Oropharyngeal Candidiasis (OPC) and S-ECC

NCT05761197 | Recruiting

• 1 other identifier: 31690
• Study Type: observational
• Target: 70
• Locations: 1 country
• Sites: 1

Brief Summary

The overall objective of this study is to investigate the association of early Candida infection (known as oral thrush or oropharyngeal candidiasis, OPC) in children during the first year of life with the onset and severity of severe early childhood caries (S-ECC).

Conditions

Candida Infection; Oral Thrush; Early Childhood Caries

Keywords

Oral candidiasis; Candida infection; Oral thrush; Early childhood caries; Oral Health

Outcome Measures

Primary Outcomes (1)

• To explore the association between OPC and S-ECC onset and severity

  Caries will be measured by ICDAS scoring system; Plaque and oral swab samples will be collected at each study visit (Baseline, 6-month, 12-month,18-month and 24-month follow-ups); Candida strains will be detected using culturing-dependent and -independent sequencing techniques.

  24 months

Secondary Outcomes (1)

• To evaluate the influence of OPC on the oral microbiota

  24 months

Other Outcomes (1)

• To study the role of Candida on biofilm cariogenic properties

  24 months

Study Arms (2)

Children with history of OPC

Individuals in the non-OPC cohort will be age and sex-matched to individuals in the OPC cohort.

Children without history of OPC

Individuals in the OPC cohort will be age and sex-matched to individuals in the non-OPC cohort.

Eligibility Criteria

• Age: 9 Months - 24 Months
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17)
• Sampling Method: Probability Sample

Study Population

The study team will recruit 70 subjects (35 subjects with a history of OPC and 35 subjects without a history of OPC) for this study.

You may qualify if:

• Male or female individuals at the age of 9-24-month-old
• Must have at least one fully erupted tooth at baseline visit
• Parent/guardian willing and able to provide informed consent
• With or without a history of OPC (the study team will enroll 35 participants with and 35 participants without a history of OPC)

You may not qualify if:

• Presence of a systemic medical condition (e.g. Down syndrome etc.)
• Presence of an orofacial deformity
• Presence of dental caries
• Use of systemic antimicrobial therapy within 30 days of the baseline visit
• Presence of any condition which, in the opinion of the investigator, makes participation in the project not in the individual's best interest.

Sponsors & Collaborators

• Temple University: lead
• Children's Hospital of Philadelphia: collaborator

Study Sites (1)

Temple University

Philadelphia, Pennsylvania, 19140, United States

RECRUITING

Related Publications (28)

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• Hajishengallis E, Parsaei Y, Klein MI, Koo H. Advances in the microbial etiology and pathogenesis of early childhood caries. Mol Oral Microbiol. 2017 Feb;32(1):24-34. doi: 10.1111/omi.12152. Epub 2016 Feb 4.

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• Bowen WH, Burne RA, Wu H, Koo H. Oral Biofilms: Pathogens, Matrix, and Polymicrobial Interactions in Microenvironments. Trends Microbiol. 2018 Mar;26(3):229-242. doi: 10.1016/j.tim.2017.09.008. Epub 2017 Oct 30.

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• Hajishengallis E, Forrest CB, Koo H. Early Childhood Caries: Future Perspectives in Risk Assessment. JDR Clin Trans Res. 2016 Jul;1(2):110-111. doi: 10.1177/2380084416637577. Epub 2016 Mar 7. No abstract available.

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• American Academy on Pediatric Dentistry; American Academy of Pediatrics. Policy on early childhood caries (ECC): classifications, consequences, and preventive strategies. Pediatr Dent. 2008-2009;30(7 Suppl):40-3. No abstract available.

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• de Carvalho FG, Silva DS, Hebling J, Spolidorio LC, Spolidorio DM. Presence of mutans streptococci and Candida spp. in dental plaque/dentine of carious teeth and early childhood caries. Arch Oral Biol. 2006 Nov;51(11):1024-8. doi: 10.1016/j.archoralbio.2006.06.001. Epub 2006 Aug 7.

