Effect of statin therapy on oral Candida carriage in hyperlipidemia patients: A pioneer study.

BACKGROUND: Hyperlipidemia affects about 25% of the adult population globally. Statins are the most commonly used drugs in the management of hyperlipidemia. Laboratory and retrospective clinical studies have observed the inhibitory effects of statins on the growth of different Candida species. The effect of statin therapy on oral Candida carriage has not yet been investigated. OBJECTIVES: This pioneer controlled study aimed to assess and compare asymptomatic oral Candida carriage in a group of 50 hyperlipidemic patients who were on regular statin therapy (HLS group) and in a control group of 50 subjects, matched in terms of gender, age and dental status, who were hyperlipidemic, but not on statin therapy (HLNS group). MATERIAL AND METHODS: The patients were recruited from the outpatient clinics of 2 university hospitals. The concentrated oral rinse technique was used to isolate oral Candida species in both groups. Candida species were identified using the germ tube test and the VITEK® 2 system. RESULTS: The Candida prevalence and colony count were significantly lower in the HLS group as compared to the HLNS group (n = 20, 40% vs. n = 30, 60%, respectively; p = 0.040). There was no significant difference in the oral Candida prevalence or colony count between different age groups in either the statin or control subjects. CONCLUSIONS: Statin therapy is associated with a reduction in oral Candida carriage in both prevalence and the colony count in hyperlipidemic patients.

Diabetes mellitus risk among Jordanians in a dental setting: a cross-sectional study.

BACKGROUND: Dental offices can be useful to screen and identify patients at risk of developing diabetes mellitus (DM) using risk prediction tools. The Finnish Diabetes Risk Score (FINDRISC) is a validated, questionnaire-based tool used to predict the 10-year risk of developing type II DM. OBJECTIVES: To determine the 10-year DM risk among Jordanians using the FINDRISC questionnaire in a dental setting. MATERIALS AND METHODS: Participants attending two university dental teaching centres between March 2017 and February 2018 were interviewed using an Arabic translated version of the FINDRISC questionnaire. Anthropometrics including weight, height, waist circumference (WC) and body mass index (BMI) were recorded. Random capillary blood glucose level was measured for each participant. Statistical analysis was done using Chi-square and independent t-tests. RESULTS: A total of 1,247 (436 males and 811 females) participants were included. As defined by BMI, 1,012 (81.2%) participants were either overweight or obese. Abdominal adiposity as determined by WC was seen in 738 (59.2%) participants. The mean (±â€…SD) FINDRISC score for females (11.3 ± 4.3) was significantly higher (P = 0.001) than males (10.4 ± 4.9). After age adjustment, more females were in the high-risk categories (FINDRISC ≥ 15) compared with males. This trend was seen among all age groups, but was statistically significant in the older age groups; 55-64 years (P = 0.037) and ≥ 65 years (P = 0.004). CONCLUSION: In a developing Middle Eastern country such as Jordan, almost half of Jordanians attending university dental clinics are at a moderate to high risk of developing type II DM in 10 years. The risk of DM should be considered in dental patients, particularly older females.

Awareness of oral medicine among medical practitioners, evidence of the unbridged interdisciplinary gap.

RATIONALE, AIMS, AND OBJECTIVES: Inadequate awareness of oral health and related disciplines appears to be common among medical practitioners. This study was designed to evaluate the awareness of oral medicine (OM) specialty and its scope of practice among Jordanian medical practitioners and to outline potential strategies for improvement where appropriate. METHOD: A specially designed questionnaire was electronically distributed to Jordanian medical practitioners and thereafter via personal interviews to improve the response rate. The questionnaire comprised nine questions and covered demographical details and characteristics of participants, in addition to their awareness of OM and agreement to refer a group of common oral and dental conditions to OM specialists. Pearson Chi-square tests were used to examine the significance of association between the variables of respondents and awareness of OM. Significance level was set at P values < 0.05. RESULTS: A total of 1492 respondents completed the questionnaire, of which 779 (52.2%) were aware of OM as an independent specialty. Age group, higher degrees in medicine, country of graduation, and the specialty type were significant determinants of OM awareness level. Oral ulceration and other mucosal pathology, including fungal infections, were the most likely conditions to be referred to OM specialists while participants had apparent problems separating the scope of practice of OM from other dental disciplines. CONCLUSION: This study provides evidence on the profound interdisciplinary gap between medicine and dentistry and highlights the importance of more focused education and training in oral health-related disciplines to be provided to clinicians and medical trainees as described.

