FACTORS RELATED TO ORAL CANDIDIASIS IN ELDERLY USERS AND NON-USERS OF REMOVABLE DENTAL PROSTHESES
Identifieur interne : 000767 ( Pmc/Corpus ); précédent : 000766; suivant : 000768FACTORS RELATED TO ORAL CANDIDIASIS IN ELDERLY USERS AND NON-USERS OF REMOVABLE DENTAL PROSTHESES
Auteurs : Cyra Maria Pires De Carvalho Bianchi ; Hélcio Aparecido Bianchi ; Tomoko Tadano ; Claudete Rodrigues De Paula ; Hugo Dias Hoffmann-Santos ; Diniz Pereira Leite ; Rosane Christine HahnSource :
- Revista do Instituto de Medicina Tropical de São Paulo [ 0036-4665 ] ; 2016.
Abstract
This study examined the association between oral candidiasis in elderly users and
nonusers of prosthesis and its predisposing factors. To this end, we performed a
cross-sectional study where saliva samples from 48 patients were collected they used
prosthesis and 43 patients (control group) who did not use. Among the 91 patients,
Url:
DOI: 10.1590/S1678-9946201658017
PubMed: 27007560
PubMed Central: 4804554
Links to Exploration step
PMC:4804554Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">FACTORS RELATED TO ORAL CANDIDIASIS IN ELDERLY USERS AND NON-USERS OF
REMOVABLE DENTAL PROSTHESES</title><author><name sortKey="Bianchi, Cyra Maria Pires De Carvalho" sort="Bianchi, Cyra Maria Pires De Carvalho" uniqKey="Bianchi C" first="Cyra Maria Pires De Carvalho" last="Bianchi">Cyra Maria Pires De Carvalho Bianchi</name><affiliation><nlm:aff id="aff1">Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Investigation and Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>cyrabianchi@terra.com.br</email></nlm:aff></affiliation></author><author><name sortKey="Bianchi, Helcio Aparecido" sort="Bianchi, Helcio Aparecido" uniqKey="Bianchi H" first="Hélcio Aparecido" last="Bianchi">Hélcio Aparecido Bianchi</name><affiliation><nlm:aff id="aff2">Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Investigation and Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>hbianchi@terra.com.br</email></nlm:aff></affiliation></author><author><name sortKey="Tadano, Tomoko" sort="Tadano, Tomoko" uniqKey="Tadano T" first="Tomoko" last="Tadano">Tomoko Tadano</name><affiliation><nlm:aff id="aff3">University Hospital Júlio Muller, Laboratory of Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>mokacba@terra.com.br</email></nlm:aff></affiliation></author><author><name sortKey="De Paula, Claudete Rodrigues" sort="De Paula, Claudete Rodrigues" uniqKey="De Paula C" first="Claudete Rodrigues" last="De Paula">Claudete Rodrigues De Paula</name><affiliation><nlm:aff id="aff4">Federal University of São Paulo, Institute of Biomedical Sciences, Laboratory of Pathogenic Yeasts. SP, Brazil. E-mail:<email>crpmicol@uol.com.br</email></nlm:aff></affiliation></author><author><name sortKey="Hoffmann Santos, Hugo Dias" sort="Hoffmann Santos, Hugo Dias" uniqKey="Hoffmann Santos H" first="Hugo Dias" last="Hoffmann-Santos">Hugo Dias Hoffmann-Santos</name><affiliation><nlm:aff id="aff5">Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Investigation and Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>biohoffmann@gmail.com</email></nlm:aff></affiliation></author><author><name sortKey="Leite, Diniz Pereira" sort="Leite, Diniz Pereira" uniqKey="Leite D" first="Diniz Pereira" last="Leite">Diniz Pereira Leite</name><affiliation><nlm:aff id="aff6">Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Investigation and Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>djbiologico@gmail.com</email></nlm:aff></affiliation></author><author><name sortKey="Hahn, Rosane Christine" sort="Hahn, Rosane Christine" uniqKey="Hahn R" first="Rosane Christine" last="Hahn">Rosane Christine Hahn</name><affiliation><nlm:aff id="aff7">Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Investigation and Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>rchahn@terra.com.br</email></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27007560</idno><idno type="pmc">4804554</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804554</idno><idno type="RBID">PMC:4804554</idno><idno type="doi">10.1590/S1678-9946201658017</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000767</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000767</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">FACTORS RELATED TO ORAL CANDIDIASIS IN ELDERLY USERS AND NON-USERS OF