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• Raja M, Hannan A, Ali K. Association of oral candidal carriage with dental caries in children. Caries Res. 2010;44(3):272-6. doi: 10.1159/000314675. Epub 2010 May 27.

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• Yang XQ, Zhang Q, Lu LY, Yang R, Liu Y, Zou J. Genotypic distribution of Candida albicans in dental biofilm of Chinese children associated with severe early childhood caries. Arch Oral Biol. 2012 Aug;57(8):1048-53. doi: 10.1016/j.archoralbio.2012.05.012. Epub 2012 Jun 18.

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• Qiu R, Li W, Lin Y, Yu D, Zhao W. Genotypic diversity and cariogenicity of Candida albicans from children with early childhood caries and caries-free children. BMC Oral Health. 2015 Nov 17;15(1):144. doi: 10.1186/s12903-015-0134-3.

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• Xiao J, Moon Y, Li L, Rustchenko E, Wakabayashi H, Zhao X, Feng C, Gill SR, McLaren S, Malmstrom H, Ren Y, Quivey R, Koo H, Kopycka-Kedzierawski DT. Candida albicans Carriage in Children with Severe Early Childhood Caries (S-ECC) and Maternal Relatedness. PLoS One. 2016 Oct 14;11(10):e0164242. doi: 10.1371/journal.pone.0164242. eCollection 2016.

  PMID: 27741258 BACKGROUND

• Duangthip D, D D. Early childhood caries and candida albicans. Evid Based Dent. 2018 Dec;19(4):100-101. doi: 10.1038/sj.ebd.6401337.

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• Xiao J, Huang X, Alkhers N, Alzamil H, Alzoubi S, Wu TT, Castillo DA, Campbell F, Davis J, Herzog K, Billings R, Kopycka-Kedzierawski DT, Hajishengallis E, Koo H. Candida albicans and Early Childhood Caries: A Systematic Review and Meta-Analysis. Caries Res. 2018;52(1-2):102-112. doi: 10.1159/000481833. Epub 2017 Dec 21.

  PMID: 29262404 BACKGROUND

• Metwalli KH, Khan SA, Krom BP, Jabra-Rizk MA. Streptococcus mutans, Candida albicans, and the human mouth: a sticky situation. PLoS Pathog. 2013;9(10):e1003616. doi: 10.1371/journal.ppat.1003616. Epub 2013 Oct 17. No abstract available.

  PMID: 24146611 BACKGROUND

• Koo H, Bowen WH. Candida albicans and Streptococcus mutans: a potential synergistic alliance to cause virulent tooth decay in children. Future Microbiol. 2014;9(12):1295-7. doi: 10.2217/fmb.14.92. No abstract available.

  PMID: 25517895 BACKGROUND

• Falsetta ML, Klein MI, Colonne PM, Scott-Anne K, Gregoire S, Pai CH, Gonzalez-Begne M, Watson G, Krysan DJ, Bowen WH, Koo H. Symbiotic relationship between Streptococcus mutans and Candida albicans synergizes virulence of plaque biofilms in vivo. Infect Immun. 2014 May;82(5):1968-81. doi: 10.1128/IAI.00087-14. Epub 2014 Feb 24.

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• Hwang G, Liu Y, Kim D, Li Y, Krysan DJ, Koo H. Candida albicans mannans mediate Streptococcus mutans exoenzyme GtfB binding to modulate cross-kingdom biofilm development in vivo. PLoS Pathog. 2017 Jun 15;13(6):e1006407. doi: 10.1371/journal.ppat.1006407. eCollection 2017 Jun.

