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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Candida Colonization on the Denture of Diabetic and Non-diabetic Patients</title>
<author><name sortKey="Lotfi Kamran, Mohammad Hossein" sort="Lotfi Kamran, Mohammad Hossein" uniqKey="Lotfi Kamran M" first="Mohammad Hossein" last="Lotfi-Kamran">Mohammad Hossein Lotfi-Kamran</name>
<affiliation><nlm:aff id="AF0001">Assistant Professor, Department of Prosthodontics, School of Dentistry, Yazd University of Medical Sciences, Yazd, Iran</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Jafari, Abbas Ali" sort="Jafari, Abbas Ali" uniqKey="Jafari A" first="Abbas Ali" last="Jafari">Abbas Ali Jafari</name>
<affiliation><nlm:aff id="AF0002">Associate Professor, Department of Parasitology and Mycology, School of Medicine, Yazd University of Medical Sciences, Yazd, Iran</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Falah Tafti, Abbas" sort="Falah Tafti, Abbas" uniqKey="Falah Tafti A" first="Abbas" last="Falah-Tafti">Abbas Falah-Tafti</name>
<affiliation><nlm:aff id="AF0001">Assistant Professor, Department of Prosthodontics, School of Dentistry, Yazd University of Medical Sciences, Yazd, Iran</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Tavakoli, Ehsan" sort="Tavakoli, Ehsan" uniqKey="Tavakoli E" first="Ehsan" last="Tavakoli">Ehsan Tavakoli</name>
<affiliation><nlm:aff id="AF0003">Dentist, Yazd University of Medical Sciences, Yazd, Iran</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Falahzadeh, Mohammad Hossein" sort="Falahzadeh, Mohammad Hossein" uniqKey="Falahzadeh M" first="Mohammad Hossein" last="Falahzadeh">Mohammad Hossein Falahzadeh</name>
<affiliation><nlm:aff id="AF0004">Assistant Professor, Department of Bioinformatics, School of Health, Yazd University of Medical Sciences, Yazd, Iran</nlm:aff>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">21528026</idno>
<idno type="pmc">3075448</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075448</idno>
<idno type="RBID">PMC:3075448</idno>
<date when="2009">2009</date>
<idno type="wicri:Area/Pmc/Corpus">002C02</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002C02</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Candida Colonization on the Denture of Diabetic and Non-diabetic Patients</title>
<author><name sortKey="Lotfi Kamran, Mohammad Hossein" sort="Lotfi Kamran, Mohammad Hossein" uniqKey="Lotfi Kamran M" first="Mohammad Hossein" last="Lotfi-Kamran">Mohammad Hossein Lotfi-Kamran</name>
<affiliation><nlm:aff id="AF0001">Assistant Professor, Department of Prosthodontics, School of Dentistry, Yazd University of Medical Sciences, Yazd, Iran</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Jafari, Abbas Ali" sort="Jafari, Abbas Ali" uniqKey="Jafari A" first="Abbas Ali" last="Jafari">Abbas Ali Jafari</name>
<affiliation><nlm:aff id="AF0002">Associate Professor, Department of Parasitology and Mycology, School of Medicine, Yazd University of Medical Sciences, Yazd, Iran</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Falah Tafti, Abbas" sort="Falah Tafti, Abbas" uniqKey="Falah Tafti A" first="Abbas" last="Falah-Tafti">Abbas Falah-Tafti</name>
<affiliation><nlm:aff id="AF0001">Assistant Professor, Department of Prosthodontics, School of Dentistry, Yazd University of Medical Sciences, Yazd, Iran</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Tavakoli, Ehsan" sort="Tavakoli, Ehsan" uniqKey="Tavakoli E" first="Ehsan" last="Tavakoli">Ehsan Tavakoli</name>
<affiliation><nlm:aff id="AF0003">Dentist, Yazd University of Medical Sciences, Yazd, Iran</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Falahzadeh, Mohammad Hossein" sort="Falahzadeh, Mohammad Hossein" uniqKey="Falahzadeh M" first="Mohammad Hossein" last="Falahzadeh">Mohammad Hossein Falahzadeh</name>
<affiliation><nlm:aff id="AF0004">Assistant Professor, Department of Bioinformatics, School of Health, Yazd University of Medical Sciences, Yazd, Iran</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">Dental Research Journal</title>
<idno type="ISSN">1735-3327</idno>
<idno type="eISSN">2008-0255</idno>
<imprint><date when="2009">2009</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background:</title>
<p>Oral candidiasis is a common opportunistic infection in diabetic patients. Presence of denture in the oral cavity of diabetic patients can promote <italic>Candida</italic>