REMOVABLE DENTAL PROSTHESES</title><author><name sortKey="Bianchi, Cyra Maria Pires De Carvalho" sort="Bianchi, Cyra Maria Pires De Carvalho" uniqKey="Bianchi C" first="Cyra Maria Pires De Carvalho" last="Bianchi">Cyra Maria Pires De Carvalho Bianchi</name><affiliation><nlm:aff id="aff1">Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Investigation and Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>cyrabianchi@terra.com.br</email></nlm:aff></affiliation></author><author><name sortKey="Bianchi, Helcio Aparecido" sort="Bianchi, Helcio Aparecido" uniqKey="Bianchi H" first="Hélcio Aparecido" last="Bianchi">Hélcio Aparecido Bianchi</name><affiliation><nlm:aff id="aff2">Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Investigation and Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>hbianchi@terra.com.br</email></nlm:aff></affiliation></author><author><name sortKey="Tadano, Tomoko" sort="Tadano, Tomoko" uniqKey="Tadano T" first="Tomoko" last="Tadano">Tomoko Tadano</name><affiliation><nlm:aff id="aff3">University Hospital Júlio Muller, Laboratory of Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>mokacba@terra.com.br</email></nlm:aff></affiliation></author><author><name sortKey="De Paula, Claudete Rodrigues" sort="De Paula, Claudete Rodrigues" uniqKey="De Paula C" first="Claudete Rodrigues" last="De Paula">Claudete Rodrigues De Paula</name><affiliation><nlm:aff id="aff4">Federal University of São Paulo, Institute of Biomedical Sciences, Laboratory of Pathogenic Yeasts. SP, Brazil. E-mail:<email>crpmicol@uol.com.br</email></nlm:aff></affiliation></author><author><name sortKey="Hoffmann Santos, Hugo Dias" sort="Hoffmann Santos, Hugo Dias" uniqKey="Hoffmann Santos H" first="Hugo Dias" last="Hoffmann-Santos">Hugo Dias Hoffmann-Santos</name><affiliation><nlm:aff id="aff5">Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Investigation and Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>biohoffmann@gmail.com</email></nlm:aff></affiliation></author><author><name sortKey="Leite, Diniz Pereira" sort="Leite, Diniz Pereira" uniqKey="Leite D" first="Diniz Pereira" last="Leite">Diniz Pereira Leite</name><affiliation><nlm:aff id="aff6">Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Investigation and Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>djbiologico@gmail.com</email></nlm:aff></affiliation></author><author><name sortKey="Hahn, Rosane Christine" sort="Hahn, Rosane Christine" uniqKey="Hahn R" first="Rosane Christine" last="Hahn">Rosane Christine Hahn</name><affiliation><nlm:aff id="aff7">Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Investigation and Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>rchahn@terra.com.br</email></nlm:aff></affiliation></author></analytic><series><title level="j">Revista do Instituto de Medicina Tropical de São Paulo</title><idno type="ISSN">0036-4665</idno><idno type="eISSN">1678-9946</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>This study examined the association between oral candidiasis in elderly users and
nonusers of prosthesis and its predisposing factors. To this end, we performed a
cross-sectional study where saliva samples from 48 patients were collected they used
prosthesis and 43 patients (control group) who did not use. Among the 91 patients,
<italic>Candida</italic> spp were isolated in 40 (83.3%) who used prosthesis and
in 23 (53.5%) in the control group. A statistically significant association was
determined between the two groups, the isolation of yeasts and dental prosthesis
(<italic>p</italic> < 0.05, OR = 4.3). The most common etiological agent was
<italic>Candida albicans</italic> (37 isolates), with 23 (62.2%) in the denture
group and 14 (37.8%) (control group). Among patients who presented clinical
manifestations of oral candidiasis (n = 24), 83.3% (n = 20) belonged to the group
that wore dentures, while only 16.7% (n = 4) belonged to the control group. Elderly
patients with diabetes had 4.4 times higher estimated risk of developing oral
candidiasis when compared with individuals without this condition. There was no
statistically significant association between being user prostheses and have diabetes
with the onset of candidiasis. No statistically significant association was
determined between xerostomia, use of prosthesis and oral candidiasis. The use of
prosthetics and poor oral hygiene in elderly patients predisposes to the development
