中老年患者口腔念珠菌携带情况的研究

目的研究口腔修复门诊戴用和不戴可摘义齿中老年患者口腔念珠菌携带情况及常见的念珠菌菌种,并分析相关因素。方法选择不戴可摘义齿患者54人(A组),戴上颌可摘义齿患者84人(B组),年轻学生51人作为对照组(C组)。采集唾液培养并初步鉴定菌种,分析相关因素。结果 A组念珠菌检出率为51.9%,白念珠菌占82.1%。B组念珠菌检出率为82.1%,白念珠菌占73.9%。C组念珠菌检出率为17.6%,白念珠菌占55.6%。A、B、C 3组间及每两组间的念珠菌检出率差异均有统计学意义(P≤0.01)。结论戴用可摘义齿的中老年患者口腔念珠菌检出率显著高于不戴义齿中老年患者;中老年患者口腔念珠菌检出率明显高于年轻对照组。白念珠菌仍是口腔中主要念珠菌种。     

Oral disorders and treatment implications in people over 75 years

The oral health of subjects over 75 yr and living independently in the southwest of Britain was assessed. The majority (80%) of the sample were edentulous, and a large proportion of both edentate and dentate subjects were using dentures. More than half of the denture wearers were using loose, very unhygienic, or structurally defective dentures. Mucosal pathoses were quite common, although most of the lesions were denture-induced stomatitis found in association with unhygienic dentures. The dentate subjects had, on average, 11 natural teeth, frequently with evidence of root caries and deep periodontal pockets or extreme bone loss. The oral health problems suggest that there is a significant need to develop effective methods of improving oral hygiene in this age group. The prosthetic treatment is related principally to denture repairs while there is a need to control root caries among the growing population of elderly dentate people.     

RPDs基托材料对口腔念珠菌定植的影响

目的：初步研究可摘局部义齿（RPDs）不同基托材料对口腔念珠菌的定植的影响。方法：临床随机选择RPDs修复患者147例。其中树脂基托义齿（A组）58例,钴铬合金铸造基托义齿（B组）63例,纯钛及钛合金铸造基托义齿（C组）26例。吐唾法取样,用CHROMagar培养基鉴定念珠菌菌种。培养基中念珠菌菌落计数为每个样本的念珠菌检出强度。通过统计学方法,比较3组不同基托材料义齿戴用人群念珠菌检出率和检出强度的差异。结果：147例不同基托材料义齿戴用人群中检出的念珠菌包括白色念珠菌、热带念珠菌、克柔念珠菌3个菌种。A、B、C组白色念珠菌和非白色念珠菌检出率无显著差异。白色念珠菌的菌落形成单位数,A组显著高于B、C组（P〈0.05）;B组显著高于C组（P〈0.05）。非白色念珠菌间的菌落形成单位数无明显差异。结论：戴不同材料义齿患者口腔除了能检出白色念珠菌,还可检出非白色念珠菌;口腔念珠菌的菌落形成单位数与义齿基托材料密切相关,钛及钛合金基托义齿应为预防义齿性口炎的首选义齿。     

Oral candidosis in long-term hospital care: comparison of edentulous and dentate subjects

OBJECTIVE: To obtain information on the oral health status of the elderly living in a medicalized, geriatric institution.
DESIGN: A cross-sectional clinical investigation with complementary microbiological studies.
SUBJECTS AND METHODS: A cohort of 233 elderly in one long-term care ward; collection of demographic data; clinical examination to determine dental and prosthetic status and health of the oral mucosae; swabs for detection of mucosal and denture colonization by Condido; paraffin stimulated saliva for detection of colonization by mutans streptococci and lactobacilli.
MAIN OUTCOME MEASURES: Oral and denture hygiene; oral mucosal health; degree of colonization by Condida , mutans streptococci and lactobacilli.
RESULTS: Mean age of the 233 patients was 85.6 ± 6.9 years; 61% were totally dependent, 62.7% were wearing one or two complete dentures; 19.7% had natural teeth and no denture and 17.6% neither teeth nor denture. Of those wearing dentures 72% had denture stomatitis. Of those with natural teeth 72% were affected by active caries. Yeast counts were significantly correlated with the intensity of the erythema of the palatal mucosa, plaque score of the natural teeth, denture plaque score, and salivary counts of mutans streptococci and lactobacilli.
CONCLUSIONS: High oral yeast counts and frequent prevalence of oral candidosis in elderly subjects living in institutions are associated with poor oral hygiene and neglect of denture care.     

