Association of Candida albicans Carriage in the Supragingival Plaque With Severity of Early Childhood Caries: A Cross-Sectional Study in Sri Lanka

Introduction Early Childhood Caries (ECC) is a global public health problem. An association between ECC and Candida albicans is well documented. However, whether this association is uniform or varies across different ECC severity levels remains poorly understood. This study aimed to investigate whether supragingival plaque C. albicans carriage shows a severity-dependent association with ECC in a cohort of Sri Lankan preschool children. Methods A cross-sectional study was conducted among 135 preschool children aged 2–5 years, stratified into three groups based on the dmft: severe ECC (S-ECC, n = 50), mild-to-moderate ECC (MM-ECC, n = 35), and caries-free (CF, n = 50). Their supragingival plaque samples were cultured on CHROMagar TM Candida medium. Presumptively identified C. albicans colonies were confirmed at species and genotype levels using PCR. Results C. albicans carriage across ordered ECC severity groups (CF: 6.0%, MM-ECC: 14.3%, S-ECC: 56.0%) increased significantly (Cochran–Armitage trend test, p < .001). Multivariable logistic regression analysis after adjustments for age and sex demonstrated that S-ECC was strongly associated with supragingival plaque C. albicans carriage (adjusted OR 22.6, 95% CI 6.8-105.1; p < .001). The corresponding association for MM-ECC was positive but not significant (adjusted OR 3.0, 95% CI 0.7-15.7; p = .166). Sensitivity analysis using Firth’s penalized and mixed-effects logistic regression analyses yielded consistent results. Genotype A was the predominant genotypic variant, particularly in S-ECC. Conclusion This is the first study to report a relationship between supragingival plaque C. albicans carriage and ECC in Sri Lankan preschool children. C. albicans carriage increased across ordered ECC severity categories and was strongly associated with S-ECC, whereas the association with MM-ECC was not statistically significant. These findings suggest that the association between C. albicans carriage and ECC is most evident in S-ECC rather than consistently observed across all levels of ECC severity. Longitudinal studies are required to clarify the temporal relationship between C. albicans colonization and ECC severity.