of oral candidiasis.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Silva, So" uniqKey="Silva S">SO Silva</name></author><author><name sortKey="Trentin, Ms" uniqKey="Trentin M">MS Trentin</name></author><author><name sortKey="Linden, Mss" uniqKey="Linden M">MSS Linden</name></author><author><name sortKey="Carli, Jp" uniqKey="Carli J">JP Carli</name></author><author><name sortKey="Silveira, N" uniqKey="Silveira N">N Silveira</name></author><author><name sortKey="Luft, Lr" uniqKey="Luft L">LR Luft</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Campbell, Chct" uniqKey="Campbell C">CHCT Campbell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Goiato, Mc" uniqKey="Goiato M">MC Goiato</name></author><author><name sortKey="Castelleoni, L" uniqKey="Castelleoni L">L Castelleoni</name></author><author><name sortKey="Santos, Dm" uniqKey="Santos D">DM 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uniqKey="Wathen W">WF Wathen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Artico, G" uniqKey="Artico G">G Artico</name></author><author><name sortKey="Freitas, Rs" uniqKey="Freitas R">RS Freitas</name></author><author><name sortKey="Santos, Am" uniqKey="Santos A">AM Santos</name></author><author><name sortKey="Benard, G" uniqKey="Benard G">G Benard</name></author><author><name sortKey="Romiti, R" uniqKey="Romiti R">R Romiti</name></author><author><name sortKey="Migliari, Da" uniqKey="Migliari D">DA Migliari</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cardoso, Mbr" uniqKey="Cardoso M">MBR Cardoso</name></author><author><name sortKey="Lago, Ec" uniqKey="Lago E">EC Lago</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Rev Inst Med Trop Sao Paulo</journal-id><journal-id journal-id-type="iso-abbrev">Rev. Inst. Med. Trop. Sao Paulo</journal-id><journal-id journal-id-type="publisher-id">rimtsp</journal-id><journal-title-group><journal-title>Revista do Instituto de Medicina Tropical de São Paulo</journal-title></journal-title-group><issn pub-type="ppub">0036-4665</issn><issn pub-type="epub">1678-9946</issn><publisher><publisher-name>Instituto de Medicina Tropical</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27007560</article-id><article-id pub-id-type="pmc">4804554</article-id><article-id pub-id-type="doi">10.1590/S1678-9946201658017</article-id><article-id pub-id-type="other">00215</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>FACTORS RELATED TO ORAL CANDIDIASIS IN ELDERLY USERS AND NON-USERS OF
REMOVABLE DENTAL PROSTHESES</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>BIANCHI</surname><given-names>Cyra Maria Pires de Carvalho</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>BIANCHI</surname><given-names>Hélcio Aparecido</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>TADANO</surname><given-names>Tomoko</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>de PAULA</surname><given-names>Claudete Rodrigues</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>HOFFMANN-SANTOS</surname><given-names>Hugo Dias</given-names></name><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>LEITE</surname><given-names>Diniz Pereira</given-names><suffix>Jr</suffix></name><xref ref-type="aff" rid="aff6"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>HAHN</surname><given-names>Rosane Christine</given-names></name><xref ref-type="aff" rid="aff7"><sup>7</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label>Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Investigation and Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>cyrabianchi@terra.com.br</email></aff><aff id="aff2"><label>2</label>Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Investigation and Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>hbianchi@terra.com.br</email></aff><aff id="aff3"><label>3</label>University Hospital Júlio Muller, Laboratory of Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>mokacba@terra.com.br</email></aff><aff id="aff4"><label>4</label>Federal University of São Paulo, Institute of Biomedical Sciences, Laboratory of Pathogenic Yeasts. SP, Brazil. E-mail:<email>crpmicol@uol.com.br</email></aff><aff id="aff5"><label>5</label>Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Investigation and Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>biohoffmann@gmail.com</email></aff><aff id="aff6"><label>6</label>Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Investigation and Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>djbiologico@gmail.com</email></aff><aff id="aff7"><label>7</label>Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Investigation and Mycology. Cuiabá, Mato Grosso, Brazil. E-mail:<email>rchahn@terra.com.br</email></aff><author-notes><corresp id="c01"><bold>Correspondence to:</bold> Dr <bold>ª</bold> Rosane C. Hahn, Universidade
Federal de Mato Grosso, Faculdade de Medicina, Laboratório de Investigação. Av.
Fernando Correa da Costa 2367, Boa Esperança 78060-900 Cuiabá, MT, Brasil. Fone: +55
65 36158809 Fax: +55 65 36158856.
