A. M. G. Darwazeh

The relationship between colonisation, secretor status and in-vitro adhesion of Candida albicans to buccal epithelial cells from diabetics

This study investigated whether oral candida infection in diabetics and adhesion of Candida albicans to buccal epithelial cells in vitro were related. Buccal cells from 50 patients with diabetes mellitus showed a significant increase in adhesion of C. albicans strain CDS 88 compared with those collected from 50 non-diabetic controls matched for age, sex and denture status. Oral candida carriage, candida infection and secretor status were also investigated in both groups. The frequency of carriage was increased, but not significantly, and there was a significantly higher incidence of candida infection in diabetic patients compared with controls. Diabetic patients who were non-secretors had a significantly increased frequency of oral candida carriage.

Oral Disorders Associated with Diabetes Mellitus

The protean manifestations of diabetes include various associated oral disorders such as sialosis, xerostomia, impairment of taste, and localized infections of which oral candidosis is the most commonly observed. The association of specific oral diseases and diabetes is of importance both in the detection of undiagnosed diabetes and in the elucidation of the pathogenesis of various oro‐facial diseases. The clinical features and possible causes of oral disorders recognized to be associated with diabetes are reviewed with emphasis on good oral hygiene in the diabetic patient.

Prevalence of pulp stones in Jordanian adults

OBJECTIVE The purpose of this study was to describe the prevalence of pulp stones in a sample of Jordanian dental patients. The article also presents frequency distributions of this condition among different types of teeth. STUDY DESIGN Data were collected through radiographic examinations of a random sample of periapical and bitewing films of 4573 teeth from 814 dental records from the Faculty of Dentistrys filing system. RESULTS Pulp stones were identified in 22% of the teeth examined. First and second molars were the teeth most commonly affected. Pulp stone incidence was not significantly different among different age and gender groups.

The effect of glycemic control on Candida colonization of the tongue and the subgingival plaque in patients with type II diabetes and periodontitis

OBJECTIVES Identify the relationship between the tongue and subgingival plaque Candida colonization, and its relationship to the quality of glycemic control (assessed by glycosylated hemoglobin) and other confounders, in type II diabetics who have periodontitis. STUDY DESIGN Candida species were isolated from the tongue and subgingival plaque of the 2 deepest periodontal pockets from 78 patients, and were identified by RapID Yeast Plus System. Students t test, χ(2) test or Fishers exact test, analysis of variance, multivariate logistic regression analysis, and Spearmans correlation test were used. RESULTS Candida species colonized 46 (59%) and 38 (48.7%) of the patients tongue and subgingival plaque, respectively. Subgingival Candida was more prevalent in females than males (P = .041). The quality of glycemic control correlated with the prevalence of subgingival Candida (P = .047) and the severity of gingival disease (P = .047). CONCLUSION Poor glycemic control and female gender may be associated with increased subgingival Candida in patients with type II diabetes.

Oral Candida colonization and candidiasis in patients with psoriasis.

OBJECTIVES The objective of this study was to investigate oral Candida colonization and candidosis in a group of patients with psoriasis and controls. STUDY DESIGN A total of 100 patients with psoriasis and matched controls underwent the concentrated oral rinse test for Candida isolation. Candida species were identified by the VITEK 2 Identification System. Categorical variables were evaluated using the χ(2) test. The median Candida count was compared using the Mann-Whitney U test. RESULTS Oral candidiasis was diagnosed in 3% of the patients with psoriasis. The Candida count and prevalence were significantly higher in the patients with psoriasis compared with controls (69% vs 44%, P < .001), but with no relationship to the severity or treatment of psoriasis. Oral Candida was significantly higher in late-onset (at age ≥30 years) compared with early-onset psoriasis (at age <30 years). CONCLUSIONS Patients with psoriasis have increased oral Candida colonization and candidiasis. Further studies are needed to clarify the predisposing factor(s) for oral Candida in patients with psoriasis.

Association between recurrent aphthous stomatitis and inheritance of a single‐nucleotide polymorphism of the NOS2 gene encoding inducible nitric oxide synthase

BACKGROUND  Recurrent aphthous stomatitis is a common ulcerative disease of the oral mucosa. Recurrent oral aphthous ulceration is also a feature of the more serious and systemic Behçets disease. Nitric oxide is a free radical synthesized by one of a family of nitric oxide synthase (NOS) enzymes and is an important regulator of inflammation and immunity. Association of NOS3 gene polymorphisms encoding endothelial nitric oxide synthase has been reported in Behçets disease but not recurrent aphthous stomatitis. The aim of this study was to investigate any association between NOS2 gene polymorphisms that encode inducible nitric oxide synthase and recurrent aphthous stomatitis. METHODS  This is a case control association study. Eighty-three Jordanian recurrent aphthous stomatitis patients and 83 age, gender and ethnically matched controls were genotyped for three NOS2 single-nucleotide polymorphisms, rs10459953, rs1060822 and rs2297518. Chi-squared analysis was used to compare the allele frequencies and genotypes. RESULTS  There was a significant association between recurrent aphthous stomatitis and inheritance of single-nucleotide polymorphism rs2297518 (P = 0.006). Although no direct association was demonstrated between rs10459953 or rs1060822 and recurrent aphthous stomatitis, a strong linkage disequilibrium was identified between rs1060822 and rs2297518. CONCLUSION  Inheritence of a NOS2 single-nucleotide polymorphism rs2297518 is associated with increased risk of recurrent aphthous stomatitis in a Jordanian population. Confirmatory studies in other populations and investigation of other NOS2 gene polymorphisms will enhance our understanding of the functional basis of this association and help elucidate the role of inducible nitric oxide synthase in recurrent aphthous stomatitis.

