Mandibular Osteomyelitis Associated with Candida Albicans in Marijuana and Heroin Abusers

Cross-kingdom microbial interactions in dental implant-related infections: is Candida albicans a new villain?

Candida albicans, an oral fungal opportunistic pathogen, has shown the ability to colonize implant surfaces and has been frequently isolated from biofilms associated with dental implant-related infections, possibly due to its synergistic interactions with certain oral bacteria. Moreover, evidence suggests that this cross-kingdom interaction on implant can encourage bacterial growth, leading to increased fungal virulence and mucosal damage. However, the role of Candida in implant-related infections has been overlooked and not widely explored or even considered by most microbiological analyses and therapeutic approaches. Thus, we summarized the scientific evidence regarding the ability of C. albicans to colonize implant surfaces, interact in implant-related polymicrobial biofilms, and its possible role in peri-implant infections as far as biologic plausibility. Next, a systematic review of preclinical and clinical studies was conducted to identify the relevance and the gap in the existing literature regarding the role of C. albicans in the pathogenesis of peri-implant infections.

A systematic review on the implication of Candida in peri-implantitis

Background

Candida is a heterogeneous fungal genus. Subgingival sulcus is a refuge for Candida, which has already been related to the pathogenic inflammation of periodontitis. This work aims to review the presence of Candida in the sulcular fluid surrounding dental implants and discuss its potential role in peri-implantitis.

Results

A bibliographical research was performed in PubMed, Scopus and Web of Science databases, with the keywords candida, peri-implantitis, periimplantitis, “dental implant” and implant. Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. At the end, nine observational studies were included, which analysed 400 dental implants with PI and 337 without peri-implantitis. Presence of Candida was assessed by traditional microbiological culture in blood agar or/and CHROMagar, though identification was also detected by quantitative real-time PCR, random amplified polymorphic DNA or ATB ID 32C. Dentate individuals and implants with peri-implantitis (range, 3–76.7%) had a bigger presence of Candida. C. albicans was the most isolated species, followed by Candida parapsilosis, Candida tropicalis, and Candida dubliniensis.

Conclusion

Candida is part of the microbiological profile of the peri-implant sulcular fluid. More studies are needed to compare the link between Candida and other microorganisms and to discover the true role of these fungi in peri-implantitis.

Effect of Probiotics on Oral Candidiasis: A Systematic Review and Meta-Analysis

Oral candidiasis (OC) is an increasing health problem due to the introduction of new drugs, population aging, and increasing prevalence of chronic illness. This study systematically reviews the effects of the oral intake of probiotics, prebiotics, and synbiotics on Candida spp. counts (colony-forming units (CFU)/mL) in oral and palatal samples. A literature search was conducted. Twelve studies, eight randomized clinical trials (RCTs), and four pre-post studies, resulted as eligible for the meta-analysis, which was performed through a Bayesian random-effects model. All studies analyzed probiotics, and none of them analyzed prebiotics or synbiotics. The treatments effects were measured in terms of odds ratio (OR) of OC (CFU/mL >10², 10³, or 10⁴). The meta-analytic OR was 0.71 (95% credibility interval (CrI): 0.37, 1.32), indicating a beneficial effect of treatment; the I² index was 56.3%. Focusing only on RCTs, the OR was larger and more precise at 0.53 (95% CrI: 0.27, 0.93). The effect of treatment appeared to be larger on denture wearers. Our findings indicate that the intake of probiotics can have a beneficial effect on OC and that the effects could vary according to the patients' characteristics. Due to the presence of medium-high-risk studies, the results should be interpreted with caution.