Correlation of cariogenic bacteria and dental caries in adults

Many studies suggest that mutans streptococci (MS), Lactobacillus (LB), and salivary buffering capacity are important risk factors for dental caries. However, target populations for most studies were children. In adult patients, the same risk factors affect the number of fillings or prostheses or secondary caries. It is therefore important to investigate these risk factors as predictors of caries in adults. In the present study, we evaluated the oral conditions of adult subjects at private dental offices using bite-wing radiographs. Detection of salivary LB level using Dentocult LB had a statistically significant correlation with the number of flat surface caries and approximal caries (P < 0.001). Detection of salivary MS level using Dentocult MS and salivary buffering capacity did not predict dental caries. Thus, detection of salivary LB level using Dentocult LB may be a useful tool for detecting approximal and secondary caries.     

Salivary proteins as a biomarker for dental caries—A systematic review

AimTo develop a systematic review based on the relation between salivary proteins and dental caries by comparing subjects with and without caries experience and to evaluate whether salivary proteins can be considered biomarkers for dental caries or not.MethodsAn electronic search was performed in the PubMed Medline, Ovid Medline, ISI Web of Science, Medline, Cochrane Library, Lilacs, Scielo, BBO, Paho and Wholis databases applying the following MeSH terms: “dental caries” OR “tooth demineralization” OR “dental caries susceptibility” OR “dental enamel solubility” AND “salivary proteins and peptides” OR “saliva” AND “proteins”. To be eligible for the systematic review, the observational controlled studies had to have groups with and without caries experience. Studies with high risk of bias were excluded.ResultsFrom a total of 188 identified studies, only seven were included in this systematic review. Four studies were classified as “low risk of bias” and three as “moderate risk of bias”. Three studies reported a relation between salivary proteins and dental caries.ConclusionThere was not sufficient evidence to establish salivary proteins as a biomarker for this disease although three of the seven studies showed a relation between salivary proteins and dental caries in terms of protein phenotypes, total protein concentration and protein molecular weight.     

Salivary characteristics and dental caries: Evidence from general dental practices

BackgroundSaliva is one of the intraoral host factors that influence caries development. The authors conducted a study to investigate whether salivary characteristics are associated with recent dental caries experience.MethodsDentist-investigators and dental staff members collected data pertaining to a two-year cumulative incidence of dental caries (previous 24 months) and salivary characteristics during baseline assessment in an ongoing longitudinal study. The systematic random sample consisted of patients (n = 1,763) visiting general dental practices (n = 63) within the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT). The authors estimated adjusted rate ratios (RRs) by using generalized estimating equations log-linear regression to relate salivary characteristics to coronal carious lesions into dentin.ResultsLow resting pH (≤ 6.0) in the overall sample and low stimulated salivary flow rate (≤ 0.6 milliliter/minute) in older adults (≥ 65 years old) were associated with increased dental caries (RR, 1.6; 95 percent confidence interval [CI], 1.1–2.2; RR, 2.4; 95 percent CI, 1.5–3.8, respectively). Low buffering capacity was associated with decreased dental caries in children and adolescents (RR, 0.3; 95 percent CI, 0.1–1.0; RR, 0.2; 95 percent CI, 0.1–0.7, respectively). A thick, sticky or frothy salivary consistency also was associated with decreased dental caries in adults (RR, 0.6; 95 percent CI, 0.4–1.0). Associations between other salivary characteristics and dental caries for the overall sample and within each age group were not statistically significant.ConclusionsSalivary characteristics were associated weakly with previous dental caries experience, but the authors did not find consistent trends among the three age groups. Different salivary characteristics were associated with an increased caries experience in older adults and a lowered caries experience in children and adolescents and adults.Practical ImplicationsFurther investigations are needed in this population setting to understand the study’s conflicting results. The study findings cannot support the use of salivary tests to determine caries risk in actual clinical settings.     

Oral health status, salivary factors and microbial analysis in patients with active gastro-oesophageal reflux disease

Aim: To present a complex oral health status including salivary factors, microbial analysis and periodontal and hygiene indices in patients with active gastro‐oesophageal reflux disease (GORD). Return of stomach contents is quite common in cases of gastro‐oesophageal reflux. Pathological acid movement from the stomach into the oesophagus and oral cavity may lead to a development of dental erosion. Long‐lasting untreated GORD may damage hard dental and periodontal tissues and alter the oral microbial environment. The quality and amount of the saliva play an important role in hard and soft oral tissues changes. Method: Fifty patients with diagnosed GORD using 24‐hour pH manometry underwent dental examination; 24 patients had active GORD and had been waiting for surgical therapy. In this patient group oral health status and salivary analysis were evaluated. Results: Indicated low salivary flow rates and buffering capacity with a low caries risk but a high risk for dental erosion progression.     

