Photodynamic Therapy Against Candida Spp. in Complete Denture Wearers

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02642900
Recruitment Status : Completed
First Posted : December 30, 2015
Last Update Posted : December 30, 2015
Information provided by (Responsible Party):
Regina Tamaki, University of Sao Paulo

Brief Summary:
Candida albicans is the most prevalent species in denture-related stomatitis (DS). There are several treatment options for this condition, including the use of antifungal agents such as nystatin and miconazole. The side effects and the increasing number of resistant species caused by the use of these drugs encourage the development of alternative therapies. Photodynamic Therapy (PDT) has been used as a promising treatment of stomatitis. In this randomized clinical trial, the effectiveness of PDT was evaluated. Patients in this study were allocated to two groups. One group was treated with nystatin, and the other group was treated with PDT.

Condition or disease Intervention/treatment Phase
Photochemotherapy Reaction Procedure: Photodynamic Therapy Drug: Nystatin 100.000 units Phase 4

Detailed Description:

Different Candida species, including albicans, tropicalis, and parapsilosis, are present in the human oral microbiota, gastrointestinal tract and vagina. These species are typically harmless commensals. Candida albicans, the most prevalent species, may be present in up to 80% of healthy individuals. This species is found with high frequency in dental prostheses and is thought to be the main pathogen associated with stomatitis in elderly denture wearers. Biofilms of Candida albicans are usually found in intravenous catheters, prostheses, and these biofilms promote a high resistance to antifungal drugs. The standard treatment of stomatitis is topical antifungal agents, including nystatin and miconazole. The use of topical antifungal agents has caused some problems. Poor responses to these agents are the result of dilution and fast elimination of the drug because of the action of the saliva, which reduced the drug's concentration. The drug's toxicity can cause mild and transient gastrointestinal side effects, such as nausea, vomiting and diarrhea. Alternative treatments or adjuvant treatments have been used to treat these diseases, such as the use of probiotic bacteria and photodynamic therapy (PDT) using a non-toxic dye (photosensitizer - PS) in combination with a source of visible light with a peak wavelength suitable for absorption by the PS. The photodynamic process rapidly generates reactive oxygen species (ROS) such as peroxides, hydroxyl radicals, superoxide ions and singlet oxygen. Singlet oxygen has been implicated as the major causative agent of cellular damage in the photodynamic process, but it does not cause cellular damage in host tissues. The amount of ROS formation is the main predictor of yeast killing.

This study aimed to evaluate the effectiveness of photodynamic therapy (PDT) in the treatment of denture stomatitis in complete denture wearers.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 22 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Photodynamic Therapy Against Candida Spp. in Complete Denture Wearers: a Randomized Clinical Trial
Study Start Date : July 2009
Actual Primary Completion Date : February 2011
Actual Study Completion Date : July 2011

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Dentures
Drug Information available for: Nystatin

Arm Intervention/treatment
Experimental: Nystatin 100.000 units
Patients were treated with a topical antifungal nystatin oral suspension(1000.000 units) 5mL every six hours/14 days. Patients were instructed to rinse the solution for 5 minutes and then to spit the solution out. Samples were collected on days 7, 14 and 30 after the end of treatment (follow-up).
Drug: Nystatin 100.000 units
Control group treated with nystatin
Other Name: Nystatin

Active Comparator: Photodynamic Therapy
Patients used mouthwash with methylene blue 0.005% for 20 minutes (pre-irradiation time). The palatal mucosa was irradiated using a low level laser with the following settings: wavelength of 660 nm, energy density of 120 J/cm ², output power of 40 milliwatt, 2 minutes per point. PDT was performed in two sessions (one session per week). Samples were collected immediately after each clinical procedure and 30 days after the second procedure (follow-up).
Procedure: Photodynamic Therapy
evaluate the effectiveness of photodynamic therapy (PDT) in the treatment of denture stomatitis in complete denture wearers.
Other Name: photochemotherapy

Primary Outcome Measures :
  1. Treatment evolution of participants with Candida-related denture stomatitis, treated with PDT or Nystatin, by numbers of colony forming units per milliliter (cfu/mL) recovered from the palatal mucosa, from baseline to end of treatment [ Time Frame: through study completion, an average of 45 days ]

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • patients presenting denture-related stomatitis, confirmed by clinical and microbiological evaluation

Exclusion Criteria:

  • were based on the patients' medical history, and were excluded patients with a history of head and neck cancer, those with type III DS (classification proposed by Newton), and individuals who had received or were receiving treatment with antibiotics, antifungal agents or steroids for the past three months.

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To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02642900

Faculdade de Odontologia da Universidade de São Paulo
São Paulo, Brazil, 05508-000
Sponsors and Collaborators
University of Sao Paulo
Principal Investigator: Regina Tamaki, Profa. Dra. Associated Professor

Responsible Party: Regina Tamaki, Professora Doutora, University of Sao Paulo Identifier: NCT02642900     History of Changes
Other Study ID Numbers: DML01
First Posted: December 30, 2015    Key Record Dates
Last Update Posted: December 30, 2015
Last Verified: December 2015

Keywords provided by Regina Tamaki, University of Sao Paulo:
Complete denture
Candida spp
Photodynamic therapy

Additional relevant MeSH terms:
Anti-Bacterial Agents
Anti-Infective Agents
Antifungal Agents
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action