|Year : 2020 | Volume
| Issue : 2 | Page : 169-175
Evaluating the role of local host factors in the candidal colonization of oral cavity: A review update
Imran Khan1, Tanveer Ahmad2, Nikhat Manzoor3, Moshahid Alam Rizvi3, Uqba Raza4, Shubhangi Premchandani4
1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry; Department of Biosciences, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi, India
2 Department of Biosciences, Faculty of Natural Sciences; Department of Human Anatomy, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
3 Department of Biosciences, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi, India
4 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
|Date of Submission||23-Jul-2020|
|Date of Acceptance||28-Sep-2020|
|Date of Web Publication||16-Dec-2020|
Prof. Nikhat Manzoor
Medical Mycology Lab, Department of Biosciences, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi-110 025
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Human oral cavity is home to a number of organisms, Candida albicans being one of them. This review article aims at understanding the correlation between the oral candidal colonization and the local host factors that may influence it with special emphasis on congenital craniofacial anomalies such as cleft lip and palate (CLP). Various scientific databases were searched online and relevant articles were selected based on the inclusion criteria. A comparative study was done to understand the interdependence of various factors (including CLP) and oral candidal colonization. The results revealed a strong association of certain local host factors which may influence the oral colonization of Candida species. Factors such as mucosal barrier, salivary constituents and quantity of saliva, congenital deformities like CLP, oral prostheses such as dentures/palatal obturators and fixed orthodontic appliances (FOAs) were identified. All these factors may directly affect the growth of Candida in the oral cavity. Although numerous studies have pointed a positive correlation between Oral Candidal colonization and local host factors such as oral prostheses, FOA, and oral mucosal barrier only one study has been done, in the Indian subcontinent with respect to the correlation of candidal colonization and CLP. After the evaluation of all the factors mentioned in various case studies, it can be concluded that the presence of local host factors such as orofacial clefts, dental prostheses, FOA, xerostomia, and atrophy of the oral mucous membrane lead to significant increase in candidal colonization, but since very few studies in regard to CLP have been done worldwide and in India, in particular, further studies are warranted.
Keywords: Candida albicans, candidal carriage, cleft lip and palate, orofacial clefts
|How to cite this article:|
Khan I, Ahmad T, Manzoor N, Rizvi MA, Raza U, Premchandani S. Evaluating the role of local host factors in the candidal colonization of oral cavity: A review update. Natl J Maxillofac Surg 2020;11:169-75
|How to cite this URL:|
Khan I, Ahmad T, Manzoor N, Rizvi MA, Raza U, Premchandani S. Evaluating the role of local host factors in the candidal colonization of oral cavity: A review update. Natl J Maxillofac Surg [serial online] 2020 [cited 2021 Jun 24];11:169-75. Available from: https://www.njms.in/text.asp?2020/11/2/169/303496
| Introduction|| |
The oral cavity is home to more than 700 different species of microorganisms making it the second most diversely inhabited cavity in the human body, gut being the first. Humans inheritably do not have any microorganisms in their oral cavity but the process of acquisition of microbes starts right at the time of birth. In a matter of minutes, the oral cavity becomes home to various microorganisms depending on the type of birth, intimacy with people around and the external environment. The oral cavity harbors numerous Candida species right from the 1st day of a newborn's life.
Candida is a dimorphic fungus comprising of more than 150 species. It normally resides as a commensal and is harmless which may become pathogenic owing to factors such as any change in the normal oral flora, altered anatomy as in congenital deformities like cleft lip and palate (CLP) or debilitation of the host immune system. Candida albicans is the most common species of Candida found in the oral cavity, being present in 30%–50% of the people with varying carriage., The oral carriage of Candida ranges from 3%–75% owing to factors such as age, smoking, gender, oral hygiene status, and association of systemic diseases to name a few.
CLP is the most common form of orofacial clefts with its incidence rate being as high as 1/700 births worldwide. In India, approximately 35,000 cases of cleft are seen annually.,
This literature review aims at understanding the correlation between oral candidal colonization with orofacial clefts as well as other local host factors.
| Materials and Methods|| |
An English language systematic search was carried out at PubMed, ResearchGate, Scopus, and Google Scholar databases for articles published between 2000 and 2020 with the keywords Oral Candidiasis, Candida species, C. albicans, Candidal colonization, Candidal carriage, Host factors, Local factors, Risk factors, Host pathogen interaction, CLP, orofacial clefts, obturators, denture stomatitis, and orthodontic appliance. Apart from that, cross references were also searched.
