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      Candida prevalence and oral hygiene due to orthodontic therapy with conventional brackets

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          Abstract

          Background

          Conventional brackets are often used during orthodontic therapy of patients with malocclusion. The complex construction of such brackets greatly inhibits oral hygiene, which predisposes to increased carriage of microbiota. Orthodontic brackets could act as reservoir of yeast and predispose to oral candidosis. The aim of this study was to assess Candida prevalence and the role of oral hygiene during fixed appliance therapy . A further aim was to characterize the isolated yeasts according to their ability to form biofilms.

          Methods

          Seventeen participants (average age 17 ± 7 years) were monitored by taking oral rinses and elastomeric ligature samples, and by evaluating the approximal plaque index (API) and gingival bleeding index (GBI) before and after placement of the orthodontic conventional brackets for 12 weeks. Isolated yeasts were counted and biofilm formation was evaluated.

          Results

          One hundred and sixteen samples (67 oral rinses and 49 orthodontic elastomers) were collected. Ten patients (58.8% subjects) were Candida-carriers (two were colonized after bracket placement) and C. albicans was the most common species. The average number of yeasts in the oral cavity showed some fluctuation during the study, but in general had an upward trend (adj. R2 = 0.7967, p = 0.07025). A correlation was found between median number of yeasts and the periodontal indices (API, GBI). The average API values decreased in the Candida-carriers (adj. R 2 = 0.95; p = 0.01709), while average GBI values increased in the noncarriers (adj. R 2 = 0.92; p = 0.0256).

          Conclusions

          Treatment with orthodontic appliances promotes Candida yeast colonization, which is variable over time in terms of strain and species, with dominance of C. albicans, and without increased biofilm-forming activity. The API value decreases over time in carriers, and the GBI value increases in uncolonized patients, which may have predictive significance for the development of oral candidiasis during orthodontic treatment.

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          Most cited references13

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          Candida albicans Increases Dentine Demineralization Provoked by Streptococcus mutans Biofilm.

          Streptococcus mutans are considered the most cariogenic bacteria, but it has been suggested that Candida albicans could increase their cariogenicity. However, the effect of this dual-species microorganisms' combination on dentine caries has not been experimentally evaluated. Biofilms of C. albicans, S. mutans and C. albicans + S. mutans (n = 12/biofilm) were grown in ultra-filtered tryptone yeast extract broth culture medium for 96 h on root dentine slabs of known surface hardness and exposed 8 times per day for 3 min to 10% sucrose. The medium was changed 2 times per day (after the 8 cariogenic challenges and after the overnight period of famine), and aliquots were analyzed to determinate the pH (indicator of biofilm acidogenicity). After 96 h, the biofilms were collected to determine the wet weight, colony-forming units, and the amounts of extracellular polysaccharides (soluble and insoluble). Dentine demineralization was assessed by surface hardness loss (% SHL). The architecture of the biofilms was analyzed by confocal laser scanning microscopy (CLSM) and transmission electron microscopy (TEM). Data were analyzed by ANOVA followed by Tukey's test (α = 0.05). The dual-species C. albicans + S. mutans biofilm provoked higher % SHL on dentine (p < 0.05) than the S. mutans and C. albicans biofilm. This was supported by the results of biofilm acidogenicity and the amounts of soluble (6.4 ± 2.14 vs. 4.0 ± 0.94 and 1.9 ± 0.97, respectively) and insoluble extracellular polysaccharides (24.9 ± 9.22 vs. 18.9 ± 5.92 and 0.7 ± 0.48, respectively) (p < 0.05). The C. albicans biofilm alone presented low cariogenicity. The images by CLSM and TEM, respectively, suggest that the C. albicans + S. mutans biofilm is more voluminous than the S. mutans biofilm, and S. mutans cells interact with C. albicans throughout polysaccharides from the biofilm matrix. These findings show that C. albicans enhances the cariogenic potential of the S. mutans biofilm, increasing dentine demineralization.
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            Candida and Oral Candidosis: A Review

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              The effect of fixed orthodontic appliances on the oral carriage of Candida species and Enterobacteriaceae.

              The aim of this investigation was to evaluate the prevalence of Candida and Enterobacteriaceae in a group of adolescents during fixed orthodontic appliance (FOA) therapy. The experimental group was recruited from a larger sample of orthodontic patients who were clinically examined once to obtain baseline data before active treatment. The group comprised 27 subjects; 13 males, 14 females (mean age 15.5 +/- 2.3 years). Thereafter, the experimental group was examined three times during a 3 month follow-up period after insertion of the FOA. The whole mouth plaque score was obtained, and the oral cavity was then sampled for Candida species and Enterobacteriaceae using three different microbiological culture techniques, namely the oral rinse, pooled plaque and the imprint culture.A significant increase in candidal numbers was observed after FOA insertion when the imprint technique was used (P < 0.001), although the overall candidal prevalence rates obtained using the oral rinse and pooled plaque techniques did not demonstrate such a change. The predominant Candida species isolated was C. albicans and the number of coliform carriers significantly increased after the insertion of a FOA, as detected by the oral rinse (P < 0.05) and the pooled plaque (P < 0.05) techniques. In total, eight coliform species were isolated following FOA therapy compared with the three species isolated before insertion of the appliance. The results also revealed a significant increase in plaque index due to the introduction of a FOA. Taken together, these data imply that insertion of a FOA is likely to promote oral carriage of Candida and coliform species. Furthermore, it appears that routine oral hygiene instruction and information on appliance hygiene given to these patients may not necessarily reduce plaque accumulation and possible attendant effects. Further work with a larger cohort is required to confirm these findings.
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                Author and article information

                Contributors
                kinga.grzegocka@uj.edu.pl
                Journal
                BMC Oral Health
                BMC Oral Health
                BMC Oral Health
                BioMed Central (London )
                1472-6831
                10 October 2020
                10 October 2020
                2020
                : 20
                : 277
                Affiliations
                [1 ]GRID grid.5522.0, ISNI 0000 0001 2162 9631, Department of Orthodontics, Dental Institute, Faculty of Medicine, , Jagiellonian University Medical College, ; ul. Montelupich 4/108, 31-155 Kraków, Poland
                [2 ]GRID grid.5522.0, ISNI 0000 0001 2162 9631, Department of Mycology, Chair of Microbiology, Faculty of Medicine, , Jagiellonian University Medical College, ; Kraków, Poland
                [3 ]GRID grid.5522.0, ISNI 0000 0001 2162 9631, Department of Prosthodontics, Dental Institute, Faculty of Medicine, , Jagiellonian University Medical College, ; Kraków, Poland
                Author information
                https://orcid.org/0000-0002-9177-9544
                https://orcid.org/0000-0002-2554-9409
                https://orcid.org/0000-0002-9244-9301
                https://orcid.org/0000-0002-8759-0810
                https://orcid.org/0000-0003-0811-9295
                https://orcid.org/0000-0001-5724-5808
                Article
                1267
                10.1186/s12903-020-01267-4
                7547526
                33036600
                fe11dc6d-6242-47a8-9d44-4f953721b157
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 1 April 2020
                : 30 September 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100004569, Ministerstwo Nauki i Szkolnictwa Wyższego;
                Award ID: K/ZDS/003737
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Dentistry
                orthodontic brackets,candida,oral hygiene,periodontal index
                Dentistry
                orthodontic brackets, candida, oral hygiene, periodontal index

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