Candida species detection in potentially malignant and malignant disorders of the oral mucosa: A meta-analysis

Background: Candida species, mainly Candida albicans, have been related to dysplastic changes and malignant transformation of different oral mucosal lesions. Objective: The objective was to assess the possible influence of Candida detection in oral leukoplakia (OL), oral lichen planus (OLP), and oral cancerous lesions. Search Methods: A PubMed search through February 2018, using the following MESH terms, was performed: “Candida,” “precancerous conditions,” “mouth,” and “mouth neoplasms.” Selection Criteria: The selection criteria included studies with findings on Candida detection in premalignant and malignant oral lesions. Data Collection and Analysis: For continuous outcomes, the estimates of effects of an intervention were expressed as mean differences using the inverse variance method and for dichotomous outcomes, the estimates of effects of an intervention were expressed as odds ratios using Haenszel—Mantel method, both with 95% confidence intervals. Results: Fifteen studies on Candida detection in premalignant and malignant oral lesions were included in this meta-analysis. Nearly 61.5% of oral cancers, 32.2% of OLs, and 29.1% of OLP lesions were infected by Candida species. Candida infection does not increase the risk for developing OL (P = 0.32) or OLP (P = 0.31). A higher mean age, male gender, tobacco consumption, and location of the lesions on tongue or floor of the mouth were factors that did not have a significant influence on developing Candida-infected OL. Dysplastic OLs were 10.62 times more likely to be Candida-infected lesions. A greater number of OL lesions infected by Candida species than OLP lesions were found (P < 0.01). Having oral cancer increased 4.92-fold risk of Candida infection. No statistically significant association between Candida-infected oral cancer lesions and Candida-infected OL lesions was observed (P = 0.21). Conclusions: Candida infection worsens the biological behavior of potentially malignant and malignant lesions of the oral cavity