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Microorganisms in the biofilms mentioned above are mostly bacteria. However, Candida sp. may also be an important member of the oral biofilm. Candida biofilms both affect soft and hard tissue, they are complex biofilms, and Candida sp. interact with bacteria and host factors [50]. Candida might be an active member of a cariogenic biofilm and acts synergistically with S. mutans in biofilm matrix formation. The low pH generated by oral streptococci enables Candida albicans to grow in yeast form, and C. albicans lowers oxygen tension, which promotes streptococcal growth [50]. C. albicans is the most frequent yeast isolated in denture stomatitis, the hyphae form is more present and seems to be the more invasive form, while proteolytic and lipolytic enzymes induce inflammation at the palatum [50]. Also on dentures and at the palatum, the combination of C. albicans with oral streptococci strengthens the pathogenicity. The interaction of S. oralis with C. albicans increases the biomass of the biofilm and the inflammatory response [51]. Furthermore, it activates µ-calpain, an enzyme targeting E-cadherin that is an important epithelial cell adhesion molecule [51]. The biofilm formation on oral surfaces is summarized in Figure 3.

Fig. 3. Simplified diagram of oral biofilm formation.