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Prevalence of Candida albicans in primary endodontic infections associated with a higher frequency of apical periodontitis in type two diabetes mellitus patients

Abstract

To identify the prevalence of C. albicans in primary endodontic infections of type two diabetes mellitus (T2DM) patients and compare their clinical and radiographical characteristics with a non-diabetic control group, establishing the possible relationship between primary endodontic infection, T2DM, and C. albicans, since diabetes mellitus (DM), influences the development, course, and response to the treatment of apical periodontitis, but the presence of Candida albicans (C. albicans) has not been considered before. A total of 120 patients were selected and divided into two groups: 60 T2DM diagnosed patients and 60 non-diabetic controls. A clinical examination and radiographic analysis were performed to establish a periapical index score (PAI). Root canal samples were taken. Deoxyribonucleic acid (DNA) was extracted, and specific primers were used to identify C. albicans by polymerase chain reaction (PCR). A twofold increase in the prevalence of C. albicans in T2DM patients was observed in contrast to control patients (p = 0.0251). Sixty-five percent of T2DM patients with positive C. albicans scored a ≥ 3 PAI, while only 27% of the patients without C. albicans had a ≥ 3 PAI score (p = 0.0065). Long-term DM patients presented C. albicans more frequently (p < 0.0001). In this study, long-term T2DM patients carried C. albicans in their root canals more frequently when having a primary endodontic infection. Furthermore, this C. albicans presence seems to be related to a higher frequency of apical periodontitis.

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Acknowledgments

The authors wish to thank Dr. Adriana Lucia Arenas Pérez for her kind attention and to allow us to attend the clinic of Endodontics at the Centro Universitario de Estudios de Posgrado e Investigación, UMSNH to invite patients to participate in this study.

Statement of author contributions

R.D.T.L., R.A.D.P., A.L.G.N., M.E.R.A., R.M.P.S., and M.S.V.G. conceived and planned the idea; R.D.T.L., R.A.D.P., and M.E.R.A. collected the samples; R.A.D.P., A.L.G.N., J.L.A.H., and R.E.M.M. carried out the laboratory experiments; J.L.A.H., R.E.M.M., and M.E.R.A contributed to the interpretation of the results; R.A.D.P., A.L.G.N., R.M.P.S., and M.S.V.G analyzed the data; R.A.D.P. and M.S.V.G took the lead in writing the manuscript. All authors provided critical feedback and helped shape the research, analysis, and manuscript.

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Correspondence to Rubén Abraham Domínguez-Pérez.

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An informed and voluntary written consent was obtained prior to clinical examination according to the ethical principles of the Declaration of Helsinki (version 2013). The protocol study was approved by the Ethical Committee of the dentistry department of the faculty.

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The authors declare that they have no conflict of interest.

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De la Torre-Luna, R., Domínguez-Pérez, R.A., Guillén-Nepita, A.L. et al. Prevalence of Candida albicans in primary endodontic infections associated with a higher frequency of apical periodontitis in type two diabetes mellitus patients. Eur J Clin Microbiol Infect Dis 39, 131–138 (2020) doi:10.1007/s10096-019-03702-z

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Keywords

  • Apical periodontitis
  • Candida albicans
  • Diabetes mellitus
  • Endodontics
  • Primary endodontic infection
  • Root canal treatment