E-mail:<email>rchahn@terra.com.br</email>.</corresp></author-notes><pub-date pub-type="epub"><day>22</day><month>3</month><year>2016</year></pub-date><pub-date pub-type="collection"><year>2016</year></pub-date><volume>58</volume><elocation-id>17</elocation-id><history><date date-type="received"><day>22</day><month>1</month><year>2015</year></date><date date-type="accepted"><day>04</day><month>8</month><year>2015</year></date></history><permissions><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0"><license-p>This is an open-access article distributed under the terms of the Creative
Commons Attribution License</license-p></license></permissions><abstract><p>This study examined the association between oral candidiasis in elderly users and
nonusers of prosthesis and its predisposing factors. To this end, we performed a
cross-sectional study where saliva samples from 48 patients were collected they used
prosthesis and 43 patients (control group) who did not use. Among the 91 patients,
<italic>Candida</italic> spp were isolated in 40 (83.3%) who used prosthesis and
in 23 (53.5%) in the control group. A statistically significant association was
determined between the two groups, the isolation of yeasts and dental prosthesis
(<italic>p</italic> < 0.05, OR = 4.3). The most common etiological agent was
<italic>Candida albicans</italic> (37 isolates), with 23 (62.2%) in the denture
group and 14 (37.8%) (control group). Among patients who presented clinical
manifestations of oral candidiasis (n = 24), 83.3% (n = 20) belonged to the group
that wore dentures, while only 16.7% (n = 4) belonged to the control group. Elderly
patients with diabetes had 4.4 times higher estimated risk of developing oral
candidiasis when compared with individuals without this condition. There was no
statistically significant association between being user prostheses and have diabetes
with the onset of candidiasis. No statistically significant association was
determined between xerostomia, use of prosthesis and oral candidiasis. The use of
prosthetics and poor oral hygiene in elderly patients predisposes to the development
of oral candidiasis.</p></abstract><kwd-group><kwd>Candidiasis</kwd><kwd>Dental prosthesis</kwd><kwd>Xerostomia</kwd><kwd>Elderly</kwd></kwd-group><counts><fig-count count="3"></fig-count><table-count count="2"></table-count><equation-count count="0"></equation-count><ref-count count="37"></ref-count><page-count count="1"></page-count></counts></article-meta></front><body><sec sec-type="intro"><title>INTRODUCTION</title><p>Proportionally, the fastest growing segment of the population is the elderly population,
composed of individuals aged 60 and over. The oral cavity is considered to be of prime
physiological and metabolic importance, and undergoes numerous changes with the aging
process, including: shrinkage of periodontal tissues due to reduced cellularity;
reduction in the thickness of oral mucosa due to progressive tissue dehydration;
reduction of the papillae; and systemic changes that have a direct effect on oral
tissues and physiological processes<xref rid="B01" ref-type="bibr">1</xref>.</p><p>The high frequency of partial or complete absence of the teeth, and the need for
improvements in the health and quality of life of elderly persons requires the use of
dental prostheses. The presence of oral devices like prostheses and orthodontic
appliances can alter the oral environment, leading to modifications in the physical and
biological characteristics of the saliva and other oral structures, often causing an
imbalance in the local microbiota<xref rid="B02" ref-type="bibr">2</xref>.</p><p>Denture can interfere with, or contribute to, the detection of clinical or subclinical
disease processes resulting from the interaction between the prosthesis and
microorganisms; moreover, denture is often related to the appearance of oral lesions,
such as traumatic ulcers, mucogingival hyperplasias, and oral candidiasis<xref rid="B03" ref-type="bibr">3</xref>.</p><p>Numerous epidemiological studies have been conducted on elderly institutionalized
patients who use health services and are members of senior citizens centers in various
regions throughout Brazil. Denture stomatitis affects two-thirds of removable prosthesis
wearers, resulting in patient injury, including bleeding, pain, and discomfort, which
can make the use of prosthesis unviable, thereby directly compromising the overall
health and quality of life of these individuals<xref rid="B04" ref-type="bibr">4</xref><sup>-</sup><xref rid="B05" ref-type="bibr">5</xref>.</p><p>This study aimed to determine possible correlations between oral candidiasis in elderly
wearers and non-wearers of denture, and the presence of yeasts of
the<italic>Candida</italic> species, together with their interrelation with
predisposing factors to this pathology, such as diabetes, hyposalivation and oral
hygiene.</p></sec><sec sec-type="methods"><title>METHODS</title><p>This work was approved by the Ethical Committee under the case number
242715/CEP/HUJM/2013. Participants in this study attended the <italic>Padre Firmo Pinto
Duarte Filho</italic> Senior Citizens Center, run by the city government; the
philanthropic foundation <italic>Abrigo do Bom Jesus de Cuiabá</italic>; and the private
institutions: Dentistry Clinic of the School of Dentistry of the University of
<italic>Cuiabá</italic> (UNIC), and <italic>Três Américas</italic> Clinic Ltd., all
located in the City of <italic>Cuiabá</italic>, MT, Brazil.</p><p>In this epidemiological cross-sectional study, the collection of biological material was
performed from December 2012 to April 2013. Written consent was obtained from each
participant in the study. The study population consisted of 91 elderly patients (over 60
years old) and selection was not performed according to sex or ethnicity. None of the
participants were being prescribed antibiotic therapies nor used antiseptic mouthwash in
the 10 days preceding saliva collection. No special care was taken regarding guidance on
their diet and tooth-brushing routines.</p><p>Two groups were studied. Group A, consisting of 48 patients who wore complete removable
dentures; 10 men aged 66 to 83 years old, and 38 women aged 62 to 84 years old; and
Group B (the control group), consisting of 43 patients who did not wear complete
removable dental prostheses; 18 men aged 66 to 93 years old and 25 women aged 63 to 89
years old. The exclusion criteria included patients with altered cognition (memory
impairment, dementia, disorientation), as they would not be able to answer to the
questions and could cause problems for the spontaneous saliva collection; patients with
infectious diseases that were undergoing treatment (tuberculosis and leprosy); patients
on antibiotics or immunosuppressants; and frequent mouthwash users. Saliva was collected
from the participants without stimulation, using disposable plastic collectors
(Exalab(r) ). The samples were immediately plated in duplicate on sterile Petri dishes
containing Sabouraud dextrose agar (Difco<sup>TM)</sup> plus chloramphenicol at a
concentration of 100 mg/L of medium, and in duplicate on sterile Petri dishes containing
Mycosel<sup>TM</sup> agar (Difco<sup>TM)</sup>. Media pH was adjusted to between 5.6
and 6.0<xref rid="B06" ref-type="bibr">6</xref>. On each plate, a 100 µL sample of pure
saliva was inoculated with the aid of a calibrated micropipette. The plates containing
the seeded culture media were then forwarded to the Mycology Research Laboratory of the
Faculty of Medicine of the Federal University of <italic>Mato Grosso</italic> (FM-UFMT).
