Evaluation of different treatment methods against denture stomatitis: a randomized clinical study

Mucoadhesive delivery systems for oral candidiasis treatment: A systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis aimed to evaluate the clinical and mycological effectiveness of mucoadhesives as vehicles for drugs or natural products in the treatment of oral candidiasis.

MATERIALS AND METHODS

The search for articles was carried out in the Medline/PubMed, SCOPUS, EMBASE, Web of Science, Cochrane Library, and SciELO databases before August 2023. We selected the studies, extracted the data, evaluated the study quality, graded the evidence, performed the risk of bias, and carried out meta-analysis.

RESULTS

A total of 389 potentially relevant articles were identified, and 11 studies (1869 participants) met the inclusion criteria of the systematic review. The overall risk of bias was considered low. The most common presentation of mucoadhesives was tablets, with miconazole being the most frequently drug used in the delivery system. Mucoadhesives demonstrated comparable efficacy with topical or systemic antifungal agents, with no significant differences between treatments in terms of clinical (RR = 0.907; 95CI = 0.3-1.297; p = 0.591; I2 = 64.648) or mycological (RR = 0.95; 95CI = 0.667-1.360; p = 0.789; I2 = 73.271) efficacy.

CONCLUSIONS

Mucoadhesives may be a suitable alternative to conventional treatments, with the advantage of reducing the frequency of application by up to 5 times and the daily dosage by up to 20 times.

Denture stomatitis: Treatment with antimicrobial drugs or antifungal gels? A systematic review of clinical trials

STATEMENT OF PROBLEM

Gel formulations containing antimicrobials are a potential alternative for the development of new medicines for the treatment of denture stomatitis (DS). However, whether they are more effective than antifungal drugs is unclear.

PURPOSE

The purpose of this systematic review was to identify whether gels formulated with antimicrobial substances are more effective and biocompatible for the treatment of DS than antifungal drugs.

MATERIAL AND METHODS

This systematic review was structured according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022379510). Searches were performed in the PubMed, Lilacs, Web of Science, Scopus, Embase, and Google Scholar databases in November 2022. Randomized and nonrandomized clinical trials comparing the efficacy of experimental gels and conventional antifungals in the treatment of DS were included.

RESULTS

Gels formulated with Zataria multiflora essential oil and clove and cinnamon extracts showed higher antimicrobial efficacy compared with miconazole and clotrimazole. Formulations containing Uncaria tomentosa, Punica granatum, and propolis extract showed similar efficacy to nystatin and miconazole. Two formulations containing P. granatum were less effective than nystatin and miconazole. Gels of Z. multiflora and miconazole induced adverse effects including burning, itching, nausea, and vomiting. The included studies did not evaluate the biocompatibility of the gels.

CONCLUSIONS

Gels formulated with natural antimicrobials such as Z. multiflora, U. tomentosa, P. granatum, propolis, and clove and cinnamon showed higher or similar antimicrobial efficacy to conventional antifungals in the treatment of DS. The biocompatibility of experimental gels based on natural agents should be evaluated.

Antimicrobial photodynamic therapy in the treatment of oral erythematous candidiasis: a controlled and randomized clinical trial

OBJECTIVE

To analyze the clinical and microbiological efficacy of antimicrobial photodynamic therapy (aPDT) in patients with erythematous candidiasis (EC).

METHODS

This study was a controlled and randomized clinical trial in patients diagnosed with EC, who were allocated into a control group (CG) and experimental group (EG) treated with nystatin oral suspension and aPDT with methylene blue 0.1%, respectively. A clinical index was used to classify the EC lesions from mild to severe and assess the treatment efficacy. Microbiological samples were collected before and after aPDT session and analyzed by counting colony-forming units (CFUs) of Candida and Staphylococcus sp.

RESULTS

A total of 41 patients (CG (n = 18); EG (n = 23)) were analyzed in our research. Of these, 16 (94.1%) of the CG and 16 (84.2%) of the EG exhibited complete remission of the lesions. Regarding the degree of the lesion, it was observed that the severe lesions were more difficult to present remission, while all the mild and moderate lesions showed complete regression (p = 0.001). The microbiological analysis showed that Candida albicans and Staphylococcus sp. were the most prevalent microorganisms, and the aPDT group showed a decrease in CFUs of these microorganisms after the first aPDT session (p < 0.05).