The relationship of Candida colonization of the oral and vaginal mucosae of mothers and oral mucosae of their newborns at birth.

OBJECTIVE: Vaginal Candida colonization is common during pregnancy. Vaginal Candida may transmit vertically to the mouth of newborns during labor. The aim of this study was to assess and compare oral Candida colonization between vaginally born newborns and cesarean-born newborns and to investigate the association of the mother's vaginal and oral Candida colonization and the newborn's oral colonization at the time of delivery. STUDY DESIGN: Culture swabs were collected from the oral and vaginal mucosae of 100 pregnant women and from the oral mucosa of their 100 full-term newborns. Fifty (50%) of the mothers gave birth vaginally and the other 50 (50%) by cesarean section. RESULTS: The prevalence of oral and vaginal Candida in pregnant mothers was 49% and 40%, respectively. Oral Candida colonization in newborns was 7%. Oral Candida was isolated from 5 of 50 (10%) in the vaginally born group and from 2 of 50 (4%) in the cesarean-born group (P = .44). In vaginally born group, oral Candida was isolated from 5 of 20 (25%) in those born to mothers with vaginal colonization of Candida, and 0 of 30 (0.0%) in mothers without vaginal colonization of Candida (P = .007). CONCLUSIONS: The mother's vaginal Candida may constitute an important source of oral Candida in the newborns, particularly in those delivered vaginally.

Prevalence and awareness of halitosis in a sample of Jordanian population.

OBJECTIVES: This study was conducted to estimate the prevalence and awareness of halitosis among the subjects of a population, and also to compare the results of Halimeter(®) readings to self-estimation of halitosis and to assess the relationship between halitosis and oral health. MATERIALS AND METHODS: A sample of 205 employees from the Jordan University for Science and Technology (JUST) were selected as study subjects. A standardized questionnaire focusing on dental hygiene, self-reported halitosis, and smoking was filled by all participants. In the clinical examination, the objective values for assessment of oral health and the presence of halitosis were gathered through an organoleptic test (OLT) and the measurement of volatile sulfur compound (VSC) level by Halimeter for each participant. RESULTS: The prevalence of halitosis was 78%, with low rate of awareness (20.5%). The amount of TC played the most important role in increasing the concentration of VSCs in mouth air (P < 0.001). CONCLUSION: A statistically significant correlation was found between OLT and Halimeter values (P < 0.001). Subjective patients' opinion did not correlate with the objective evaluation of halitosis. TC scores and smoking were the factors significantly associated to halitosis. The Halimeter showed promising characteristics regarding diagnosis of halitosis for clinical setting and field surveys.

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. Student's t test, χ(2) test or Fisher's exact test, analysis of variance, multivariate logistic regression analysis, and Spearman's 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.

Prevalence of oral mucosal lesions in psoriatic patients: A controlled study.

OBJECTIVES: This study aimed to investigate and compare the prevalence of oral mucosal lesions in a group of psoriatic patients and healthy subjects, and its correlation to multiple clinical parameters. STUDY DESIGN: 100 psoriatic patients and 100 closely matched controls underwent clinical oral examination. Oral lesions were diagnosed according to the criteria proposed by the World Health Organization (WHO). The patients filled the Hospital Anxiety and Depression (HAD) questionnaire and the Dermatology Life Quality Index (DLQI). The severity of psoriasis was assessed by the Psoriasis Area and Severity Index (PASI). Categorical variables were evaluated using Chi-square test or Fisher's exact test with overall significance set at p< 0.05. RESULTS: Oral mucosal lesions were diagnosed in 43 (43%) psoriatic patients and 17 (17%) control subjects (p=0.000). Comparing psoriatic patients to control subjects the prevalence of fissured tongue (FT) was 35% vs. 13% (p=0.000); geographic tongue (GT) 17% vs. 9% (p=0.09); combination of FT and GT 5% vs. 5% (p=1.00); oral candidosis 3% vs. 0% (p=0.81); leukoedema 1% vs. 3% (p=0.62); physiologic melanin pigmentations 4% vs. 1% (p=0.37) respectively. The clinical type of psoriasis, duration of the disease, method of disease management (medicated vs. non-medicated for psoriasis), smoking habit, psychological status or the disease severity did not influence the prevalence of FT and GT. Psoriatic patients who experienced "very large" to "extremely large" adverse effect of psoriasis on their quality of life have significantly higher prevalence of GT (p=0.04). CONCLUSIONS: FT is significantly more common in psoriatic patients compared to controls; hence studies investigating the nature of this relationship are warranted. Oral health care providers should be aware of the predisposition of psoriatic patients to oral candidosis. Key words:Oral lesions, fissured tongue, geographic tongue, leukoedema, oral Candida, candidosis, psoriasis.