- Studies containing data suggestive of correlation between orofacial clefts and prevalence of candidiasis/carriage of C. albicans
- Studies suggesting other local host factors that affect the oral colonization of C. albicans.
- Studies other than the ones in English language
- Studies having no/inadequate data
- Exclusively in vitro or animal studies.
| Results|| |
A total of 51 studies were searched and thirty nine were included while twelve studies were excluded. Out of the twelve excluded studies, two were in language other than English; four were in vitro or animal studies while six had insufficient or no data supporting the correlation between Candidal colonization and the local host factors.
The various host factors which may influence the colonization of Candida in the oral cavity, as derived from the various articles have summarized in [Table 1].,
|Table 1: Predisposing host factors and their effects on oral Candidal colonization|
Click here to view
| Discussion|| |
The ability of various microorganisms to colonize the oral mucosa and the type of infections caused may be determined by strain-specific features of that particular microorganism like invasiveness, ability to adhere to the mucosa and their ability to form biofilm and Candida, being a ubiquitous fungus is no exception. Apart from these, there are some local host factors which may influence the oral candidal colonization in humans. The various local factors have been discussed below:
The defense of the host includes mechanical barriers to the penetration of the fungus like the epithelium, antimicrobial factors as well as the innate and the adaptive cellular immunity.
The first line of defense against the microorganisms (in this case, Candida species) is the mucosa. Earlier it was believed that the role of the oral mucosa is passive in restraining the invasion of underlying tissues by Candida species. Recent researches, however, indicate a very active role of the cells of the epithelium in triggering the immune responses.,
For establishing infection, the Candida species must be adherent to the epithelium, proliferate and be able to penetrate the oral epithelium (non-keratinized or keratinized). Proteins present in the cells of the oral mucosa might cause retardation of Candida invasion. Pathogen detection at the epithelial surface is mainly immune mediated process which involves pathogen-associated molecular pattern recognition by a receptor group named pattern recognition receptors (PRRs). The PRRs include Nod-like receptors, Toll-like receptors and C-type lectin receptors.,,,
Various cell types are involved in innate immunity: monocytes, neutrophils, dendritic cells, Natural Killer cells, CD8+ and CD4+ T cells, epithelial cells, non-MHC restricted T cells, keratinocytes, and stromal cells. These cells play a significant role in protection through direct effects by either phagocytosis or secretion of antimicrobial compounds that neutralize the fungal components.
Any alteration in the oral epithelium, i.e., atrophy, dysplasia or hyperplasia affects the mucosal barrier's efficiency. The oral mucosal constant desquamation occurring at a much faster rate in comparison to the growth of Candida species helps protect the host against Candidiasis to some extent.
Salivary role in Candidal Colonization is not very clear.,,, A continuous salivary flow removes loosely adhered Candida, thereby, preventing its colonization into the oral cavity. Moreover, while some salivary proteins like lactoferrin, lysozyme, defensins, histatins, calprotectins, and IgA antibodies help keep a check on the growth of Candida,[19xs],, others like statherins and mucines might enhance adhesion of Candida species by acting as receptors of mannoproteins in the various species of Candida.,,, Xerostomia creates an imbalance in the normal oral microflora, favoring the growth of some bacteria such as Staphylococcus aureus, Lactobacillus as well as fungi such as Candida. Studies have shown a positive correlation between patients of Sjogren's Syndrome (both Primary and Secondary), Chronic Hepatitis C virus infection and oral candidiasis. Diabetes Mellitus, Sialadenosis and other such disorders which cause xerostomia too predispose to candidiasis.
Low salivary pH also increases the chances of adhesion and proliferation of Candida species by increasing the enzymatic activities of lipases and proteinases which are significant for the virulence of Candida species.,
Congenital craniofacial anomalies like cleft lip and palate
CLP patients present with an abnormal oronasal communication which may be a cause of altered flora in the oral cavity and such patients often require intervention at the early stages of their lives, the mainstay of the treatment being surgical therapy. Maintaining proper oral hygiene is often a challenge in such patients which may render them susceptible to oral infections, such as candidiasis. Immaturity of the immune system and poor oral hygiene play a significant role in the same. Surgical intervention often requires the administration of prophylactic antibiotics in such cases which further increase their chances of acquiring candidiasis. [Table 2] summarizes the work of various researchers in establishing a correlation between orofacial clefts and prevalence of Candida species.
|Table 2: Various studies showing correlation of orofacial clefts with prevalence of Candida albicans|
Click here to view
The oral microbiota changes and favors the growth of Candida species and other microorganisms when an individual starts wearing a dental prosthesis, be it a complete denture or a partial denture, eventually leading to denture stomatitis.