CONCLUSIONS

aPDT proved to be a clinically and microbiologically effective therapy for treating EC.

TRIAL REGISTRATION

Registered at ClinicalTrials.gov; Set 12th, 2019; No. RBR-8w8599.

CLINICAL RELEVANCE

aPDT is a promising alternative treatment since it presents satisfactory results and does not cause damage to oral tissues or develop resistance to the treatment.

Efficacy of adjunct photodynamic therapy on Candida growth and oral health quality of life in denture stomatitis patients with type 2 diabetes mellitus wearing implant-retained overdentures: a randomized clinical study

AIM

The aim of the present clinical trial was to study the efficacy of combined miconazole and PDT in the improvement of quality of life and levels of Candida species in chronic hyperglycemic patients with denture stomatitis (DS).

METHODS

One hundred patients were randomly divided into five groups; 20 each in the miconazole, PDT, miconazole+ PDT, CHX and distilled water groups. Methylene blue mediated irradiation was conducted using 600nm diode laser with power, energy density and radiance as 100 mW, 3527 mW/cm2 and 9 J, respectively. Patients were advised to apply 2.5 ml of 2% topical miconazole four times a day. The existence of Candida spp. was detected by means of microbiological culture technique. Candida colony counts from the palates and dentures surfaces, quantified as colony forming unit (CFU)/mL were evaluated at baseline, end of 14 days, 28 days and 60 days. Oral health related quality of life was assessed with the help of a questionnaire.

RESULTS

The quality of life showed significant improvement in the group where combination treatment was executed. The overall CFU/mL values were greater in the dentures in comparison to those from the palates of the patients of all the five groups. During all time periods of the study, the CFU/mL values obtained from combination treatment group showed significant differences. Candida albicans was the most predominant yeast.

CONCLUSION

This study showed the effectiveness of methylene blue- PDT in combination with miconazole in improving oral health related quality of life and significantly reducing Candida CFU counts to resolve palatal inflammation in diabetic individuals with implant-supported complete dentures.

Natural products for the treatment of denture stomatitis: A systematic review

STATEMENT OF PROBLEM

Evidence for the efficacy and safety of natural products for the treatment of denture stomatitis is lacking.

PURPOSE

The purpose of this systematic review was to answer the question "Are topical natural substances effective and safe compared with conventional antifungals in the treatment of denture stomatitis?"

MATERIAL AND METHODS

A structured search in 11 databases, including non-peer-reviewed, was undertaken. Two authors independently selected the studies, extracted the data, assessed the study quality, and graded the evidence, with disagreement resolved with a third reviewer. Data were evaluated descriptively by following Synthesis Without Meta-analysis (SWiM) reporting items. This study was registered at the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42020216213.

RESULTS

After the removal of duplicates, 1925 records remained, and after a 2-phase reading of abstracts and full texts, 17 studies were included. Propolis, green tea, ginger, Zataria multiflora, chitosan, garlic, Artemisia, Schinus terebinthifolius Raddi, Uncaria tomentosa, Punica granatum, and Ricinus communis appeared to have similar efficacy and safety when compared with nystatin or miconazole. Most of the studies presented a high risk of bias.

CONCLUSIONS

Certainty in the body of evidence that natural products might be appropriately used in the treatment of denture stomatitis is low. Well-designed randomized controlled trials are still needed to evaluate the topic better because there is high heterogeneity among the studies.

Chemical Profiling, Bioactive Properties, and Anticancer and Antimicrobial Potential of Juglans regia L. Leaves

The aim of this study was to assess the biological potential of the polyphenolic fraction isolated from J. regia leaves, collected in the Subcarpathian region (Poland). The phenolic profile was determined using the UPLC-PDA-MS/MS method. Biological activity was determined by evaluating the antioxidant, anticancer, antibacterial, and antifungal effects. Prior to this study, the purified polyphenolic fraction was not been tested in this regard. A total of 40 phenolic compounds (104.28 mg/g dw) were identified, with quercetin 3-O-glucoside and quercetin pentosides dominating. The preparation was characterized by a high ability to chelate iron ions and capture O₂^•- and OH^• radicals (reaching IC₅₀ values of 388.61, 67.78 and 193.29 µg/mL, respectively). As for the anticancer activity, among the six tested cell lines, the preparation reduced the viability of the DLD-1, Caco-2, and MCF-7 lines the most, while in the antibacterial activity, among the seven tested strains, the highest susceptibility has been demonstrated against K. pneumoniae, S. pyogenes, and S. aureus. Depending on the needs, such a preparation can be widely used in the design of functional food and/or the cosmetics industry.

