Impact of Fixed Orthodontic Appliances on Staphylococcus aureus and Candida albicans
DOI:
https://doi.org/10.5195/d3000.2025.975Keywords:
fixed orthodontic appliances, Oral Staphylococcus aureus, Oral Candida albicans, Antimicrobial Resistance, Disk Diffusion MethodAbstract
Objective: This study investigated the prevalence of salivary S. aureus and C. albicans in patients with fixed orthodontic appliances and assessed their resistance profiles to selected antibacterial and antifungal agents over three-time intervals. Material and Methods: A prospective cohort of 40 patients (20 males, 20 females) undergoing orthodontic treatment was followed across three time points: baseline (T0), two weeks post-application (T1), and four weeks post-application (T2). Unstimulated saliva samples were collected and cultured for microbial identification. Organisms were confirmed via Vitek biochemical testing. Antimicrobial susceptibility was determined using the disc diffusion method against six antibacterial and six antifungal agents. Data were analyzed using two way-ANOVA and chi-square tests. Results: Among the 80 total samples analyzed, 73.75% were positive for S. aureus and/or C. albicans. S. aureus was most prevalent, with Clindamycin and Vancomycin showing the strongest antibacterial activity. Resistance to Amoxicillin, Ampicillin, and Erythromycin was notably high. For C. albicans, Fluconazole and Amphotericin B demonstrated the highest efficacy, while Clotrimazole and Nystatin showed poor inhibition. Resistance patterns might suggest a biofilm-associated microbial adaptation and reduced susceptibility over time. Conclusion: Fixed orthodontic appliances significantly influence oral microbial ecology by facilitating colonization of resistant strains of S. aureus and C. albicans. The findings highlight the importance of routine microbial surveillance and personalized antimicrobial strategies in orthodontic care to mitigate infection risks and manage emerging resistance.
References
Lucchese A, bondemark L. The influence of orthodontic treatment on oral microbiology. Biological mechanisms of tooth movement, 2021: 139–158.
Mazin H, Salman SA, Salah R. The effect of fixed orthodontic appliances on gingival health diode laser versus scalpel gingivectomy view project periodontology view project. IOSR Journal of dental and medical sciences (IOSR-JDMS), 15(11), 2016: 82–88. Available at: https://doi.Org/10.9790/0853-1517078288.
Deo PN, Deshmukh R. Oral microbiome: unveiling the fundamentals. journal of oral and maxillofacial pathology. JOMFP. 2019; 23(1), p. 122.
Kado I, Hisatsune J, Tsuruda K, Tanimoto K, Sugai M. The impact of fixed orthodontic appliances on oral microbiome dynamics in Japanese patients. Sci Rep. 2020;10(1):21989. doi: 10.1038/s41598-020-78971-2.
Kim SH, Choi DS, Jang I, Cha BK, Jost-Brinkmann PG, Song JS. Microbiologic changes in subgingival plaque before and during the early period of orthodontic treatment. Angle Orthod. 2012 ;82(2):254-60. doi: 10.2319/030311-156.1.
Rojo P et al. (2010). Community-associated S. Aureus infections in children. Expert rev anti infect ther, 8, 541–554.
Ryu,s.; Song, P.I.; Seo, C.H.; Cheong, H.; Park, Y. Colonization and infection of the skin by S. Aureus: immune system evasion and the response to cationic antimicrobial peptides. Int. J. Mol. Sci. 2014, 15, 8753–8772.
Kale, P. & Dhawan, B. (2016). The changing face of community-acquired methicillin-resistant staphylococcus aureus. Indian J. Med. Microbiol., 34, 275–285.
Casanova, G.N.; Ruiz, S.M.; Bellido, M.J.L. Mechanisms of resistance to daptomycin in staphylococcus aureus. Rev. Española quimioter. (2017), 30, 391–396.
Sirichoat, A.; Lulitanond, A.; Kanlaya, R.; Tavichakorntrakool, R.; Chanawong, A.; Wongthong, S.; Thongboonkerd, V. Phenotypic characteristics and comparative proteomics of staphylococcus aureus strains with different vancomycin-resistance levels. Diagn. Microbiol. Infect. Dis. 2016, 86, 340–344.
Romaniuk, J.A.; Cegelski, L. Bacterial cell wall composition and the influence of antibiotics by cell-wall and whole-cell NMR. Philos. Trans. R. Soc. B biol. Sci. 2015, 370.
Al-tekreeti AR, al-halbosiy MMF, dheeb BI, hashim AJ, al-zuhairi AFH. Molecular identification of clinical candida isolates by simple and randomly amplified polymorphic DNA-PCR. Arab J. Sci. Eng. (2017); doi 10.1007/s13369-017-2762-1.
Hussain AF, sulaiman GM, dheeb BI, hashim AJ, seddiq SH. Improving conditions for gliotoxin production by local isolates of aspergillus fumigatus. Journal of biotechnology research center. (2017); 11(2):14-24.
Ayesha A. Prevalence, antifungal susceptibility and biofilm characterization of candida species isolated from tertiary care hospitals, 2016; quaid-i-azam university, islamabad, pakistan.(2018); 1-22.
Khanpayeh E, Jafari AA, Tabatabaei Z. Comparison of salivary Candida profile in patients with fixed and removable orthodontic appliances therapy. Iran J Microbiol. 2014 Aug;6(4):263-8.
Al-Harba, Huda Reyad; Nasir-Alla, Nebrass; Jabir, Azher Abdulhafidh. The Correlation between Oral Candida albicans and Interlukine-23 in Diabetic Patients in Hilla City, Iraq. Medical Journal of Babylon 21(4):p 915-920, October-December 2024. | DOI: 10.4103/MJBL.MJBL_517_23.
