Candida albicans and Early Childhood Caries: A Systematic Review and Meta-Analysis

Abstract

Oral Candida albicans has been detected in children with early childhood caries (ECC) and has demonstrated cariogenic traits in animal models of the disease. Conversely, other studies found no positive correlation between C. albicans and caries experience in children, while suggesting it may have protective effects as a commensal organism. Thus, this study aimed to examine whether oral C. albicans is associated with ECC. Seven electronic databases were searched. The data from eligible studies were extracted, and the risk of bias was evaluated. A fixed effects model (Mantel-Haenszel estimate) was used for meta-analysis, and the summary effect measure was calculated by odds ratio (OR) and 95% confidence interval (CI). Fifteen cross-sectional studies were included for the qualitative assessment and 9 studies for meta-analysis. Twelve studies revealed higher oral C. albicans prevalence in ECC children than in caries-free children, while 2 studies indicated an equivalent prevalence. A pooled estimate, with OR = 6.51 and 95% CI = 4.94-8.57, indicated a significantly higher ECC experience in children with oral C. albicans than those without C. albicans (p < 0.01). The odds of experiencing ECC in children with C. albicans versus children without C. albicans were 5.26 for salivary, 6.69 for plaque, and 6.3 for oral swab samples. This systematic review indicates that children with oral C. albicans have >5 times higher odds of having ECC compared to those without C. albicans. Further prospective cohort studies are needed to determine whether C. albicans could be a risk factor for ECC, and whether it is dependent on different sample sources (saliva/plaque).

Keywords: Candida albicans; Child dentistry; Clinical studies; Early childhood caries; Fungal pathogen; Odds ratio; Risk factor; Yeast infection.

Conflict of interest statement

Declaration of interests: The authors declare no conflict of interests.

© 2017 S. Karger AG, Basel.

Figures

Fig.1. Screening and assessing studies for inclusion eligibility

The four-phase Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram was used to determine the number of studies identified, screened, eligible, and included in the systematic review and meta-analysis (http://www.prisma-statement.org).

Fig.2. Odds Ratio of ECC prevalence in children with and without oral C. albicans

Meta-analysis from all oral sample sources (saliva, plaque, oral mucosal swab and carious lesions). Evaluations of the presence of C. albicans and dental caries (outcome: presence of ECC vs. absence of ECC). Pooled effect measures of odds ratio (OR) and 95% confidence interval (CI0) indicated that regarding ECC experience, there is a statistically significant difference between children with the presence of oral C. albicans and absence of oral C. albicans; OR is 6.51 (favors the presence of oral C. albicans) and P<0.01. Study heterogeneity (I2) and the related P value was also calculated (P<0.01). The solid line indicates when OR=1. The red dotted line indicates the overall OR value.

Fig.3. Odds Ratio of ECC prevalence in children with and without oral C. albicans (sub-group analysis)

Evaluation of the presence of saliva/plaque/oral mucosal C. albicans and dental caries (outcome: presence of ECC vs. absence of ECC). (A) Pooled effect measures of odds ratio (OR) and 95% confidence interval (CI0) indicated that regarding ECC experience, there is a statistically significant difference between children with the presence of salivary C. albicans and absence of salivary C. albicans; OR is 5.26 (favors the presence of salivary C. albicans) and P<0.01. Study heterogeneity (I2) and the related P value was also calculated (P=0.03). (B) Regarding ECC experience, there is a statistically significant difference between children with the presence of plaque C. albicans and absence of plaque C. albicans; OR is 6.69 (favors the presence of plaque C. albicans) and P<0.01. Study heterogeneity I2, P<0.01. (C) Regarding ECC experience, there is a statistically significant difference between children with the presence of swab C. albicans and absence of swab C. albicans; OR is 6.3 (favors the presence of swab C. albicans) and P<0.01. Study heterogeneity I2, P=0.49. The solid line indicates when OR=1. The red dotted line indicates the overall OR value.