Clinical characteristics and relevance of oral Candida biofilm in tongue smears

Eunae Cho, Youn Jung Park, Ki Yeol Kim, Dawool Han, Hyun Sil Kim, Jeong Seung Kwon, Hyung Joon Ahn

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9 Citations (Scopus)


Dimorphic Candida exist as commensal yeast carriages or infiltrate hyphae in the oral cavity. Here, we investigated the clinical relevance of Candida hyphae in non-pseudomembranous oral candidiasis (OC) by smears of tongue biofilms. We conducted a retrospective study of 2829 patients who had had tongue smears regardless of OC suspicion. Clinical characteristics were evaluated using a novel method of assessing hyphae. Clinical factors (moderate/severe stimulated pain, pain aggravated by stimulation, tongue dorsum appearance and initial topical antifungal use) were highly significant in the high-grade hyphae group but were statistically similar in the low-grade hyphae and non-observed hyphae group, suggesting low-grade hyphae infection as a subclinical OC state. In addition to erythematous candidiasis (EC), a new subtype named “morphologically normal symptomatic candidiasis” (MNSC) with specific pain patterns and normal tongue morphology was identified. MNSC had a significantly higher proportion of moderate and severe stimulated pain cases than EC. Low unstimulated salivary flow rate (<0.1 mL/min) was found to be a common risk factor in MNSC and EC. In non-pseudomembranous OC, pain patterns were dependent on Candida hyphae degree regardless of tongue dorsum morphology.

Original languageEnglish
Article number77
Pages (from-to)1-13
Number of pages13
JournalJournal of Fungi
Issue number2
Publication statusPublished - 2021 Feb

Bibliographical note

Funding Information:
Funding: This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (NRF-2016R1A5A2008630, NRF-2019R1A2C1003028) and the BK21 FOUR Project, Yonsei University College of Dentistry.

Publisher Copyright:
© 2021, MDPI AG. All rights reserved.

All Science Journal Classification (ASJC) codes

  • Ecology, Evolution, Behavior and Systematics
  • Plant Science
  • Microbiology (medical)


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