Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review
  • Published:

Xerostomia and hyposalivation in association with oral candidiasis: a systematic review and meta-analysis

Evidence-Based Dentistry (2022)Cite this article

Abstract

Introduction Several studies reported that hyposalivation was associated with a higher prevalence of oral Candida colonisation and oral candidiasis, and despite the correlation between these conditions, no previous systematic review was conducted to examine this relationship in its utmost depth.

Objectives This study aims to investigate the relationship between xerostomia, hyposalivation and oral candidiasis.

Search methods This systematic review and meta-analysis was conducted in February 2021 through an electronic search.

Data sources The electronic search was performed on PubMed, Scopus, Web of Science through Clarivate, Medline through Clarivate and Cochrane Library.

Data selection This systematic review and meta-analysis included cohort, observational nested case-control cohort studies, and studies of other designs providing the number of patients with and without xerostomia or hyposalivation crossed with the number of patients with and without oral candidiasis or oral Candida growth. Studies included were conducted on adult populations with no restriction to sex or race. Included studies should use a reliable diagnostic method for all conditions of interest.

Data extraction Results were obtained from the implementation of the search strategy and managed using the EndNote Web and Rayyan Qatar Computing Research Institute (QCRI). Quantitative data synthesis was performed using the Review Manager 5.4 software.

Results A total of 429 studies were identified by searching the databases, of which nine studies were included for qualitative and quantitative data synthesis. The analysis included 590 xerostomic patients and 697 controls subgrouped into two categories: Candida growth (207 patients and 195 controls) and oral candidiasis (383 patients and 502 controls). The Candida growth subgroup analysis shows that the xerostomic patients are at higher risk for oral Candida growth than controls (OR [95% CI] = 3.13 [2.02-4.86]) and the oral candidiasis subgroup analysis yields that xerostomic patients are at higher risk for developing manifest oral candidiasis than controls (OR [95% CI] = 2.48 [1.83-3.37]).

Conclusion Our study concludes that patients with xerostomia have a higher risk than non-xerostomic control groups of developing oral candidiasis and oral fungal growth. Major inter-study heterogeneity, however, may restrict confidence in the accuracy of our results, and caution should therefore be taken in interpreting the evidence. In caring for patients with hyposalivation, we recommend healthcare professionals consider the possible association between both conditions. Furthermore, we recommend further research with improved methodological qualities and more valid diagnostic methods.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Humphrey S P, Williamson R T. A review of saliva: normal composition, flow, and function. J Prosthet Dent 2001; 85: 162-169.

  2. Barbe A G. Medication-Induced Xerostomia and Hyposalivation in the Elderly: Culprits, Complications, and Management. Drugs Aging 2018; 35: 877-885.

  3. Tanasiewicz M, Hildebrandt T, Obersztyn I. Xerostomia of Various Etiologies: A Review of the Literature. Adv Clin Exp Med 2016; 25: 199-206.

  4. Nederfors T. Xerostomia and Hyposalivation. Adv Dent Res 2000; 14: 48-56.

  5. Orellana M F, Lagravère M O, Boychuk D G, Major P W, Flores-Mir C. Prevalence of xerostomia in population-based samples: a systematic review. J Public Health Dent 2006; 66: 152-158.

  6. Agostini B A, Cericato G O, Silveira E et al. How Common is Dry Mouth? Systematic Review and Meta-Regression Analysis of Prevalence Estimates. Braz Dent J 2018; 29: 606-618.

  7. Pina G, Mota Carvalho R, Silva B, Almeida F T. Prevalence of hyposalivation in older people: A systematic review and meta-analysis. Gerodontology 2020; 37: 317-331.

  8. Barbe A G. Medication-Induced Xerostomia and Hyposalivation in the Elderly: Culprits, Complications, and Management. Drugs Aging 2018; 35: 877-885.

  9. CDC. Candida infections of the mouth, throat, and esophagus. 2020. Available at https://www.cdc.gov/fungal/diseases/candidiasis/thrush/index.html (accessed May 2021).

  10. Gaitán-Cepeda L A, Sánchez-Vargas O, Castillo N. Prevalence of oral candidiasis in HIV/AIDS children in highly active antiretroviral therapy era. A literature analysis. Int J STD AIDS 2015; 26: 625-632.

  11. Zomorodian K, Kavoosi F, Pishdad G R et al. Prevalence of oral Candida colonization in patients with diabetes mellitus. J Mycol Med 2016; 26: 103-110.

  12. Deng Z, Kiyuna A, Hasegawa M, Nakasone I, Hosokawa A, Suzuki M. Oral candidiasis in patients receiving radiation therapy for head and neck cancer. Otolaryngol Head Neck Surg 2010; 143: 242-247.

  13. Taylor M, Raja A. Oral Candidiasis. In StatPearls. Treasure Island (FL): StatPearls Publishing, 2021.

  14. Nadig S D, Ashwathappa D T, Manjunath M, Krishna S, Annaji A G, Shivaprakash P K. A relationship between salivary flow rates and Candida counts in patients with xerostomia. J Oral Maxillofac Pathol 2017; 21: 316.

  15. Torres S R, Peixoto C B, Caldas D M et al. Relationship between salivary flow rates and Candida counts in subjects with xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 93: 149-154.

  16. Billings M, Dye B A, Iafolla T, Grisius M, Alevizos I. Elucidating the role of hyposalivation and autoimmunity in oral candidiasis. Oral Dis 2017; 23: 387-394.

  17. Tarapan S, Matangkasombut O, Trachootham D et al. Oral Candida colonization in xerostomic postradiotherapy head and neck cancer patients. Oral Dis 2019; 25: 1798-1808.