Oral Candida flora in a group of Jordanian patients with β-thalassemia major

OBJECTIVE Thalassemic patients present with multiple immune abnormalities that may predispose them to oral Candida, however this has not been investigated. The aim of this study was to assess oral candidal colonization in a group of patients with beta-thalassemia major both qualitatively and quantitatively. STUDY DESIGN The oral mycologic flora of 50 beta-thalassemia major patients and 50 age- and sex-matched control subjects was assessed using the concentrated oral rinse technique. Candida species were identified using the germ tube test and the Vitek yeast identification system. RESULTS Oral Candida was isolated from 37 patients (74%) and 28 healthy subjects (56%; P = .04). The mean candidal count was significantly higher in thalassemic patients compared with the healthy group (P < .05) and in patients who had surgical splenectomy compared with nonsplenectomized patients (P = .04). CONCLUSION Oral Candida colonization and candidal counts are significantly higher in beta-thalassemia major patients than in healthy subjects. Surgical splenectomy may increase the quantity of colonizing oral candidal organisms in thalassemic patients.

Oral candidal colonization in cleft patients as a function of age, gender, surgery, type of cleft, and oral health.

PURPOSE To assess the colonization rate of oral Candida species and the influence of age, gender, oral health status, number of surgeries, and type of cleft. PATIENTS AND METHODS A prospective study of 60 patients with cleft and 60 control subjects was carried out at the Cleft Centre at King Abdullah University Hospital and the Maxillofacial Unit at Jordan University of Science and Technology between October 2007 and June 2008. Oral health was assessed using the Gingival, Plaque, and Decayed, Missing, and Filled (DMFT/dmft) indexes using World Health Organization criteria. A culture swab was obtained from the tongue and buccal and palatal mucosae. Candida albicans and other Candida species were identified using the germ tube test and the automated biochemical test panel VITEK. RESULTS The colonization rate of Candida in patients with cleft (63.3%) was significantly higher than in healthy control subjects (18.3%). The colonization rate of Candida and the distribution of C albicans varied with age but were not significantly associated with gender in patients with cleft and healthy controls. The candidal colonization rate was highest in patients with cleft who had at least 3 surgeries (78.2%) and in patients with bilateral clefts (77.7%). Patients with cleft had a significantly poorer health status than healthy controls; however, this was not influenced by the type of the cleft or the number of surgeries. CONCLUSION Patients with cleft had a significantly higher rate of oral candidal colonization compared with control subjects, which varied with age, type of cleft, and the number of surgical interventions. Oral health status was significantly poorer in patients with cleft.

Prevalence of oral lesions among Jordanian children

Introduction: Prevalence studies on oral lesions in children are scarce, and none of them was conducted in Jordan. Objectives: To determine the prevalence of oral mucosal lesions among Jordanian children. Materials and Methods: A stratified cluster random sampling technique was used to select a sample of first and sixth-grade school children. Systematic oral examination was performed using natural light, and lesions were diagnosed based on the clinical diagnostic criteria proposed by the WHO. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20 (SPSS Inc., Chicago, IL, USA), and P < 0.05 was considered statistically significant. Data were analyzed using Chi-squared test or Fishers exact test where appropriate. Results: The study included 1366 school children (639 [46.8%] males and 727 [53.2%] females) of whom 620 (45.4%) were 6-year-old and 746 (54.6%) were 12-year-old. The prevalence of oral lesions among children was 47.4%, without a significant difference in prevalence between males (46.6%) and females (47%). Prevalence was significantly higher in 12-year-old children (50%) compared to 6-year-old children (44.2%; P = 0.032). The most commonly diagnosed lesions were racial pigmentation (16.8%), fissured tongue (14.6%), and hematoma (5.3%). Discussion: Oral mucosal lesions are common in children in general, with no overall preference to gender, but the prevalence increases significantly with age. General dental practitioners and pediatric dentists should be aware of the common oral mucosal lesions in their communities for optimum diagnosis, management, and possible prevention. Conclusions: Oral lesions are common among Jordanian children and dentists should be aware of their diagnosis and management.

What Makes Oral Candidiasis Recurrent Infection? A Clinical View

Clinical oral Candida infection (candidiasis) is one of the common oral mucosal infections, and its management is usually frustrating due to either treatment failure or recurrence. Historically, oral candidiasis has been branded as disease of diseased. The unsuccessful management of oral candidiasis can due to either incorrect diagnosis, failure to identify (or correct) the underlying predisposing factor(s), or inaccurate prescription of antifungal agents. Failure to properly treat oral candidiasis will lead to persistence of the fungal cell in the oral cavity and hence recurrence of infection. The oral health care provider should be aware of these fall pits in order to successfully manage oral candidiasis.