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Insulin-dependent diabetes mellitus and oral soft tissue pathologies. II. Prevalence and characteristics of Candida and candidal lesions

  • Author Footnotes
    a University of Pittsburgh, School of Dental Medicine, Departments of Restorative Dentistry and Oral Medicine and Pathology.
    James Guggenheimer
    Correspondence
    Reprint requests: James Guggenheimer, DDS G-137 Salk University of Pittsburgh School of Dental Medicine 3501 Terrace St Pittsburgh, PA 15261
    Footnotes
    a University of Pittsburgh, School of Dental Medicine, Departments of Restorative Dentistry and Oral Medicine and Pathology.
    Affiliations
    University of Pittsburgh School of Dental Medicine, Pittsburgh, Pa, USA
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  • Author Footnotes
    b University of Pittsburgh, School of Dental Medicine, Department of Dental Public Health.
    Paul A. Moore
    Footnotes
    b University of Pittsburgh, School of Dental Medicine, Department of Dental Public Health.
    Affiliations
    University of Pittsburgh School of Dental Medicine, Pittsburgh, Pa, USA
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  • Author Footnotes
    c University of Pittsburgh, School of Dental Medicine, Department of Oral Medicine and Pathology.
    Karen Rossie
    Footnotes
    c University of Pittsburgh, School of Dental Medicine, Department of Oral Medicine and Pathology.
    Affiliations
    University of Pittsburgh School of Dental Medicine, Pittsburgh, Pa, USA
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  • Author Footnotes
    c University of Pittsburgh, School of Dental Medicine, Department of Oral Medicine and Pathology.
    Daniel Myers
    Footnotes
    c University of Pittsburgh, School of Dental Medicine, Department of Oral Medicine and Pathology.
    Affiliations
    University of Pittsburgh School of Dental Medicine, Pittsburgh, Pa, USA
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  • Author Footnotes
    b University of Pittsburgh, School of Dental Medicine, Department of Dental Public Health.
    Mary Beth Mongelluzzo
    Footnotes
    b University of Pittsburgh, School of Dental Medicine, Department of Dental Public Health.
    Affiliations
    University of Pittsburgh School of Dental Medicine, Pittsburgh, Pa, USA
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  • Author Footnotes
    b University of Pittsburgh, School of Dental Medicine, Department of Dental Public Health.
    Harvey M. Block
    Footnotes
    b University of Pittsburgh, School of Dental Medicine, Department of Dental Public Health.
    Affiliations
    University of Pittsburgh School of Dental Medicine, Pittsburgh, Pa, USA
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  • Author Footnotes
    b University of Pittsburgh, School of Dental Medicine, Department of Dental Public Health.
    Robert Weyant
    Footnotes
    b University of Pittsburgh, School of Dental Medicine, Department of Dental Public Health.
    Affiliations
    University of Pittsburgh School of Dental Medicine, Pittsburgh, Pa, USA
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  • Author Footnotes
    d University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology.
    Trevor Orchard
    Footnotes
    d University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology.
    Affiliations
    University of Pittsburgh School of Dental Medicine, Pittsburgh, Pa, USA
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  • Author Footnotes
    a University of Pittsburgh, School of Dental Medicine, Departments of Restorative Dentistry and Oral Medicine and Pathology.
    b University of Pittsburgh, School of Dental Medicine, Department of Dental Public Health.
    c University of Pittsburgh, School of Dental Medicine, Department of Oral Medicine and Pathology.
    d University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology.
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      Objective

      To assess the prevalence of Candida albicans and oral infection with Candida in patients with insulin-dependent diabetes mellitus (IDDM).

      Study Design

      This cross-sectional study compared the prevalence of candidiasis in 405 subjects with IDDM and 268 nondiabetic control subjects. Assessments included evidence of clinical manifestations of candidiasis and a quantitative measure of Candida pseudohyphae in a cytologic smear from the midline posterior dorsal tongue.

      Results

      More subjects with IDDM than control subjects without IDDM (15.1% vs 3.0%) were found to have clinical manifestations of candidiasis, including median rhomboid glossitis, denture stomatitis, and angular cheilitis. IDDM subjects were also more likely to have any Candida pseudohyphae in their cytologic smears (23.0% vs 5.7%; P <.0001), as well as pseudohyphae counts of >10/cm2 (7.1 % vs 0.8%; P < .0001). Diabetic subjects with median rhomboid glossitis were more likely to have a longer duration of IDDM and complications of nephropathy and retinopathy. Denture stomatitis was associated with smoking, retinopathy, higher Candida counts, poor glycemic control, and longer duration of IDDM. A multivariate regression analysis found 3 factors to be significantly associated with the presence of Candida pseudohyphae in the subjects with IDDM: current use of cigarettes (odds ratio, 2:4), use of dentures (odds ratio, 2:3), and elevated levels of glycosylated hemoglobin (odds ratio, 1:9). The use of anti-microbials, immunosuppressants, or drugs with xerostomic side effects was not related to the presence of Candida.

      Conclusions

      Candida pseudohyphae and oral soft tissue manifestations of candidiasis were more prevalent in subjects with IDDM than in control subjects without diabetes. The presence of Candida pseudohyphae was significantly associated with cigarette smoking, use of dentures, and poor glycemic control.
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