Incubation was performed in a biochemical oxygen demand (BOD) incubator for 48 to 72 h
at 25 °C. </p><p>Following incubation, characteristic colony forming units (CFUs) of yeasts of the genus
<italic>Candida</italic> were counted and the number of CFUs/mm of saliva was
calculated. When colonies presenting macroscopic characteristics consistent with yeasts
were observed, smears were taken and stained using the Gram method, in order to observe
the morphological staining characteristics. Isolated colonies were tested for purity
using plating on CHROMagar<sup>TM</sup> chromogenic medium (DIFCO<sup>TM)</sup>.
<italic>Candida</italic> species were identified using VITEK(r) 2 Compact System
equipment (BioMérieux Inc.), in accordance with the manufacturer's recommendations<xref rid="B07" ref-type="bibr">7</xref>. </p><p>The strains used as controls were <italic>Candida glabrata</italic> (ATCC MYA
2950),<italic>Candida lusitaniae</italic> (ATCC 34449), <italic>Candida
utilis</italic> (ATCC 9950), <italic>Geotrichum capitatum</italic> (ATCC
28576),<italic>Kloeckera apis</italic> (ATCC 32857), <italic>Prototheca
wickerhamii</italic> (ATCC 16529), and <italic>Trichosporon mucoide</italic>(ATCC
204094)<xref rid="B07" ref-type="bibr">7</xref>.</p></sec><sec sec-type="results"><title>RESULTS</title><p>Yeasts isolates of the genus <italic>Candida</italic> were obtained from the samples of
40 patients (83.3%) who wore denture, while in the control group (non-wearers), samples
of 23 patients (53.5%) also contained these fungal organisms (<xref ref-type="table" rid="t01">Table 1</xref>). The presence of characteristic clinical signs and symptoms
of oral candidiasis were verified in 24 (26.4%) participants of the study population. A
statistically significant association was verified between the yeast isolates of the
genus <italic>Candida</italic> and the presence of oral candidiasis (<italic>p</italic>= 0.009).</p><p><table-wrap id="t01" orientation="portrait" position="float"><label>Table 1</label><caption><title> Correlation between the isolation of yeasts of the genus
<italic>Candida</italic> in the oral cavity and the presence of
candidiasis</title></caption><table frame="hsides" rules="groups"><colgroup span="1"><col span="1"></col><col span="1"></col><col span="1"></col><col span="1"></col><col span="1"></col><col span="1"></col><col span="3"></col></colgroup><thead><tr><th align="left" rowspan="2" colspan="1"></th><th align="left" rowspan="1" colspan="1"><bold>Presence of oral candidiasis</bold></th><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="2" colspan="1"><bold>Absence of oral candidiasis</bold></th><th align="left" rowspan="1" colspan="1"><bold><italic>p</italic> value</bold></th><th align="left" rowspan="1" colspan="1"><bold>OR</bold></th><th align="left" colspan="3" rowspan="2"><bold>IC95%</bold></th></tr><tr><th align="left" rowspan="1" colspan="1"><bold>n</bold></th><th align="left" colspan="2" rowspan="1"><bold>%</bold></th><th align="left" rowspan="1" colspan="1"><bold>n</bold></th><th align="left" colspan="4" rowspan="1"><bold>%</bold></th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Patient samples with yeast
isolates</td><td align="left" rowspan="1" colspan="1">23</td><td align="left" rowspan="1" colspan="1">37</td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">40</td><td align="left" rowspan="1" colspan="1">63</td><td align="left" rowspan="2" colspan="1">0.009</td><td align="left" rowspan="2" colspan="1">15.5</td><td align="left" rowspan="2" colspan="1">1.9 - 121.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Patient samples without yeast
isolates</td><td align="left" rowspan="1" colspan="1">01</td><td align="left" rowspan="1" colspan="1">04</td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">27</td><td align="left" colspan="4" rowspan="1">96</td></tr></tbody></table></table-wrap></p><p>Elderly wearers of removable prostheses presented a 4.4-fold greater chance of
<italic>Candida</italic> spp isolation than elderly non-wearers (95% CI = 1.65-11.4).
