{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T15:59:34Z","timestamp":1790870374587,"version":"4.1.0"},"reference-count":57,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001807","name":"FAPESP","doi-asserted-by":"publisher","award":["2022\/04995-6"],"award-info":[{"award-number":["2022\/04995-6"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001807","name":"FAPESP","doi-asserted-by":"publisher","award":["2020\/06043-7"],"award-info":[{"award-number":["2020\/06043-7"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Complete dentures (CD) are prone to biofilm formation, particularly by Candida species, which may lead to denture stomatitis (DS). As edentulism remains highly prevalent among the global ageing population, denture-related infections represent a significant public health concern. The novelty of this study lies in integrating the clinical severity of DS with the prevalence, microbial load, and antifungal susceptibility profile of Candida spp., providing new insights into the pathogenesis and therapeutic management of this condition. Biofilm from the CD and palate was seeded for prevalence and microbial load. The identification of strains was confirmed molecularly, and susceptibility to micafungin, nystatin, fluconazole, and miconazole was assessed by the broth microdilution method. Prevalence was shown in percentage, microbial load was analyzed using a generalized linear model test, and susceptibility was assessed using Pearson\u2019s Chi-square test (p &lt; 0.05). Candida albicans was the most prevalent regardless of DS. However, a higher microbial load of C. albicans was observed with increased severity of DS (p = 0.038). Except for Candida tropicalis, the microbial load of the CD was higher than that of the palate. C. tropicalis showed resistance to fluconazole with increased severity of DS (p = 0.004). All strains were susceptible to nystatin and miconazole, and three were resistant to micafungin. The findings suggest that the prevalence of Candida spp. is not a determining factor in the variation in DS severity. Nevertheless, patients with severe inflammation harbor an increased load of C. albicans on both sites. Nystatin and miconazole appear to be effective treatments for DS.<\/jats:p>","DOI":"10.3390\/microorganisms13092057","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T10:55:37Z","timestamp":1756983337000},"page":"2057","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Candida spp. in Denture Stomatitis: Prevalence, Microbial Load, and Antifungal Resistance Across Severity Levels"],"prefix":"10.3390","volume":"13","author":[{"given":"Marco Aurelio","family":"Fifolato","sequence":"first","affiliation":[{"name":"Department of Dental Materials and Prosthesis, Ribeir\u00e3o Preto School of Dentistry, University of S\u00e3o Paulo, Avenida do Caf\u00e9 S\/N, Ribeir\u00e3o Preto 14040-904, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7701-9311","authenticated-orcid":false,"given":"Lorena Mosconi","family":"Clemente","sequence":"additional","affiliation":[{"name":"Department of Dental Materials and Prosthesis, Ribeir\u00e3o Preto School of Dentistry, University of S\u00e3o Paulo, Avenida do Caf\u00e9 S\/N, Ribeir\u00e3o Preto 14040-904, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3108-8589","authenticated-orcid":false,"given":"Adriana Barbosa","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Department of Dental Materials and Prosthesis, Ribeir\u00e3o Preto School of Dentistry, University of S\u00e3o Paulo, Avenida do Caf\u00e9 S\/N, Ribeir\u00e3o Preto 14040-904, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0734-0652","authenticated-orcid":false,"given":"Viviane de C\u00e1ssia","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Department of Dental Materials and Prosthesis, Ribeir\u00e3o Preto School of Dentistry, University of S\u00e3o Paulo, Avenida do Caf\u00e9 S\/N, Ribeir\u00e3o Preto 14040-904, S\u00e3o Paulo, Brazil"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Respiratorias (Ciberes), Hospital Clinic de Barcelona, Villaroel, 170, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7351-5740","authenticated-orcid":false,"given":"Helio Cesar","family":"Salgado","sequence":"additional","affiliation":[{"name":"Department of Physiology, Ribeir\u00e3o Preto Medical School. University of S\u00e3o Paulo, Avenida do Caf\u00e9 S\/N, Ribeir\u00e3o Preto 14040-904, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evandro","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Restorative