  18. Stroup D F, Berlin J A, Morton S C et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA 2000; 283: 2008-2012.

  19. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan - a web and mobile app for systematic reviews. Syst Rev 2016; 5: 210.

  20. Wells G A, Shea B, O'Connell D A et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2000. Available at http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (accessed May 2021).

  21. Review Manager (RevMan) Version 5.4. The Cochrane Collaboration. 2020.

  22. Arruda C, Artico G, Freitas R, Migliari D. Prevalence of Candida spp. in Healthy Oral Mucosa Surfaces with Higher Incidence of Chronic Hyperplastic Candidosis. J Contemp Dent Pract 2016; 17: 618-622.

  23. Belazi M, Velegraki A, Fleva A et al. Candidal overgrowth in diabetic patients: potential predisposing factors. Mycoses 2005; 48: 192-196.

  24. Buranarom N, Komin O, Matangkasombut O. Hyposalivation, oral health, and Candida colonization in independent dentate elders. PLoS One 2020; DOI: 10.1371/journal.pone.0242832.

  25. Cunha K S, Rozza-de-Menezes R E, Luna E B et al. High prevalence of hyposalivation in individuals with neurofibromatosis 1: a case-control study. Orphanet J Rare Dis 2015; 10: 24.

  26. Nittayananta W, Chanowanna N, Jealae S, Nauntofte B, Stoltze K. Hyposalivation, xerostomia and oral health status of HIV-infected subjects in Thailand before HAART era. J Oral Pathol Med 2010; 39: 28-34.

  27. Rhodus N L, Bloomquist C, Liljemark W, Bereuter J. Prevalence, density, and manifestations of oral Candida albicans in patients with Sjögren's syndrome. J Otolaryngol 1999; 26: 300-305.

  28. Serrano J, López-Pintor R M, Ramírez L et al. Risk factors related to oral candidiasis in patients with primary Sjögren's syndrome. Med Oral Patol Oral Cir Bucal 2020; DOI: 10.4317/medoral.23719.

  29. Shinozaki S, Moriyama M, Hayashida J N et al. Close association between oral Candida species and oral mucosal disorders in patients with xerostomia. Oral Dis 2012; 18: 667-672.

  30. Suryana K, Suharsono H, Antara I G P J. Factors associated with oral candidiasis in people living with HIV/AIDS: a case control study. HIV AIDS (Auckl) 2020; 12: 33-39.

  31. Coronado-Castellote L, Jiménez-Soriano Y. Clinical and microbiological diagnosis of oral candidiasis. J Clin Exp Dent 2013; DOI: 10.4317/jced.51242.

  32. Ikebe K, Morii K, Matsuda K, Hata K, Nokubi T. Association of candidal activity with denture use and salivary flow in symptom-free adults over 60 years. J Oral Rehabil 2006; 33: 36-42.

  33. Radfar L, Shea Y, Fischer S H et al. Fungal load and candidiasis in Sjögren's syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 96: 283-287.

  34. Tapper-Jones L, Aldred M, Walker D M. Prevalence and intraoral distribution of Candida albicans in Sjögren's syndrome. J Clin Pathol 1980; 33: 282-287.

  35. Navazesh M, Wood G J, Brightman V J. Relationship between salivary flow rates and Candida albicans counts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 80: 284-288.

  36. Obradović R R, Kesić L G, Pejčić A N, Petrović M S, Živković N D, Živković D M. Diabetes mellitus and oral candidiasis. Acta Stomatol Naissi 2011; 27: 1025-1034.

  37. Hill L V, Tan M H, Pereira L H, Embil J A. Association of oral candidiasis with diabetic control. J Clin Pathol 1989; 42: 502-505.

  38. Akpan A, Morgan R. Oral candidiasis. Postgrad Med J 2002; 78: 455-459.

  39. Dupont B, Greybill J R, Armstrong D, Laroche R, Touze J E, Wheat L J. Fungal infections in AIDS patients. J Med Vet Mycol 1992; 30 Suppl 1: 19-28.

Download references

Author information

Authors and Affiliations

  1. Faculty of Dentistry, Universitas Prima, Indonesia

    Molek Molek & Florenly Florenly

  2. Faculty of Medicine, Universitas Prima, Indonesia

    I. Nyoman Ehrich Lister & Fioni Fioni

  3. Faculty of Medicine, Damascus University, Syria

    Tuka Abdul Wahab

  4. South West Acute Hospital, Enniskillen, UK

    Clarissa Lister

Authors
  1. Molek Molek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Florenly Florenly
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. Nyoman Ehrich Lister
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tuka Abdul Wahab
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Clarissa Lister
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fioni Fioni
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Dr Molek: searching strategy, methodology and result. Prof Dr I. Nyoman Ehrich Lister: data extraction and statistic analysis. Dr Florenly: filtering studies included and quality appraisal of studies. Dr Tuka Abdul Wahab: introduction, data extraction. Dr Clarissa Lister: filtering studies included and quality appraisal of studies. Dr Fioni: designed/planning/idea of the paper led to submission, team leader, searching strategy, approved the final version, revised manuscript.

Corresponding author

Correspondence to Fioni Fioni.

Ethics declarations

The authors declare no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Molek, M., Florenly, F., Lister, I. et al. Xerostomia and hyposalivation in association with oral candidiasis: a systematic review and meta-analysis. Evid Based Dent (2022). https://doi.org/10.1038/s41432-021-0210-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41432-021-0210-2

This article is cited by

Search

Advanced search

Quick links