A statistically significant association was verified between the presence of a complete
prosthesis and the isolation of yeasts of the genus <italic>Candida</italic>(<italic>p</italic> = 0.004).</p><p>Among patients with clinical manifestations of oral candidiasis (n = 24), 83.3% (n = 20)
belonged to the group who wore removable dental prostheses, while only 16.7% (n = 4)
belonged to the control group. A statistically significant association was determined
between the use of removable dental prostheses and the presence of oral candidiasis
(<italic>p</italic> = 0.001). Elderly individuals who wore removable dental
prostheses showed a 6.9-fold higher chance of developing oral candidiasis compared with
elderly non-wearers.</p><p><xref ref-type="fig" rid="f01">Figure 1</xref> shows the different levels of
oral/removable dentures hygiene and the origin of the samples. At the time of
collection, elderly individuals who attended the <italic>Padre Firmo</italic> Senior
Citizens Center were 3.2 times more likely to present regular oral hygiene (Grade 2)
compared to those who resided at the Shelter <italic>Bom
Jesus</italic>(<italic>p</italic> = 0.05, OR = 3.2; 95%; CI = 1.1-9.4). In contrast,
at the time of collection, elderly individuals who resided at the Shelter <italic>Bom
Jesus</italic> were 5.8 times more likely to present poor oral hygiene (Grade 3)
compared with those who attended the <italic>Padre Firmo</italic> Senior Citizens
Center. Thus, a statistically significant association was verified for this variable
(<italic>p</italic> = 0.05, OR = 5.8; 95% CI = 1.7-19.0).</p><p><fig id="f01" orientation="portrait" position="float"><label>Fig. 1</label><caption><title><bold>-</bold> Correlation between the presence of candidiasis and the
isolation of genus <italic>Candida</italic> yeasts in the oral cavity. </title></caption><graphic xlink:href="0036-4665-rimtsp-00017-gf01"></graphic></fig></p><p><fig id="f02" orientation="portrait" position="float"><label>Fig. 2</label><caption><title><bold>-</bold> Association between the different levels of oral hygiene, or the
removable dentures hygiene, and the origin of the samples.</title></caption><graphic xlink:href="0036-4665-rimtsp-00017-gf02"></graphic></fig></p><p>Elderly patients with diabetes showed a 4.4-fold <italic>higher</italic> chance of
developing oral candidiasis (<italic>p</italic> = 0.004; OR = 4.4; 95% CI = 1.6-11.9)
compared to individuals without diabetes. However, no statistical association was
verified between prosthesis exposure and outcome in elderly diabetic patients with
candidiasis.</p><p>No statistically significant association was determined between the presence of
hyposalivation and an outcome of oral candidiasis in this sample. Given the data
analyzed, no statistically significant association was determined between prosthesis
exposure and this outcome in elderly patients with hyposalivation and candidiasis (<xref ref-type="table" rid="t02">Table 2</xref>) (<xref ref-type="fig" rid="f03">Fig.