colonization and results in the higher incidence of oral and systemic candidiasis. The general purpose of the present study was to evaluate and compare <italic>Candida</italic>
colonization in denture of diabetic patients and non-diabetic control group.</p>
</sec>
<sec id="st2"><title>Methods:</title>
<p>In current case-control study, samples for mycological examinations were collected from the palatal impression surface of maxillary dentures from 92 edentulous patients including 46 dia-betic and 46 non-diabetic denture wearers. All samples were cultured directly on sabouraud agar me-dium and isolated colonies were counted and identified based on specific tests. Data were statistically analyzed using Mann-Whitney and Spearman correlation tests.</p>
</sec>
<sec id="st3"><title>Results:</title>
<p>The higher density of isolated colonies was seen in diabetic group in compare with control group (P = 0.0001). There was a statistically significant correlation between the blood glucose level (P = 0.0001) and the duration of denture usage (P = 0.022) with the colonization of <italic>Candida</italic>
on denture of diabetic patients. <italic>C. albicans</italic>
was the most common isolated Candida species in both groups, though diabetic patients with dentures had more non-albicans <italic>Candida</italic>
isolated from their dentures compared to non-diabetic patients.</p>
</sec>
<sec id="st4"><title>Conclusions:</title>
<p>Mycological findings from the present study revealed that diabetes mellitus can in-crease colonization of <italic>Candida</italic>
in denture and mouth. By elimination of local and systemic factors in diabetic patients and improving their oral health care, <italic>Candida</italic>
colonization and the risk of oral and systemic candidiasis will be decreased.</p>
</sec>
</div>
</front>
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</TEI>
<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Dent Res J (Isfahan)</journal-id>
<journal-id journal-id-type="publisher-id">DRJ</journal-id>
<journal-title-group><journal-title>Dental Research Journal</journal-title>
</journal-title-group>
<issn pub-type="ppub">1735-3327</issn>
<issn pub-type="epub">2008-0255</issn>
<publisher><publisher-name>Medknow Publications</publisher-name>
<publisher-loc>India</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">21528026</article-id>
<article-id pub-id-type="pmc">3075448</article-id>
<article-id pub-id-type="publisher-id">DRJ-6-23</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Candida Colonization on the Denture of Diabetic and Non-diabetic Patients</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Lotfi-Kamran</surname>
<given-names>Mohammad Hossein</given-names>
</name>
<xref ref-type="aff" rid="AF0001">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Jafari</surname>
<given-names>Abbas Ali</given-names>
</name>
<xref ref-type="aff" rid="AF0002">**</xref>
<xref ref-type="corresp" rid="cor1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Falah-Tafti</surname>
<given-names>Abbas</given-names>
</name>
<xref ref-type="aff" rid="AF0001">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tavakoli</surname>
<given-names>Ehsan</given-names>
</name>
<xref ref-type="aff" rid="AF0003">***</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Falahzadeh</surname>
<given-names>Mohammad Hossein</given-names>
</name>
<xref ref-type="aff" rid="AF0004">****</xref>
</contrib>
</contrib-group>
<aff id="AF0001"><label>*</label>
Assistant Professor, Department of Prosthodontics, School of Dentistry, Yazd University of Medical Sciences, Yazd, Iran</aff>
<aff id="AF0002"><label>**</label>
Associate Professor, Department of Parasitology and Mycology, School of Medicine, Yazd University of Medical Sciences, Yazd, Iran</aff>
<aff id="AF0003"><label>***</label>
Dentist, Yazd University of Medical Sciences, Yazd, Iran</aff>
<aff id="AF0004"><label>****</label>
Assistant Professor, Department of Bioinformatics, School of Health, Yazd University of Medical Sciences, Yazd, Iran</aff>
<author-notes><corresp id="cor1">Correspondence to: Abbas Ali Jafari, Department of Parasitology and Mycology, School of Medicine, Yazd University of Medical Sciences, Yazd, Iran. Email: <email xlink:href="jafariabbas@ssu.ac.ir">jafariabbas@ssu.ac.ir</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><season>Spring</season>
