of chronically hospitalized psychiatric patients in Israel. Ten percent of the patients hospitalized for more than 2 years in the 18 psychiatric institutions in Israel were selected at random. The dental status (DMF-T index) was calculated, demographic and medical data were retrieved from the files. Of the 431 patients examined (250 men, 181 women, average age 54 years) 312 patients had only partial natural dentition. The average DMF-T score was 26.74 (out of 32), one of the highest in the literature. The caries component accounted for 2.3% of the DMF-T, the missing teeth component 72% and the restored teeth component 5%. There was an adverse correlation between age and caries and between duration of hospitalization and number of teeth. The average number of carious and missing teeth was higher than in the healthy population. No all-edentulous patients had dentures. These findings confirm the urgent need for an intervention program to improve dental health care in high-risk, difficult-to-treat, psychiatric chronic inpatients.

Treating the modern complete denture patient: a review of the literature

This article reviews the physical and mental compromises of today's patients, techniques, materials, occlusion, impressions, and soft liners and makes recommendations as to managing these compromises when fabricating complete dentures. References used were primarily from the "classical literature," and an effort was made to ascertain whether these treatment recommendations are appropriate for today's more difficult patients. An effort was made to incorporate recent recommendations where appropriate.

Oral candidiasis

Oral candidiasis is a common opportunistic infection of the oral cavity caused by an overgrowth of Candida species, the commonest being Candida albicans. The incidence varies depending on age and certain predisposing factors. There are three broad groupings consisting of acute candidiasis, chronic candidiasis, and angular cheilitis. Risk factors include impaired salivary gland function, drugs, dentures, high carbohydrate diet, and extremes of life, smoking, diabetes mellitus, Cushing's syndrome, malignancies, and immunosuppressive conditions. Management involves taking a history, an examination, and appropriate antifungal treatment with a few requiring samples to be taken for laboratory analysis. In certain high risk groups antifungal prophylaxis reduces the incidence and severity of infections. The prognosis is good in the great majority of cases.

Differences in risk factors among clinical types of oral candidiasis in the Women's Interagency HIV Study

OBJECTIVES

The purpose of this study was to determine the prevalence and concurrence/associations of oral candidiasis types and multiple risk factors in women.

STUDY DESIGN

A cross-sectional analysis of baseline data for 577 human immunodeficiency virus (HIV)-seropositive and 152 HIV-seronegative women from the Women's Interagency HIV Study was conducted. Pseudomembranous candidiasis (PC) and erythematous (EC) candidiasis, angular cheilitis (AC), and denture stomatitis (DS) were studied, and bivariate and multivariate regression analyses were performed.

RESULTS

Prevalences were 8% for PC, 7% for EC, 18% for DS, and 3% for AC; all except AC usually occurred alone. HIV seropositivity was associated with PC, EC, and DS, but not AC. Among HIV-seropositive women, low CD4 cell counts were associated with PC, but not with EC or DS. Heroin/methadone use was associated with PC and EC; salivary hypofunction was associated with PC; high viral load was associated with EC, and poor oral hygiene, with EC and DS.

CONCLUSIONS

Risk factors varied among candidiasis types, suggesting differences in pathogenic mechanisms and usefulness as markers of HIV infection/progression.

Oral clearance and pathogenic oropharyngeal colonization in the elderly

The elderly have an increased incidence of oropharyngeal colonization with respiratory pathogens, a well-known risk factor for the development of pneumonia. Changes in the oral milieu may occur secondary to decreased salivary production and abnormalities in swallowing. These abnormalities, common in the elderly, may result in impaired clearance of organisms, allowing pathogenic colonization. To test this hypothesis, we performed a prospective cross-sectional analysis of 75 elderly institutionalized patients and measured oral clearance using (99m)Tc-human serum albumin (HSA) administered to the oropharynx. Oropharyngeal cultures, salivary cell populations, elastase activity, and clinical parameters were measured simultaneously. Retention of radiolabel ranged from 100% to 2.3% over 120 min of observation. Clearance in the oropharynx was significantly decreased in those patients who had oropharyngeal colonization with gram-negative bacilli (GNB), Staphylococcus aureus (SA), or yeast compared with those demonstrating normal flora by 95% confidence intervals. Decreased clearance was also seen in patients on antidepressants by 95% confidence levels. The absolute number of salivary lymphocytes/ml and buccal cells/ml was increased in colonized patients versus noncolonized persons (mean +/- SEM, 128 x 10(3) +/- 49 x 10(3), 25.4 +/- 11.6 x 10(3)). Elastase activity was elevated in patients who had GNB compared with patients without GNB (mean +/- SEM, 10.6 nM +/- 5.7, versus 2.2 nM +/- 1.2, p = 0.036). We conclude that a decrease in salivary clearance of potentially pathogenic organisms may be a major risk factor for the development of colonization in the elderly.