Alhamadi W, Al-Saigh RJ, Al-Dabagh NN, Al-Humadi HW. Oral Candida in Patients with Fixed Orthodontic Appliance: In Vitro Combination Therapy. Biomed Res Int. (2017); 2017:1802875. doi: 10.1155/2017/1802875.
Navazesh, M. And kumar, S. K. 2008. Measuring salivary flow: challenges and opportunities. The journal of the american dental association, 139, 35S-40S.
Kaushik, R., Yeltiwar, R. K. And pushpanshu, K. 2011. Salivary interleukin‐1β levels in patients with chronic periodontitis before and after periodontal phase I therapy and healthy controls: A case‐control study. Journal of periodontology, 82, 1353-1359
James C, natalie S. Microbiology. A laboratory manual. Pearson education, 2014. Available from: https://lib.Hpu.Edu.Vn/handle/123456789/28998
Hudzicki J. Kirby-bauer disk diffusion susceptibility test protocol. American society for microbiology. 2009;15:55-63.
Scognamiglio T, Zinchuk R, Gumpeni P, Larone DH. Comparison of inhibitory mold agar to Sabouraud dextrose agar as a primary medium for isolation of fungi. J Clin Microbiol. 2010 May;48(5):1924-5. doi: 10.1128/JCM.01814-09.
Nadeem, S.G., Hakim, S.T. And kazmi, S.U. (2010) ‘use of chromagar candida for the presumptive identification of candida species directly from clinical specimens in resource-limited settings’, libyan journal of medicine, 5(1).
Abdulbaqi NJ, dheeb BI, irshad R. Expression of biotransformation and antioxidant genes in the liver of albino mice after exposure to aflatoxin B1 and an antioxidant sourced from turmeric (curcuma longa). Jordan journal of biological sciences. (2018); 11(2) 89 – 93.
Cohen, J. (2013). Statistical power analysis for the behavioral sciences. Routledge.
Wade, W.G. The oral microbiome in health and disease, pharmacological research, (2013); 69(1), pp. 137–143.
Salman, S.A. And salah, R. (2016) ‘the effect of fixed orthodontic appliances on gingival health diode laser versus scalpel gingivectomy view project periodontology view project’, IOSR journal of dental and medical sciences (IOSR-JDMS), 15(11), pp. 82–88. Available at: https://doi.Org/10.9790/0853- 1517078288.
Moyes DL, Wilson D, Richardson JP, Mogavero S, Tang SX, Wernecke J, Höfs S, Gratacap RL, Robbins J, Runglall M, Murciano C, Blagojevic M, Thavaraj S, Förster TM, Hebecker B, Kasper L, Vizcay G, Iancu SI, Kichik N, Häder A, Kurzai O, Luo T, Krüger T, Kniemeyer O, Cota E, Bader O, Wheeler RT, Gutsmann T, Hube B, Naglik JR. Candidalysin is a fungal peptide toxin critical for mucosal infection. Nature. 2016 Apr 7;532(7597):64-8. doi: 10.1038/nature17625.
Ali T, basit A, karim AM, lee J-H, jeon J-H, lee S H. Mutation-based antibiotic resistance mechanism in methicillin-resistant staphylococcus aureus clinical isolates. Pharmaceuticals. Https://doi.Org/10.3390/ph14050420 18. (2021);14(5):420.
Nobile CJ, johnson AD. (2015). Candida albicans biofilms and human disease. Annu rev microbiol, 69:71–92.
Parastan R, kargar M, solhjoo K, kafilzadeh F. A synergistic association between adhesion-related genes and multidrug resistance patterns of staphylococcus aureus isolates from different patients and healthy individuals. Journal of global antimicrobial resistance. 2020;22:379-85. Https://doi.Org/10.1016/j.Jgar.2020.02.025
Abbasi Montazeri, E., Khosravi, A.D., Khazaei, S. et al. Prevalence of methicillin resistance and superantigenic toxins in Staphylococcus aureus strains isolated from patients with cancer. BMC Microbiol 21, 262 (2021). https://doi.org/10.1186/s12866-021-02319-7
Gardete S, Tomasz A. Mechanisms of vancomycin resistance in Staphylococcus aureus. J Clin Invest. 2014 Jul;124(7):2836-40. doi: 10.1172/JCI68834.
Achkar JM, fries BC. Candida infections of the genitourinary tract. Clinical microbiology reviews. (2010); 23(2), 253–273.
Abdalwahd N., Al-Saigh R.J., Al-Humadi H.W. Assessment of antifungal drugs’ activity against some Candida albicans isolates in the presence or absence of human albumin: a study employing an in vitro pharmacokinetics / pharmacodynamics model. Rev. Clin. Pharmacol. Pharmacokinet. Int. Ed. 38(Sup2): 39-42 (2024). https://doi.org/10.61873/SEXH5182
Bhavan, P., Rajkumar, R, Subramanian, Radhakrishnan, Seenivasan, Dr. Chandrasekar & Kannan, Soundarapandian. Culture and Identification of Candida Albicans from Vaginal Ulcer and Separation of Enolase on SDS-PAGE. International Journal of Biology. (2010); Vol 2. 10.5539/ijb.v2n1p84.
Abbas, Nada Fadhil. Comparison between Conventional Methods and Molecular Diagnosis for Candida albicans and Candida dubliniensis isolated from Cancer Patients Infected with Oral Candidiasis. Medical Journal of Babylon 21(Suppl 2):p S276-S281, November 2024. | DOI: 10.4103/MJBL.MJBL_1079_23
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Maryam Aljbouri, Nebras Al-Dabbagh, Thaer Jaber Al-Khafaji

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Revised 7/16/2018. Revision Description: Removed outdated link.