Incidence of immediate and delayed hypersensitivity to Candida albicans in denture stomatitis

Isolation and identification of Candida from the oral cavity

Various techniques are available for the isolation of Candida within the oral cavity. Such methods play an important role in the diagnosis and management of oral candidosis. The growing importance of Candida is in part related to the emergence of HIV infection and the more widespread use of immunosuppressive chemotherapy. Along with the Candida albicans there has been a greater recognition of the importance of the nonalbicans Candida species in oral candidosis. Identification of infecting strains of Candida is important because isolates of Candida species differ widely, both in their ability to cause infection and also in their susceptibility to antifungal agents. Thus this review provides an overview of the reliable methods of candidal isolation and identification of isolates from the oral cavity.

Innate versus adaptive immunity in Candida albicans infection

Candida albicans is a common opportunistic pathogen, causing both superficial and systemic infection. Clinical observations indicate that mucocutaneous infections are commonly associated with defective cell-mediated immune responses, whereas systemic infection is more frequently seen in patients with deficiencies in neutrophil number or function. Analysis of mechanisms of host resistance against gastrointestinal and oral infection in mouse models has demonstrated an absolute dependence on CD4(+) T cells, although clearance also involves phagocytic cells. Both IL-12 and TNF-alpha appear to be important mediators, but mouse strain-dependent variations in susceptibility to infection may be related to T-cell enhancement of production of phagocytic cells by the bone marrow. In murine systemic infection, the role of innate and adaptive responses is less well defined. Studies in immunodeficient and T-cell-depleted mice suggest that clearance of the yeast may be predominantly a function of the innate response, whereas the adaptive response may either limit tissue damage or have the potential to cause immunopathology, depending on the host genetic context in which the infection takes place.

Oral candidal infection and denture stomatitis: a comprehensive review

Denture stomatitis rarely occurs without at least one predisposing factor that lowers patient resistance. A new disinfection technique for dentures and oral tissue may eliminate topical or anti-fungal drug use.

A retrospective study of patients with recurrent chronic atrophic candidosis

A retrospective study was carried out in thirty-seven patients who had recurrent chronic atrophic candidosis (CAC). The factors commonly believed to predispose to CAC were investigated, including corrected whole blood folate, iron saturation, and vitamin B12. The incidence of CAC based on clinical and microbiologic criteria was assessed before and after antifungal therapy and correction of predisposing factors. No significant difference was found. Hence, the role of additional, less well-known predisposing factors in the etiopathology of CAC should be considered when one is treating patients with recurrent, chronic Candida infections.

The role of C. albicans in denture stomatitis

Denture stomatitis is an erythematous disorder of the denture-bearing tissues, especially the maxillary hard palate. Frequently it mimics many oral lesions. Early diagnosis of the lesion is essential to assure rational therapy. A diagnostic procedure based upon the enumeration of Candida albicans appeared to be feasible. A control group of twenty fully dentate subjects with no clinical evidence of stomatitis was sampled to establish normal concentrations of C. albicans in the oral flora. Samples were taken from a triangular area of the hard palate, serially diluted in broth, and all dilutions were incubated aerobically. In the control population, C. albicans never exceeded 100 organisms per square centimeter per subject sample. A population of edentulous patients with denture stomatitis, prior to any therapy, was similarly sampled. In many of these patients the concentration of C. albicans always exceeded 10,000 organisms per square centimeter per patient. The patients received denture replacements and antimycotic antibiotic therapy. Follow-up cultures were taken 4 to 6 weeks after completion of therapy. All patients were found to be free of denture stomatitis.