Tongue lesions in a Jordanian population. Prevalence, symptoms, subject’sknowledge and treatment provided

Tongue lesions constitute a considerable proportion of oral mucosal lesions, and are health concern to both oralhealth care providers and public.Objectives: The aim of this study was to determine the prevalence of tongue lesions and conditions among a groupof Jordanian population attending dental clinics, in addition to assessment of their symptoms, knowledge, andtreatment provided for their tongue lesions. Study design: A total of 2000 dental out-patients were screened fortongue lesions.Results: Fissured tongue was the most common tongue lesion diagnosed in 11.5% of the subjects, followed bycoated tongue (8.2%), geographic tongue (4.8%), hairy tongue (2.4%) and median rhomboid glossitis (0.5%).Symptoms were reported by 28% of the subjects with geographic tongue and 23% with fissured tongue. The majorityof the subjects (ranging from 61.1%-86.4%) were neither aware about their tongue lesions nor worried abouttheir prognosis. Less than 50% of those who were aware of their tongue lesions sought medical advice.Conclusion: The high prevalence of tongue lesions necessitates higher awareness of the general dental practitionerby their etiology, diagnosis and management (AU)

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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 Behçet's 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 Behçet's 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.

Tongue lesions in a Jordanian population. Prevalence, symptoms, subject's knowledge and treatment provided.

UNLABELLED: Tongue lesions constitute a considerable proportion of oral mucosal lesions, and are health concern to both oral health care providers and public. OBJECTIVES: The aim of this study was to determine the prevalence of tongue lesions and conditions among a group of Jordanian population attending dental clinics, in addition to assessment of their symptoms, knowledge, and treatment provided for their tongue lesions. STUDY DESIGN: A total of 2000 dental out-patients were screened for tongue lesions. RESULTS: Fissured tongue was the most common tongue lesion diagnosed in 11.5% of the subjects, followed by coated tongue (8.2%), geographic tongue (4.8%), hairy tongue (2.4%) and median rhomboid glossitis (0.5%). Symptoms were reported by 28% of the subjects with geographic tongue and 23% with fissured tongue. The majority of the subjects (ranging from 61.1%-86.4%) were neither aware about their tongue lesions nor worried about their prognosis. Less than 50% of those who were aware of their tongue lesions sought medical advice. CONCLUSION: The high prevalence of tongue lesions necessitates higher awareness of the general dental practitioner by their etiology, diagnosis and management.

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.

The relationship between tobacco smoking and oral colonization with Candida species.

AIM: The aim of this study was to assess and compare the quantitative and qualitative oral colonization of Candida species between a group of healthy tobacco smokers and a comparable group of nonsmokers, and to investigate a possible correlation between oral candidal colonization and the quantity or duration of the smoking habit. METHODS AND MATERIALS: Fifty smokers and 50 nonsmokers were included in the study. Candida species were isolated using the concentrated oral rinse (COR) technique and identified using the germ tube test and API 20 C AUX yeast identification system. RESULTS: Overall candidal transmission was 84 percent. Candida species were isolated from 42 (84 percent) of the smokers and 37 (74 percent) of the nonsmokers (p>0.05). The mean CFU/ml were 333 (SD=358) and 268 (SD=332), respectively (p>0.05). CONCLUSION: Tobacco smoking did not appear to increase oral colonization with Candida species in healthy subjects. CLINICAL SIGNIFICANCE: The effects of smoking on oral tissues and the mechanisms by which Candida proliferate intra-orally as a result of cigarette smoking warrant additional study.

