The effect of orthodontic appliances on the Oral Candida colonisation: a systematic review

No.	Study ID/	Design	Patients (M/F)	Age^a	Appliance	Sample site	Timing	Analysis method	Outcome	Additional measures	Quality of the study
1	Arendorf 1985¹³	Prospective	Exp: 33 (15/18)	8–17 y	ROA	Six mucosal site (ant and post palate, ant and post tongue, r and l cheek)	T0 = before AppInsT1 = during therapyT2 = after AppRem (after average 9 mos)	Imprint Culture (Arendorf and Walker technique)	Prevalence (%) Density	PI + saliv pH	C
2	Hägg 2004¹⁴	Prospective	Exp: 27 (13/14)	15.5 + 2.3 y	FOA	Rinse Dorsum of the tongue Supra and subgingival plaque	T0=before AppInsT1 = 1 mos after T0T2 = 2 mos after T0T3 = 3 mos after T0	Oral Rinse (Samaranayake technique) Imprint Culture (Arendorf and Walker technique) (SDA, Gram stain, germ tube test, API 20 C AUX) Pooled Plaque	Prevalence (%)Density (CFU)Species composition	PI + count of Enterobacteriaceae + total bacterial count	B
3	Arslan 2008¹⁵	Prospective	Exp 1: 72Exp 2: 42 (19/23) Candida carriers out of 72 subjects, that were treated	19.8 y	FOA (metal brackets)	Dorsum of the tongue (only for T0)Mid-palate (only for T0)SalivaU5/L5U1/L1	T0 = before AppInsT1 = 1 mos after T0T2 = 6 mos after T0T3 = 12 mos after T0	Swab Culture (Kleinegger method, SDA)Salivary culture (SDA, Gram staining, germ-tube test, chlamydospore, API 20C AUX system))Pooled plaque (SDA)	Prevalence (%)Density (CFU)Species composition	None	B
4	Lee 2008¹⁶	Prospective	Exp: 97 (38/59)	17.7 y	FOA	Rinse	From T0 = before AppIns to T10 = 12 mos after T0	Oral rinse technique (Samaranayake technique, SDA)Phenotypic methods (germ-tube test; API ID 32C)Genotypic methods (RAPD analysis)Dendogram analysis	Prevalence (%)Species composition	None	C
5	Mahmoudadabi 2009¹⁷	Prospective	Exp 1: 34Exp 2: 34	13 y (Exp 1)12.5 y (Exp 2)	ROA (upper) Cr	Saliva Surface of upper appliance (not considered)	T0 = before AppInsT1 = over 8 mos after T0	Culture (Arendorf and Walker, Davenport techiques) (CHROMagar; germ-tube test)	Prevalence (%)Count (CFU)Species composition	None	C
6	Gonçalves e Silva 2014¹⁸	Prospective	Exp 1: 30Exp 2: 30	9.1+−1.7 (Exp 1)7.7+−1.5 (Exp 2)	ROA Cr	Cheek and lateral surface of the tongue Saliva	T0 = before AppInsT1 = at least 6 mos after T0	Culture (SDA; CHROMagar) Phenotypic methods Exfoliative cytology	Prevalence (%)Count (CFU)Species composition	Counts of Anti-C.albicansIgA	B
7	Arab 2016⁸	Prospective	Exp 1: 30 (6/24)	12–18 y	FOA	Saliva	T0 = before AppInsT1 = 6 we after T0T2 = 12 we after T0T3 = 18 we after T0	Culture (SDA)	Count (CFU)	Salivary flow and pH Microbial counts (S. mutans/L. acidophilus)	C
8	Khanpayeh 2014¹⁹	Prospective	Exp 1: 40Exp 2: 40 (35/45)	7–18 y	FOA (metal) ROA	Unstimulated saliva	T0 = before AppInsT1 = 6 mos after T0	Culture (SDA; Germ-tube test; corn meal agar)Biochemical tests (API 20C method)	Frequency (%)Species composition	None	B
9	Kundu 2016²⁰	Prospective	Exp 1: 10Exp 2: 10 (not considered)	6–15 y	ROA Fixed space maintainers (nc)	Unstimulated saliva	T0 = before AppInsT1 = 1 mo after T0T2 = 3 mos after T0T3 = 6 mos after T0	Culture (SDA)	Count (CFU)	Bacterial count (S. mutans and Lactobacillussp.)	B
10	Zheng 2016²¹	Prospective	Exp 1: 50 (23/27)	10–18 (13.6 y)	FOA	Gargle	T0 = before AppInsT1 = 1 mo after T0T2 = 2 mos after T0T3 = 3 mos after T0T4 = 6 mos after T0	Culture (CHROMagar)PCR (Tiangen Biotech)	Incidence (%)Count (CFU)Species composition	None	B
11	Shukla 2017²²	Prospective	Exp 1: 60	16–18 y	FOA	Buccal and labial Plaque of anterior teeth and U6 + L6	T0 = before AppInsT1 = 2 mo after T0T2 = 3 mos after T0	Swab Culture (SDA; Gram stain; germ tube test, counts in CFU)	Count (CFU)	S. mutans	B
12	Grzegocka 2020²³	Prospective	Exp 1: 17 (6M/11)	17+−7 y	FOA	Oral rinse Elastomeric rings (nc)	T0 = before AppInsT1 = 2 we after T0T2 = 6 we after T0T3 = 12 we after T0	Culture (Dalmau plate technique)Biochemical tests (API 20C AUX)	Prevalence (%)Count(CFU) Species composition	APIGBIBiofilm formation	C
13	Sanz-Orrio-Soler 2020²⁴	Prospective Controlled Trial	Exp 1: 124 (43/80)	19.5 y	FOA (metal or ceramic)	U and L vestibule	T0 = before AppInsT1 = 1 mo after T0T2 = 6 mos after T0T3 = 12 mos after T0T4 = 6 mos after	Swab Culture (CHROMagar plates, Becton Dickinson)	Frequency (%)Species composition	Questionnaire about hygiene habits	B
14	Pellissari 2021²⁵	Prospective	Exp 1: 23 (7/10)Exp 2: 6 (2/4)	20.7+− 8.7 y (Exp 1)19.6+−1.3 y (Exp 2)	FOACr	Biofilm around bck	From 3 to 6 mos after AppIns	Culture Biochemical tests (VITEK 2 compact system)	Prevalence (%)Species composition	Fungal strains and resistance to Antifungals Bacterial strains and resistance to Antimicrobials	B
15	Rodríguez Rentería 2021²⁶	Prospective	Exp 1: 55 (34/21)	8.4 y	ROA	Support oral mucosa Surface of ROA (not considered)	T0 = before AppInsT1 = 4 we after T0	Chromogenic culture (ID 32 C AUX system)	Frequency (%)Species composition	Microbial species (Str.aureus, P.aeruginosa)	C
16	Kouvelis 2021²⁷	Prospective	Exp 1: 30 (17/13)	13.97 +− 2.07	FOA	Saliva	T0 = before AppInsT1 = 4 we after T0T1 = 12 we after T0	Culture	Count	Salivary pH, flow rate, buffering capacityOther microbial species	C