3</xref>).</p><p><table-wrap id="t02" orientation="portrait" position="float"><label>Table 2</label><caption><title> Correlation between the isolation of yeasts of the
genus<italic>Candida</italic> in the oral cavity and the presence of
candidiasis</title></caption><table frame="hsides" rules="groups"><colgroup span="1"><col span="1"></col><col span="1"></col><col span="1"></col><col span="1"></col><col span="1"></col><col span="1"></col><col span="3"></col></colgroup><thead><tr><th align="left" rowspan="2" colspan="1"></th><th align="left" rowspan="1" colspan="1"><bold>Xerostomic patients with candidiasis</bold></th><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="2" colspan="1"><bold>Xerostomic patients without candidiasis</bold></th><th align="left" rowspan="1" colspan="1"><bold><italic>p</italic> value</bold></th><th align="left" rowspan="1" colspan="1"><bold>OR</bold></th><th align="left" colspan="3" rowspan="2"><bold>IC95%</bold></th></tr><tr><th align="left" rowspan="1" colspan="1"><bold>n</bold></th><th align="left" colspan="2" rowspan="1"><bold>%</bold></th><th align="left" rowspan="1" colspan="1"><bold>n</bold></th><th align="left" colspan="4" rowspan="1"><bold>%</bold></th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Patients wearers of removable
dentures</td><td align="left" rowspan="1" colspan="1">08</td><td align="left" rowspan="1" colspan="1">89</td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">10</td><td align="left" rowspan="1" colspan="1">50</td><td align="left" rowspan="2" colspan="1">0.07</td><td align="left" rowspan="2" colspan="1">8.0</td><td align="left" rowspan="2" colspan="1">0.8 - 76.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Patients non-wearers of removable
dentures</td><td align="left" rowspan="1" colspan="1">01</td><td align="left" rowspan="1" colspan="1">11</td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">10</td><td align="left" colspan="4" rowspan="1">50</td></tr></tbody></table></table-wrap></p><p><fig id="f03" orientation="portrait" position="float"><label>Fig. 3</label><caption><title><bold>-</bold> Association between oral candidiasis and the use of removable
dentures in patients with hyposalivation.</title></caption><graphic xlink:href="0036-4665-rimtsp-00017-gf03"></graphic></fig></p></sec><sec sec-type="discussion"><title>DISCUSSION</title><p>The results obtained here indicate that the use of removable dental prostheses and
deficient hygienization of the prostheses among elderly patients predisposes them to a
candidiasis infection<xref rid="B08" ref-type="bibr">8</xref><sup>-</sup><xref rid="B10" ref-type="bibr">10</xref>.</p><p>Denture stomatitis is an entity that is associated with those who wear removable dental
prostheses and oral candidiasis. The etiology of this fungal infection is multifactorial
and has been associated with the use of removable dental prostheses, hyposalivation and
<italic>Candida albicans</italic><xref rid="B08" ref-type="bibr">8</xref><sup>,</sup><xref rid="B11" ref-type="bibr">11</xref>. It is known that <italic>Candida
albicans</italic> exerts an important role in the development of denture stomatitis,
since it can initiate, maintain, and exacerbate this condition. However, an iatrogenic
factor is required (poor adaption wear due to prolonged use) or poor removable dental
prostheses hygienization<xref rid="B11" ref-type="bibr">11</xref><sup>-</sup><xref rid="B12" ref-type="bibr">12</xref>.</p><p>In this study, the mean patient age was 72.7 years old. PEREIRA<xref rid="B13" ref-type="bibr">13</xref> studied adults who were 50 years old or over, analyzing data for
two age groups: 50-74 years old, and 75 years old and over. SALIBA<xref rid="B14" ref-type="bibr">14</xref> examined individuals aged 42 to 102 years old, dividing the data
obtained into age groups. FRARE<xref rid="B15" ref-type="bibr">15</xref> also grouped
the data of the individuals evaluated in their study and they were aged 55 years old or
over. Thus, important variations in the grouping of data according to age exist in the
samples studied.</p><p>Different methods of saliva collection are also verified among such studies. Our group
opted for whole saliva collection, since this permits identification and quantification
of yeast isolates with a high degree of confidence. As expected, the isolation of yeasts
in patients who wore removable dental prostheses (83.3%) was clearly much higher than
among non-wearers (53.5%).</p><p>Although several groups<xref rid="B16" ref-type="bibr">16</xref><sup>-</sup><xref rid="B17" ref-type="bibr">17</xref> claim that the identification of genus
<italic>Candida</italic> yeasts using the CHROMagar technique is highly realiable, in
this study , the technique was used to verify the degree of purity of the yeast colonies
isolated. For the final classification of the species obtained, an automated and
classical microculture plate method was used<xref rid="B18" ref-type="bibr">18</xref>.
<italic>C. albicans</italic> was the most frequently isolated among elderly
participants from the public and private institutions evaluated. This finding confirms
the results published by a number of other research groups<xref rid="B19" ref-type="bibr">19</xref><sup>-</sup><xref rid="B20" ref-type="bibr">20</xref>.</p><p>Concerning the distribution of species in the genus <italic>Candida</italic>, variations
exist in percentages reported in the literature, from 30%<xref rid="B21" ref-type="bibr">21</xref> to approximately 80%<xref rid="B22" ref-type="bibr">22</xref>. Regarding
the presence of non-<italic>albicans</italic>species, the most frequently reported
isolates are <italic>C. glabrata</italic>,<italic>C. dubliniensis</italic>, <italic>C.