<year>2009</year>
</pub-date>
<volume>6</volume>
<issue>1</issue>
<fpage>23</fpage>
<lpage>27</lpage>
<history><date date-type="received"><month>10</month>
<year>2008</year>
</date>
<date date-type="accepted"><month>12</month>
<year>2008</year>
</date>
</history>
<permissions><copyright-statement>© Dental Research Journal</copyright-statement>
<copyright-year>2009</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><sec id="st1"><title>Background:</title>
<p>Oral candidiasis is a common opportunistic infection in diabetic patients. Presence of denture in the oral cavity of diabetic patients can promote <italic>Candida</italic>
colonization and results in the higher incidence of oral and systemic candidiasis. The general purpose of the present study was to evaluate and compare <italic>Candida</italic>
colonization in denture of diabetic patients and non-diabetic control group.</p>
</sec>
<sec id="st2"><title>Methods:</title>
<p>In current case-control study, samples for mycological examinations were collected from the palatal impression surface of maxillary dentures from 92 edentulous patients including 46 dia-betic and 46 non-diabetic denture wearers. All samples were cultured directly on sabouraud agar me-dium and isolated colonies were counted and identified based on specific tests. Data were statistically analyzed using Mann-Whitney and Spearman correlation tests.</p>
</sec>
<sec id="st3"><title>Results:</title>
<p>The higher density of isolated colonies was seen in diabetic group in compare with control group (P = 0.0001). There was a statistically significant correlation between the blood glucose level (P = 0.0001) and the duration of denture usage (P = 0.022) with the colonization of <italic>Candida</italic>
on denture of diabetic patients. <italic>C. albicans</italic>
was the most common isolated Candida species in both groups, though diabetic patients with dentures had more non-albicans <italic>Candida</italic>
isolated from their dentures compared to non-diabetic patients.</p>
</sec>
<sec id="st4"><title>Conclusions:</title>
<p>Mycological findings from the present study revealed that diabetes mellitus can in-crease colonization of <italic>Candida</italic>
in denture and mouth. By elimination of local and systemic factors in diabetic patients and improving their oral health care, <italic>Candida</italic>
colonization and the risk of oral and systemic candidiasis will be decreased.</p>
</sec>
</abstract>
<kwd-group><kwd>Candida albicans</kwd>
<kwd>Colonization</kwd>
<kwd>Denture</kwd>
<kwd>Diabetes</kwd>
</kwd-group>
</article-meta>
</front>
<body><sec sec-type="intro" id="sec1-1"><title>Introduction</title>
<p>Diabetes mellitus is a common and growing global health problem which causes several complica-tions. Periodontal diseases are considered the sixth complication of this disease. Diabetics have an increased predisposition to the manifestations of oral diseases like candidiasis, which is associated with poor glycemic control and therapeutic dentures.<xref ref-type="bibr" rid="CIT1">1</xref>
This predisposition also contributes to xerostomia, which may be due to increased glucose levels in oral fluids or immune dysregulation.<xref ref-type="bibr" rid="CIT2">2</xref>
Wearing complete denture is also known as an-other risk factor, which can promote colonization of <italic>Candida</italic>
, produce Candidal biofilm and result in oral candidiasis. Association of denture and diabetes can increase the incidence of oral <italic>Candida</italic>
dis-orders in diabetic patients. <italic>Candida</italic>
species are present in the oral cavity of almost half of the population without causing disease.<xref ref-type="bibr" rid="CIT2">2</xref>
Asymptomatic carriage may cause a higher risk of <italic>Candida</italic>
associated complications through yeast infections if they become immunosuppressed.<xref ref-type="bibr" rid="CIT3">3</xref>
<xref ref-type="bibr" rid="CIT4">4</xref>
Diabetes mellitus is a chronic metabolic disease, which causes several disorders. Immunodeficiency and increased susceptibility to opportunistic infections are seen in diabetic patients. Colonization of Candida is more prevalent in people with diabetes mellitus<xref ref-type="bibr" rid="CIT5">5</xref>
