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

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 candidi asis in 405 subjects with IDDM and 268 nondiabetic control subjects. Assess ments included evidence of clinical manifestations of candidiasis and a qua ntitative measure of Candida pseudohyphae in a cytologic smear from the mid line 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, includi ng median rhomboid glossitis, denture stomatitis, and angular cheilitis. ID DM 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 count s of >10/cm(2) (7.1% vs 0.8%; P < .0001). Diabetic subjects with median rho mboid glossitis were more likely to have a longer duration of IDDM and comp lications of nephropathy and retinopathy. Denture stomatitis was associated with smoking, retinopathy, higher Candida counts, poor glycemic control, a nd longer duration of IDDM. A multivariate regression analysis found 3 fact ors to be significantly associated with the presence of Candida pseudohypha e in the subjects with IDDM: current use of cigarettes (odds ratio, 2:4), u se of dentures (odds ratio, 2:3), and elevated levels of glycosylated hemog lobin (odds ratio, 1:9). The use of antimicrobials, immunosuppressants, or drugs with xerostomic side effects was not related to the presence of Candi da. Conclusions. Candida pseudohyphae and oral soft tissue manifestations of ca ndidiasis were more prevalent in subjects with IDDM than in control subject s without diabetes. The presence of Candida pseudohyphae was significantly associated with cigarette smoking, use of dentures, and poor glycemic contr ol.