Oral Candida carriage and species prevalence amongst habitual gutka-chewers and non-chewers

Smokeless tobacco consumption induces dysbiosis of oral mycobiome: a pilot study

Smokeless tobacco (SLT) alters the oral microbiome of smokeless tobacco users. Dysbiosis of oral bacteriome has been determined; however, the mycobiome of SLT users has not been characterized. The oral mycobiome was assayed by amplification and sequencing of the fungal internal transcribed spacer (ITS1) region from oral swab samples of non-SLT users, SLT users (with or without oral lesions), and SLT with alcohol users. We observed that the richness and diversity of oral mycobiome were significantly decreased in SLT with oral lesions users than in non-users. The β-diversity analysis showed significant dissimilarity of oral mycobiome between non-users and SLT with oral lesions users. Linear discriminant analysis effect size and random forest analysis of oral mycobiome affirm that the genus Pichia was typical for SLT with oral lesions users. Prevalence of the fungal genus Pichia correlates positively with Starmerella, Mortierella, Fusarium, Calonectria, and Madurella, but is negatively correlated with Pyrenochaeta, Botryosporium, and Alternaria. Further, the determination of oral mycobiome functionality showed a high abundance of pathotroph-saprotroph-symbiotroph and animal pathogen-endophyte-epiphyte-undefined saprotroph at trophic and guild levels, respectively, indicating possibly major changes in normal growth repression of types of fungi. The oral mycobiome in SLT users was identified and comprehensively analyzed for the first time. SLT intake is associated with oral mycobiome dysbiosis and such alterations of the oral mycobiome may contribute to oral carcinogenesis in SLT users. This study will provide a basis for further large-scale investigations on the potential role of the mycobiome in SLT-induced oral cancer. KEY POINTS: • SLT induces dysbiosis of the oral microbiome that can contribute to oral cancer. • Oral mycobiome diversity is noticeably reduced in SLT users having oral lesions. • Occurrence of Pichia can be used as a biomarker for SLT users having oral lesions.

Comparison of the Anti-bacterial Efficacy of Saussurea costus and Melaleuca alternifolia Against Porphyromonas gingivalis, Streptococcus mutans, and Enterococcus faecalis: An in-vitro Study

The aim was to compare the in-vitro antibacterial effectiveness of two herbal extracts (a) Saussurea-costus (S. costus) and (b) Melaleuca-alternifolia (M. alternifolia) against Porphyromonas gingivalis (P. gingivalis), Streptococcus mutans (S. mutans) and Enterococcus faecalis (E. faecalis). Aqueous extracts from M. alternifolia were prepared by adding 2 grams of S. costus and M. alternifolia, respectively to 100 ml distilled water. Bacterial strains of P. gingivalis, E. faecalis and S. mutans were treated into 3 groups. In groups 1 and 2, bacterial strains were treated with aqueous extracts of S. costus and M. alternifolia, respectively. In the control-group, bacterial strains were exposed to distilled water. Antibacterial activity of the samples and nanoparticles was determined. The minimum-inhibitory-concentration (MIC) values were determined using the microdilution method. P < 0.01 was considered statistically significant. The MIC for all bacterial strains treated with S. costus was significantly higher than that of M. alternifolia (P < 0.001). There was no significant difference in MIC for strains of P. gingivalis, E. faecalis and S. mutans treated with S. costus. For bacterial strains treated with M. alternifolia, the MIC was significantly higher for P. gingivalis compared with E. faecalis and S. mutans strains (P < 0.01). There was no difference in MIC for E. faecalis and S. mutans strains treated with M. alternifolia. The in-vitro antibacterial efficacy of M. alternifolia is higher than S. costus against P. gingivalis, E. faecalis and S. mutans.

Study on the role of nano antibacterial materials in orthodontics (a review)

Nanoparticles (NPs) are insoluble particles with a diameter of fewer than 100 nanometers. Two main methods have been utilized in orthodontic therapy to avoid microbial adherence or enamel demineralization. Certain NPs are included in orthodontic adhesives or acrylic resins (fluorohydroxyapatite, fluorapatite, hydroxyapatite, SiO2, TiO2, silver, nanofillers), and NPs (i.e., a thin layer of nitrogen-doped TiO2 on the bracket surfaces) are coated on the surfaces of orthodontic equipment. Although using NPs in orthodontics may open up modern facilities, prior research looked at antibacterial or physical characteristics for a limited period of time, ranging from one day to several weeks, and the limits of in vitro studies must be understood. The long-term effectiveness of nanotechnology-based orthodontic materials has not yet been conclusively confirmed and needs further study, as well as potential safety concerns (toxic effects) associated with NP size.