Association of candidal activity with denture use and salivary flow in symptom-free adults over 60 years

The purpose of this study was to examine the amount of palatal mucosa Candida species associated with denture use and stimulated salivary flow in symptom-free adults over 60 years. The subjects were 351 (189 men and 162 women) independently living elderly people with a mean age of 66.7 +/- 4.3 (SD) years. Candidal activity of palatal mucosa was evaluated by the pH change in the medium that was associated with the acid production of the yeast. Subjects whose stimulated salivary flow rate was less than 0.5 ml/min were placed in the hyposalivation group. A multiple logistic regression analysis was used to determine if an independent variable was statistically significant after controlling for other variables. Candidal activity of the palatal mucosa was significantly associated with the dental status of the maxillae (Kruskal-Wallis test, P < 0.001), but was not significantly associated with age or drug intake. In maxillary denture wearers, Candidal activity of palatal mucosa had a significantly positive correlation with candidal activity of tissue fitting surfaces of maxillary dentures (r = 0.806, P < 0.001). A multiple logistic regression analysis showed that high candidal activity of the palate was significantly associated with being male and wearing maxillary removable dentures. Stimulated salivary flow rate was likely to be negatively related to high candidal activity (P = 0.07). This study suggests that the activity of Candida species in the oral cavity is associated with the wearing of removable dentures and stimulated salivary flow, independent of age or gender even in the relatively healthy elderly.     

Isolation of Candida species from the oral cavity and fingertips of complete denture wearers.

STATEMENT OF PROBLEM: Candida species usually colonize in the oral cavity of denture wearers and may also colonize on their fingers because of frequent manual manipulation of the dentures. PURPOSE: This study investigated the association between oral and fingertip candidal isolation in a group of denture wearers. MATERIAL AND METHODS: Oral rinse and fingerprints obtained from 25 healthy male complete denture wearers were microbiologically investigated for candidal growth, and isolated Candida species were identified with a germ tube test and a commercially available yeast identification system. Denture cleanliness, hand washing, and denture wearing and handling habits were recorded for each subject. RESULTS: Candida species were isolated from the oral cavity of 15 (60%) and fingertips of 11 (44%) subjects. Ten (66.7%) subjects had concomitant oral and fingertip candidal isolation, whereas 5 (33.3%) subjects had only oral Candida (P=.005). CONCLUSION: The hands of denture wearers who had oral Candida were significantly more colonized with Candida species than oral Candida-free subjects. Further studies identifying Candida species to the strain level and the significance of hand Candida as a source for mouth reinfection are needed.     

健康老年人口腔念珠菌与义齿修复的相关研究

目的 研究健康老年人群中口腔念珠菌的定植状况,分析义齿修复对老年人口腔念珠菌定植的影响。方法 212例健康老年人分为4组：A1组（男性,有义齿）,B1组（男性,无义齿）,A2组（女性,有义齿）和B2组（女性,无义齿）。标准含潄法取样,样本接种于沙堡琼脂培养基培养念珠菌,CHROMagar CandidaTM鉴定培养基鉴定白色念珠菌,碳水化合物同化反应鉴定体系鉴定念珠菌菌种。培养基中念珠菌菌落计数为每个样本的念珠菌检出强度。比较4组健康老年人念珠菌检出率和检出强度有无统计学差异。结果 212例老年人中116例检出念珠菌,检出率为54.72％。检出念珠菌包括白色念珠菌、近平滑念珠菌、克柔念珠菌、热带念珠菌等10个菌种。A1、B1、A2和B2组念珠菌检出率分别为66.67%,36.07%,64.15%和56.00%;白色念珠菌检出率分别为56.25%,21.31%,56.60%和38.00%。A1组念珠菌、白色念珠菌检出率高于B1组（P<0.05）。高念珠菌强度者在A1、A2组所占比例分别较B1、
B2组高（P<0.05）。结论 健康老年人口腔总念珠菌及白色念珠菌检出率和检出强度增高与义齿修复相关。老年人
口腔念珠菌检出率和检出强度的差异主要是白色念珠菌检出率和检出强度的差异所造成。     