Dental health of children with cerebral palsy following sialodochoplasty

Drooling occurs commonly in children with cerebral palsy (CP). Surgical procedures, known as sialodochoplasties, are often performed for the control of drooling. These Include major salivary gland excision, parasympathetic nerve section, duct ligation, and duct re-routing. Alterations in saliva amount, flow, and consistency occur following sialodochoplasty, and the resultant effect on dental homeostasis requires further investigation.
This controlled study investigated 19 children with CP following sialodochoplasty (surgery group) and 75 children with CP treated nonsurgically (control group) who attended our hospital. Dental caries experience—including dmft, DMFT, and partial DMFS scores of mandibular incisors and canines only—plaque index, and enamel developmental defects index were recorded. Saliva buffering capacity and bacterial counts were assessed.
The surgical group (median DMFT = 5.00) had significantly more dental caries when compared with the control group (median DMFT = 0.00), Wilcoxon Signed-rank Test, P < 0.0001.
This study has shown that children with CP following sialodochoplasty have increased risk of dental caries when compared with those treated nonsurgically for drooling. Although no caries predictors were identified, alterations to the caries-protective role of saliva are considered the likely cause. Children who undergo this procedure should receive intensive pre-and postsurgical preventive dental therapy.     

Evaluation of oral hygiene status, salivary characteristics and dental caries experience in acute lymphoblastic leukemic (ALL) children

Leukemia constitutes approximately 30% of all childhood cancers and Acute Lymphoblastic Leukemia (ALL) is the most common type of malignancy. Oral dryness, ulceration, increased dental decay seen is due to altered salivary flow rate and buffering capacity in these children. Oxidative stress may play an important role in the malignancies resulting in onset of inflammatory oral pathologies. Saliva constitutes first line of defense against free radical-mediated oxidative stress. The present study attempted to relate the oral health status, salivary flow rate, salivary pH, gingival health status, dental caries experience and total salivary antioxidant levels in ALL children. A total of 120 children aged 4-10 years (90 leukemic children, study group and 30 normal healthy siblings, control group) were divided into 4 groups of 30 each. Oral health status, gingival status and dental caries experience was recorded followed by un-stimulated saliva collection. Total antioxidant capacity of un-stimulated saliva was evaluated. The results depicted deterioration in oral health status, gingival status and increased dental caries experience in leukemic children. Salivary flow rate, salivary pH and total salivary antioxidant levels were lowered in leukemic children when compared with control group.     

Evaluation of the relationship between caries indices and salivary secretory IgA, salivary pH, buffering capacity and flow rate in children with Down's syndrome

The aim of this study was to compare the caries prevalence and salivary secretory IgA (sIgA), salivary pH, buffering capacity and flow rate between Down's syndrome (DS) and control subjects. Seventy-three institutionalised children with DS and 70 normal children aged 7-12 years old were included in this study. Tooth-brushing habits and daily dietary sugar exposures of the children, family income and education levels of the parents were recorded. DMFS and dfs scores were assessed according to the World Health Organisation's criteria and stimulated whole saliva samples were collected. Salivary sIgA levels were determined by radial immunodiffusion technique, the average salivary flow rate was measured from the total volume, and salivary pH and buffering capacity were determined using a pH micro-electrode. All data were analysed using SPSS version 11.0. The DMFS and dfs scores were significantly lower in the DS group than the control group (P < 0.05). Otherwise, the difference in plaque scores between the DS and control groups was not statistically significant (P > 0.05). There were no significant differences in tooth-brushing habits and daily dietary sugar exposures of the children, family income and education levels of the parents between the two groups (P > 0.05). Salivary sIgA levels were significantly higher in the DS group (P < 0.05). Salivary pH, buffering capacity and flow rate were quite similar in both the DS and control groups (P > 0.05). In conclusion, the patients with DS had a significantly lower prevalence of caries and significantly higher levels of salivary sIgA in this study. This finding tends to support the hypothesis that higher levels of salivary sIgA may protect against dental caries.     

Effectiveness and safety of botulinum toxin in comparison with surgery for drooling in paediatric patients with neurological disorders: a systematic review

Different therapeutic methods for chronic drooling in paediatric patients with neurological problems have been described in the scientific literature. However, there is no consensus on the ideal strategy of treatment. The aim of this study was to compare botulinum toxin injection therapy and surgical modalities to control drooling in paediatric patients with neurological disorders. A systematic literature search was conducted on nine electronic databases for publications until April 2020. Six articles were included with a total sample of 209 patients, 67.4% (n = 141) of whom had cerebral palsy. All studies used injections of botulinum toxin type A with application to the submandibular and/or parotid salivary glands. The surgical treatments were duct ligation in the parotid and/or submandibular salivary glands, duct relocation in the submandibular salivary glands, and glandular excision of the submandibular and sublingual salivary glands. There were complications in only 16.1% (n = 27) of the sample (11 cases due to botulinum toxin application and 16 due to surgery). Drooling control was assessed by objective and subjective measures. Although surgical procedures presented a higher risk of adverse effects than botulinum toxin type A in all the studies and measurements performed, they presented larger and longer-lasting positive effects on drooling. We suggest bilateral submandibular duct relocation with bilateral sublingual gland excision or isolated bilateral submandibular duct ligation, which were the surgical techniques with the largest samples in this review. Nevertheless, further studies are necessary to compare samples with botulinum toxin type A and surgical treatment.     