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• Kim D, Sengupta A, Niepa TH, Lee BH, Weljie A, Freitas-Blanco VS, Murata RM, Stebe KJ, Lee D, Koo H. Candida albicans stimulates Streptococcus mutans microcolony development via cross-kingdom biofilm-derived metabolites. Sci Rep. 2017 Jan 30;7:41332. doi: 10.1038/srep41332.

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• Koo H, Andes DR, Krysan DJ. Candida-streptococcal interactions in biofilm-associated oral diseases. PLoS Pathog. 2018 Dec 13;14(12):e1007342. doi: 10.1371/journal.ppat.1007342. eCollection 2018 Dec. No abstract available.

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• Kim HE, Liu Y, Dhall A, Bawazir M, Koo H, Hwang G. Synergism of Streptococcus mutans and Candida albicans Reinforces Biofilm Maturation and Acidogenicity in Saliva: An In Vitro Study. Front Cell Infect Microbiol. 2021 Feb 19;10:623980. doi: 10.3389/fcimb.2020.623980. eCollection 2020.

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• Jean J, Goldberg S, Khare R, Bailey LC, Forrest CB, Hajishengallis E, Koo H. Retrospective Analysis of Candida-related Conditions in Infancy and Early Childhood Caries. Pediatr Dent. 2018 Mar 15;40(2):131-135.

  PMID: 29663914 BACKGROUND

• Kressin NR, Nunn ME, Singh H, Orner MB, Pbert L, Hayes C, Culler C, Glicken SR, Palfrey S, Geltman PL, Cadoret C, Henshaw MM. Pediatric clinicians can help reduce rates of early childhood caries: effects of a practice based intervention. Med Care. 2009 Nov;47(11):1121-8. doi: 10.1097/MLR.0b013e3181b58867.

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• Hedrick VE, Comber DL, Estabrooks PA, Savla J, Davy BM. The beverage intake questionnaire: determining initial validity and reliability. J Am Diet Assoc. 2010 Aug;110(8):1227-32. doi: 10.1016/j.jada.2010.05.005.

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• Broffitt B, Levy SM, Warren J, Cavanaugh JE. Factors associated with surface-level caries incidence in children aged 9 to 13: the Iowa Fluoride Study. J Public Health Dent. 2013 Fall;73(4):304-10. doi: 10.1111/jphd.12028. Epub 2013 Jul 26.

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• Gugnani N, Pandit IK, Srivastava N, Gupta M, Sharma M. International Caries Detection and Assessment System (ICDAS): A New Concept. Int J Clin Pediatr Dent. 2011 May-Aug;4(2):93-100. doi: 10.5005/jp-journals-10005-1089. Epub 2010 Apr 15.

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• Shoaib L, Deery C, Ricketts DN, Nugent ZJ. Validity and reproducibility of ICDAS II in primary teeth. Caries Res. 2009;43(6):442-8. doi: 10.1159/000258551. Epub 2009 Nov 12.

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• Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies. Pediatr Dent. 2016 Oct;38(6):52-54. No abstract available.

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• Drury TF, Horowitz AM, Ismail AI, Maertens MP, Rozier RG, Selwitz RH. Diagnosing and reporting early childhood caries for research purposes. A report of a workshop sponsored by the National Institute of Dental and Craniofacial Research, the Health Resources and Services Administration, and the Health Care Financing Administration. J Public Health Dent. 1999 Summer;59(3):192-7. doi: 10.1111/j.1752-7325.1999.tb03268.x. No abstract available.