–<xref ref-type="bibr" rid="CIT7">7</xref>
and many studies have shown a higher prevalence of <italic>Candida</italic>
colonization in the oral cav-ity of diabetics compared with non-diabetic individuals.<xref ref-type="bibr" rid="CIT1">1</xref>
<xref ref-type="bibr" rid="CIT8">8</xref>
In addition, significantly higher preva-lence of oral candidiasis in people with diabetes is reported<xref ref-type="bibr" rid="CIT4">4</xref>
. Also <italic>Candida</italic>
infection is found commonly in denture wearers. Acrylic dentures are an important predisposing factor for oral candidosis as these appliances, which are usually ill fitting with suboptimal hygiene, act as reservoirs of infection. For instance, high salivary yeast counts are much more common in complete denture wearers than in dentate individuals.<xref ref-type="bibr" rid="CIT8">8</xref>
Commensal existence of intra-oral <italic>Candida</italic>
species varies from 20% to 50% in a healthy edentulous population and up to 75% in denture-wearers.<xref ref-type="bibr" rid="CIT9">9</xref>
The manifestation of oral candidiasis can occur in many different forms includ-ing median rhomboid glossitis, atrophic glossitis, denture stomatitis (stomatitis prothetica), and an-gular cheilitis. Usually, oral candidosis is associated with a high density of yeasts in the lesions.<xref ref-type="bibr" rid="CIT10">10</xref>
<xref ref-type="bibr" rid="CIT11">11</xref>
Oral candidosis have been reported in 9% to 65% of the population.<xref ref-type="bibr" rid="CIT12">12</xref>
<xref ref-type="bibr" rid="CIT13">13</xref>
These variations are far too important to be explained by demographic varia-tions or socio-economic dissimilarities alone, but may be linked, in part, to differences in denture usage and hygiene habits as well as to underlying systemic predisposing factors.<xref ref-type="bibr" rid="CIT14">14</xref>
The aim of the present study was to assess the prevalence of yeast on the denture of diabetic and non-diabetic denture wearers.</p>
</sec>
<sec sec-type="materials|methods" id="sec1-2"><title>Materials and Methods</title>
<p>Forty six non-insulin dependent diabetes patients (23 men and 23 women), who were complete denture-wearers and were admitted to the Yazd Centre of Diabetes Research were entered consecutively into this study as case group. The patients were in the age range of 62.8 ± 11.2 years. Their diabetic status was determined by history of previous diag-nosis of diabetes, and their blood glucose levels were determined before sample collection using IME-DC (Germany) glucometer (with the mean fasting blood glucose level of 289.2 ± 72.8 mg/dl). The control group included 46 (24 men and 22 women) non-diabetics (with the fasting blood glu-cose level less than 110 mg/dl) selected from pa-tients attending the Department of Prosthetic Dentistry, University of Yazd Medical Sciences and Health Services.</p>
<p>Each patient completed a medical and dental history and signed an informed consent document. All patients accepted denture sample collection. Samples were obtained in the morning when pa-tients fasted by swabbing from the palatal impres-sion surface of maxillary dentures, and cultured on sabouraud glucose agar plates. All isolated yeasts were first counted and then identified by sub-culturing on CHROMagar <italic>Candida</italic>
(CHRO-Magar, France), performing the germ tube test, hyphae/pseudohyphae and chlamydospores growth as described by Terai and Sandven.<xref ref-type="bibr" rid="CIT15">15</xref>
<xref ref-type="bibr" rid="CIT16">16</xref>
Each isolated colony was known as a colony forming units on denture in this study as used in reference method.<xref ref-type="bibr" rid="CIT17">17</xref>
</p>
<sec id="sec2-1"><title></title>
<sec id="sec3-1"><title>Inclusion and exclusion criteria</title>
<p>All patients in both groups had worn complete dentures for more than one year. No patient in either group had received antibiotics, steroids or immune therapy, or used any antiseptic mouth wash for the 6 months before entering the study. People with complete denture with more than one year fasting blood glucose (FBS) level more than 130 mg/dl (in test group), and people without any diabetic history and FBS less than 110 mg/dl (in control group) were included in this study.</p>
</sec>
<sec id="sec3-2"><title>Statistical analysis</title>