An inflammatory mycotic infection, denture stomatitis presents mainly as oral mucosal inflammation below the tissue surface (intaglio surface) of maxillary dental prosthesis. The maxillary denture covers a larger area of the palate thus making it devoid of the protective action of saliva, whereas, the mandibular denture being relatively loose ensures an adequate flow of saliva beneath it.
Denture stomatitis is multifactorial with candidal colonization and age related immune suppression acting as major risk factors.,, Earlier, studies reported that about 54%–74% of denture stomatitis cases were due to C. albicans,,, but now there are reports of cases demonstrating non-albicans species in denture stomatitis.
Newton in 1962, proposed a classification based on the clinical presentation of the denture stomatitis:
- Type I: Localized inflammation or pinpoint hyperemia
- Type II: Diffuse erythema
- Type III: Inflammatory papillary hyperplasia.
The findings of various researchers in this regard have summarized in [Table 3].
|Table 3: Various studies showing the prevalence of denture stomatitis among denture users|
Click here to view
Fixed orthodontic appliance
FOAs increase the area for plaque retention as well as make it difficult for the patient to maintain a proper oral hygiene. These factors contribute towards increased oral candidal colonization in patients undergoing fixed orthodontic therapy. [Table 4] displays some of the studies that prove the correlation between FOA and oral candidal carriage.
|Table 4: Various studies showing the correlation between fixed orthodontic appliance and oral candidal carriage|
Click here to view
The results seen after carefully evaluating all the given studies suggest a strong correlation between increased number of Colony Forming Units of Candida species as well as increased prevalence in the presence of the above mentioned factors. There is extensive data that suggests association of Candida with denture prosthesis, FOA, etc., but very few studies have shown a possible correlation between congenital craniofacial anomalies like CLP and oral candidal colonization, therefore, more research work is warranted in this context.
| Conclusion|| |
C. albicans is one of the commensals of the oral cavity which tends to increase in number under favorable circumstances. The increase in oral candidal colonization may be due to local or systemic factors. Mechanical alterations like presence of a denture or orthodontic appliance also favor candidal proliferation in the oral cavity. Local factors such as mucosal barrier and salivary constituents play an important role too. While certain enzymes present in saliva may inhibit the growth of Candida, conditions like xerostomia accelerate its growth. Similarly, an intact mucosa would be inhibitory for the growth of Candida whereas any atrophy/discontinuity would favor its growth. Other contributing factors can be the use of obturators, prophylactic antibiotics given before surgical repair of the cleft and inability to maintain a good oral hygiene.
CLP are one of the most commonly seen forms of congenital craniofacial defects with a high prevalence rate in the Indian subcontinent. They lead to mechanical alteration of the oral cavity making it more prone to plaque accumulation which is favorable for the growth of microorganisms in the oral cavity.
However, very few studies exclusively on CLP patients and oral Candida colonization have been done worldwide and only one study has been done in India. Therefore, further research and studies in finding correlation of candidal colonization with CLP patient's is warranted.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Deo PN, Deshmukh R. Oral microbiome: Unveiling the fundamentals. J Oral Maxillofac Pathol 2019;23:122-8.
] [Full text]
Sampaio-Maia B, Monteiro-Silva F. Acquisition and maturation of oral microbiome throughout childhood: An update. Dent Res J (Isfahan) 2014;11:291-301.
Singh A, Verma R, Murari A, Agrawal A. Oral candidiasis: An overview. J Oral Maxillofac Pathol 2014;18:S81-5.
Byadarahally Raju S, Rajappa S. Isolation and identification of Candida
from the oral cavity. ISRN Dent. 2011;2011:487921.
Alrayyes S, Alruwaili H, Taher I, Elrahawy K, AlmaeenA, AshekhiA, et al. Oral Candidal carriage and associated risk indicators among adults in Sakaka, Saudi Arabia. BMC Oral Health, 2019;19:86.
ICMR Task Force Project. Cleft Lip and Palate Anomaly in India: Clinical Profile, Risk Factors and Current Status of Treatment: A Hospital Based Study; 2016. p. 1-74.
