{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T23:33:46Z","timestamp":1782171226139,"version":"3.54.5"},"reference-count":59,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T00:00:00Z","timestamp":1685404800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005632","name":"National Center for Research and Development","doi-asserted-by":"publisher","award":["SZPITALE-JEDNOIMIENNE\/18\/2020"],"award-info":[{"award-number":["SZPITALE-JEDNOIMIENNE\/18\/2020"]}],"id":[{"id":"10.13039\/501100005632","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Critically ill COVID-19 patients requiring mechanical ventilation in the intensive care unit are at risk of developing invasive candidiasis. In this study we aimed to (1) characterize oral cultivable mycobiota of mechanically ventilated adult COVID-19 patients in an ICU setting by sampling four distinct oral niches in two fixed time points with regards to oral health status, (2) investigate Candida spp. infections in this population, and (3) compare oral mycobiota with selected bacteriobiota strains during the observation in the ICU. We recruited 56 adult COVID-19 patients who qualified for mechanical ventilation. Patients received either standard or extended oral care procedures with tooth brushing. Oral samples were taken first within 36 h and after 7 days of intubation. Yeast-like fungi were identified by MALDI\/TOF mass spectrometry. Yeast infection cases were retrospectively analyzed. Candida spp. in oral sampling was identified in 80.4% and 75.7%, C. albicans in 57.1% and 61.1%, and non-albicans\u00a0Candida species in 48.2% and 47.2% patients at baseline and follow-up, respectively. There were no differences in the overall CFU counts of Candida spp. species and individual Candida species in oral samples, both at baseline and follow-up. At baseline, a higher prevalence of Candida spp. was associated with a higher identification rate of Lactobacillus spp. (64.4% vs. 27.3%, p = 0.041). At follow-up, there was a borderline lower prevalence of Candida spp. in patients with Lactobacillus spp. identified (57.1% vs. 87.0%, p = 0.057). The incidence rate of candidiasis was 5.4% and the incidence density was 3.1\/1000 pds. In conclusion, non-albicans\u00a0Candida species in oral samples were identified in nearly half of patients. Oral health was moderately impaired. A high incidence of yeast infections, including invasive cases, in patients hospitalized in the ICU due to COVID-19 and requiring mechanical ventilation was noted. Severe COVID-19 and disease-specific interventions within the ICU possibly played a major role promoting Candida spp. infections.<\/jats:p>","DOI":"10.3390\/microorganisms11061442","type":"journal-article","created":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T02:01:15Z","timestamp":1685498475000},"page":"1442","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Oral Myco- and Bacteriobiota and Yeast Infections in Mechanically Ventilated COVID-19 Patients"],"prefix":"10.3390","volume":"11","author":[{"given":"Iwona","family":"Gregorczyk-Maga","sequence":"first","affiliation":[{"name":"Institute of Dentistry, Faculty of Medicine, Jagiellonian University Medical College, ul. Montelupich 4, 31-155 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Kania","sequence":"additional","affiliation":[{"name":"Doctoral School of Medicine and Health Sciences, Jagiellonian University Medical College, ul. \u015bw. Anny 12, 31-008 Krak\u00f3w, Poland"},{"name":"Chair of Metabolic Diseases, Faculty of Medicine, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beata","family":"Sulik-Tyszka","sequence":"additional","affiliation":[{"name":"Department of Dental Microbiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Namys\u0142","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University Hospital in Krakow, Jakubowskiego Street 2, 30-688 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Sepio\u0142o","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University Hospital in Krakow, Jakubowskiego Street 2, 30-688 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorota","family":"Romaniszyn","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estera","family":"Jachowicz-Matczak","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0756-1639","authenticated-orcid":false,"given":"Jadwiga","family":"W\u00f3jkowska-Mach","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"91","DOI":"10.5604\/18982395.1227563","article-title":"Assessment of Candida spp. frequency in the oral cavity ontocenosis of healthy individuals in different age groups","volume":"10","author":"Malm","year":"2016","journal-title":"J. Pre.-Clin. Clin. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1590\/1807-3107bor-2017.vol31.0038","article-title":"Association between pathogens from tracheal aspirate and oral biofilm of patients on mechanical ventilation","volume":"31","author":"Souza","year":"2017","journal-title":"Braz. Oral Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00284-022-02824-6","article-title":"COVID-19-Associated Candidiasis: Possible Patho-Mechanism, Predisposing Factors, and Prevention Strategies","volume":"79","author":"Ahmed","year":"2022","journal-title":"Curr Microbiol"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1097\/CPM.0000000000000279","article-title":"Respiratory Tract Colonization by Candida species Portends Worse Outcomes in Immunocompromised Patients","volume":"25","author":"Pendleton","year":"2018","journal-title":"Clin. Pulm. Med."