Application of the Extracts of Uncaria tomentosa in Endodontics and Oral Medicine: Scoping Review

Background: The main purpose of endodontic treatment is to eliminate the bacteria that are responsible for the contamination and infection of the internal surfaces in order to resolve any pulp or periapical pathology. In fact, some bacteria, such as Enterococcus faecalis, can escape the action of root canal irrigants by aggregating into a biofilm and penetrating deeply into the dentinal tubules. Uncaria tomentosa is a plant belonging to the Rubiaceae family and also commonly known as cat’s claw due to the shape and position of the spines; it is a traditional Peruvian medicinal plant of Amazonian origin. Applications in the dental field have been described both in the prevention and treatment of stomatitis and as an antibacterial and anti-inflammatory agent; it has also been investigated as an additive in irrigants and specifically as gels in endodontic cements. The aim of this scoping review is to summarize all the scientific evidence on the possible applications of Uncaria tomentosa extracts in endodontics and, more generally, in oral medicine, in order to understand whether the active ingredients extracted from Uncaria tomentosa can bring a real advantage in endodontics, in the reduction of endodontic failures and in the onset of recurrent endodontic lesions. Methods: The scoping review was carried out strictly following the PRISMA-ScR checklist; the search was carried out on five databases (PubMed, Scopus, Science Direct, EBSCO and Web of Science) and a register (Cochrane library). Results: The research produced a number of bibliographic sources totaling 2104. With the removal of duplicates, 670 were obtained; potentially eligible articles amounted to 23, of which only seven in vitro studies (four microbiological studies), five clinical studies (three randomized trials) and a case report were included. Conclusions: From the data in the literature, it can be stated that the active ingredients present in Uncaria tomentosa could represent an interesting product to be used in the endodontic field, both in endocanalary cements and as a gel.

Nanocarriers of Miconazole or Fluconazole: Effects on Three-Species Candida Biofilms and Cytotoxic Effects In Vitro

The contribution of different Candida species in oral fungal infections has stimulated the search for more effective therapies. This study assessed the antibiofilm effects of nanocarriers of miconazole (MCZ) or fluconazole (FLZ) on Candida biofilms, and their cytotoxic effects on murine fibroblasts. Three-species biofilms (Candida albicans/Candida glabrata/Candida tropicalis) were formed on 96-well plates, and they were treated with nanocarriers (iron oxide nanoparticles coated with chitosan—“IONPs-CS”) of MCZ or FLZ at 39/78/156 µg/mL; antifungals alone at 156 µg/mL and artificial saliva were tested as positive and negative controls, respectively. Biofilms were analyzed by colony forming units (CFU), biomass, metabolic activity, and structure/viability. The cytotoxicity (L929 cells) of all treatments was determined via 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) reduction assay. Data were submitted to one- or two-way ANOVA, followed by Tukey’s or Fisher LSD’s tests (p < 0.05). IONPs-CS-MCZ at 78 µg/mL promoted similar antibiofilm and cytotoxic effects compared with MCZ at 156 µg/mL. In turn, IONPs-CS-FLZ at 156 µg/mL was overall the most effective FLZ antibiofilm treatment, surpassing the effects of FLZ alone; this nanocarrier was also less cytotoxic compared with FLZ alone. It can be concluded that both nanocarriers are more effective alternatives to fight Candida biofilms compared with their respective positive controls in vitro, being a promising alternative for the treatment of oral fungal infections.