Denture plaque and adherence of Candida albicans to denture-base materials in vivo and in vitro

The aim of this paper is to review our understanding of the mechanisms and clinical significance of adhesion of C. albicans to denture-base materials in relation to denture plaque and denture-related stomatitis. Earlier reports in the literature of a 65% prevalence level of denture-related stomatitis seem to be exaggerated. More recent studies indicate that denture-related stomatitis is considerably less common, particularly in normal healthy subjects. The etiology of the condition is discussed in this review, and although much of the literature supports the view that the condition is strongly associated with C. albicans, this is not always so. In some subjects, the cause appears to be related to a non-specific plaque. This review also considers the role of denture plaque in the pathogenesis of denture-related stomatitis, the sequential development of denture plaque, and its colonization by Candida organisms. Designing controlled in vivo studies is difficult, and as a consequence, many investigators have had to resort to in vitro studies. The majority of these studies have attempted to investigate the hydrophobicity of C. albicans, relating the surface free-energy of denture-base materials, particularly acrylic resin, to that of the organism. Surprisingly little work has been directed at surface roughness and how it affects retention of organisms. Further, no attention has been paid to the properties and character of the surface, other than average surface roughness, as it affects adhesion. A comparison of results from in vitro studies on the effect on adhesion of pre-coating the surfaces of denture-base materials with saliva has produced equivocal conclusions. This is largely due to little standardization of experimental protocols between studies, particularly in the collection and handling of the saliva used. In conclusion, the review strongly supports the suggestion that adherence of C. albicans to denture-base materials in vitro is related to the hydrophobicity of the organism. The clinical significance of the observation and the mechanisms for the development and maturation of denture plaque are yet to be understood. There is a clear need for further investigation of other factors that may moderate the adhesion of organisms and subsequent colonization of denture-base materials.

Drugs and oral disorders

This chapter affirms that drugs and medicaments may have a profound effect on the periodontal structures. In some instances, such as drug-induced melanosis, the effect may be insignificant to the health of the patient. In other circumstances, drug-induced disorders may initiate painful, destructive disease processes that will not be successfully managed unless the causal role of drugs is recognized and altered. Finally, the clinician must remain aware of the contribution of drug-induced xerostomia and smoking to increased susceptibility to dental and periodontal diseases.

Dental health among institutionalized psychiatric patients in Spain

This study assessed the dental health of an institutionalized psychiatric population in Spain. The study population was composed of 347 males and 218 females with a mean age of 58.0. The mean length of hospitalization was 26.1 years. The largest proportion of the patients (62%) was diagnosed as having schizophrenia. All subjects were taking psychotropic drugs, with a mean number of 2.1 medications. The sample was examined according to the WHO dental criteria. The DMFT index demonstrated the mean number of carious teeth to be 7.9; missing teeth, 17.0; and filled teeth, 0.0. The DMFT index increased significantly with the patient's age and length of hospitalization. Female and demented patients had significantly higher DMFT scores. These findings suggest that institutionalized patients with mental illness in Spain have extensive untreated dental disease.

Oropharyngeal candidosis in the older patient

Colonization of the oral and pharyngeal regions by Candida spp., particularly C. albicans, is extremely common in humans, particularly in early and late life. A variety of local and systemic conditions predispose the transformation of the benign colonization to a pathological state, which may have severe local or serious systemic consequences. The finding of oropharyngeal candidosis in an older patient, therefore, merits investigation of the likely host factors responsible for the organism adopting its pathogenic behavior. This paper provides non-dental clinicians managing older patients a review of the clinical characteristics, risk factors, diagnosis, and management of oropharyngeal candidosis in older adults.

Effect of treatment of palatal inflammatory papillary hyperplasia with local and systemic antifungal agents accompanied by renewal of complete dentures

The aim of this study was to estimate the effect of local and systemic antifungal treatment, accompanied by renewal of complete dentures, on palatal inflammatory papillary hyperplasia (PIPH). The treatment groups consisted of 26 subjects treated with a local antifungal agent (miconazole, 2% gel) for 4 weeks and 13 subjects treated with a systemic antifungal agent (fluconazole, 50 mg) for 2 weeks (test groups). Ten subjects fitted with new complete dentures served as a control group. Variables examined before antifungal and prosthetic treatment included estimation of the size and color of the affected palatal area, measurements of the lengths of the papillae, and salivary variables. Six months after the completion of prosthetic treatment healing was determined as disappearance or marked reduction of the redness of the PIPH. Healing was more often observed in test groups (64%) than in the control group (20%) (p = 0.012). Fifty-eight per cent of the subjects treated with a local (miconazole, 2%) and 77% of those treated with a systemic (fluconazole, 50 mg) antifungal agent were healed. Even though papillary hyperplastic tissue did not disappear, the treatment of PIPH with an antifungal agent without surgery before renewal of dentures might be an alternative treatment in mild cases.