A Comparison of the Prevalence Rate of Oral Candida Colonization between Opium Users and Cigarette Smokers in Kerman, Iran

Background

Candidiasis is the most common opportunistic oral infection and smoking is considered as one of its well-known risk factors. However, it remains unknown whether opium users are susceptible to increased oral candida colonization. The aim of the present study is to compare the prevalence rate of oral candida colonization between opium users and cigarette smokers in Kerman, Iran.

Methods

This case-control study included 75 healthy male respondents divided into three groups (25 in each group): cigarette smokers, cigarette and opium users, and non-smokers as control group. The samples were obtained from oral mucosa by scraping the mucosa with a sterile cotton swab then inoculated into Sabouraud Dextrose Agar (SDA) and CHROMagar plates and also examined with the light microscope.

Findings

Candida was identified in 38.70% of respondents. The most frequently isolated species was Candida albicans (90.66%). The highest prevalence of candida carriage was found in cigarette smokers (52.00%). The difference of candida carriage between the two groups of cigarette smokers and cigarette plus opium users and the control group was statistically significant (P = 0.007 and P = 0.015, respectively).

Conclusion

In the present study, it was revealed that the prevalence of oral candida carriage was significantly higher among cigarette and opium users in comparison to the non-users.

Role of antimicrobial photodynamic therapy in reducing whole salivary oral yeasts colonization in type-2 diabetic and non-diabetic patients with and without dental implants

OBJECTIVE

The aim was to assess the impact of antimicrobial photodynamic therapy (aPDT) in reducing whole salivary oral yeasts colonization in type-2 diabetic and non-diabetic patients with dental implants.

METHODS

Type-2 diabetic and self-reported non-diabetic patients were included. Participants were divided into the following groups: Group-1: Type-2 diabetic patients with dental implants; Group-2: Non-diabetic patients with dental implants; Group-3: Type-2 diabetic patients without dental prostheses; Group-4: Non-diabetic patients without dental prostheses. In each group, participants were subdivided into 2-sub-groups. In the test-subgroup, participants received routine oral hygiene maintenance instructions (OHMI) and underwent full mouth disinfection using aPDT; and in the control-group, participants received OHMI alone. Unstimulated whole saliva samples were collected, hemoglobin A1c levels were measured and yeast colonization was assessed at baseline and at 3-months' follow-up in all groups. Sample-size estimation was done and group-comparisons were done. P-values <0.01 were considered statistically significant.

RESULTS

At baseline, the mean oral yeasts colonization was significantly higher among patients in Group-1 (P < 0.001) and 3 (P < 0.001) compared with individuals in groups 2 (P < 0.001) and 4 (P < 0.001). At baseline and at 3-months of follow-up, the mean HbA1c levels and oral yeasts colonization were significantly higher among patients in Group-1 (P < 0.001) and 3 (P < 0.001) compared with individuals in groups 2 (P < 0.001) and 4 (P < 0.001).

CONCLUSION

In the short-term, routine OHMI with adjunct aPDT is more effective in reducing whole salivary oral yeasts counts than OHMI alone in patients with and without dental implants.

Identification of candida albicans and nonalbicans candida resistant species in tobacco users and oral squamous cell carcinoma patients: Comparison of HiCrome agar and automated VITEK 2 system

Introduction:

Candida is most common fungal pathogen in the immunocompromised and medically ill patients. Higher prevalence of Candida albicans has been reported in tobacco users and oral squamous cell carcinoma (OSCC) patients which may be due to immunosuppression. Recently, emergence of nonalbicans candida (NAC) species resistant to conventional antifungal treatment has been observed that requires accurate identification of organisms at species level for reduction of progression of suspicious oral lesions toward malignancy.