List of inclusion and exclusion criteria_

Field	Inclusion	Exclusion
Patients	Children, adolescents or young adults (<25 years) of any sex, ethnicity and malocclusion, in general good health	Adults (>25 years)In vitro studiesAnimal studies
Intervention (exposure)	Orthodontic treatment with any vestibular fixed appliance (metal or ceramic, conventionally-ligated or self-ligated) or any removable appliances	Patients not receiving orthodontic treatmentPatients receiving orthodontic treatment without specific descriptions of the materials and applied techniquePatients receiving partial appliancesPatients receiving or having received systemic antibiotic treatment less than a month before or during orthodontic treatmentSmoking patients
Comparison	A. No comparison (For the descriptive analysis of Candida changes in treated patients)B. Ortho-tx vs no-tx (Comparison between treated and non treated patients)C. Ortho-tx vs ortho-tx (Comparison between ROA and FOA)
Outcome	Quantitative and qualitative analysis of Candida colonies, from intra-oral mucosal sites, saliva or supra/sub-gingival plaque.All available time-points will be included and categorized into pre-treatment, short-term (< 3 months) treatment, mid-term (3–6 months) treatment and long-term (< 6 months) treatment, post-treatment	No clear mention of the analysis or time-point
Study design	Randomized clinical trials or non-randomized, prospective or retrospective, cohort studies

Swedish council on technology assessment in health-care (SBU) criteria for grading assessed studies_

SBU criteria for grading assessed studies
Grade A (High level of evidence)Randomized clinical study or prospective study with a well-defined control group, defined diagnosis and endpoints, diagnostic reliability tests and reproducibility tests described
Grade B (Moderate level of evidence)Cohort study or retrospective case series with defined control or reference group, defined diagnosis and endpoints, diagnostic reliability tests and reproducibility tests described
Grade C (Low level of evidence)Large attrition, unclear diagnosis and endpoints, poorly defined patient material

Definitions of evidence level_

Level	Evidence	Definition
1	Strong	At least two studies assessed with level “A”
2	Moderate	One study with level “A” and at least two studies with level “B”
3	Limited	At least two studies with level “B”
4	Inconclusive	Fewer than two studies with level “B”

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DOI: https://doi.org/10.2478/aoj-2022-0006 | Journal eISSN: 2207-7480 | Journal ISSN: 2207-7472

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Language: English

Page range: 51 - 62

Submitted on: Nov 1, 2021

Accepted on: Jan 1, 2022

Published on: Mar 14, 2022

Published by: Australian Society of Orthodontists Inc.

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Related subjects:

Medicine,

Basic medical science,

Basic medical science, other

© 2022 Alessandra Campobasso, Eleonora Lo Muzio, Giovanni Battista, Vito Carlo Alberto Caponio, Domenico Ciavarella, Lorenzo Lo Muzio, published by Australian Society of Orthodontists Inc.
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 38 (2022): Issue 1 (January 2022)

The effect of orthodontic appliances on the Oral Candida colonisation: a systematic review

Figures & Tables

Figure 1

Characteristics of the studies_

List of inclusion and exclusion criteria_

Swedish council on technology assessment in health-care (SBU) criteria for grading assessed studies_

Definitions of evidence level_

Paradigm

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