Phytotherapy in the management of denture stomatitis: A systematic review and meta-analysis of randomized controlled trials

Medicinal plant extracts are commonly applied for infectious diseases and are perceived as alternatives to conventional antimicrobial agents. We aimed to confirm the efficacy of phytotherapy for denture stomatitis compared with conventional therapies and placebo. A comprehensive literature search was conducted in Pubmed, Embase, Cochrane Library (CENTRAL), Scopus, and Web of Science, in addition to manual searching. Randomized controlled trials (RCTs) published in English, and studying the treatment of denture stomatitis with herbal medicines, were included. The outcome measures included the relief of clinical signs, reduced Candida colony counts, adverse effects, and patient satisfaction. Nineteen RCTs were included for a systematic review based on selection criteria. Two of them were analyzed using a random-effects model. There was no difference in the relief of clinical signs (odds ratio (OR) = 0.96; 95% confidence interval (CI): 0.43-2.15) and microbiological improvement (OR = 1.74; 95% CI: 0.55-5.45) between propolis and miconazole. Most of the included studies showed that phytomedicines had fewer side effects and more patient satisfaction than antifungals or disinfectants. However, further RCTs with more standardly prepared herbal formulations are required to verify the clinical efficacy of phytotherapy as an alternative or adjunctive therapy for denture stomatitis.

Antimicrobial, Antioxidant, and Cytotoxic Activities of Juglans regia L. Pellicle Extract

The difficulty to treat resistant strains-related hospital-acquired infections (HAIs) promoted the study of phytoextracts, known sources of bioactive molecules. Accordingly, in the present study, the pharmacological activities of Juglans regia (L.) pellicle extract (WPE) were investigated. The antiviral effect was tested against Herpes simplex virus type 1 and 2, Poliovirus 1, Adenovirus 2, Echovirus 9, Coxsackievirus B1 through the plaque reduction assay. The antibacterial and antifungal activities were evaluated against medically important strains, by the microdilution method. DPPH and superoxide dismutase (SOD)s-like activity assays were used to determine the antioxidant effect. Besides, the extract was screened for cytotoxicity on Caco-2, MCF-7, and HFF1 cell lines by the 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay. The total phenolic and flavonoid contents were also evaluated. Interestingly, WPE inhibited Herpes simplex viruses (HSVs) replication, bacterial and fungal growth. WPE showed free radical scavenging capacity and inhibited superoxide anion formation in a dose-dependent manner. These effects could be attributed to the high content of phenols and flavonoids, which were 0.377 ± 0.01 mg GE/g and 0.292 ± 0.08 mg CE/g, respectively. Moreover, WPE was able to reduce Caco-2 cell viability, at both 48 h and 72 h. The promising results encourage further studies aimed to better elucidate the role of WPE in the prevention of human infectious diseases.

Microbiological evaluation of an experimental denture cleanser containing essential oil of Lippia sidoides

The antimicrobial activity of an experimental solution containing essential oil of Lippia sidoides for denture cleaning was evaluated by (1) minimum inhibitory (MIC) and fungicidal/bactericidal concentration (MFC/MBC) tests against Candida albicans, Staphylococcus aureus, and Pseudomona aeruginosa; (2) the metabolic activity of C. albicans biofilm formed on flat-bottom microplates and denture base specimens based on the reduction of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT); and (3) scanning electron microscopy, to evaluate the fungal biofilm morphology. The solution showed antimicrobial action against the pathogens tested (C. albicans - MIC and MFC: 19.53 µg ml^-1, S. aureus - MIC and MBC: 78.12 µg ml^-1, P. aeruginosa - MIC: 625 µg ml^-1, MBC: 2,500 µg ml^-1), reduced the metabolic activity of C. albicans biofilm up to 97%, and caused cell wall damage at low concentrations (195.3-390.6 µg ml^-1) and in short time periods (20 min). Therefore, the experimental solution has the potential to be used as an alternative in the prevention and treatment of denture-induced infections.