tropicalis,</italic> and <italic>C. parapsilosis</italic><xref rid="B21" ref-type="bibr">21</xref><sup>-</sup><xref rid="B22" ref-type="bibr">22</xref>.</p><p>The presence of removable dental prostheses increases the number of genus
<italic>Candida</italic> yeasts, predisposing patients to the development of
candidiasis. This finding is justified due to the excellent adhesion of these
microorganisms to acrylic prostheses a finding in agreement with the majority of
previous reports<xref rid="B23" ref-type="bibr">23</xref><sup>-</sup><xref rid="B24" ref-type="bibr">24</xref>.</p><p>The prevalence of denture stomatitis varies between 11% and 67% of removable dental
prostheses wearers<xref rid="B25" ref-type="bibr">25</xref>, with the use of dentures
during sleep considered a contributing factor<xref rid="B08" ref-type="bibr">8</xref><sup>,</sup><xref rid="B22" ref-type="bibr">22</xref><sup>,</sup><xref rid="B26" ref-type="bibr">26</xref><sup>-</sup><xref rid="B30" ref-type="bibr">30</xref>.</p><p>In this study, patients who wore removable dental prostheses were 6.9 times more likely
to develop oral candidiasis than elderly non-wearers. This fact could be explained by
the precarious conditions of the dental prostheses (poor adaption and fabrication) or
high porosity due to prolonged use. All of these are factors associated with an increase
in colony counts of genus <italic>Candida</italic>yeasts<xref rid="B01" ref-type="bibr">1</xref><sup>,</sup><xref rid="B21" ref-type="bibr">21</xref>. The majority of researchers conclude that
denture hygienization is inadequately performed by most patients who wear removable
dental prostheses and that this fact is strongly related to the increased prevalence of
<italic>Candida</italic> spp<xref rid="B31" ref-type="bibr">31</xref>.</p><p>Of the 91 patients evaluated in this study, 31.9% (n = 29) wore removable dental
prostheses and had diabetes. Diabetic patients who wore dentures showed a 4.4-fold
greater chance of developing oral candidiasis. Numerous systemic medical conditions
(candidiasis, leukemia, AIDS) show a well-defined relationship with effects in the oral
cavity. However, definitive associations between diseases like diabetes mellitus and the
oral manifestations observed in this study are considered controversial<xref rid="B32" ref-type="bibr">32</xref>.</p><p>SOUSA<xref rid="B24" ref-type="bibr">24</xref> investigated the prevalence of oral
mucosal alterations in patients affected by type 2 diabetes mellitus. This author
analyzed heredity factors, blood glucose control, and local factors (use of prostheses
and dry mouth). The results obtained showed that in 68.8% of diabetic patients (n = 66)
(<italic>p</italic> < 0.001), heredity factors were significant. Reduced salivary
flow in diabetic patients was 49% (n = 47), while among non-diabetic patients, it was
34% (n = 34). The presence of candidiasis was 30.5% among diabetic patients (n = 29),
similar to that obtained in this study, and 36% among non-diabetic patients (n = 36).
This group concluded that oral alterations were not associated with diabetes mellitus,
and considered the influence of other factors, including the use of prostheses.
SHULMAN<xref rid="B33" ref-type="bibr">33</xref> and YAMASHITA<xref rid="B34" ref-type="bibr">34</xref> also reported no association between diabetes and alterations in
oral soft tissues and the use of complete removable dental prostheses.</p><p>In this study, the clinical condition of hyposalivation affected 31.8% (n = 29) of the
studied population. Common causes of this disorder, that should be highlighted include
local cancer therapy; psychological disorders; autoimmune diseases; and use of certain
medications, such as antidepressants, antihypertensives, and diuretics. The use of
medications is a major cause of xerostomia, but is rarely associated with irreversible
damage to the salivary glands.</p><p>IACOPINO & WATEN<xref rid="B35" ref-type="bibr">35</xref> and ARTICO<xref rid="B36" ref-type="bibr">36</xref> reviewed the literature concerning infection by
genus <italic>Candida</italic> yeasts and denture stomatitis. The authors described the
clinical lesions and affirmed that the main predisposing factors
to<italic>Candida</italic> spp. infection were deficiencies in the host immune
system, xerostomia, and the use of denture.</p><p>Abundant fungal structures are observed in specimens obtained from the surface of
complete removable dental prostheses. This fact allows us to infer that inadequate use
of prostheses, together with inadequate hygienization favor the growth of
genus<italic>Candida</italic> yeasts, particularly <italic>C. albicans</italic><xref rid="B09" ref-type="bibr">9</xref><sup>,</sup><xref rid="B10" ref-type="bibr">10</xref><sup>,</sup><xref rid="B12" ref-type="bibr">12</xref>.</p><p>The most important preventive measure, specific to the elderly population, is the
control of the oral environment, particularly regarding the prevention of dental caries
(coronary, root, and periodontal)<xref rid="B37" ref-type="bibr">37</xref>.</p><p>These actions will tend to diminish the need for complete dentures, which should reduce
the incidence of oral candidiasis. Daily hygienization and disinfection of removable
dental prostheses is necessary to promote health and conservation of the oral tissues.
The maintenance of healthy mucosa is related to the degree of cleanliness of the
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