Journal of oral biology and craniofacial research · 2026
Oral Candida colonisation and cariogenic bacteria in children and adolescents with cleft lip and/or palate: A systematic review and meta-analysis.
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Hendrawan Muhammad Irpan, Amanda Elsa Ayu, Alwi Ita Purnama, Mubarak Husni, Taufiqurrahman Irham, Tajrin Andi
Аннотация
PURPOSE: Children with cleft lip and/or palate (CL/P) face a disproportionate cariogenic burden, yet the role of oral Candida and its partnership with cariogenic bacteria remains poorly quantified. This systematic review and meta-analysis synthesised observational evidence on oral Candida colonisation, cariogenic bacterial carriage, and clinical caries outcomes in non-syndromic CL/P, with GRADE-rated certainty.
METHODS: Following PRISMA 2020 and the Cochrane Handbook (PROSPERO CRD420261402624), six databases were searched from inception to 27 May 2026. Eligible studies were observational designs enrolling children aged 0-18 years with non-syndromic CL/P versus non-cleft controls. Risk of bias used ROBINS-E. Random-effects meta-analyses (DerSimonian-Laird) pooled risk ratios (RR) for dichotomous outcomes and standardised mean differences (SMD) for continuous caries indices, with GRADE certainty.
RESULTS: Ten studies (2011-2026; 421 CL/P vs 567 controls) were included. Oral Candida carriage was nearly threefold higher in CL/P (RR 2.94, 95% CI 2.04-4.22; I 2 = 23.4%; k = 4), with C. albicans predominant. High salivary Streptococcus mutans counts were similarly elevated (RR 2.74, 95% CI 1.42-5.27; I 2 = 0%), whereas Lactobacillus carriage showed no significant difference (RR 1.33, 95% CI 0.71-2.47). Caries indices were directionally higher in three of four datasets but highly heterogeneous (SMD 0.74; I 2 = 92.3%). GRADE certainty was Low to Very Low.
CONCLUSION: CL/P children carry elevated oral Candida and S. mutans burdens, supporting an early fungal-bacterial cariogenic shift. Candida assessment should be integrated into caries-risk evaluation from the deciduous-dentition stage within the multidisciplinary cleft pathway.
METHODS: Following PRISMA 2020 and the Cochrane Handbook (PROSPERO CRD420261402624), six databases were searched from inception to 27 May 2026. Eligible studies were observational designs enrolling children aged 0-18 years with non-syndromic CL/P versus non-cleft controls. Risk of bias used ROBINS-E. Random-effects meta-analyses (DerSimonian-Laird) pooled risk ratios (RR) for dichotomous outcomes and standardised mean differences (SMD) for continuous caries indices, with GRADE certainty.
RESULTS: Ten studies (2011-2026; 421 CL/P vs 567 controls) were included. Oral Candida carriage was nearly threefold higher in CL/P (RR 2.94, 95% CI 2.04-4.22; I 2 = 23.4%; k = 4), with C. albicans predominant. High salivary Streptococcus mutans counts were similarly elevated (RR 2.74, 95% CI 1.42-5.27; I 2 = 0%), whereas Lactobacillus carriage showed no significant difference (RR 1.33, 95% CI 0.71-2.47). Caries indices were directionally higher in three of four datasets but highly heterogeneous (SMD 0.74; I 2 = 92.3%). GRADE certainty was Low to Very Low.
CONCLUSION: CL/P children carry elevated oral Candida and S. mutans burdens, supporting an early fungal-bacterial cariogenic shift. Candida assessment should be integrated into caries-risk evaluation from the deciduous-dentition stage within the multidisciplinary cleft pathway.