<p>Mann-Whitney test was used to analyze the differ-ences between the means of isolated colonies (dis-tribution of data was not normal). Spearman corre-lation test was used for analyzing the correlation between serum glucose level and duration of denture usage with the <italic>Candida</italic>
colonization on denture. Differences were considered significant if P < 0.05. All statistical calculations were per-formed using SPSS software.</p>
</sec>
</sec>
</sec>
<sec sec-type="results" id="sec1-3"><title>Results</title>
<p>Positive culture of <italic>Candida</italic>
enrolled on the denture of all diabetic subjects but this was seen in 78.3% of non-diabetics. Participants’ demographic charac-teristics are summarized in <xref ref-type="table" rid="T0001">table 1</xref>
. The control group included more men. A significantly greater proportion of subjects with diabetes mellitus had higher colonization of <italic>Candida</italic>
compared to con-trol subjects. The average number of isolated colonies was 296.9 in diabetics, though it was 64.7 in non-diabetic group; and Mann-Whitney test showed that this difference was statistically sig-nificant (P = 0.0001).</p>
<table-wrap id="T0001" position="float"><label>Table 1</label>
<caption><p>Mean (SD) of variations for denture <italic>Candida</italic>
colonization.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Variables</th>
<th align="center" rowspan="1" colspan="1">Diabetic</th>
<th align="center" rowspan="1" colspan="1">Non-diabetic</th>
<th align="center" rowspan="1" colspan="1">P-value</th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="1" colspan="1">Age (years)</td>
<td align="center" rowspan="1" colspan="1">62.8(11.2)</td>
<td align="center" rowspan="1" colspan="1">61.4(12.4)</td>
<td align="center" rowspan="1" colspan="1">0.7010</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">FBS (mg/dl)</td>
<td align="center" rowspan="1" colspan="1">289.2(72.8)</td>
<td align="center" rowspan="1" colspan="1">94.7(8.2)</td>
<td align="center" rowspan="1" colspan="1">0.0001</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Denture use (years)</td>
<td align="center" rowspan="1" colspan="1">5.1(2.04)</td>
<td align="center" rowspan="1" colspan="1">5.2(1.8)</td>
<td align="center" rowspan="1" colspan="1">0.2410</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Colony counts (CFU/each sample)</td>
<td align="center" rowspan="1" colspan="1">296.9(136.6)</td>
<td align="center" rowspan="1" colspan="1">64.7(42.6)</td>
<td align="center" rowspan="1" colspan="1">0.0001</td>
</tr>
</tbody>
</table>
</table-wrap>
<p><italic>C. albicans</italic>
was the most commonly isolated species in both groups followed by <italic>C. tropicalis</italic>
, <italic>T. glabrata</italic>
, <italic>C. krusei</italic>
, and <italic>C. guillermondii</italic>
(<xref ref-type="fig" rid="F0001">figure 1</xref>
). The higher isolation and colonization of non-<italic>albicans</italic>
species was seen in diabetic compared to non-diabetic group (P ≤ 0.05). A statistically sig-nificant correlation was found between the number of colonies and amount of serum glucose level in diabetic group (P = 0.0001). Also, there was seen a statistical significant correlation between the colo-nization rate and the duration of using denture in diabetic group (P = 0.022).</p>
<fig id="F0001" position="float"><label>Figure 1</label>
<caption><p>Frequency of Candida species isolated from denture of diabetic and non-diabetic groups.</p>
</caption>
<graphic xlink:href="DRJ-6-23-g001"></graphic>
</fig>
</sec>
<sec sec-type="discussion" id="sec1-4"><title>Discussion</title>
<p>Candidal infections are a major problem in the world, especially among the immunosuppressed people.<xref ref-type="bibr" rid="CIT7">7</xref>
<xref ref-type="bibr" rid="CIT10">10</xref>
<xref ref-type="bibr" rid="CIT11">11</xref>
<xref ref-type="bibr" rid="CIT18">18</xref>
Furthermore, increased susceptibil-ity to periodontal<xref ref-type="bibr" rid="CIT19">19</xref>
and oral infections with <italic>Candida</italic>
spp. has long been associated with diabetes mellitus, but the results remain controversial and contradictory.<xref ref-type="bibr" rid="CIT1">1</xref>
<xref ref-type="bibr" rid="CIT4">4</xref>
<xref ref-type="bibr" rid="CIT5">5</xref>
<xref ref-type="bibr" rid="CIT18">18</xref>