Oral Candida flora in a group of Jordanian patients with beta-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 lesions in Saudi renal transplant patients.

Renal transplantation has evolved as the best treatment option for patients with end-stage renal disease. Different oral problems arise in these patients, either as a direct consequence of drug-induced immunosuppression or pharmacokinetics. To determine the prevalence of intra-oral lesions in a group of medically stable Saudi renal transplant patients (RTP) and to identify possible risk factors, in comparison with age and sex-matched healthy control subjects (HCS), we studied 58 RTP and 52 HCS. All subjects had a thorough oral examination and oral lesions were diagnosed according to the clinically accepted criteria. Gingival overgrowth (GO), erythematous candidiasis (EC) and hairy leukoplakia (HL) were diagnosed in RTP with prevalence of 74.1%, 15.5%, and 8.6%, respectively. The severity of the gingival overgrowth significantly correlated with the use of cyclosporine and nifedipine combination therapy, serum cyclosporine, and serum creatinine level. In conclusions, the finding of our study strongly propose that RTP should undergo routine and regular comprehensive oral examination, and any suspicious lesion must be investigate and treated.

Radiographic assessment of post-retained crowns in an adult Jordanian population.

AIM: The objective of this study was to radiographically assess and compare the quality of post-retained crowns fabricated at the Dental Health Centre of the Jordan University of Science & Technology (JUST). METHODS AND MATERIALS: Study data were collected in 2002 from existing dental records for all patients receiving treatment with post-retained crowns between October, 1997 and June, 1999. The posts were assessed radiographically to evaluate various aspects of the quality of post-retained crowns. All 129 posts were fabricated in the dental school. RESULTS: The most-frequently restored teeth were the maxillary incisors (38.8%). Sixty-two percent of the posts were tapered, while 38% were parallel-sided. The mean length of the posts was 0.95 mm (SD 0.41) with a range between 0.22-2.85 mm. Caries was diagnosed radiographically in 10.8% of cases with lesions located on root surfaces in 64.3% of them, while 35.7% of lesions were within the root canal. Three posts (2.3%) were deviated from the line of the root canal in the mesio-distal plane. No evidence of root filling was found in 2.3% of the cases. In the remainder of teeth 15.5% had gutta percha extended to the radiographic apex of the tooth, while 59.7% fell 0.5-1 mm short of the radiographic apex. Gutta-percha was extruded beyond the apex in 22.5% of the teeth. Space between the end of the post and the root filling was found in 22.2%. The percentage of canals with apparently completely healthy periapical tissue was 51.2%. In the rest of the cases 34.8% had areas of radiolucency at or near the root apices and 14% demonstrated widening of the periodontal space around the root apex. Root resection had been completed in 2.3% cases. Signs of external resorption were apparent in one case (0.78%). CONCLUSION: The standards of the treatment of the endodontically treated teeth made at the dental hospital were satisfactory but could be improved by a controlled academic supervisory environment and a strict scientific approach to fixed prosthodontics within the dental school.

Oral fungal colonization and oral candidiasis in renal transplant patients: the relationship to Miswak use.

OBJECTIVES: The aim of this study was to determine and compare the prevalence of oral candidal colonization and oral candidiasis in a group of medically stable renal transplant patients (RTPs) and age and sex-matched healthy control (HC) subjects. STUDY DESIGN: The oral cavities of 58 RTPs and 52 HC subjects were clinically examined for the presence of oral candidiasis. Oral fungal colonization was determined by using the concentrated oral rinse technique. RESULTS: Prevalence of oral fungal colonization was not significantly higher in RTPs than in HC subjects (74.1% vs 59.6%, respectively; P =.1), but the density of growth was significantly higher in RTPs (P <.0017). Oral candidiasis was diagnosed in 15.5% of RTPs but in none of HC subjects (P =.002). RTPs who used a chewing stick (Miswak: Salvadora persica ) for oral hygiene had a significantly lower prevalence of oral candidiasis (P =.04) compared with other RTPs. CONCLUSIONS: RTPs are at high risk of developing oral candidiasis. More clinical investigations are needed to determine the antimycotic effect of Miswak. Regular oral screening is recommended for RTPs.