Oral mucosal lesions among institutionalized elderly in Denmark

The purpose of the study was to determine the prevalence of oral mucosal lesions among institutionalized elderly. The study population comprised 486 elderly from eight nursing homes, and 199 elderly from five hospital long-term care facilities in the eastern part of Denmark. Approximately half of the subjects exhibited one or more pathologic conditions of the oral mucosa. Denture related traumatic ulcerations were found in 3.9% of the nursing home residents, compared to 8.3% among the elderly in hospital long-term care. The most prevalent finding was denture stomatitis, which was manifest in about one third of the elderly. The prevalence was strongly influenced by the denture hygiene; 54% of the elderly with poor denture hygiene suffered from denture stomatitis, as compared to only 7% of those with clean dentures. The prevalence of denture stomatitis was also related to the usage of dentures at night and to the age of the dentures. The prevalence decreased significantly with increasing age, although the oldest age group did not have better denture hygiene, or more favorable wearing habits. It did not appear that sex, type of residency, degree of urbanization, denture conditions, or the use of anticholinergic drugs influenced the prevalence of denture stomatitis. The prevalence and severity of the disease can probably be reduced if the denture hygiene is improved and if the elderly only use their dentures during the daytime.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of oral stereognosis in relation to age and the use of complete dentures

The purpose of this study was to examine the age-related difference in oral sensory function by testing oral stereognostic ability (OSA) and to determine the effect of wearing complete dentures on OSA. Subjects were 20 dentate and 30 edentulous elderly patients free from oral symptoms and pathologies, and 30 younger dentate students as controls. The OSA tests were conducted with test pieces of 12 shaped forms. The duration time for recognition was noted and the answers were recorded using a three-point scale. anova and paired t-tests were used to examine significant differences. P-values <0.05 were considered to be statistically significant. The OSA score in older dentate participants and complete denture wearers was significantly higher than in younger dentate subjects. However, no significant difference was found in the OSA score between older dentate participants and complete denture wearers. When older edentulous subjects removed the maxillary and mandible complete dentures, the OSA score was significantly lower and the response time significantly longer than with dentures. Within the limitations of this study, an age-related difference in oral sensory function, as measured by OSA tests, was found. However, oral sensory function was not significantly different between fully dentate persons and complete denture wearers in the elderly.     

Etiology, pathogenesis, therapy, and prophylaxis of oral yeast infections

Etiologic factors in oral candidosis are immature antimicrobial host defenses, acquired suppression of immune defense mechanisms (AIDS, immunosuppressive or radiation therapy), or changes of the environmental conditions of the oral cavity (antibiotics, dentures, epithelial changes). After colonization and adhesion of Candida to the epithelial surface the subsequent mucosal lesion is due to tissue destruction by potent proteolytic enzymes or toxins and an inflammatory response to Candida antigens. Topical antimycotic treatment with nystatin, amphotericin B, or miconazole is important especially to prevent spread of the infection. Chronic Candida infections require long-term antifungal therapy, and patient compliance may be difficult to obtain. In denture stomatitis colonization of the fitting denture surface by Candida should be controlled by, for example, using a chlorhexidine solution as a denture disinfectant. However, recurrences are frequent if the local or the systemic predisposing conditions are not corrected. Fluconazole, a new bis-triazole, may be important for long-term treatment of immunocompromised patients.     

Oral mucosal lesions among elderly in Israel

The prevalence of ulcerative or proliferative oral mucosal lesions (OML) is an important parameter in evaluating the oral health of an elderly population. This paper relates the prevalence of OML in an elderly population to possible risk factors and defined high-risk groups. The second objective was to examine whether effective prediction of OML was possible from interview data alone. The elderly population of a Jerusalem neighborhood was surveyed in 1981: 456 elderly were interviewed by trained interviewers, and their oral cavities were examined by an oral epidemiologist. Specific diagnoses were confirmed by an independent senior clinician. Almost 40% of the elderly presented ulcerative or proliferative oral mucosal lesions. The prevalence of these OML was strongly related to the condition and age of dentures. The association between these OML and oral hygiene disappeared after controlling for the condition of the denture. Two variables ascertained by interview--age of denture and self-reported suitability of denture--turned out to be strong predictors of denture condition.     