In the present study a higher colonization of <italic>Candida</italic>
species was seen in diabetic patients compared with control group. This finding showed statistical significance when compared with non-diabetic patients (P = 0.0001). A similar trend was observed by some investigators that Candidal carriage was higher among diabetics wearing dentures.<xref ref-type="bibr" rid="CIT20">20</xref>
–<xref ref-type="bibr" rid="CIT22">22</xref>
However, in Daniluk’s study<xref ref-type="bibr" rid="CIT13">13</xref>
there was no statistically significant differ-ence between the two groups in <italic>Candida albicans</italic>
colonization. Most of similar studies reported iso-lated <italic>Candida</italic>
species as <italic>C. albicans</italic>
and other <italic>Candida</italic>
species; however in current study, differ-ent <italic>Candida</italic>
species were also identified based on the specific diagnostic tests, which is an advantage for this study. In our study, the frequency of oral non-albicans <italic>Candida</italic>
isolates was more common in diabetic patients with denture than non-diabetic patients with denture (P = 0.0207).</p>
<p>A statistically significant correlation was found between the number of colonies and the serum glu-cose levels in diabetic group (P = 0.0001). Also there was a statistically significant correlation between the colonization rate and the duration of us-ing denture in diabetic group (P = 0.022). <italic>Candida</italic>
colonization in denture wearers, especially immunocompromised patients, can be disruptive to dental treatment and may be a barrier to patients’ health. The surface irregularities of acrylic resin are a factor in the entrapment of microorganisms, especially <italic>Candida albicans</italic>
. Consequently, con-trolling the spread of fungal infection in risk pa-tients who wear removable prostheses and who are more susceptible to fungal infections because of their immunosuppression is of critical importance.</p>
<p>The higher colonization of non-<italic>albicans Candida</italic>
species in diabetic group in the present study supported other reports by different studies<xref ref-type="bibr" rid="CIT20">20</xref>
<xref ref-type="bibr" rid="CIT23">23</xref>
and showed diabetics’ higher susceptibility to colonization with these species. Unfortunately, these species are less susceptible to common anti-fungal drugs than <italic>C. albicans</italic>
.<xref ref-type="bibr" rid="CIT24">24</xref>
This fact high-lights the importance of controlling the oral colo-nization in diabetic group. <italic>C. dubliniensis</italic>
is a new species of <italic>Candida</italic>
, which was isolated from the diabetic oral cavity in few similar studies<xref ref-type="bibr" rid="CIT23">23</xref>
but this species wasn’t identified in the present study.</p>
<p>Concerning the maintenance of denture hygiene in order to improve oral mucosal health, the participants were informed to control their blood glucose level, and to regularly clean their dentures and keep them dry overnight. These are simple and efficient ways to control yeast colonization in denture wearers.<xref ref-type="bibr" rid="CIT25">25</xref>
<xref ref-type="bibr" rid="CIT26">26</xref>
This precaution seems appropriate since it is apparently difficult to improve the oral hygiene in denture wearers by mechanical or chemical plaque control.<xref ref-type="bibr" rid="CIT27">27</xref>
<xref ref-type="bibr" rid="CIT28">28</xref>
</p>
</sec>
<sec sec-type="conclusion" id="sec1-5"><title>Conclusion</title>
<p>Since using complete denture causes more susceptibility to <italic>Candida</italic>
l colonization, oral candidiasis and other consequences particularly in diabetic patients, controlling the level of serum glucose, drinking enough water in diabetic patients with xerostomia, regularly disinfection of denture and leaving the dentures exposed to the air at night are the possible solutions for improving the diabetic oral health status.</p>
</sec>
</body>
<back><ack><p>We thank Dr Molla (Faculty of Dentistry, Research Affairs) and Dr Ezzadini (University of Yazd Medical Sciences and Health Services, Research Affairs) for their financial supports (thesis number 291) and special thank to Ms Farzaneh Mirzaei for her kind help in laboratory works.</p>
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