Mossey P, Little J. Addressing the challenges of cleft lip and palate research in India. Indian J Plastic Surg 2009;42:9.
van Wyk C, Steenkamp V. Host factors affecting oral candidiasis. Southern Afr J Epidemiol Infect 2011;26:1, 18-21.
Darwazeh A, Darwazeh T. What makes oral candidiasis recurrent infection? A clinical view. J Mycol 2014; article id 758394:1-5.
Kimsa Ł, Tokarska-Rodak M. Occurrence of Candida
spp. In healthy oral microbiota. Health Probl Civilizat 2020;14:124-30.
Naglik JR, Moyes DL, Wächtler B, Hube B. Candida albicans
interactions with epithelial cells and mucosal immunity. Microbes Infect 2011;13:963-76.
Weindl G, Wagener J, Schaller M. Epithelial cells and innate antifungal defence. J Dent Res 2010;89:666-75.
Cheng SC, Joosten LA, Kulberg BJ, Netea MG. Interplay between Candida albicans
and the Mammalian Innate Host Defence. Infect Immun 2012;80:1304-13.
Kashima M, Takahashi H, Shimozuma M, Epstein WL, Fukuyama K. Candidacidal activities of proteins partially purified from rat epidermis. Infect Immun 1989;57:186-90.
Naglik JR, Moyes D. Epithelial cell innate response to Candida albican
. Adv Dent Res 2011;23:50-5.
Gomes Pde S, Fernandes MH. Defensins in the oral cavity: Distribution and biological role. J Oral Pathol Med 2010;39:1-9.
Gow NA, van de Veerdonk FL, Brown AJ, Netea MG. Candida albicans
morphogenesis and host defence: Discriminating invasion from colonization. Nat Rev Microbiol 2011;10:112-22.
Gauglitz GG, Callenberg H, Weindl G, Korting HC. Host defence against Candida albicans
and the role of pattern-recognition receptors. Acta Derm Venereol 2012;92:291-8.
Fabian TK, Hermann P, Beck A, Fejerdy P, Fabian G. Salivary defence proteins: Their network and role in innate and acquired oral immunity. Int J Mol Sci 2012;13:4295-320.
Salerno C, Pascale M, Contaldo M, Esposito V, Busciolano M, Milillo L, et al
. Candida-associated denture stomatitis. Med Oral Patol Oral Cir Bucal 2011;16:e139-43.
Hoshing C, Dixit S, Mootha A, Diwan N. Role of Candida albicans
in denture stomatitis. J Indian Acad Oral Med Radiol 2011;23:617-9. [Full text]
Kanaguchi N, Narisawa N, Ito T, Kinoshita Y, Kusumoto Y, Shinozuka O, et al
. Effects of salivary protein flow and indigenous microorganisms on initial colonization of Candida albicans
in an in vivo
model. BMC Oral Health 2012;12:36.
Lazarin AA, Machado AL, Zamperini CA, Wady AF, Spolidorio DM, Vergani CE. Effect of experimental photopolymerized coatings on the hydrophobicity of a denture base acrylic resin and on Candida albicans
adhesion. Arch Oral Biol 2013;58:1-9.
Farah CS, Lynch N, McCullough MJ. Oral fungal infections: An update for the general practitioner. Aust Dent J 2010:55:48-54.
Dandekeri S, Prasad K, Shetty M, Hegde C, Sowmya MK, Jagdeesh M. Occurrence of Streptococcus and Candida
species and salivary pH in patients wearing complete denture. Int J Health Rehabil Sci 2013;2:198-203.
Tovani-Palone M. Acute pseudomembranous candidiasis front at cleft lip and palate: Are there additional correlations? West Indian Med J 2016;65:1-6.
Mÿburgh HP, Bütow KW. Cleft soft palate reconstruction: Prospective study on infection and antibiotics. Int J Oral Maxillofac Surg 2009;38:928-32.
Rawashdeh MA, Ayesh JA, Darwazeh AM. Oral candidal colonization in cleft patients as a function of age, gender, surgery, type of cleft, and oral health. J Oral Maxillofac Surg 2011;69:1207-13.
Chopra A, Lakhanpal M, Rao NC, Gupta N, Vashisth S. Oral health in 4-6 years children with cleft lip/palate: A case control study. N Am J Med Sci 2014;6:266-9.
Machorowska-Pieniążek A, Mertas A, Skucha-Nowak M, Tanasiewicz M, Morawiec T. A comparative study of oral microbiota in infants with complete cleft lip and palate or cleft soft palate. Biomed Res Int 2017;2017:1460243.
