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Colonization of Candida: prevalence among tongue-pierced and non-pierced immunocompetent adults
Oral Diseases , 08/31/09

Zadik Y et al. – Piercing of the tongue was found to be a risk factor for colonization of Candida albicans, without an influence of whether or not an ornament is in place.

Exclusive Author Commentary
Yehuda Zadik, 09/16/09

The aim of the study was to examine the possible association between tongue piercing and colonization of Candida. The authors' hypothesis was that there is an elevation in the prevalence of colonization of Candida, since tongue piercing sites can serve as relatively protected, warmed and moisten colonization niche. Based on previous studies that demonstrated relation between Candida and acrylic denture and poor oral hygiene, we suspected that also in the pierced tongue, Candida will be even more prevalent when acrylic ornament and poor hygiene are involved. We also assayed the hypothesis that the tongue ornament could have a cleansing effect, which according current tongue ornament wearers have less Candida than individuals with pierced tongue but not wear ornament currently. We took swab from 201 healthy young adults' tongue: tongue-pierced study group (115) and face-pierced but no tongue-pierced (86) comparison group. All the subjects were immunocompetent without local or systemic risk factors for immunodeficiency, dry mouth and/or Candida, e.g., intra-oral acrylic removal prosthodontic or orthodontic appliance, diabetes mellitus, HIV, hyposalivation-induced medications, antibiotics, glucocorticoids (by oral administration, inhalation or oral topical agents) or other immunosuppressive agents within 6 months prior to examination, or history of head and neck irradiation and/or anti-cancer cytotoxic chemotherapy. Positive tongue Candida colonizations were obtained in 23 (20.0%) of the tongue pierced subjects and in 8 (9.3%) of comparison group (p=0.048). All colonizations were of Candida albicans. Within the tongue pierced group, positive grows were found in 7 (21.2%) and 16 (19.5%) of the 33 current ornament wearers and 82 non-wearers, respectively (OR=1.111, 95% CI=0.410-3.011, p=0.803). According the logistic regression analysis of possible risk factors for tongue colonization, tongue piercing or smoking of more than 10 cigarettes per day were the only statistically significant influencing factors in the multivariate analysis (p=0.034, p=0.024, respectively). Male gender, daily alcohol consumption of more than 15gr, or regular daily tongue brushing have non significant protecting effect against Candida colonization in the tongue. We concluded that the piercing of the tongue is a risk factor for colonization of Candida albicans, without influence whether or not an ornament is in place. Since body piercing is getting popularity mostly among young adults only during recent years, the possible clinical significance of these finding probably will be manifested in the next decades as these current young adults will get older and become medically compromised with additional local and systemic risk factors for Candidal infection. I wants to thanks to my partners and co-authors: Dr. Tamar Halperin PhD and Mrs. Saar Burnstein MSc from the Central Medical Laboratories, Mrs. Estela Derazne MA from the Statistical Consultation Unit and last but not least Drs. Vadim Sandler DMD and Clariel Ianculovici DMD from the Zrifin Central Dental Clinic, all of the Medical Corps of Israel Defense Forces. Dr. Yehuda Zadik DMD MHA, Jerusalem, Israel.

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