},{"key":"ref_5","first-page":"47","article-title":"Anticandidal Activities by Lactobacillus Species: An Update on Mechanisms of Action","volume":"2","year":"2021","journal-title":"Front. Oral Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/978-3-030-28524-1_6","article-title":"The Relationship of Candida albicans with the Oral Bacterial Microbiome in Health and Disease","volume":"1197","author":"Bertolini","year":"2019","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1128\/CMR.00013-11","article-title":"Polymicrobial Interactions: Impact on Pathogenesis and Human Disease","volume":"25","author":"Peters","year":"2012","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Allison, D.L., Willems, H.M.E., Jayatilake, J.A.M.S., Bruno, V.M., Peters, B.M., and Shirtliff, M.E. (2016). Candida\u2013Bacteria Interactions: Their Impact on Human Disease. Microbiol. Spectr., 4.","DOI":"10.1128\/microbiolspec.VMBF-0030-2016"},{"key":"ref_9","first-page":"116","article-title":"COVID-19 and periodontal disease: Etiopathogenic and clinical immplications","volume":"12","author":"Martu","year":"2020","journal-title":"Rom. J. Oral Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Mocanu, R.C., Martu, M.-A., Luchian, I., Sufaru, I.G., Maftei, G.A., Ioanid, N., Martu, S., and Tatarciuc, M. (2021). Microbiologic Profiles of Patients with Dental Prosthetic Treatment and Periodontitis before and after Photoactivation Therapy\u2014Randomized Clinical Trial. Microorganisms, 9.","DOI":"10.3390\/microorganisms9040713"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical Characteristics of Coronavirus Disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/j.chest.2021.04.002","article-title":"Hospital-Acquired Infections in Critically Ill Patients with COVID-19","volume":"160","author":"Grasselli","year":"2021","journal-title":"Chest"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s13756-023-01218-y","article-title":"Impact of tooth brushing on oral bacteriota and health care-associated infections among ventilated COVID-19 patients: An intervention study","volume":"12","author":"Anna","year":"2023","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Fiema, M., Wlodarczyk, A., Wojkowska-Mach, J., Garlicki, J., and Gregorczyk-Maga, I. (2022). Atypical Presentation of Aspergillus niger Infection in the Oral Cavity as a Prediction of Invasive Pulmonary Aspergillosis in a Patient with COVID-19: Case Report and Literature Review. Microorganisms, 10.","DOI":"10.3390\/microorganisms10081630"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e31","DOI":"10.1097\/CCM.0000000000004748","article-title":"Unexpectedly High Frequency of Enterococcal Bloodstream Infections in Coronavirus Disease 2019 Patients Admitted to an Italian ICU: An Observational Study","volume":"49","author":"Bonazzetti","year":"2021","journal-title":"Crit. Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s15010-021-01643-4","article-title":"Multidrug-resistant Acinetobacter baumannii infections in COVID-19 patients hospitalized in intensive care unit","volume":"50","author":"Russo","year":"2022","journal-title":"Infection"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1186\/s13054-019-2663-7","article-title":"The SOFA score\u2014Development, utility and challenges of accurate assessment in clinical trials","volume":"23","author":"Lambden","year":"2019","journal-title":"Crit. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/civ933","article-title":"Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America","volume":"62","author":"Pappas","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","unstructured":"European Centre for Disease Prevention and Control (2017). Surveillance of Healthcare-Associated Infections and Prevention Indicators in European Intensive Care Units HAI-Net ICU Protocol, Version 2.2, ECDC."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Leber, A.L. (2016). Clinical Microbiology Procedures Handbook, ASM Press. [4th ed.].","DOI":"10.1128\/9781555818814"},{"key":"ref_21","first-page":"4333","article-title":"Cultivable oral bacteriota dysbiosis in mechanically ventilated COVID-19 patients","volume":"13","author":"Fiema","year":"2022","journal-title":"Front. Microbiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0003-9969(80)90147-8","article-title":"The prevalence and intra-oral distribution of Candida albicans in man","volume":"25","author":"Arendorf","year":"1980","journal-title":"Arch. Oral Biol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"103575","DOI":"10.1016\/j.micpath.2019.103575","article-title":"Characterization of oral candidiasis and the Candida species profile in patients with oral mucosal diseases","volume":"134","author":"Hu","year":"2019","journal-title":"Microb. Pathog."