Dentistry, Ribeir\u00e3o Preto School of Dentistry, University of S\u00e3o Paulo, Avenida do Caf\u00e9 S\/N, Ribeir\u00e3o Preto 14040-904, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1629-2207","authenticated-orcid":false,"given":"Cl\u00e1udia Helena Lovato da","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Dental Materials and Prosthesis, Ribeir\u00e3o Preto School of Dentistry, University of S\u00e3o Paulo, Avenida do Caf\u00e9 S\/N, Ribeir\u00e3o Preto 14040-904, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"498305","DOI":"10.1155\/2013\/498305","article-title":"The impact of edentulism on oral and general health","volume":"2013","author":"Emami","year":"2013","journal-title":"Int. J. Dent."},{"key":"ref_2","first-page":"661","article-title":"The global burden of oral diseases and risks to oral health","volume":"83","author":"Petersen","year":"2005","journal-title":"Bull. World Health Organ."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"104335","DOI":"10.1016\/j.jdent.2022.104335","article-title":"Global prevalence of edentulism and dental caries in middle-aged and elderly persons: A systematic review and meta-analysis","volume":"127","author":"Roccuzzo","year":"2022","journal-title":"J. Dent."},{"key":"ref_4","first-page":"60","article-title":"Research and development of digital design and fabrication of complete denture","volume":"53","author":"Sun","year":"2018","journal-title":"Chin. J. Stomatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"28","DOI":"10.5005\/jcdp-1-2-36","article-title":"Denture hygiene: A review and update","volume":"1","author":"Shay","year":"2000","journal-title":"J. Contemp. Dent. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Kaur, J., and Nobile, C.J. (2023). Antifungal drug-resistance mechanisms in Candida biofilms. Curr. Opin. Microbiol., 71.","DOI":"10.1016\/j.mib.2022.102237"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Lueyar, T.K., Karygianni, L., Attin, T., and Thurnheer, T. (2023). Dynamic interactions between Candida albicans and streptococci in multispecies oral biofilm. MicrobiologyOpen, 12.","DOI":"10.1002\/mbo3.1381"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1308\/205016817822230175","article-title":"Denture stomatitis: Causes, cures and prevention","volume":"6","author":"Hannah","year":"2017","journal-title":"Prim. Dent. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1111\/prd.12129","article-title":"Oral inflammation and infection, and chronic medical diseases: Implications for the elderly","volume":"72","author":"Scannapieco","year":"2016","journal-title":"Periodontology 2000"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/jam.14949","article-title":"Biofilm of Candida albicans: Formation, regulation and resistance","volume":"131","author":"Pereira","year":"2021","journal-title":"J. Appl. Microbiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1111\/apm.13412","article-title":"Pathophysiological microenvironments in oral candidiasis","volume":"132","year":"2024","journal-title":"APMIS"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1046\/j.1365-2842.2002.00816.x","article-title":"Oral hygiene habits, denture cleanliness, yeasts and stomatitis in elderly people","volume":"29","author":"Kazazoglu","year":"2002","journal-title":"J. Oral Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/j.1741-2358.2009.00359.x","article-title":"The prevalence of denture stomatitis and its predisposing conditions in an older Greek population","volume":"28","author":"Kossioni","year":"2011","journal-title":"Gerodontology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"311","DOI":"10.11607\/ijp.3844","article-title":"Phase 1 clinical trial on palatal brushing in denture stomatitis","volume":"27","author":"Kabawat","year":"2014","journal-title":"Int. J. Prosthodont."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1590\/1678-7757-2016-0222","article-title":"Ricinus communis and sodium hypochlorite as denture cleansers","volume":"25","author":"Salles","year":"2017","journal-title":"J. Appl. Oral Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.bjm.2017.05.008","article-title":"Lactoferrin, chitosan and Melaleuca alternifolia in candidiasis treatment","volume":"49","author":"Felipe","year":"2018","journal-title":"Braz. J. Microbiol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Clemente, L.M., Ribeiro, A.B., Fortes, C.V., Oliveira, V.C., Macedo, A.P., Salgado, H.C., and Silva-Lovato, C.H. (2023). Risk factors and biomarkers in denture stomatitis. Arch. Oral