Open Access

The effect of orthodontic appliances on the Oral Candida colonisation: a systematic review

Alessandra Campobasso
Alessandra Campobasso
, 
Eleonora Lo Muzio
Eleonora Lo Muzio
, 
Giovanni Battista
Giovanni Battista
, 
Vito Carlo Alberto Caponio
Vito Carlo Alberto Caponio
, 
Domenico Ciavarella
Domenico Ciavarella
 and 
Lorenzo Lo Muzio
Lorenzo Lo Muzio
   | Mar 14, 2022
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Published Online: Mar 14, 2022
Page range: 51 - 62
Received: Nov 01, 2021
Accepted: Jan 01, 2022
DOI: https://doi.org/10.2478/aoj-2022-0006
© 2022 Alessandra Campobasso et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Flow diagram of the included studies according to the PRISMA.
Flow diagram of the included studies according to the PRISMA.

Characteristics of the studies.

No. Study ID/ Design Patients (M/F) Agea Appliance Sample site Timing Analysis method Outcome Additional measures Quality of the study
1 Arendorf 198513 Prospective Exp: 33 (15/18) 8–17 y ROA Six mucosal site (ant and post palate, ant and post tongue, r and l cheek) T0 = before AppInsT1 = during therapyT2 = after AppRem (after average 9 mos) Imprint Culture (Arendorf and Walker technique) Prevalence (%) Density PI + saliv pH C
2 Hägg 200414 Prospective Exp: 27 (13/14) 15.5 + 2.3 y FOA Rinse Dorsum of the tongue Supra and subgingival plaque T0=before AppInsT1 = 1 mos after T0T2 = 2 mos after T0T3 = 3 mos after T0 Oral Rinse (Samaranayake technique) Imprint Culture (Arendorf and Walker technique) (SDA, Gram stain, germ tube test, API 20 C AUX) Pooled Plaque Prevalence (%)Density (CFU)Species composition PI + count of Enterobacteriaceae + total bacterial count B
3 Arslan 200815 Prospective Exp 1: 72Exp 2: 42 (19/23) Candida carriers out of 72 subjects, that were treated 19.8 y FOA (metal brackets) Dorsum of the tongue (only for T0)Mid-palate (only for T0)SalivaU5/L5U1/L1 T0 = before AppInsT1 = 1 mos after T0T2 = 6 mos after T0T3 = 12 mos after T0 Swab Culture (Kleinegger method, SDA)Salivary culture (SDA, Gram staining, germ-tube test, chlamydospore, API 20C AUX system))Pooled plaque (SDA) Prevalence (%)Density (CFU)Species composition None B
4 Lee 200816 Prospective Exp: 97 (38/59) 17.7 y FOA Rinse From T0 = before AppIns to T10 = 12 mos after T0 Oral rinse technique (Samaranayake technique, SDA)Phenotypic methods (germ-tube test; API ID 32C)Genotypic methods (RAPD analysis)Dendogram analysis Prevalence (%)Species composition None C
5 Mahmoudadabi 200917 Prospective Exp 1: 34Exp 2: 34 13 y (Exp 1)12.5 y (Exp 2) ROA (upper) Cr Saliva Surface of upper appliance (not considered) T0 = before AppInsT1 = over 8 mos after T0 Culture (Arendorf and Walker, Davenport techiques) (CHROMagar; germ-tube test) Prevalence (%)Count (CFU)Species composition None C
6 Gonçalves e Silva 201418 Prospective Exp 1: 30Exp 2: 30 9.1+−1.7 (Exp 1)7.7+−1.5 (Exp 2) ROA Cr Cheek and lateral surface of the tongue Saliva T0 = before AppInsT1 = at least 6 mos after T0 Culture (SDA; CHROMagar) Phenotypic methods Exfoliative cytology Prevalence (%)Count (CFU)Species composition Counts of Anti-C.albicansIgA B
7 Arab 20168 Prospective Exp 1: 30 (6/24) 12–18 y FOA Saliva T0 = before AppInsT1 = 6 we after T0T2 = 12 we after T0T3 = 18 we after T0 Culture (SDA) Count (CFU) Salivary flow and pH Microbial counts (S. mutans/L. acidophilus) C
8 Khanpayeh 201419 Prospective Exp 1: 40Exp 2: 40 (35/45) 7–18 y FOA (metal) ROA Unstimulated saliva T0 = before AppInsT1 = 6 mos after T0 Culture (SDA; Germ-tube test; corn meal agar)Biochemical tests (API 20C method) Frequency (%)Species composition None B
9 Kundu 201620 Prospective Exp 1: 10Exp 2: 10 (not considered) 6–15 y ROA Fixed space maintainers (nc) Unstimulated saliva T0 = before AppInsT1 = 1 mo after T0T2 = 3 mos after T0T3 = 6 mos after T0 Culture (SDA) Count (CFU) Bacterial count (S. mutans and Lactobacillussp.) B
10 Zheng 201621 Prospective Exp 1: 50 (23/27) 10–18 (13.6 y) FOA Gargle T0 = before AppInsT1 = 1 mo after T0T2 = 2 mos after T0T3 = 3 mos after T0T4 = 6 mos after T0 Culture (CHROMagar)PCR (Tiangen Biotech) Incidence (%)Count (CFU)Species composition None B
11 Shukla 201722 Prospective Exp 1: 60 16–18 y FOA Buccal and labial Plaque of anterior teeth and U6 + L6 T0 = before AppInsT1 = 2 mo after T0T2 = 3 mos after T0 Swab Culture (SDA; Gram stain; germ tube test, counts in CFU) Count (CFU) S. mutans B
12 Grzegocka 202023 Prospective Exp 1: 17 (6M/11) 17+−7 y FOA Oral rinse Elastomeric rings (nc) T0 = before AppInsT1 = 2 we after T0T2 = 6 we after T0T3 = 12 we after T0 Culture (Dalmau plate technique)Biochemical tests (API 20C AUX) Prevalence (%)Count(CFU) Species composition APIGBIBiofilm formation C
13 Sanz-Orrio-Soler 202024 Prospective Controlled Trial Exp 1: 124 (43/80) 19.5 y FOA (metal or ceramic) U and L vestibule T0 = before AppInsT1 = 1 mo after T0T2 = 6 mos after T0T3 = 12 mos after T0T4 = 6 mos after Swab Culture (CHROMagar plates, Becton Dickinson) Frequency (%)Species composition Questionnaire about hygiene habits B
14 Pellissari 202125 Prospective Exp 1: 23 (7/10)Exp 2: 6 (2/4) 20.7+− 8.7 y (Exp 1)19.6+−1.3 y (Exp 2) FOACr Biofilm around bck From 3 to 6 mos after AppIns Culture Biochemical tests (VITEK 2 compact system) Prevalence (%)Species composition Fungal strains and resistance to Antifungals Bacterial strains and resistance to Antimicrobials B
15 Rodríguez Rentería 202126 Prospective Exp 1: 55 (34/21) 8.4 y ROA Support oral mucosa Surface of ROA (not considered) T0 = before AppInsT1 = 4 we after T0 Chromogenic culture (ID 32 C AUX system) Frequency (%)Species composition Microbial species (Str.aureus, P.aeruginosa) C
16 Kouvelis 202127 Prospective Exp 1: 30 (17/13) 13.97 +− 2.07 FOA Saliva T0 = before AppInsT1 = 4 we after T0T1 = 12 we after T0 Culture Count Salivary pH, flow rate, buffering capacityOther microbial species C