Sensitivity to antifungals by Candida spp samples isolated from cases of chronic atrophic candidiasis (CAC)

The treatment of choice for chronic atrophic candidiasis (CAC), also known as denture stomatitis, is topical antifungal therapy. This study aimed to isolate, identify, and assess the antifungal susceptibility of Candida species from mucosal sites in denture wearers with a diagnosis of CAC and determine the prevalence of associated variables. The sample consisted of 44 patients wearing complete or partial dentures who had a clinical diagnosis of CAC. Using sterile cotton swabs, specimens were collected from the oral mucosa of all patients and grown at 30ºC for 48 h in CHROMagar Candida, as a means of isolating and screening the species. The complementary identification of the species was performed using the VITEK 2 automated system (BioMérieux), as well as the determination of their susceptibility to antifungal agents. Data were analyzed using the chi-square test. STATA 13.1 was used for statistical analysis (α = 5%). Of 44 patients with CAC, 33 (75%) had lesions classified as Newton type II. Yeasts were isolated in 38 cases. The most prevalent species was Candida albicans. None of the isolates were resistant to the antifungals tested. Our findings suggest that current indications for antifungal agents are appropriate. Also, antifungal susceptibility testing and proper fungal identification can help dentists to determine the optimal course of treatment for CAC.

The antimicrobial and antibiofilm properties of allicin against Candida albicans and Staphylococcus aureus - A therapeutic potential for denture stomatitis

The objective of this study is to determine the therapeutic efficacy of allicin against Candida albicans (C. albicans) and Staphylococcus aureus (S. aureus), the common etiological agents for denture stomatitis (DS). The minimum inhibitory concentration (MICs), minimum bactericidal concentrations (MBCs) and minimum fungicidal concentration (MFCs) of allicin were determined by the broth microdilution method followed by checkerboard microdilution method for a synergistic interaction between allicin + nystatin and allicin + CHX. The potential of allicin to eradicate C. albicans and S. aureus biofilms was assessed by treating biofilm formed on self- polymerized acrylic resin with allicin at a sub-MIC concentration for 5 min. The commercial denture cleanser (brand X) was used as a positive control. A Kruskal-Wallis test followed by the post-hoc Mann-Whitney U test was applied (SPSS 20.0), and the level of significance was set at P < 0.05. Allicin exhibited antimicrobial activity against C. albicans (MIC:8 µg/ml and MFC:16 µg/ml) and S. aureus (MIC:8 µg/ml and MBC:8 µg/ml). A synergistic interaction was observed between allicin + nystatin and allicin + CHX (FICI ≤ 0.5). Allicin exhibited significant biofilm eradication against C. albicans and S. aureus biofilms with percentages of 50.0% and 52.6%, respectively. The results of this study suggest a possible application of allicin in treating C. albicans and S. aureus infection in DS.

A single-center 18-year experience with oral candidiasis in Brazil: a retrospective study of 1,534 cases

Despite the large number of published studies about oral candidiasis and associated risk factors, reports of large single-center retrospective studies on the prevalence of oral candidiasis, risk factors, and the oral candidiasis types diagnosed more frequently in oral diagnostic reference centers are scarce. The objective of the present study was to retrospectively survey the demographic and clinical profiles of 1,534 patients diagnosed with candidiasis and treated at the Center for Diagnosis of Oral Diseases (CDOD), Pelotas Dental School, Federal University of Pelotas between 1997 and 2014. Using a retrospective, cross-sectional, epidemiological design, data on race, gender, age, systemic diseases, oral candidiasis type and location, symptoms, and harmful habits such as smoking and alcohol consumption were collected. The statistical analysis was performed using STATA version 13.1. Risk factors for chronic atrophic candidiasis (CAC) were evaluated using Poisson regression with robust variance (p ≤ 0.05). The majority of patients with oral candidiasis seen at the CDOD over the 18-year period of analysis were Caucasian women, aged 51-60 years, nonsmokers, and nondrinkers, with no systemic disease, and who wore some form of dental prostheses. CAC was the single most common clinical type of candidiasis detected, and the most frequently affected oral site was the palate. These data from a large single-center in Brazil agree with previous evidence about the clinical and demographic profiles of patients with oral candidiasis.

Plants' Natural Products as Alternative Promising Anti-Candida Drugs

Candida is a serious life-threatening pathogen, particularly with immunocompromised patients. Candida infections are considered as a major cause of morbidity and mortality in a broad range of immunocompromised patients. Candida infections are common in hospitalized patients and elderly people. The difficulty to eradicate Candida infections is owing to its unique switch between yeast and hyphae forms and more likely to biofilm formations that render resistance to antifungal therapy. Plants are known sources of natural medicines. Several plants show significant anti-Candida activities and some of them have lower minimum inhibitory concentration, making them promising candidates for anti-Candida therapy. However, none of these plant products is marketed for anti-Candida therapy because of lack of sufficient information about their efficacy, toxicity, and kinetics. This review revises major plants that have been tested for anti-Candida activities with recommendations for further use of some of these plants for more investigation and in vivo testing including the use of nanostructure lipid system.