Biol., 155.","DOI":"10.1016\/j.archoralbio.2023.105799"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Ghannoum, M.A., Jurevic, R.J., Mukherjee, P.K., Cui, F., Sikaroodi, M., Naqvi, A., and Gillevet, P.M. (2010). Oral mycobiome in healthy individuals. PLoS Pathog., 6.","DOI":"10.1371\/journal.ppat.1000713"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e331","DOI":"10.1111\/j.1741-2358.2011.00476.x","article-title":"Salivary immunity in elderly with Candida-related denture stomatitis","volume":"29","author":"Gasparoto","year":"2012","journal-title":"Gerodontology"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ribeiro, A.B., de Ara\u00fajo, C.B., Fortes, C.V., Clemente, L.M., Paranhos, H.F.O., Watanabe, E., Salgado, H.C., and Silva-Lovato, C.H. (2022). Hygiene protocol effects on denture stomatitis remission. Antibiotics, 11.","DOI":"10.3390\/antibiotics11101320"},{"key":"ref_21","first-page":"690","article-title":"Disinfection protocols on Candida spp. and DS","volume":"124","author":"Bueno","year":"2020","journal-title":"J. Prosthet. Dent."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1016\/j.prosdent.2020.12.018","article-title":"Local hygiene protocols and denture-related stomatitis","volume":"128","author":"Ribeiro","year":"2022","journal-title":"J. Prosthet. Dent."},{"key":"ref_23","first-page":"259","article-title":"Treatment of DS and immune cells","volume":"15","author":"Maciag","year":"2017","journal-title":"Oral Health Prev. Dent."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"66","DOI":"10.5114\/aoms.2017.64715","article-title":"DS treatment improves endothelial function","volume":"13","author":"Osmenda","year":"2017","journal-title":"Arch. Med. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/S1473-3099(02)00181-0","article-title":"Resistance of Candida species to antifungals","volume":"2","author":"Sanglard","year":"2002","journal-title":"Lancet Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3390","DOI":"10.1021\/acs.chemrev.0c00199","article-title":"Antifungal drug resistance in Candida","volume":"121","author":"Lee","year":"2021","journal-title":"Chem. Rev."},{"key":"ref_27","first-page":"367","article-title":"Antifungal susceptibility of Candida spp.","volume":"48","author":"Demitto","year":"2012","journal-title":"J. Bras. Patol. Med. Lab."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"46","DOI":"10.2174\/1874210601509010046","article-title":"DS fluconazole treatment effects","volume":"9","author":"Figueiral","year":"2015","journal-title":"Open Dent. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1111\/j.1574-6976.2011.00278.x","article-title":"C. glabrata, C. parapsilosis, C. tropicalis: Biology & resistance","volume":"36","author":"Silva","year":"2012","journal-title":"FEMS Microbiol. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"441","DOI":"10.2174\/1567201819666220418104042","article-title":"Oral candidiasis and novel therapies","volume":"20","author":"Contaldo","year":"2023","journal-title":"Curr. Drug Deliv."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"313","DOI":"10.2174\/1389203720666190722152415","article-title":"Virulence factors in Candida","volume":"21","author":"Staniszewska","year":"2020","journal-title":"Curr. Protein Pept. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Fr\u00edas-De-Le\u00f3n, M.G., Hern\u00e1ndez-Castro, R., Conde-Cuevas, E., Garc\u00eda-Coronel, I.H., V\u00e1zquez-Aceituno, V.A., Soriano-Urs\u00faa, M.A., Farf\u00e1n-Garc\u00eda, E.D., Ochar\u00e1n-Hern\u00e1ndez, E., Rodr\u00edguez-Cerdeira, C., and Arenas, R. (2021). C. glabrata resistance and virulence. Pharmaceutics, 13.","DOI":"10.3390\/pharmaceutics13101529"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.jmoldx.2010.11.014","article-title":"Molecular identification of Candida species","volume":"13","author":"Cornet","year":"2011","journal-title":"J. Mol. Diagn."},{"key":"ref_34","unstructured":"CLSI (2017). M27-A4: Method for Broth Dilution Antifungal Susceptibility Testing, CLSI."},{"key":"ref_35","first-page":"1791","article-title":"Factors influencing antifungal testing","volume":"51","author":"Cortez","year":"2020","journal-title":"Braz. J. Microbiol."