The isolation,identification and molecular analysis of Candida spp. isolated from the oral cavities of patients with diabetes mellitus

Previous studies have shown a high incidence (77%) of isolation of Candida spp. from the oral cavities of patients with type 1 diabetes mellitus. The aim of the present study was to assess the prevalence of yeast in the oral cavities of patients suffering from type 1 and type 2 diabetes mellitus. The patients were classified according to the level of diabetic control (HbA1c), and further stratified on the presence or absence of dental prosthesis. Oral rinse samples were assessed for the growth of yeast and the degree of colonization. Oral isolates were defined to the species level by both phenotypic and novel molecular methods. The overall proportion (60%) of diabetic patients who had Candida spp. isolated from the oral cavity was similar to that previously reported. Local oral factors, such as the presence of dentures, seemed to have a greater influence than diabetic status on the amount and species of Candida isolated from the oral cavities of diabetic patients. Diabetic patients with dentures had more non-albicans Candida isolated from their mouths than dentate diabetic patients. Candida dubliniensis was isolated from diabetic patients and may have a predilection for dentate patients.     

The influence of denture-wearing and age on the oral microflora.

The effects of denture-wearing and age on the prevalence of selected bacteria of dental significance and on the carriage of opportunistic pathogens in molar plaque and whole saliva were determined in 120 healthy subjects, 41 of whom wore partial dentures. The subjects were divided into four age groups: 20-39 years (group A), 40-59 years (group B), 60-79 years (group C), and greater than or equal to 80 years (group D). The proportions, mean log10 viable counts, and isolation frequency of yeasts and lactobacilli in saliva and plaque were consistently higher in partial-denture wearers. The proportions of staphylococci and mutans streptococci were also raised in denture wearers, but these differences did not reach statistical significance. When the data were analyzed for age effects, both yeasts and lactobacilli were found to be increased in saliva with age, but statistically significant differences were generally found only between denture wearers in group D and subjects in the control group A. The isolation frequency of yeasts from plaque was also significantly higher in denture wearers of the oldest age group (D) compared with those in group A. A. viscosus predominated over A. naeslundii in the older age groups, regardless of the presence of dentures. Enterobacteria were isolated occasionally but only from the saliva of denture wearers in group D. Spirochetes and black-pigmented anaerobes were generally found in lower numbers in denture wearers. Collectively, the data show that components of the oral microflora in adults can be independently influenced by both age and the wearing of partial dentures.     

Relationship between oral Candida species and risk factors with reference to drugs with xerostomic side effects among institutionalised elderly in Aichi Pref., Japan

OBJECTIVE: To clarify the relationship between Candida carriage and drugs which have reported xerostomic side effects in the elderly. DESIGN: Cross-sectional study. Setting Two long-term care facilities in Aichi Pref., Japan. PARTICIPANTS: Eight men and 63 women with a mean age of 86 years (range 62 to 95 years) with at least some of their natural teeth. METHOD: Oral examination by dentists, microbiological test by microbiologists, questionnaire interviews, and data obtained from medical files. The Candida species (CFU) was adopted as an objective variable with risk indicators being age, number of teeth, saliva flow rate, denture wearing, xerostomic drugs, activities of daily living (ADL), frequency of brushing and type of meals. RESULTS: Bivariate analysis confirmed that participants with a higher number of Candida species (CFU) fell into the following categories: denture wearing (p < 0.05), older age (p < 0.05), xerostomic drugs (p < 0.10), more teeth, poor ADL, soft/liquid meals, and brushing once a day. This was in contrast to the categories of no denture wearing, younger age, no xerostomic drugs, fewer teeth, good ADL, normal meals, and brushing two or more times a day, in that order of significant probability on an ascending scale. A multiple logistics regression model confirmed that the variables of older age (80 years and over) and more teeth (six or more) had statistically significant (p < 0.05) effects on the number of Candida species present (CFU). Xerostomic drugs and the other variables had no significant effect. CONCLUSION: Older age and more teeth had a significant effect on the number of oral Candida species in the elderly. The results of this study did not support a role of those drugs as a risk indicator for oral Candida carriage. Larger trials are needed to assess the effect of drugs on the presence of oral Candida.     

