Support for the role of Candida spp. in extensive caries lesions of children.

Candida spp. are frequently detected in the mouths of children with extensive caries lesions compared with caries-free subjects. In this study we evaluated the presence of Candida spp. in association with mutans streptococci and lactobacilli in the saliva of children with dental decay, before and after anti-caries treatment. Samples of saliva from 14 children with caries lesions and from 13 caries-free subjects were evaluated for the presence of mutans streptococci, lactobacilli and Candida spp. by culture. Eleven of 14 carious subjects hosted Candida spp. in their saliva as against only 2 out of 13 subjects without caries lesions. Carious subjects were treated by adopting a conventional protocol for caries disease (rinses with a mouthwash containing 0.2% chlorhexidine and fluorine). After treatment, the salivary bacterial counts decreased for mutans streptococci and in some cases for lactobacilli, but large numbers of Candida spp. remained in the saliva of several children. The latter were treated with the antifungal drug nystatin (oral rinses) and evaluation of the level of yeasts in the saliva showed disappearance of the microorganism in several cases. The results indicate that antiseptic treatment alone for dental decay is not sufficient for the eradication of microorganisms potentially responsible for caries lesions, in particular when yeasts are present. We hypothesize that the oral cavity of children could act as a reservoir of fungi, and eradication could be needed to prevent both exacerbation of caries lesions, and colonization by Candida spp. of other host sites.