  PMID: 10649591 BACKGROUND

Related Links

• The Global Burden of Disease 2015 study aims to use all available data of sufficient quality to generate reliable and valid prevalence, incidence, and disability-adjusted life year (DALY) estimates of oral conditions for the period of 1990 to 2015.
• As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016
• This review provides a broader perspective about the etiology and pathogenesis of ECC based on previous and current knowledge on biofilm matrix, microbial diversity
• The article discusses recent advances in the role of the biofilm matrix and interactions between opportunistic pathogens and commensals in the pathogenesis of dental caries.
• Early identification and early application of preventive measures are essential to help eliminate this costly and painful disease
• AAPD encourages healthcare providers and caregivers to implement preventive practices that can decrease a child's risks of developing this preventable disease to reduce the burden on the child, the family, and society
• This study determined the presence of mutans streptococci and Candida spp. in supragingival dental plaque and infected dentine of caries-free children, with early childhood caries and caries
• This study was carried out to identify association between oral candidal carriage in children and dental caries.
• In this study, the authors investigate the presence and genotypic distribution of C. albicans in the dental biofilm of Chinese children with severe early childhood caries (S-ECC).
• This study aimed to explore the genotypic diversity and cariogenicity of C. albicans from children with early childhood caries and caries-free children.
• The goal of this study was to examine the C. albicans carriage in children with severe early childhood caries (S-ECC) and the maternal relatedness.
• Children with oral C. albicans have higher odds of experiencing ECC, compared to children without C. albicans.
• This systematic review indicates that children with oral C. albicans have \>5 times higher odds of having ECC compared to those without C. albicans.
• The presence of C. albicans in the oral environment can now be considered an additional factor that needs to be taken into account in evaluating risks to caries
• The authors suggest the need to explore how Candida infection is acquired and whether some strains are more infectious than others.
• Using a rodent model, the authors explored the implications of the cross-kingdom interaction for the pathogenesis of dental caries.
• Enhanced understanding of GtfB-Candida interactions may provide new perspectives for devising effective therapies to disrupt this cross-kingdom relationship associated with an important childhood oral disease.
• This study was conducted to investigate how microbial products from this cross-kingdom association modulate S. mutans build-up in biofilms.
• Clinical data, together with in vivo studies, provide compelling evidence of the importance of cross-kingdom interactions in the severity of mucosal diseases and dental caries.
• The authors provide feasible data to support the clinical findings in regards to the synergistic association between S. mutans and C. albicans in the pathogenesis of ECC.
• The purpose of this study was to assess whether there is an association between oral thrush or other Candida-related conditions in infancy and early childhood caries (ECC) diagnosed by pediatricians.
• Early childhood caries (ECC) is a serious and preventable disease which pediatric clinicians can help address by counseling to reduce risk.
• The purpose of this cross-sectional investigation was to determine the validity and reliability of a self-administered beverage intake questionnaire (BEVQ) that estimates mean daily intake of beverages consumed across 19 beverage categories.
• As dental caries can progress throughout a person's lifetime, understanding caries risk factors unique to specific life phases is important. This study aims to assess caries incidence and risk factors for young adolescents.
• The ICDAS criteria was developed by an international team of caries researchers to integrate several new criteria systems into one standard system for caries detection and assessment.
• The aim of this in vitro study was to assess the validity and reproducibility of the ICDAS II (International Caries Detection and Assessment System) criteria in primary teeth.
• The American Academy of Pediatric Dentistry (AAPD) encourages healthcare providers and caregivers to implement preventive practices that can decrease a child's risks of developing this disease.
• The workshop's goal was to review current methods of diagnosis of dental caries in primary teeth and to propose case definitions and diagnostic criteria for future research projects regarding dental caries in preschool-aged children.

MeSH Terms

Conditions

Candidiasis; Candidiasis, Oral

Condition Hierarchy (Ancestors)

Mycoses; Bacterial Infections and Mycoses; Infections; Mouth Diseases; Stomatognathic Diseases

Study Officials

• Yuan Liu, DDS, MS, PhD

  Temple University Kornberg School of Dentistry

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Yuan Liu, DDS, MS, PhD

CONTACT

215-707-8029; yuan.liu0008@temple.edu

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 22, 2023
• First Posted: March 9, 2023
• Study Start: January 1, 2025
• Primary Completion (Estimated): August 31, 2028
• Study Completion (Estimated): August 31, 2028
• Last Updated: July 14, 2025

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)