Notes

Key words: Candida albicans, tobacco, oral health.

NOTES
The relationship between cigarette
smoking and oral colonization with Candida species in healthy adult subjects
Selma Muzurovi1, Mirsada Huki2, Emina
Babaji3, Rubina Smaji4
Dental Clinic, Health CentreDom zdravljaNovi Grad, Public
Institution MedicalCentreof Sarajevo Canton, 2Institute for
Clinical Microbiology, University Clinical Centre of Sarajevo,
Sarajevo, 3Department of Otolaryngology and Maxillofacial
Surgery, Cantonal Hospital Zenica, 4Department of Preventive
and Pediatric Dentistry, School of Dental Medicine, University of
Sarajevo; Bosnia and Herzegovina
1

Corresponding author: Emina Babaji; Cantonal Hospital

Zenica; Crkvice 67, 72 000 Zenica, Bosnia and Herzegovina;
Phone: +387 32 405 133; fax: +387 32 226 576;
Email: eminababajic@hotmail.com
Original submission: 22 October 2012; Revised submission:
09 November 2012; Accepted: 19 December 2012.
Med Glas (Zenica) 2013; 10(2):397-399

ABSTRACT
The aim of the study was to determine presence
of Candida species in oral cavity and to investigate their relation with the smoking habit. This
prospective study included 140 healthy respondents (75 male and 65 female) divided into two
groups according to the age: group I (from 18 to
30 years) and group II (from 31 to 60 years).
In 77 (55%) cases the respondents were smokers. Group I included 37 (52.8%) and group II
40 (57.1%) smokers. There were significantly
more male smokers, 49 (62.3%). Candida spp.
were identified in 40 (29%) healthy respondents
(carriers). The most frequently isolated was Candida albicans. Patients with the presence of oral
Candida were smokers in 33 (82.5%) cases, while patients without Candida were smokers in 44
(44%) cases. Smoking has an influence on oral
colonization with Candida species. Both have a
bad influence on oral health.
Table 1. Relation between smoking, tartar, plaque and oral
hygiene
No (%) of examinees
Tartar
Oral hygiene
Plaque
(Dental calculus)
index
Yes
54
(70%)

No
23
(30%)

Yes
48
(62%)

No
29
(38%)

Low
46
(60%)

High
31
(40%)

Nonsmokers

30
(48%)

33
(52%)

27
(43%)

36
(57%)

23
(36%)

43
(64%)

0.001

Smokers

0.001

0.001

INTRODUCTION
Fungi are aerobic microorganisms, very adaptable to a different environment (1). The most important of them associated as a commensal with
oral cavity belong to the genus Candida (2). The
most frequently isolated is Candida albicans
(over 80%) (3,4). Many predisposing factors (local and general) lead to an increasing number and
invasiveness of Candida species, causing damage
to the oral mucosa. Some of factors are tobacco
smoking, bad oral hygiene, wearing of dentures,
hypovitaminosis, iron deficiency, pregnancy, HIV
infection, diabetes mellitus and debilitated patients such as those receiving antibiotic, steroids or
cytotoxic therapy ( 4-7). Effects of cigarette smoke on the oral mucosa are chemical and thermic
(8,9). Tobacco use is a primary cause of many
oral diseases and adverse oral conditions (10). In
some industrialized countries studies have shown
that smoking is responsible for more than half of
the periodontitis cases among adults (11).
The aim of this study was to assess oral colonization of Candida species and to investigate a relation
between oral Candida colonization and smoking
cigarettes. The purpose of this study is to introduce
some oral health adverse factors and point out the
necessity of good oral hygiene maintenance.
EXAMINEES AND METHODS
A prospective study was conducted among 140
healthy respondents (75 males and 65 females),
between the ages of 18 to 60 at the Dental Clinic,
Health Centre Dom zdravlja Novi Grad, the Public Institution Medical Centre of Sarajevo Canton
from 01.01. 2010 to 01.07. 2011. Patients were divided into two equal groups according to the age.
Group I included patients aged from 18 to 30 years
(average 23), and group II included patients aged
between 31 to 60 years (average 42 years).
Medical history was taken and clinical examination was performed. For the assessment of oral
hygiene the dental plaque index, oral hygiene index and dental calculus index were used.
For isolation of Candida species (spp.) samples
were taken by sterile swab and stained by methylene blue and examined microscopically (40x)
detecting the presence of blastospores and pse-

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Medicinski Glasnik, Volume 10, Number 2, August 2013