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Vila, T., Sultan, A.S., Montelongo-Jauregui, D., and Jabra-Rizk, M.A. (2020). Oral Candidiasis: A Disease of Opportunity. J. Fungi, 6.","DOI":"10.3390\/jof6010015"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1177\/10454411990100030701","article-title":"Oral colonization by Candida albicans","volume":"10","author":"Cannon","year":"1999","journal-title":"Crit. Rev. Oral Biol. Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Bojang, E., Ghuman, H., Kumwenda, P., and Hall, R.A. (2021). Immune Sensing of Candida albicans. J. Fungi, 7.","DOI":"10.3390\/jof7020119"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1590\/S1678-9946201658017","article-title":"Factors Related to oral candidiasis in elderly users and non-users of removable dental prostheses","volume":"58","author":"Bianchi","year":"2016","journal-title":"Rev. Inst. Med. Trop. Sao Paulo"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"4S","DOI":"10.14219\/jada.archive.2003.0367","article-title":"Diabetes and oral health: An overview","volume":"134","author":"Ship","year":"2003","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_29","first-page":"50","article-title":"Prevalence of oral lesions modulated by patient\u2019s age: The young versus the elderly","volume":"10","author":"Popa","year":"2018","journal-title":"Rom. J. Oral Rehabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"980","DOI":"10.37358\/MP.19.4.5295","article-title":"The biomechanical properties of suture materials and their relationship to bacterial adherence","volume":"56","author":"Maftei","year":"2019","journal-title":"Mater. Plast."},{"key":"ref_31","first-page":"100937","article-title":"Fungal colonization and infections in patients with COVID-19 in intensive care units: A real-life experience at a tertiary-care hospital","volume":"82","author":"Nazli","year":"2022","journal-title":"Respir. Med. Res."},{"key":"ref_32","first-page":"1207","article-title":"ICU-acquired Candidemia in COVID-19 Patients: An Experience from a Tertiary Care Hospital in Kerala, South India","volume":"25","author":"Niyas","year":"2021","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1001\/jama.2020.2648","article-title":"Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention","volume":"323","author":"Wu","year":"2020","journal-title":"JAMA"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.15585\/mmwr.mm7137a4","article-title":"Mortality Risk Among Patients Hospitalized Primarily for COVID-19 During the Omicron and Delta Variant Pandemic Periods\u2014United States, April 2020\u2013June 2022","volume":"71","author":"Adjei","year":"2022","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s00134-017-4717-0","article-title":"Clinical characteristics and predictors of mortality in cirrhotic patients with candidemia and intra-abdominal candidiasis: A multicenter study","volume":"43","author":"Bassetti","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1086\/502581","article-title":"Excess Mortality, Hospital Stay, and Cost Due to Candidemia: A Case-Control Study Using Data From Population-Based Candidemia Surveillance","volume":"26","author":"Morgan","year":"2005","journal-title":"Infect. Control. Hosp. Epidemiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1007\/s00134-014-3408-3","article-title":"Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002\u20132010)","volume":"40","author":"Lortholary","year":"2014","journal-title":"Intensive Care Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1111\/myc.13332","article-title":"Characteristics of candidemia in COVID-19 patients; increased incidence, earlier occurrence and higher mortality rates compared to non-COVID-19 patients","volume":"64","author":"Kayaaslan","year":"2021","journal-title":"Mycoses"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.1016\/S0140-6736(03)14904-5","article-title":"Glucocorticoids and invasive fungal infections","volume":"362","author":"Lionakis","year":"2003","journal-title":"Lancet"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Arastehfar, A., Carvalho, A., Hong Nguyen, M., Hedayati, M.T., Netea, M.G., Perlin, D.S., and Hoenigl, M. (2020). COVID-19-Associated Candidiasis (CAC): An Underestimated Complication in the Absence of Immunological Predispositions?. J. Fungi, 6.","DOI":"10.3390\/jof6040211"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Riche, C.V.W., Cassol, R., and Pasqualotto, A.C. (2020). Is the Frequency of Candidemia Increasing in COVID-19 Patients Receiving Corticosteroids?. J. Fungi, 6.","DOI":"10.3390\/jof6040286"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1007\/s00134-014-3310-z","article-title":"A multicenter study of septic shock due to candidemia: Outcomes and predictors of mortality","volume":"40","author":"Bassetti","year":"2014","journal-title":"Intensive Care Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1128\/CMR.17.2.255-267.2004","article-title":"Candida infections of medical devices","volume":"17","author":"Kojic","year":"2004","journal-title":"Clin. Microbiol Rev."