Differential effects of the combination of tyrosol with chlorhexidine gluconate on oral biofilms

OBJECTIVE

This study assessed the effect of tyrosol and chlorhexidine gluconate in combination against Candida albicans, Candida glabrata, and Streptococcus mutans in the planktonic state or forming biofilms in vitro.

MATERIALS AND METHODS

Checkerboard assays were performed for determination of minimum inhibitory concentration. Biofilms were cultivated during 24 h on specimens of acrylic resin and hydroxyapatite and treated with the drugs alone or in combination twice a day for 1 min, during 3 days. The antibiofilm effect was determined by quantification of the metabolic activity and cultivable cells. The drug combination was also applied on C. albicans to investigate its action on the number of hyphae. Data were statistically examined by two-way ANOVA and Holm-Sidak test (P < 0.05).

RESULTS

The effect of drug combination on planktonic cells was classified as antagonistic for C. albicans and indifferent for the other strains. Also, the drugs were ineffective against the tested biofilms. However, the drug combination showed a synergistic effect in reducing the number of hyphae by C. albicans.

CONCLUSION

The combination of tyrosol with chlorhexidine gluconate was only effective in reducing the number of hyphae by C. albicans, a relevant virulence factor of this species.

Antifungal activity of plant-derived essential oils on Candida tropicalis planktonic and biofilms cells

Dental prosthesis supports Candida species growth and may predispose the oral cavity to lesions. C. tropicalis has emerged as a colonizer of prosthesis and has shown resistance to clinically used antifungal agents, which has increased the search for new antifungals. This work describes the effectiveness of fifteen essential oils (EOs) against C. tropicalis The EOs were obtained by hydrodistillation and were chemically characterized by gas chromatography-mass spectrometry. The antifungal activities of the EOs were evaluated by the microdilution method and showed that Pelargonium graveolens (Geraniaceae) (PG-EO) was the most effective oil. Geraniol and linalool were the major constituents of PG-EO. The 2,3-Bis-(2-Methoxy-4-Nitro-5-Sulfophenyl)-2H-Tetrazolium-5-Carboxanilide (XTT) assay showed that all the clinical C. tropicalis strains formed viable biofilms. Scanning electron microscopy examination of the biofilms revealed a complex architecture with basal layer of yeast cells and an upper layer of filamentous cells. Treatments with PG-EO, linalool, and geraniol significantly reduced the number of viable biofilm cells and inhibited biofilm formation after exposure for 48 h. PG-EO, geraniol, and linalool were not toxic to normal human lung fibroblasts (GM07492A) at the concentrations they were active against C. tropicalis Together, our results indicated that C. tropicalis is susceptible to treatment with PG-EO, geraniol, and linalool, which could become options to prevent or treat this infection.

Efficacy and safety of miconazole for oral candidiasis: a systematic review and meta-analysis

The objective of this study is to assess the efficacy and safety of miconazole for treating oral candidiasis. Twelve electronic databases were searched for randomized controlled trials evaluating treatments for oral candidiasis and complemented by hand searching. The clinical and mycological outcomes, as well as adverse effects, were set as the primary outcome criteria. Seventeen trials were included in this review. Most studies were considered to have a high or moderate level of bias. Miconazole was more effective than nystatin for thrush. For HIV-infected patients, there was no significant difference in the efficacy between miconazole and other antifungals. For denture wearers, microwave therapy was significantly better than miconazole. No significant difference was found in the safety evaluation between miconazole and other treatments. The relapse rate of miconazole oral gel may be lower than that of other formulations. This systematic review and meta-analysis indicated that miconazole may be an optional choice for thrush. Microwave therapy could be an effective adjunct treatment for denture stomatitis. Miconazole oral gel may be more effective than other formulations with regard to long-term results. However, future studies that are adequately powered, large-scale, and well-designed are needed to provide higher-quality evidence for the management of oral candidiasis.