# Denture-Associated Candidiasis and Mucormycosis in Post-COVID-19 Older Adults Managed Through an Integrated Prosthodontic and Infectious Disease Approach: A Narrative Review

## TL;DR

This review explores how older adults who wear dentures are more vulnerable to fungal infections after COVID-19 and highlights the need for combined dental and medical care.

## Contribution

The paper introduces an integrated prosthodontic and infectious disease approach to managing fungal infections in post-COVID-19 denture wearers.

## Key findings

- Denture wearers show higher rates of oral fungal colonization, with Candida albicans being the most common species.
- Mucormycosis after COVID-19 is associated with high mortality and oral symptoms like palatal necrosis and gingival ulcers.
- Poor denture hygiene and diabetes are key risk factors for fungal infections in post-COVID-19 older adults.

## Abstract

The COVID-19 pandemic has exposed significant vulnerabilities among older adults, particularly denture wearers, to opportunistic fungal infections, including mucormycosis and oral candidiasis. This narrative review, following PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Narrative Reviews) guidelines, collected evidence from 2020 to 2025 to examine the connection between denture use, systemic comorbidities, and fungal complications in elderly individuals after COVID-19. A total of 21 of 104 studies were included, covering case-control, cross-sectional, cohort, and retrospective studies from India, Europe, the Middle East, and North America. Several studies have reported higher rates of oral fungal colonization among denture wearers,with Candida albicans being the most frequently isolated species, followed by resistant strains such as Candida auris. However, these observations are primarily derived from heterogeneous observational studies and should therefore be interpreted as associative rather than causal. COVID-19-related mucormycosis (CAM) was primarily reported as rhino-orbito-cerebral disease, with oral manifestations including palatal necrosis, gingival ulcers, and tooth mobility. Key risk factors identified include diabetes mellitus, corticosteroid therapy, prolonged intensive care unit (ICU) stays, and poor denture hygiene. Mortality related to CAM ranged from 18% to 56%, while candidiasis, though less deadly, significantly affected oral function, nutrition, and overall quality of life. Diagnostic methods included clinical and intraoral examinations, microbiological cultures, imaging techniques, and emerging salivary biomarkers. Treatments included systemic antifungal medications, surgical removal, and prosthesis disinfection, highlighting the important role of prosthodontists in prevention and rehabilitation. Knowledge gaps remain regarding the predictive value of oral lesions for systemic infections, the long-term effects of COVID-19 on the oral microbiome, and the need to standardize denture hygiene protocols. This review emphasizes the importance of integrated dental and medical care in reducing morbidity and mortality among denture-wearing older adults recovering from COVID-19, while recognizing that early oral findings may serve as warning indicators rather than definitive predictors of systemic infection.