Candida albicans and Early Childhood Caries

Abstract

Early childhood caries (ECC) is a highly prevalent and costly chronic oral infectious disease in preschool children. Candida albicans has been frequently detected in children and has demonstrated cariogenic traits. However, since ECC is a multifactorial infectious disease with many predisposing non-microbial factors, it remains to be elucidated whether the presence and accumulation of C. albicans in ECC is merely a consequence of the adaptation of C. albicans to a cariogenic oral environment, or it plays an active role in the initiation and progression of dental caries. This review aims to summarize the current knowledge on C. albicans and the risk of ECC, with a focus on its synergistic relationship with the cariogenic pathogen Streptococcus mutans. We also highlight recent advances in the development of approaches to disrupt C. albicans-S. mutans cross-kingdom biofilms in ECC prevention and treatment. Longitudinal clinical studies, including interventional clinical trials targeting C. albicans, are necessary to ascertain if C. albicans indeed contributes in a significant manner to the initiation and progression of ECC. In addition, further work is needed to understand the influence of other bacteria and fungi of oral microbiota on C. albicans-S. mutans interactions in ECC.

Catalase produced by Candida albicans protects Streptococcus mutans from H 2 O 2 stress—one more piece in the cross-kingdom synergism puzzle

“…Interestingly, in C. albicans , catalase is an ROS-inducible intracellular enzyme that has also been found extracellularly in the cell wall ( 32 ). Thus, it appears that C. albicans attempts to detoxify ROS derived from the host or other sources before it can damage intracellular components ( 52 – 54 ), and thus neighboring ROS-sensitive cells can benefit from these potent detoxification mechanisms.…”

“…While oral infection with either S. mutans or C. albicans is known as a caries risk factor ( 4 , 54 ), co-infection with both species is also a risk factor for caries development and reoccurrence ( 4 , 39 , 55 ). Thus, uncovering the major mechanism responsible for the increased oxidative stress tolerance of S. mutans in dual-species biofilms with C. albicans provides another piece of the puzzle to understand this complex, often synergistic, cross-kingdom relationship.…”

Antimicrobial Effect of Low-Fluoride Toothpastes Containing Polyphosphate and Polyols: An In Vitro Assessment of Inhibition Zones

“…In contrast, C. albicans has recently been used in in vitro biofilm protocols to reproduce conditions that better resemble those of cariogenic biofilms in vivo [ 13 , 23 ] as this fungus has been identified in biofilms collected from individuals presenting cavitated caries lesions [ 6 ]. In the present study, the highest inhibition halos were promoted by the experimental toothpaste (at the 1:1, 1:2, and 1:4 dilutions; Table 4 ; Figure 4 ), so that the simultaneous action of all compounds could explain such effects.…”

“…Other bacteria are related to the disease’s onset and progression, including Lactobacillus and Actinomyces [ 4 ]. In addition, the fungus Candida albicans has been reported to contribute to the formation and development of cariogenic biofilms, especially in dentine cavities, as its proteolytic enzymes are able to break down collagen molecules [ 5 , 6 ].…”

Evaluation of Solutions Containing Fluoride, Sodium Trimetaphosphate, Xylitol, and Erythritol, Alone or in Different Associations, on Dual-Species Biofilms

“…Caries lesions result from a dynamic process, whose main causative factor are poor oral hygiene, bad eating habits (i.e., high sugar consumption), and an alteration of oral bacterial flora [ 1 , 2 ]. One commensal member of all microorganisms related to the onset of this disease is Streptococcus mutans , which is found in caries lesions of both adults and children [ 3 ]. Furthermore, Candida albicans is a commensal fungus found in 96% of children with dental caries [ 4 ], and oral cavities already colonized by this fungus may have nearly five times a greater risk of developing early childhood caries [ 5 ].…”