Effect of amine fluoride–stannous fluoride preparations on oral yeasts in the elderly: a randomised placebo‐controlled trial

Objectives: Oral yeast infections are an emerging problem among medically compromised and frail elderly. Antifungal drug resistance is also increasing because of an increase in non‐albicans Candida strains in these populations. We therefore set out to study, in the randomised‐controlled trial setting if the use of a topical amine fluoride–stannous fluoride combination (AmF–SnF₂) could control oral Candida growth in the elderly. The hypothesis was based on earlier findings showing that in vitro this combination had antifungal efficacy. Methods: A total of 194 nursing home residents were randomised to receive either the test mouth rinse and toothpaste or a placebo twice daily for 8 months. Of these, 136 completed the trial. Saliva samples were taken using the oral rinse method, cultivated and the strain level identified with routine microbial methods. Compliance and use of preparations was assessed by a nurse. Results: Significantly at the end of the trial, less mucosal lesions were observed in the test group in comparison to controls. Total bacterial count decreased in both the groups during the trial. Candida albicans was the most prevalent strain detected both at baseline and 8 months later. Only a few subjects carried non‐albicans strains. The AmF–SnF₂ did not significantly affect mean oral Candida counts, but median Candida counts were reduced in the AmF–SnF₂ group while an increase was seen in the placebo group. However, the differences observed were not statistically significant. Compliance among the regular elderly users slightly increased during the trial for both the groups. Conclusion: The number of subjects with high Candida counts decreased in the AmF–SnF₂ group. Hence, the fluoride combination might be useful as a support therapy for oral candidiasis. Prevalence of non‐albicans Candida strains was low in this population.