Document Type: Original Article

Authors

1 Dept. of Oral Medicine, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.

2 Dept. of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Statement of the Problem: Zataria multiflora (ZM) is a thyme-like plant that belongs to the Lamiaceae family. It is native to the center and south of Iran, Pakistan, and Afghanistan. Evidence shows that ZM contains thymol and carvacrol and is therefore, effective for the treatment of many conditions especially fungal infections. Oral candidiasis is the most common opportunistic infection of the oral mucosa that plays a role in the development of denture stomatitis.
Purpose: This study aimed to compare the antifungal efficacy of ZM and nystatin suspension for the treatment of denture stomatitis.
Materials and Method: This single-blind clinical trial evaluated 28 patients (> 18 years old) suffering from type II or III denture stomatitis. Patients were divided into two groups. The control group used nystatin suspension while the case group used ZM drop. The number of Candida albicans (C. albicans) colony-forming units (CFUs) and erythema of the palate were evaluated at baseline and at 14 days after treatment. Data were analyzed using SPSS version 11 via Student’s t test and repeated measure ANOVA.
Results: The results showed similar efficacy of nystatin and ZM in the reduction of C. albicans CFUs compared to the baseline value (p = 0.593). Both medications significantly decreased the colony count (p < 0.001). Nystatin and ZM had similar efficacy for the reduction of erythema as well (p = 0.256) and both caused a significant reduction in erythema of the palate (p < 0.001).
Conclusion: ZM drop was as effective as the nystatin drop in the resolution of erythema of the palate and reduction of C. albicans colony count. 

Keywords

[1]         Di*Stasio D, Lauritano D, Minervini G, Paparella RS, Petruzzi M, Romano A, et al. Management of denture stomatitis: a narrative review. J Biol Regul Homeost Agents. 2018; 32: 113-116.

[2]         De*Souza RF, Khiyani MF, Chaves CA, Feine J, Barbeau J, Fuentes R, et al. Improving practice guidelines for the treatment of denture-related erythematous stomatitis: a study protocol for a randomized controlled trial. Trials. 2017; 18: 211-217.

[3]         Gauch LM, Pedrosa SS, Silveira-Gomes F, Esteves RA, Marques-da-Silva SH. Isolation of Candida spp. from denture-related stomatitis in Pará, Brazil.Braz J Microbiol. 2017; 49: 148-151.

[4]         Bakhshi M, Taheri JB, Basir*Shabestari S, Tanik A, Pahlevan R. Comparison of therapeutic effect of aqueous extract of garlic and nystatin mouthwash in denture stomatitis. Gerodontology. 2012; 29: e680-e684.

[5]         Moghim H, Taghipoor S, Shahinfard N, Kheiri S, Panahi R. Antifungal effects of Zataria multiflora and Nigella sativa extracts against Candida albicans. JHP. 2015; 4: 138-141.

[6]         Zomorodian K, Saharkhiz MJ, Rahimi MJ, Bandegi A, Shekarkhar G, Bandegani A, et al. Chemical composition and antimicrobial activities of the essential oils from three ecotypes of Zataria multiflora.Pharmacogn Mag. 2011; 7: 53.

[7]         Bhat N, Mitra R, Reddy JJ, Oza S, Vinayak KM. Evaluation of efficacy of chlorhexidine and a herbal mouthwash on dental plaque: An in vitro comparative study. Int J Pharm Bio Sci. 2013; 4: 625-632.

[8]         Sajed H, Sahebkar A, Iranshahi M. Zataria multiflora Boiss. (Shirazi thyme)-an ancient condiment with modern pharmaceutical uses. J Ethnopharmacol. 2013; 145: 686-698.

[9]         De*Oliveira*Santos GC, Vasconcelos CC, Lopes AJ, de*Sousa*Cartágenes MD, Allan*Filho KD, do*Nascimento FR, et al. Candida infections and therapeutic strategies: mechanisms of action for traditional and alternative agents. Frontiers in Microbiology. 2018; 9: 1351.

[10]       Nazzaro F, Fratianni F, Coppola R, Feo VD. Essential oils and antifungal activity. Pharmaceuticals. 2017; 10: 86.

[11]       Offenbacher S, Barros SP, Bencharit S, Yu N, Preisser J, Moss K, et al. Differential Mucosal Gene Expression Patterns in Candida‐Associated, Chronic Oral Denture Stomatitis. J Prosth. 2019; 28: 202-208.

[12]       Amanlou M, Beitollahi JM, Abdollahzadeh S, Tohidast‐Ekrad Z. Miconazole gel compared with Zataria multiflora Boiss, gel in the treatment of denture stomatitis. Phytother. Res. 2006; 20: 966-969.

[13]       Lyu X, Zhao C, Yan ZM, Hua H. Efficacy of nystatin for the treatment of oral candidiasis: a systematic review and meta-analysis. Drug Design Development and Therapy. 2016; 10: 1161.

[14]       Duyck J, Vandamme K, Krausch-Hofmann S, Boon L, De*Keersmaecker K, Jalon E, et al. Impact of denture cleaning method and overnight storage condition on denture biofilm mass and composition: A cross-over randomized clinical trial. PLoS One. 2016; 11: e0145837.

[15]        Epstein JB, Vickars L, Spinelli J, Reece D. Efficacy of chlorhexidine and nystatin rinses in prevention of oral complications in leukemia and bone marrow transplantation. Oral Surgery Oral Medicine Oral Pathology. 1992; 73: 682-689.

[16]       Mattei AS, Alves SH, Severo CB, Guazzelli LD, Oliveira FD, Severo LC. Use of Mueller-Hinton broth and agar in the germ tube test. Rev Inst Med Trop Sao Paulo. 2014; 56: 483-485.

[17]       Jafari AA, Tafti AF, Hoseiny SM, Kazemi A. Antifungal Effect of Zataria multiflora Essence on Experimentally Contaminated Acryl Resin Plates With Candida albicans. IRCMJ. 2015; 17: 165-170.

[18]       Sedigh-Shams M, Badiee P, Adl A, Sarab MD, Abbaszadegan A, Nabavizadeh M. In vitro comparison of antimicrobial effect of sodium hypochlorite solution and Zataria multiflora essential oil as irrigants in root canals contaminated with Candida albicans. JCD. 2016; 19: 101-105.

[19]       Khosravi A, Shokri H, Tootian Z, Alizadeh M, Yahyaraeyat R. Comparative efficacies of Zataria multiflora essential oil and itraconazole against disseminated Candida albicans infection in BALB/c mice. Braz J Microbiol. 2009; 40: 439-445.

[20]       Fouladi Z, Afshari P, Gharibi T, Dabbagh MA. The comparison of Zataria multiflora boiss (Avishan Shirazi) and Clotrimazol vaginal cream in the treatment of candidiasis vaginitis. ISMJ. 2009; 12: 214-224.