Comparative Evaluation of Candida albicans at Two Oral Sites in Healthy Individuals and Individuals With or Without Diabetes With Chronic Periodontitis: A Cross-Sectional Study

Introduction: There is a synergistic and dysbiotic dental plaque microbial community with a keystone pathogen, Porphyromonas gingivalis, initiating the disruption of tissue homeostasis. The pathogenic organisms of periodontitis have been found to interact with other commensal species, such as fungi, of which Candida albicans has been found in the subgingival area, adding a new dimension to periodontal pathogenesis. Periodontitis and Candida infections are common complications seen in immunocompromised patients such as diabetics. Aim: This study aimed to detect the presence and distribution of Candida from the dorsum of the tongue and subgingival area among healthy controls without periodontitis, patients with diabetes and chronic periodontitis with good or poor glycemic control, and patients without diabetes with chronic periodontitis, and to compare the presence of Candida in both sites. This study also aimed to establish an association between Candida albicans, probing depth, and glycemic control. Materials and methods: This was a cross-sectional observational study. It was conducted on 167 patients, and they were divided into four groups, which were as follows: Group A, healthy controls; Group B, individuals without diabetes and with chronic periodontitis; Group C, individuals with diabetes and chronic periodontitis with good glycemic control; and Group D, individuals with diabetes and chronic periodontitis with poor glycemic control. The sample was collected from the dorsum of the tongue with a sterile cotton swab, and subgingival samples were obtained using a Gracey curette in sterile capped containers with phosphate-buffered saline (PBS) and transported to the microbiology department for yeast identification using Sabouraud dextrose agar (SDA) and CHROMagar. Results: The prevalence of Candida albicans on the dorsum of the tongue was 93.1%, and it was statistically significant. (p=0.001), whereas in subgingival plaque it was found to be 62.1%, which was statistically non-significant (p=0.06). The most commonly found Candida was Candida albicans (53.2%). The other non-albicans species found were Candida glabrata (22.9%) and Candida tropicalis (23.9%). The highest percentage on the dorsum of the tongue and subgingival plaque was found in diabetic patients with chronic periodontitis with poor glycoregulation (88.1% and 76.2%, respectively). There was a statistically significant association between species abundance and probing depth (p=0.001). A greater number of medium and dense species were found in sites with probing depth > 6 mm. The mean HbA1c with respect to dense species was 9.6±0.7. There was a statistically significant correlation (p=0.002) found between high HbA1c levels and dense candidal species. Conclusion: Out of the two sampling sites, Candida albicans was found more on the dorsum of the tongue. As this was a cross-sectional study, only an association could be established between Candida, probing depth, and glycemic control. More longitudinal studies are required to determine Candida as the causal organism for the progression of periodontitis and thereby provide antifungal-targeted approaches as a protocol in the future.