Aims and Objectives:

To detect and compare the prevalence of C. albicans and NAC species smokeless tobacco chewers, histopathologically confirmed oral squamous cell carcinoma patients and the normal individuals. Effectiveness of automated Vitek 2 system in comparison to HiCrome agar color media in the identification of the candida species was also evaluated.

Methodology:

One hundred and fifty patients (90 males, 60 females) aged between 20 and 76 years were divided into three groups: Group I individuals with habit of chewing Gutka, and betel quid/pan masala with or without tobacco, Group II individuals with clinically and histopathologically confirmed oral squamous cell carcinoma and Group III comprised of controls. Salivary samples were cultured on HiCrome agar color media and results were compared with those of Vitek 2 system in the accurate identification of candida species. Data were statistically analyzed and Chi-square test was used to estimate the effectiveness of color and Vitek method in the identification of candida species in all the three groups. P < 0.05 was considered to be statistically significant.

RESULTS:

HiCrome agar color method identified six candida isolates C. albicans, Candida tropicalis, Candida krusei and Candida glabrata isolates in all the three groups, with 0.00 unidentified organisms (P = 0.00001) whereas VITEK 2 system identified five isolates of candida; C. albicans, Candida famat, Candida ciferri, Candida gulleri, C. tropicalis, unidentified organisms were observed in 26% of subjects. Further confirmation by supplemental tests indicated the presence of two or three organisms of different species/or subspecies with low reactivity biopattern. Higher incidence of opportunistic infections was seen in Group II OSCC patients (P = 0.00001).

Conclusion:

The results suggested that there is shift toward NAC species, with higher species diversity in OSCC patients followed by gutka, betel quid/pan masala with or without tobacco users. Conventional agar media culture methods of species identification should be used in conjunction with automated Vitek 2 method for better control of candida-associated oral cancer.

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

OBJECTIVE

To synthesize evidence from observational studies that evaluated the association between smoking and smokeless tobacco with oral Candida carriage.

METHODS

Following 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.

RESULTS

We 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).

CONCLUSION

Our 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.

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

Background and Objectives

Studies 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.

Methodology

Study 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.

Results

Prevalence 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.

Conclusion

Based 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 Candidal Carriage in Subjects with Pure Vegetarian and Mixed Dietary Habits

INTRODUCTION

Candida albicans being a part of the normal oral microbial flora is one of the most commonly isolated species from the oral cavity. Recent studies have shown a steady rise in the number of non C. albicans species, which are relatively resistant to common antifungal agents and are being recognized as potential pathogens. It is vital to ascertain the predisposing factors leading to such a shift in the oral candidal flora.

AIM

To estimate the prevalence of candidal species among vegetarians and non-vegetarians.

MATERIALS AND METHODS

Clinical data including age, gender, and diet preference of 238 participants were noted. Participants with a history of systemic disorders, oral prosthesis, salivary gland disorders and habits such as smoking, alcoholism, and tobacco usage were excluded from the study. The participants were asked to gargle a 10 ml solution of phosphate buffered saline for one minute before depositing the same in a sterile container. The samples were cultured using Hicrome agar media. Data analysis was carried out using Statistical Package for Social Sciences (SPSS software) version 10.5 and differences between individual groups were tested by Chi-square test.

RESULTS

Among 238 samples, 127 (53.3%) samples were positive for Candida. The candidal prevalence in vegetarians (68.5%) was higher than non-vegetarians (40.7%). C. albicans was the most common species to be isolated in both vegetarians (35.1%) and non-vegetarians (39.2%). Candida glabrata and Candida tropicalis showed a higher prevalence in vegetarians (30.5% and 10.1%, respectively) in comparison to non-vegetarians (8.4% and 2.3%, respectively). Candida krusei was isolated only from vegetarians (4.6%).

CONCLUSION

Results indicate that diet plays a major role in oral candidal prevalence and species specificity which in turn may predispose the vegetarians toward these pathogenic organisms.

Role of mechanical curettage with and without adjunct antimicrobial photodynamic therapy in the treatment of peri-implant mucositis in cigarette smokers: A randomized controlled clinical trial

OBJECTIVE

The aim of the present 12-weeks follow-up randomized clinical trial was to investigate the outcome of mechanical curettage (MC) with or without adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of peri-implant mucositis in cigarette smokers.