},{"key":"ref_36","first-page":"593","article-title":"Miconazole activity against Candida biofilms","volume":"65","author":"Gebremedhin","year":"2014","journal-title":"J. Physiol. Pharmacol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.archoralbio.2008.09.005","article-title":"Isolation of Candida dubliniensis in DS","volume":"54","author":"Vicente","year":"2009","journal-title":"Arch. Oral Biol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"Observer agreement for categorical data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.riam.2010.03.007","article-title":"Oral Candida carriage in Portugal","volume":"27","author":"Martins","year":"2010","journal-title":"Rev. Iberoam. Micol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Mahdavi-Omran, S., Dastjerdi, M.R., Zuashkiani, M., Moqarabzadeh, V., and Taghizadeh-Armaki, M. (2018). Antifungal susceptibility of Candida from DS. BioMed Res. Int., 2018.","DOI":"10.1155\/2018\/3086586"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Kumar, S., Kumar, A., Roudbary, M., Mohammadi, R., \u010cern\u00e1kov\u00e1, L., and Rodrigues, C.F. (2022). Infections by rare Candida species. Pathogens, 11.","DOI":"10.3390\/pathogens11090963"},{"key":"ref_42","first-page":"51","article-title":"First report of C. nivariensis in Brazil","volume":"111","author":"Ramos","year":"2016","journal-title":"Mem. Inst. Oswaldo Cruz"},{"key":"ref_43","first-page":"871","article-title":"C. glabrata complex in Argentina","volume":"181","author":"Taverna","year":"2016","journal-title":"Mycopathologia"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Hernando-Ortiz, A., Eraso, E., Quind\u00f3s, G., and Mateo, E. (2021). Candidiasis by C. glabrata, C. nivariensis and C. bracarensis. J. Fungi, 7.","DOI":"10.3390\/jof7120998"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1590\/1519-6984.190454","article-title":"Antifungal sensitivity in chronic atrophic candidiasis","volume":"80","author":"Reinhardt","year":"2020","journal-title":"Braz. J. Biol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s40262-017-0578-5","article-title":"PK\/PD of micafungin","volume":"57","author":"Wasmann","year":"2018","journal-title":"Clin. Pharmacokinet."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1007\/s11046-014-9800-2","article-title":"Prevalence of C. nivariensis and C. bracarensis","volume":"178","author":"Li","year":"2014","journal-title":"Mycopathologia"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"303","DOI":"10.33073\/pjm-2019-032","article-title":"C. nivariensis in Poland","volume":"68","author":"Sikora","year":"2019","journal-title":"Pol. J. Microbiol."},{"key":"ref_49","first-page":"25","article-title":"Denture stomatitis: Role for Candida biofilms","volume":"114","author":"Ramage","year":"2012","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.1086\/344658","article-title":"Antifungal drug resistance","volume":"36","author":"Loeffler","year":"2003","journal-title":"Clin. Infect. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1093\/jac\/dkq019","article-title":"Miconazole against C. albicans biofilms","volume":"65","author":"Vandenbosch","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1128\/CMR.12.4.501","article-title":"Antifungal agents: Mode of action and resistance","volume":"12","author":"Ghannoum","year":"1999","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1128\/JCM.02116-07","article-title":"Candida nivariensis: Multidrug resistance","volume":"46","author":"Borman","year":"2008","journal-title":"J. Clin. Microbiol."},{"key":"ref_54","unstructured":"Nystatin (2025, August 31). LiverTox: Clinical and Research Information on Drug-Induced Liver Injury, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/31643896\/."},{"key":"ref_55","first-page":"e172","article-title":"Therapeutic tools for oral candidiasis","volume":"24","author":"Sevillano","year":"2019","journal-title":"Med. Oral Patol. Oral Cir. Bucal"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"S612","DOI":"10.1093\/cid\/civ791","article-title":"Echinocandin resistance in Candida","volume":"61","author":"Perlin","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"25469","DOI":"10.1074\/jbc.C114.571778","article-title":"Glucose directly promotes antifungal resistance in the fungal pathogen, Candida spp.","volume":"12","author":"Mandal","year":"2014","journal-title":"J. Biol. Chem."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/9\/2057\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:39:27Z","timestamp":1760035167000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/9\/2057"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,4]]},"references-count":57,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["microorganisms13092057"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms13092057","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,4]]}}}