udohyphae. Simultaneously, each sample was

cultivated on Sabouraud dextroza agar (Oxoid,
Besingstoke, UK) and brilliance Candida Agar
(Oxoid, Besingstoke, UK). Sabouraud dextroza
agar was prepared with the addition of antibiotics
(penicillin, chloramphenicol, streptomycin and
garamycin) to prevent growth of bacterial flora.
After 48 hours of incubation at 37 C, cultures
were separated into positive (growth of yeast) or
negative cultures (no yeast growth). On positive
cultures the number of yeast colonies was determined. Brilliance Candida Agar is a selective
differential medium for the rapid isolation and
identification of clinically important Candida
spp., allowing the differentiation of Candida albicans and Candida tropicalis from other species of Candida within 48 hours. The results were
confirmed by yeast assimilation test API 20C
AUX (bioMrieux, LEtiolle, France).
Standard methods of descriptive statistics were
used (mean, median, standard deviation). In a
symmetric distribution of frequencies were applied parametric statistical analysis (students t-test)
and asymmetric distribution resulted in the application of nonparametric analysis (2 test). The
value of p 0.05 was considered as significant.
RESULTS
Male patients were more represented, 75 (53.6%)
than female patients, 65 (46.4 %). According to
medical history, 77 (55% ) were cigarettes smokers,
and 63 (45% ) were nonsmokers. Group I included
37 (52.8 % ) and group II 40 (57.1%) smokers
(p=0.165). There were 49 (62. 3%) male smokers
and 28 (37.7%) female smokers (p<0.001).
Candida spp. were identified in 40 (29%) examinees (asymptomatic healthy carriers). In 34 (85%)
Candida albicans was identified, Candida glabrata in four (10%) cases, and Candida crusei in
only two (5%) (p< 0.05). Prevalence of oral Candida carriers was comparable between both males
and females: 22 (55%) and 18 (45%) (p > 0.05).
Differences in the prevalence of Candida among
the carriers according to the age groups were: 23
(58.3%) in the group I, and 17 (41.7 %) in the group II ( p>0.05).
Among the patients presented with oral Candida (40 patients), 33 (82.5%) were smokers, while patients without Candida (100 patients) were
smokers only in 44 (44 %) cases, so it can be con-

398

cluded that cigarettes smoking was significantly

correlated to the presence of Candida in the oral
cavity (p< 0.05). The consumption of tobacco cigarettes was significantly correlated with plaque,
calculus and index oral hygiene (p<0.05) (Table
1). The correlation between smoking and poor oral
hygiene was not statically significant (p= 0.864).
DISCUSSION
Candida species were identified in about one third
of the patients, and the most present was Candida albicans, which corresponds to other studies
(12,13). The relationship between oral colonization with Candida species and tobacco cigarette
smoking is still not completely elucidated. Some
studies indicate correlation, some of them deny it
(14,15). Results of this study were not in accordance with the results of the study conducted in
2010 by Darwazeh et al, where among 100 patients (50 smokers and 50 nonsmokers) Candida
spp. were isolated from 84% of the smokers and
74% of nonsmokers (16). Tobacco smoking did
not have influence on oral colonization with Candida spp. in healthy subjects in Drawazehs study
(16), which is opposite to the results of this study.
Prevalence of oral Candida carriage was comparable between both smokers and nonsmokers in
Reichart et al study (17).
In this study among the patients with oral candidiasis two-thirds were smokers, and among the
patients without candidiasis only one-third were
smokers. Those data are in accordance with the results of studies conducted by Arendorf et al, who
proved statistically significant correlation between
smoking and Candida colonisation (18). Smoking,
mobile prosthetics and systemic disease were found as predisposing factors for the development of
oral candidiasis in other studies too (4, 19).
Reportedly, the prevalence of candida carriage
is increasing significantly as a function of age,
and it is comparable among sexes, but not significantly (20). Opposite to the Drawazehs study,
the results of this study proved no statistically significant difference in the presence of oral Candida between younger and older responders. But
results of both researches agreed that there was
no statistical significance in the presence of oral
Candida between males and females (20).
Smoking cigarettes and presence of Candida
species in oral cavity have adverse effects on

Notes

oral hygiene. Those detrimental factors highlight the necessity of patient - doctor relation for
the purpose of oral health preservation. Patients
should be looking for education and visit dentists
regularly. Doctor should motivate and educate
patients providing professional care. Good cooperative work could lead to improvement of oral
health and health in general.
FUNDING
No specific funding was received for this study.
TRANSPARENCY DECLARATIONS
Competing interests: none to declare.
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Povezanost izmeu puenja cigareta i

oralne kolonizacije Candida vrstama kod
zdravih odraslih ispitanika
Selma Muzurovi1, Mirsada Huki2, Emina
Babaji3, Rubina Smaji4
Stomatoloka sluba, organizaciona jedinica Dom zdravlja Novi
Grad, Javna ustanova Dom zdravlja Kantona Sarajevo, 2Klinika
mikrobiologija, Kliniki centar Univerziteta u Sarajevu, 3Sluba
za bolesti uha, grla, nosa i maksilofacijalnu hirurgiju, Kantonalna
bolnica Zenica, 4Klinika za djeiju i preventivnu stomatologiju,
Stomatoloki fakultet s klinikama, Univerzitet u Sarajevu; Bosna
i Hercegovina
1

SAETAK
Cilj studije bio je odrediti prisutnost Candida vrsta
u usnoj duplji i ispitati povezanost s navikom puenja. U ovu prospektivnu studiju bilo je ukljueno
140 zdravih ispitanika (75 mukog i 65 enskog
spola) podijeljenih u dvije starosne skupine: grupa I (od 18 do 30 godina) i grupa II (od 31 do 60
godina). U 77 (55%) sluajeva potvreno je da su
ispitanici bili puai. U grupi I bilo je zastupljeno
37 (52,8%) i u grupi II 40 (57,1%) puaa. Znaajno vie puaa bilo je mukog spola, 49 (62,3%).
Candida vrste identifikovane su u 40 (29%) ispitanika (nosioca), a najee je izolovana Candida
albicans. Od pacijenata s kandidom 33 (82,5%) su
bili puai, dok su 44 (44%) ispitanika bez kandide
takoer bili puai. Puenje ima utjecaj na kolonizaciju oralne duplje Candida vrstama. Oba faktora
imaju neeljen utjecaj na oralno zdravlje.
Kljune rijei: Candida albicans, duhan, oralno
zdravlje.

399