Candida spp. in Denture Stomatitis: Prevalence, Microbial Load, and Antifungal Resistance Across Severity Levels

Complete dentures (CD) are prone to biofilm formation, particularly by Candida species, which may lead to denture stomatitis (DS). As edentulism remains highly prevalent among the global ageing population, denture-related infections represent a significant public health concern. The novelty of this study lies in integrating the clinical severity of DS with the prevalence, microbial load, and antifungal susceptibility profile of Candida spp., providing new insights into the pathogenesis and therapeutic management of this condition. Biofilm from the CD and palate was seeded for prevalence and microbial load. The identification of strains was confirmed molecularly, and susceptibility to micafungin, nystatin, fluconazole, and miconazole was assessed by the broth microdilution method. Prevalence was shown in percentage, microbial load was analyzed using a generalized linear model test, and susceptibility was assessed using Pearson's Chi-square test (p < 0.05). Candida albicans was the most prevalent regardless of DS. However, a higher microbial load of C. albicans was observed with increased severity of DS (p = 0.038). Except for Candida tropicalis, the microbial load of the CD was higher than that of the palate. C. tropicalis showed resistance to fluconazole with increased severity of DS (p = 0.004). All strains were susceptible to nystatin and miconazole, and three were resistant to micafungin. The findings suggest that the prevalence of Candida spp. is not a determining factor in the variation in DS severity. Nevertheless, patients with severe inflammation harbor an increased load of C. albicans on both sites. Nystatin and miconazole appear to be effective treatments for DS.