## 4 Discussion
Denture Stomatitis (DS) was the most frequently identified _Candida_-associated lesion, affecting 4.0% of type 2 DM patients. Among them, 21.42% were males and 78.58% were females. Previous systematic reviews and meta-analyses reported a higher DS prevalence (10-67%) in DM patients [15]. The lower prevalence in our study may be attributed to good denture hygiene practices among participants. However, among patients in whom DS was diagnosed, a notable lack of denture hygiene awareness was observed. Similar female predominance in DS cases has been reported in India [16], whereas [PERSON] et al. found a higher prevalence of _Candida albicans_ carriage in denture-wearing males [17]. A significantly higher median glycemic level was identified in DS patients compared to those without lesions. This aligns with previous studies [18; 19] that highlight the correlation between hyperglycemia and increased _Candida_ colonization. Regarding the clinical presentation of DS, our study revealed 21.4% and 78.6% of Newton type 1 and type 2 lesions, respectively. Similar to the previous literature, the majority of DS lesions identified in our study were Newton type 2 lesions. However, in contrast to the available literature, where the majority of Newton type 2 lesions were associated with symptoms, all of our DS patients were asymptomatic, and the lesions were diagnosed as incidental findings [20; 21]. Erytheranus Candidiasis (EC) was the second most common lesion in our study. The literature suggests that DM patients wearing dentures are at risk of developing EC [22]. Other risk factors include antibiotic and inhaler use [23]; however, such practices were less common among our participants, possibly contributing to the lower EC prevalence. A statistically significant age difference was observed between EC patients and those without lesions (\(p<0.05\); mean rank with EC: 201.25; mean rank with no lesions: 148.97). While no prior studies have reported this finding, our results suggest a higher likelihood of EC development in elderly DM patients, emphasizing the need for clinician awareness for early diagnosis and management. There are studies that indicate a high prevalence (38%) of PMC among DM patients with oral candidal lesions [5]. PMC is commonly associated with immunocompromised states, including DM [24]. The relatively lower prevalence in our study may be attributed to effective DM management at the Diabetic Clinic at T/H Peradeniya and the exclusion of DM patients with other immunosuppressive conditions. CHC is a controversial entity due to its potential for malignant transformation [25]. Our study identified a relatively higher proportion of CHC cases in DM patients compared to a previous study [25], likely due to additional risk factors such as smoking and betel quid chewing in our study population. Diagnosing CHC solely based on clinical and cytological findings poses challenges, as distinguishing it from leukoplakia with _Candida_ superinfection requires biopsy confirmation. This limitation may have resulted in an overestimation of CHC cases in our study. Only 1.1% of DM patients in our study presented with AC, which is a significantly lower prevalence than the 14.1% reported in an Indian study [16]. This suggests that DM alone is not a primary risk factor for AC, which is influenced by additional factors such as vitamin deficiencies, reduced occlusal vertical dimension, and bacterial co-infection [26]. Cytological samples from our AC patients confirmed a high bacterial colonization rate, supporting the multifactorial etiology of this lesion. More than half (53.96%) of oral candidal lesions occurred in patients older than 60 years. The literature suggests that individuals of older age are more susceptible to oral candidiasis [27]. Studies show a significantly higher _Candida_ prevalence in adults aged 56-92 years [28] and an increased colonization rate in diabetic patients over 40 years [29].