METHODS

Therapeutically, subjects with peri-implant mucositis were divided into 2 groups: (a) Group-A: MC+aPDT; and (b) Group-B: MC alone (control group). In both groups, peri-implant plaque index (PI), bleeding on probing (BOP) and probing pocket depth (PPD) were gauged at baseline and after 12-weeks follow-up. Group comparisons were performed using the Kruskall-Wallis test. P-values less than 0.05 were considered statistically significant.

RESULTS

Fifty-four male patients (28 in Group-A and 26 in Group-B) were included. The mean age of individuals in groups A and B were 50.6±0.8 and 52.2±0.5years, respectively. In groups A and B the participants were smoking 16.5±2.7 and 14.2±1.7 cigarettes daily since 25.2±6.5 and 24.6±4.3years, respectively. Periimplant PI, BOP and PPD were comparable among individuals in both groups at baseline. At 12-weeks follow-up, there was a significant reduction in PI (P<0.001) and PPD (P<0.001) among patients in groups A and B compared with their respective baseline values. At 12-weeks follow-up, PI (P<0.001) and PPD (P<0.001) were significantly higher among patients in Group-B compared with Group-A (P<0.001). BOP was comparable in both groups at baseline and at 12-weeks follow-up.

CONCLUSION

In cigarette smokers, MC with adjunct aPDT is more effective in the treatment of peri-implant mucositis compared with MC alone.

Prevalence of oral Candida carriage and Candida species among cigarette and maras powder users

OBJECTIVE

The aim of this study was to determine the prevalence of Candida carriage and Candida species among cigarette and Maras powder (MP) users.

MATERIAL AND METHODS

This study was conducted on 180 volunteering men in 20 cafehouses in the city of Kahramanmaras, Turkey. The sociodemographic characteristics of the participants and the behaviors of MP and cigarette usage were noted down. Culture specimens were obtained from bilateral buccal mucosa and dorsum of the tongue with a sterile cotton-tipped swap.

RESULTS

The specimens were inoculated into Sabouraud Dextrose Agar. The mean age of the participants was 40.49 ± 12.89 years (min = 18, max = 87). Fifty-eight percent of the cigarette users, 56.7% of the MP users, and 36.7% of the control group were Candida carriers. The difference of Candida carriage between cigarette and MP users and the control group was statistically significant (P = 0.018 and P = 0.029 respectively). The prevalence of Candida carriage was similar between cigarette and MP users (P = 0.854). The most frequently isolated species was Candida albicans at a rate of 30% in the cigarette users' group, 28.3% in the MP users' group and at a rate of 18.3% in the controls. The prevalence of Candida tropicalis carriage was found to be at a rate of 20% in cigarette and 21.7% in the MP users' group compared to 11.7% in the nonusers.

CONCLUSIONS

In the present study we found that the prevalence of oral Candida carriage was significantly higher among cigarette and MP users.

Treatment of oral fungal infections using antimicrobial photodynamic therapy: a systematic review of currently available evidence

The aim was to review the efficacy of antimicrobial photodynamic therapy (PDT) in the treatment of oral fungal infections. To address the focused question "Should PDT be considered a possible treatment regimen for oral fungal infections?" PubMed/Medline and Google-Scholar databases were searched from 1997 up to March 2014 using various combinations of the following key words: "Candida albicans"; "Candidiasis"; "Candidosis"; "denture stomatitis"; "oral" and "photodynamic therapy". Original studies, experimental studies and articles published solely in English language were sought. Letters to the editor, historic reviews and unpublished data were excluded. Pattern of the present literature review was customized to mainly summarize the pertinent information. Fifteen studies (3 clinical and 12 experimental) were included. All studies reported antimicrobial PDT to be an effective antifungal treatment strategy. One study reported PDT and azole therapy to be equally effective in the treatment of oral fungal infections. Methylene blue, toluidine blue and porphyrin derivative were the most commonly used photosensitizers. The laser wavelengths and power output ranged between ∼455 nm-660 nm and 30 mW-400 mW. The energy fluence ranged between 26-245 J cm(-2) and the duration or irradiation ranged between 10 seconds and 26 minutes. Clinical effectiveness of antimicrobial PDT as a potent therapeutic strategy for oral fungal infections requires further investigations.