Silva J, Silva T, Almeida H, Rodrigues Netto M, Cerdeira C, Höfling J, et al
species biotypes in the oral cavity of infants and children with orofacial clefts under surgical rehabilitation. Microb Pathogenesis 2018;124:203-15.
Naik A, Pai R. A study of factors contributing to denture stomatitis in a North Indian Community. Int J Dent 2011;2011:1-4.
Yano J, Yu A, Fidel PL Jr, Noverr MC. Candida glabrata has no enhancing role in the pathogenesis of Candida-associated denture stomatitis in a rat model. mSphere 2019;4:1-9.
Dar-Odeh NS, Shehabi AA. Oral candidosis in patients with removable dentures. Mycoses 2003;46:187-91.
Figueiral MH, Azul A, Pinto E, Fonseca PA, Branco FM, Scully C. Denture-related stomatitis: Identification of aetiological and predisposing factors-a large cohort. J Oral Rehabil 2007;34:448-55.
Pereira-Cenci T, Del Bel Cury AA, Crielaard W, Ten Cate JM. Development of Candida-associated denture stomatitis: New insights. J Appl Oral Sci 2008;16:86-94.
Tavakol P, Emdadi S. Evaluation of prevalence of oral candidiasis in patients using complete denture wears. Tehran Uni Med J 2001;59:86-90.
Kurnatowska AJ. Search for correlation between symptoms and signs of changes in the oral mucosa and presence of fungi. Mycoses 2001;44:379-82.
Vanden Abbeele A, de Meel H, Ahariz M, Perraudin JP, Beyer I, Courtois P. Denture contamination by yeasts in the elderly. Gerodontology 2008;25:222-8.
Aoun G, Cassia A. Evaluation of denture-related factors predisposing to denture stomatitis in a Lebanese population. Mater Sociomed 2016;28:392-6.
Garcia-Pola Vallejo M, Martinez Diaz-Canel A, Garcia Martin J, Gonzalez Garcia M. Risk factors for oral soft tissue lesions in an adult Spanish population. Community Dent Oral Epidemiol 2002;30:277-85.
Kulak-Ozkan Y, Kazazoglu E, Arikan A. Oral hygiene habits, denture cleanliness, presence of yeasts, and stomatitis in elderly people. J Oral Rehabil 2002;29:300-4.
Khasawneh S, Al-Wahadni A. Control of denture plaque and mucosal inflammation in denture wearers. J Ir Dent Assoc 2002;48:132-8.
Espinoza I, Rojas R, Aranda W, Gamonal J. Prevalence of oral mucosal lesions in elderly people in Santiago, Chile. J Oral Pathol Med 2003;32:571-5.
Peltola P, Vehkalahti MM, Wuolijoki-Saaristo K. Oral health and treatment needs of the long-term hospitalised elderly. Gerodontology 2004;21:93-9.
Marchini L, Tamashiro E, Nascimento DF, Cunha VP. Self-reported denture hygiene of a sample of edentulous attendees at a University dental clinic and the relationship to the condition of the oral tissues. Gerodontology 2004;21:226-8.
Mumcu G, Cimilli H, Sur H, Hayran O, Atalay T. Prevalence and distribution of oral lesions: A cross-sectional study in Turkey. Oral Dis 2005;11:81-7.
Triantos D: Intra-oral findings and general health conditions among institutionalized and non-institutionalized elderly in Greece. J Oral Pathol Med 2005;34:577-82.
Baena-Monroy T, Moreno-Maldonado V, Franco-Martínez F, Aldape-Barrios B, Quindós G, Sánchez-Vargas LO. Candida albicans
, Staphylococcus aureus
and Streptococcus mutans colonization in patients wearing dental prosthesis. Med Oral Patol Oral Cir Bucal 2005;10 Suppl 1:E27-39.
Marchini L, Vieira PC, Bossan TP, Montenegro FL, Cunha VP. Self-reported oral hygiene habits among institutionalised elderly and their relationship to the condition of oral tissues in Taubaté, Brazil. Gerodontology 2006;23:33-7.
Dikbas I, Koksal T, Calikkocaoglu S. Investigation of the cleanliness of dentures in a university hospital. Int J Prosthodont 2006;19:294-8.
Emami E, Séguin J, Rompré PH, de Koninck L, de Grandmont P, Barbeau J. The relationship of myceliated colonies of Candida albicans
with denture stomatitis: An in vivo
study. Int J Prosthodont 2007;20:514-20.