Frequency, species and molecular characterization of oral Candida in hosts of different age in China

INTRODUCTION: Research indicates that host age is a determining factor in yeast carriage. From the neonatal period, humans go through several dentition periods, and the emergence and substitution of teeth and changes in living habits greatly change the environment of the oral cavity, and therefore influence colonization by oral commensal organisms, certainly including Candida spp. No previous study of Candida carriage by different age groups divided by dentition has been reported. This study supplies data on the geographical specificity of C. albicans genotypic subgroup distribution. METHODS: All test individuals came from a single geographical locale over a short period. Following mucosal swab sampling, CHROMagar Candida-yeast differential media were used to determine the frequency of carriage and species. All C. albicans strains were confirmed by PCR and PCR using primers reported to span a transposable intron region in the 25S rRNA gene was used to determine genotypic subgroups. RESULTS: The results demonstrate that for the tested population, the frequency of Candida species and the distribution of C. albicans genotypic subgroups varied with age group. With increasing age, the frequency of C. albicans decreases, non-C. albicans yeasts increases; Genotypic subgroup A is the dominating strain in the oral cavities of healthy young individuals. CONCLUSIONS: The influence of dentition substitution on oral yeast carriage was minor.     

Carriage of Candida species in the oral cavity in diabetic patients: relationship to glycaemic control

To study the possible relationship between the quality of glycaemic control in diabetes mellitus and the carriage of Candida species, the Candidal carrier status of 412 diabetic patients was examined using an oral rinse technique and correlated with measurements of random blood glucose and total glycosylated haemoglobin. Candida was isolated in 210 diabetics (51%) with 13 patients (6%) carrying more than one species. The positive isolates were: Candida albicans (89%), Candida krusei (2.8%), Candida glabrata (2.8%), Candida tropicalis (6.2%), Candida stellatoidea (2.8%) and Candida parapsilosis (0.5%). No association was identified between carriage rates and the type of treatment of diabetes, or with the quality of glycaemic control. As in non-diabetic subjects, the carriage rates were higher in diabetic patients wearing dentures. Thus, the oral carriage of Candida in diabetic patients was independent of glycaemic control but in certain sub-groups the carriage rates were higher, and involved uncommon candidal species.     

Carriage of Candida species in the oral cavity in diabetic patients: relationship to glycaemic control

To study the possible relationship between the quality of glycaemic control in diabetes mellitus and the carriage of Candida species, the candidal carrier status of 412 diabetic patients was examined using an oral rinse technique and correlated with measurements of random blood glucose and total glycosylated haemoglobin. Candida was isolated in 210 diabetics (51%) with 13 patients (6%) carrying more than one species. The positive isolates were: Candida albicans (89%), Candida krusei (2.8%), Candida glabrata (2.8%), Candida tropicalis (6.2%), Candida stellatoidea (2.8%) and Candida parapsilosis (0.5%). No association was identified between carriage rates and the type of treatment of diabetes, or with the quality of glycaemic control. As in non-diabetic subjects, the carriage rates were higher in diabetic patients wearing dentures. Thus, the oral carriage of Candida in diabetic patients was independent of glycaemic control but in certain sub-groups the carriage rates were higher, and involved uncommon candidal species.     

Oral hygiene, dental visits and age of denture for prevalence of denture stomatitis

Abstract A representative sample of Finnish denture wearers (n= 3875) aged 30 or over were examined clinically and interviewed about their oral hygiene habits, use of dental services and possible prosthetic treatment during last visit to a dentist. Of these denture wearers, over 80% brushed their dentures at least once a day, and 16% visited a dentist at least once in 2 yr. For denture stomatitis the age-standardized risk ratio decreased with brushing frequency in women and increased in men. For frequency of dental visits the prevalence of denture stomatitis increased in both men and women when visits were made over 2-yr intervals. The prevalence of denture stomatitis was higher in the group with dentures over 1 yr old. It seems that the oral hygiene measures as they are generally carried out and regular dental visits are not effective enough methods in preventing denture stomatitis.     

Oral pathology and prostheses—are they related? Investigations in an elderly population

A survey of 233 elderly subjects living in the district served by the Halton Health Authority (Cheshire, England) investigated the relationship between the age of dentures, their need for replacement and the presence of any oral pathological lesions. The retention, stability, occlusion and cleanliness of the dentures were all found to be worse in the older appliances; perceived need for denture replacement was found to increase from 40% in 5-year-old dentures to 84% in dentures over 31 years old. While 41% of the sample had an oral pathological lesion, no significant relationship was found between denture age and pathology or place of residence. People resident in the community with no assistance had the highest incidence of oral pathology and those living in long-stay hospitals the least. The absence of a relationship between denture age and oral pathology is considered to be a powerful indicator of the need for regular oral examination of the edentulous population.