Evaluation of Oral Microbial Flora in Saliva of Patients of Oral Submucous Fibrosis

BACKGROUND Oral Submucous Fibrosis (OSMF) has a multifactorial origin and the risk factors vary across different parts of the world. Betel nut (areca nut) chewing is the leading cause of OSMF in parts of South East Asia as well as Indian subcontinent. Certain fungal species have been identified in the occurrence of various premalignant lesions including OSMF. Candida in mouth along with the epithelial changes like atrophy, dysplasia, and hypertrophy may predispose individuals to premalignancy. This study was carried out to evaluate the prevalence of microbial flora in saliva of patients of OSMF. METHODS The study included a total of 48 subjects, with 24 clinically diagnosed OSMF patients and a control group of 24 healthy age sex matched patients. Demographic data and salivary samples were collected from both the groups. Swabs taken were subjected for Gram staining and Sabouraud's Dextrose Agar. The positively cultured Candida samples were further analysed by using germ tube test for determining different Candida species. RESULTS In total, 58.3% of the OSMF patients and 29.2% of the control patients yielded candida organisms on culture. The difference between the two groups was statistically significant (x(2)=4.148, p=0.042). Final results of the study indicate that presence of Candida is significantly higher in OSMF patients than healthy subjects. Thus, results of the present study confirm the phenomenon of high prevalence of oral colonization by yeast in OSMF patients than healthy subjects. CONCLUSIONS In OSMF, there is an altered microbiome which may be used as an indicator for malignant transformation of OSMF. The present study shows higher incidence and intensity of candida in OSMF patients when compared to healthy individuals. Hence, it is mandatory to maintain proper oral hygiene status in OSMF patients to prevent further complications of candidiasis.