Al-Dwairi ZN: Prevalence and risk factors associated with denture-related stomatitis in healthy subjects attending a dental teaching hospital in North Jordan. J Ir Dent Assoc 2007;54:80-3.
Thiele MC, Carvalho Ade P, Gursky LC, Rosa RT, Samaranayake LP, Rosa EA. The role of candidal histolytic enzymes on denture-induced stomatitis in patients living in retirement homes. Gerodontology 2008;25:229-36.
Freitas JB, Gomez RS, De Abreu MH, Ferreira E Ferreira E. Relationship between the use of full dentures and mucosal alterations among elderly Brazilians. J Oral Rehabil 2008;35:370-4.
Coco BJ, Bagg J, Cross LJ, Jose A, Cross J, Ramage G. Mixed Candida albicans
and Candida glabrata
populations associated with the pathogenesis of denture stomatitis. Oral Microbiol Immunol 2008;23:377-83.
Dağistan S, Aktas AE, Caglayan F, Ayyildiz A, Bilge M. Differential diagnosis of denture-induced stomatitis, Candida
, and their variations in patients using complete denture: A clinical and mycological study. Mycoses 2009;52:266-71.
Mathew AL, Pai KM, Sholapurkar AA, Vengal M. The prevalence of oral mucosal lesions in patients visiting a dental school in Southern India. Indian J Dent Res 2008;19:99-103.
] [Full text]
Baran I, Nalçacı R. Self-reported denture hygiene habits and oral tissue conditions of complete denture wearers. Arch Gerontol Geriatr 2009;49:237-41.
Marcos-Arias C, Vicente JL, Sahand IH, Eguia A, De-Juan A, Madariaga L, et al
. Isolation of Candida dubliniensis
in denture stomatitis. Arch Oral Biol 2009;54:127-31.
Naik AV, Pai RC. A study of factors contributing to denture stomatitis in a north Indian community. Int J Dent 2011;2011:589064.
Bilhan H, Geckili O, Ergin S, Erdogan O, Ates G. Evaluation of satisfaction and complications in patients with existing complete dentures. J Oral Sci 2013;55:29-37.
Bhat V, Sharma S, Shetty V, Shastry C, Rao V, Shenoy S, et al
. Prevalence of Candida
associated denture stomatitis (cads) and speciation of Candida
among complete denture wearers of South West coastal region of karnataka. J Health Allied Sci NU 2012;03:059-63.
Khajehhosseini S, Amani F, Far A. Evaluation of presence of Candida
in complete denture wearer in tissue and denture surfaces using smear method. J Res Med Dent Sci 2014;2:42.
Patil S, Doni B, Maheshwari S. Prevalence and distribution of oral mucosal lesions in a geriatric Indian population. Can Geriatr J 2015;18:11-4.
Prakash B, Shekar M, Maiti B, Karunasagar I, Padiyath S. Prevalence of Candida
spp. among healthy denture and nondenture wearers with respect to hygiene and age. J Indian Prosthodont Soc 2015;15:29-32.
] [Full text]
Lucchese A, Bondemark L, Marcolina M, Manuelli M. Changes in oral microbiota due to orthodontic appliances: A systematic review. J Oral Microbiol 2018;10:1-22.
Hägg U, Kaveewatcharanont P, Samaranayake YH, Samaranayake LP. The effect of fixed orthodontic appliances on the oral carriage of Candida
species and Enterobacteriaceae. Eur J Orthod 2004;26:623-9.
Arslan SG, Akpolat N, Kama JD, Ozer T, Hamamci O. One-year follow-up of the effect of fixed orthodontic treatment on colonization by oral Candida. J Oral Pathol Med 2008;37:26-9.
Khanpayeh E, Jafari AA, Tabatabaei Z. Comparison of salivary Candida
profile in patients with fixed and removable orthodontic appliances therapy. Iran J Microbiol 2014;6:263-8.
Zheng Y, Li Z, He X. Influence of fixed orthodontic appliances on the change in oral Candida
strains among adolescents. J Dent Sci 2016;11:17-22.
Shukla C, Maurya R, Singh V, Tijare M. Evaluation of role of fixed orthodontics in changing oral ecological flora of opportunistic microbes in children and adolescent. J Indian Soc Pedod Prev Dent 2017;35:34-40.
] [Full text]
[Table 1], [Table 2], [Table 3], [Table 4]