List of inclusion and exclusion criteria.

Field Inclusion Exclusion
Patients Children, adolescents or young adults (<25 years) of any sex, ethnicity and malocclusion, in general good health Adults (>25 years)In vitro studiesAnimal studies
Intervention (exposure) Orthodontic treatment with any vestibular fixed appliance (metal or ceramic, conventionally-ligated or self-ligated) or any removable appliances Patients not receiving orthodontic treatmentPatients receiving orthodontic treatment without specific descriptions of the materials and applied techniquePatients receiving partial appliancesPatients receiving or having received systemic antibiotic treatment less than a month before or during orthodontic treatmentSmoking patients
Comparison A. No comparison (For the descriptive analysis of Candida changes in treated patients)B. Ortho-tx vs no-tx (Comparison between treated and non treated patients)C. Ortho-tx vs ortho-tx (Comparison between ROA and FOA)
Outcome Quantitative and qualitative analysis of Candida colonies, from intra-oral mucosal sites, saliva or supra/sub-gingival plaque.All available time-points will be included and categorized into pre-treatment, short-term (< 3 months) treatment, mid-term (3–6 months) treatment and long-term (< 6 months) treatment, post-treatment No clear mention of the analysis or time-point
Study design Randomized clinical trials or non-randomized, prospective or retrospective, cohort studies

Swedish council on technology assessment in health-care (SBU) criteria for grading assessed studies.

SBU criteria for grading assessed studies
Grade A (High level of evidence)Randomized clinical study or prospective study with a well-defined control group, defined diagnosis and endpoints, diagnostic reliability tests and reproducibility tests described
Grade B (Moderate level of evidence)Cohort study or retrospective case series with defined control or reference group, defined diagnosis and endpoints, diagnostic reliability tests and reproducibility tests described
Grade C (Low level of evidence)Large attrition, unclear diagnosis and endpoints, poorly defined patient material

Definitions of evidence level.

Level Evidence Definition
1 Strong At least two studies assessed with level “A”
2 Moderate One study with level “A” and at least two studies with level “B”
3 Limited At least two studies with level “B”
4 Inconclusive Fewer than two studies with level “B”
eISSN:
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Language:
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Medicine, Basic Medical Science, other
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