Changes in Biological Behavior of Candida-Infected Oral Leukoplakias: A Meta-Analysis

Background: Oral leukoplakia is the most common potentially malignant oral lesion. Candida superinfection changes its biological behavior.

Objective: To assess Candida infection of oral leukoplakias and its influence on the biological behavior of these lesions.

Search and selection methods: A search for studies on Candida infection and oral leukoplakia was conducted in the following databases: PubMed (MEDLINE, Cochrane Library), Web of Science (WoS), and Scopus.

Data analysis: The estimation of the proportion was carried out with the generic inverse variance method, using the standard error of the proportion (SE) and 95% confidence intervals (CI95%). For continuous outcomes, the estimates of effects of an intervention were expressed as mean differences (MD) using the inverse variance (IV) method, and for dichotomous outcomes, the estimates of effects of an intervention were expressed as odds ratios (OR) using Mantel-Haenszel (M-H) method all with CI95%.

Results: 17 studies that considered 2,100 oral leukoplakias were included in this meta-analysis. The mean prevalence of Candida-infected oral leukoplakias was 35%. Non-homogeneous oral leukoplakias quadruple the risk of being infected by Candida (p<0.001). Regarding epithelial dysplasia, Candida-infected oral leukoplakias were 2.47 times more likely to be dysplastic lesions (p<0.001) and 3.83 times more likely to show moderate-severe dysplasia (p=0.03). However, age, gender or mild epithelial dysplasia were factors with no relevant influence on Candida infection of oral leukoplakias (p>0.05).