Birth Cohort Study Identifies Candida albicans as a Risk Factor for Dental Caries

Candida albicans has been implicated as a potential cariogenic microorganism, yet no prospective longitudinal studies have examined its role in severe early childhood caries (S-ECC). This study aimed to evaluate the association between oral C. albicans and the onset of S-ECC in a longitudinal setting. This prospective birth cohort study (2018 to 2023) enrolled 186 low-income pregnant women in their third trimester in Western New York, United States. Overall, 160 eligible infants born to these women were followed from birth to 2 y at 7 time points. Oral samples were collected to assess Candida species ( C. albicans , Candida krusei , and Candida glabrata ) and Streptococcus mutans . The primary outcome was the onset of S-ECC. Two-step LASSO (least absolute shrinkage and selection operator)–penalized logistic regression models were developed to identify predictive factors for S-ECC from 234 covariates grouped by their proximal association with S-ECC: infant oral microorganisms, biological-environmental factors, and maternal characteristics. Logistic regression was used to validate the association between C. albicans and S-ECC. Among the 118 children who completed the study, 28% developed S-ECC. The racial background of the cohort was 57% Black, 21% White, and 22% other. Oral C. albicans colonized in 12% of infants at 1 wk, peaking at 57% by 18 mo. Salivary C. albicans was associated with a 4.47-fold increased risk for S-ECC (odds ratio [OR]; 95% CI, 1.28 to 15.58; P = 0.02), in addition to other risk factors, including plaque score (OR, 5.19; 95% CI, 2.10 to 12.83) and salivary S. mutans (OR, 9.74; 95% CI, 2.27 to 41.79). C. albicans demonstrated strong time sensitivity in predicting S-ECC as early as 1 mo, contrasting with S. mutans , which exhibited predictive ability after 1 y. Oral C. albicans could serve as a novel biological marker for predicting ECC risk in infancy, shining a light on opportunities to develop innovative caries-predictive and preventive strategies targeting fungal contributions in pediatric care settings.