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Background and Objectives  Studies of gum or periodontal disease have focused mainly on bacterial pathogens. However, information related to fungal species in the saliva and subgingival mileu is particularly lacking in smokers with periodontitis. This cross-sectional study compared the prevalence of various  Candida  species in saliva and subgingival plaque samples of smokers and non-smokers with periodontal disease.    Methodology  Study subjects were recruited into three group—Group 1: Smokers with chronic periodontitis ( N  = 30), Group 2: Non-smokers with chronic periodontitis ( N  = 30) and Group 3: Healthy controls ( N  = 30). Clinical parameters recorded included plaque index (PI), gingival index (GI), periodontal probing depth (PPD) and clinical attachment loss (CAL). Saliva and subgingival plaque samples were collected from subjects from the above groups. The collected samples were processed for isolation and identification of various  Candida  species using CHROMagar chromogenic media. Additionally, antifungal susceptibility tests were performed for the isolated  Candida  species in order to assess antifungal drug resistance to fluconazole and voriconazole.    Results  Prevalence of  Candida  species in saliva samples was quantified as 76.6% in Group 1, 73.3% in Group 2 and 36.6% in Group 3 and statistically significant differences were observed between groups 1 & 3. Prevalence of  Candida  species in subgingival plaque samples was quantified as 73.3% in Group 1, 66.6% in Group 2 and 60% in Group 3 and no statistically significant differences were observed between groups.  Candida albicans  was the most frequently isolated species followed by  Candida krusei  and  Candida tropicalis . A positive correlation was observed for smoking exposure, pack years and  Candida  colonization. A marginally significant positive correlation was observed between  Candida  colonization and increasing pocket depth and attachment loss. Antifungal drug resistance was mainly observed for  Candida krusei  in both saliva and subgingival plaque samples.    Conclusion  Based on the results we can conclude that oral candidal carriage is significantly increased in smokers with periodontal disease. Mechanistic studies are needed to understand the importance of  Candida  species in periodontal disease.

Candidal carriage in saliva and subgingival plaque among smokers and non-smokers with chronic periodontitis—a cross-sectional study