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"631865","DOI":"10.3389\/fpubh.2021.631865","article-title":"Risk Factors of Candida parapsilosis Catheter-Related Bloodstream Infection","volume":"9","author":"Yamin","year":"2021","journal-title":"Front. Public Health"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1086\/321811","article-title":"Risk factors for candidal bloodstream infections in surgical intensive care unit patients: The NEMIS prospective multicenter study. The National Epidemiology of Mycosis Survey","volume":"33","author":"Blumberg","year":"2001","journal-title":"Clin. Infect Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-019-2497-3","article-title":"Incidence and outcome of invasive candidiasis in intensive care units (icus) in europe: Results of the eucandicu project","volume":"23","author":"Bassetti","year":"2019","journal-title":"Crit. Care"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e2838\u20139","DOI":"10.1093\/cid\/ciaa1594","article-title":"Candidemia in Coronavirus Disease 2019 (COVID-19) Patients: Incidence and Characteristics in a Prospective Cohort Compared With Historical Non\u2013COVID-19 Controls","volume":"73","author":"Mastrangelo","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1111\/myc.13225","article-title":"Increased incidence of candidemia in a tertiary care hospital with the COVID-19 pandemic","volume":"64","author":"Nucci","year":"2021","journal-title":"Mycoses"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Machado, M., Est\u00e9vez, A., S\u00e1nchez-Carrillo, C., Guinea, J., Escribano, P., Alonso, R., Valerio, M., Padilla, B., Bouza, E., and Mu\u00f1oz, P. (2022). Incidence of Candidemia Is Higher in COVID-19 versus Non-COVID-19 Patients, but Not Driven by Intrahospital Transmission. J. Fungi, 8.","DOI":"10.3390\/jof8030305"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/S2213-2600(21)00442-2","article-title":"Fungal infections in mechanically ventilated patients with COVID-19 during the first wave: The French multicentre MYCOVID study","volume":"10","author":"Gangneux","year":"2022","journal-title":"Lancet Respir. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1111\/myc.13258","article-title":"Epidemiology and Mycology of Candidaemia in non-oncological medical intensive care unit patients in a tertiary center in the United States: Overall analysis and comparison between non-COVID-19 and COVID-19 cases","volume":"64","author":"Macauley","year":"2021","journal-title":"Mycoses"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"102353","DOI":"10.1016\/j.bjid.2022.102353","article-title":"Increased incidence of candidemia in critically ill patients during the Coronavirus Disease 2019 (COVID-19) pandemic","volume":"26","author":"Kolonitsiou","year":"2022","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_53","first-page":"173","article-title":"Epidemiology, diagnosis and treatment of fungal respiratory infections in the critically ill patient","volume":"26","author":"Olaechea","year":"2013","journal-title":"Rev. Esp. Quimioter"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"S433","DOI":"10.1093\/cid\/cir109","article-title":"Candida Urinary Tract Infections\u2014Epidemiology","volume":"52","author":"Sobel","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Butera, A., Gallo, S., Maiorani, C., Molino, D., Chiesa, A., Preda, C., Esposito, F., and Scribante, A. (2020). Probiotic Alternative to Chlorhexidine in Periodontal Therapy: Evaluation of Clinical and Microbiological Parameters. Microorganisms., 9.","DOI":"10.3390\/microorganisms9010069"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Butera, A., Gallo, S., Pascadopoli, M., Maiorani, C., Milone, A., Alovisi, M., and Scribante, A. (2022). Paraprobiotics in Non-Surgical Periodontal Therapy: Clinical and Microbiological Aspects in a 6-Month Follow-Up Domiciliary Protocol for Oral Hygiene. Microorganisms., 10.","DOI":"10.3390\/microorganisms10020337"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Butera, A., Pascadopoli, M., Pellegrini, M., Gallo, S., Zampetti, P., Cuggia, G., and Scribante, A. (2022). Domiciliary Use of Chlorhexidine vs. Postbiotic Gels in Patients with Peri-Implant Mucositis: A Split-Mouth Randomized Clinical Trial. Appl. Sci., 12.","DOI":"10.3390\/app12062800"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Butera, A., Pascadopoli, M., Gallo, S., P\u00e9rez-Albacete Mart\u00ednez, C., Mat\u00e9 S\u00e1nchez de Val, J.E., Parisi, L., Gariboldi, A., and Scribante, A. (2023). Ozonized Hydrogels vs. 1% Chlorhexidine Gel for the Clinical and Domiciliary Management of Peri-Implant Mucositis: A Randomized Clinical Trial. J. Clin. Med., 12.","DOI":"10.3390\/jcm12041464"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Butera, A., Maiorani, C., Natoli, V., Bruni, A., Coscione, C., Magliano, G., Giacobbo, G., Morelli, A., Moressa, S., and Scribante, A. (2020). Bio-Inspired Systems in Nonsurgical Periodontal Therapy to Reduce Contaminated Aerosol during COVID-19: A Comprehensive and Bibliometric Review. J. Clin. Med., 9.","DOI":"10.3390\/jcm9123914"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/11\/6\/1442\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:45:04Z","timestamp":1760125504000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/11\/6\/1442"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,30]]},"references-count":59,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["microorganisms11061442"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms11061442","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,30]]}}}