Efficacy of antimicrobial photodynamic therapy compared to nystatin therapy in reducing Candida colony count in patients with Candida-associated denture stomatitis: a systematic review and meta-analysis

Abstract

Purpose: This meta-analysis assessed the e cacy of antimicrobial photodynamic therapy (aPDT) compared to conventional nystatin therapy (NYT) in reducing Candida colony count in patients with Candida-Associated Denture Stomatitis (CADS) and critically appraised the available literature.Methods: This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) updated guidelines. A literature search was performed in four electronic databases to identify relevant articles up to 15 August 2021. Randomized controlled trials (RCTs) that assessed the e cacy of aPDT compared to NYT in reducing Candida colony count in patients with CADS were investigated. The weighted mean difference (MD) and 95% con dence interval were calculated. The I 2 statistic was used to determine heterogeneity at the level of α= 0.10. The Cochrane risk of bias (RoB 2) tool was used to assess the risk of bias. Certainty of the evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) ranking system.Results: Only 3 eligible RCTs with 141 participants were included in this systematic review and meta-analysis. Based on the pooled results, NYT compared to aPDT, generally performed better in reducing Candida colony count (Log 10 CFU/mL) in patients' palate and patients' denture. The included studies had a moderate risk of bias and the certainty of the evidence was low.Conclusion: Although still inconclusive, based on the current evidence aPDT may be effective in reducing Candida colony count, and treating CADS. Nonetheless, it does not appear to be more effective than conventional NYT in this regard. According to the limited number of included studies, more well-designed RCTs with larger sample sizes and standardized methodology should be conducted to validate this conclusion.

Management of Chronic Atrophic Candidiasis (Denture Stomatitis)—A Narrative Review

“…The studies focused on a range of treatments for DS, including antifungal agents, lasers, photodynamic therapy, microwave radiation, phytomedicine using natural products, and antimicrobial agents. Of the 34 RCTs, 31 were evaluated in the 15 systematic reviews [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] included in this study. The main findings of the systematic reviews based on RCTs are summarized in Table 1 .…”

“…A review of recent publications has shown that PDT was just as effective as conventional antifungal medications, particularly nystatin, in the clinical remission of DS and considerably reducing the colony-forming units (CFU/mL) of Candida species from dentures [ 18 , 35 , 39 , 42 , 43 ]. However, the recurrence of DS following PDT has also been reported [ 18 ].…”

Chemical composition, anti-fungal and cytotoxic effects of Ferula macrecolea essential oil against Candida albicans resistant and sensitive strains

“…In addition, systemic azole antifungal drugs can also be used against superficial candidiasis and chronic forms of infection (5). Antifungals are also frequently used in the treatment of oral candidiasis in immunosuppressed people such as AIDS and leukemia patients (6). The study of natural products against candidiasis has recently increased considerably with research on herbs, where the natural products derived from plants may be potentially lead to the emergence of new compounds that can act on these fungi (7,8).…”