Oral Candidal Infection of the Patients with Oral Discomforts: A Retrospective Study

Abstract

The aims of the study were to evaluate the value of DentocultⓇ CA compared to Sabouraud dextrose agar (SDA) culture, to compare the candida culture positive rate, symptom improved rate after antifungal therapy among the patients with oral discomfort retrospectively, and to provide a clinical guideline for diagnosis and treatment in oral candidal infection. The 328 dental records of patients who complained various oral discomforts at Seoul National University Dental Hospital from January 2012 to September 2013 were reviewed. Candida culture data were obtained from both Dentocult®CA and SDA and analyzed with McNemer test. Based on initial clinical diagnosis, patients records were categorized as group 1 (glossodynia without objective sign, 58 patients), group 2 (oral mucosal lesion, 101 patients), group 3 (hyposalivation, 31 patients) and group 4 (oral candidiasis, 38 patients). 100 patients were excluded because of inconsistency with initial diagnosis (e.g., squamous cell carcinoma, epithelial dysplasia, leukoplakia) and failure to follow-up after initial examination or antifungal therapy. Candida culture positive percents were compared with Chi-square test among group 1, 2, and 3. The correlation between Candida culture positive and systemic diseases was analyzed with Chi-square and Fishers extract test. After antifungal therapy, the mean Candida colony count was compared between symptom-improved and symptom-sustained with Students t-test. The result suggested that the relative validity of Dentocult®CA approximately equals that of SDA (p=0.066). Dentocult®CA showed 89.1% sensitivity and 85.3% specificity. Candida culture positive was found in 21 patients (43.1%), 40 patients (39.6%) and 22 patients (72.0%) in three groups, respectively. There was a significant difference among three groups (p=0.003). In addition, gastrointestinal disease (p=0.030) and genitourinary disease (p=0.012) had significant correlations with the Candida culture positive rate. Mean Candida colony count showed no significant differences between symptom-improved and symptom-sustained group. Oral Candida carriage is significantly related to hyposalivation. Antifungal medication can be considered initially or in the process of main symptom treatment, especially in hyposalivation group.