Salivary pH changes during soft drinks consumption in children

Summary. Dental erosion seems to have increased, perhaps partly as a result of an increase in the consumption of soft drinks.
Aim. The aim of this study was to measure salivary pH, flow rate and buffering capacity before and after soft drinks intake in children with erosive lesions and to compare these to equivalent values for healthy caries-free individuals.
Design. The study was conducted as a case-control study using standard salivary tests. Thirty children with erosion and 30 age and sex-matched children free from erosion and active caries were included in this study.
Methods. Salivary flow rate was measured through expectoration into a graduated tube, salivary buffering capacity through colourimetric procedures and salivary pH using a digital pH meter.
Results. Results showed significant differences between cases and controls for salivary pH, flow rate, buffering capacity, maximum pH drop and minimum pH reached after soft drinks intake.
Conclusions. It is concluded that all the factors studied are involved in dental erosion and that preventive care is mandatory for children who frequently drink these kinds of beverages.     

慢性哮喘对口腔健康影响的研究进展

哮喘是一种常见的慢性呼吸系统疾病,以慢性气道炎症为主要特征,患者可出现咳嗽、喘息及可逆的气流受限等症状。已有研究表明,哮喘不仅对呼吸系统产生影响,还对口腔微生态及健康产生影响,如导致口腔唾液流量、pH值、缓冲能力、唾液成分发生改变,进而导致患者口腔内菌群变化,增加龋病、牙周病等口腔疾病的发生风险等。哮喘用药、哮喘严重程度和持续时间、哮喘相关继发疾病也是影响哮喘患者口腔健康的重要因素。因此,本文通过文献回顾,就哮喘对口腔健康的影响作一综述,为哮喘患者及口腔医生临床工作提供参考。     

Influence of colonization with mutans streptococci on caries risk in Japanese preschool children: 24 month survival analysis

PURPOSE: This study evaluates how various microbial- and salivary-related risk factors influenced the hazard for caries development in preschool children. METHODS: The study population consisted of 131 subjects (age: 0.5 to 6.0 yrs). Oral examination, including two bacterial tests and buffering capacity test, was conducted at six month intervals over 24 months. A survival analysis was used to describe caries hazard over a 24-month follow-up period. A Cox proportional hazards regression analysis was performed to test the influence of salivary mutans streptococci (MS), aciduric bacteria, buffering capacity and age on caries development. RESULTS: Of the total subjects, 60 children (46%) were found to be caries-free at baseline. Caries hazard correlated significantly with salivary MS levels at baseline (relative risk, 1.7; P = 0.003), but not with aciduric bacteria and buffering capacity. This analysis showed that all of children with high colonization of MS at baseline had dental caries 15 months later. CONCLUSION: The results suggest that salivary MS level at baseline influenced caries hazard in preschool children.     

Salivary biomarkers for dental caries

As a highly prevalent multifactorial disease, dental caries afflicts a large proportion of the world's population. As teeth are constantly bathed in saliva, the constituents and properties of this oral fluid play an essential role in the occurrence and progression of dental caries. Various inorganic (water and electrolytes) and organic (proteins and peptides) components may protect teeth from dental caries. This occurs via several functions, such as clearance of food debris and sugar, aggregation and elimination of microorganisms, buffering actions to neutralize acid, maintaining supersaturation with respect to tooth mineral, participation in formation of the acquired pellicle and antimicrobial defense. Modest evidence is available on the associations between dental caries and several salivary parameters, including flow rate, buffering capacity and abundance of mutans streptococci. Despite some controversial findings, the main body of the literature supports an elevated caries prevalence and/or incidence among people with a pathologically low saliva flow rate, compromised buffering capacity and early colonization or high titer of mutans streptococci in saliva. The evidence remains weak and/or inconsistent on the association between dental caries and other saliva parameters, such as other possible cariogenic species (Lactobacillus spp., Streptococcus sanguis group, Streptococcus salivarius, Actinomyces spp. and Candida albicans), diversity of saliva microbiomes, inorganic and organic constituents (electrolytes, immunoglobulins, other proteins and peptides) and some functional properties (sugar clearance rate, etc.). The complex interactions between salivary components and functions suggest that saliva has to be considered in its entirety to account for its total effects on teeth.     

放射性龋发病因素的初步研究

为探讨放射性龋发病的相关因素和防治措施。方法,本文共收集２２例头颈部放疗患者,对其中的１０例分别于放疗前和放疗后二个月进行唾液流速和离体菌斑产酸性的检测,并比较了放疗患者与正常人唾液缓冲能力的差别。     

Association of passive smoking with caries and related salivary biomarkers in young children

OBJECTIVE: To investigate the association between passive smoking, as determined by salivary cotinine level, and caries, salivary pH, buffering capacity, flow rate and microbiological counts in young children. DESIGN: Ninety passive smokers (PS) with a mean age of 5.02 years and 90 healthy age-matched controls were included in this study. Family income, smoking habits of household members, parental education levels, child's tooth-brushing habit and child's daily dietary sugar exposure were recorded by questionnaire. Three categories were formed with respect to the number of cigarettes smoked. A dmft score was calculated according to the criteria recommended by the World Health Organization. The children were also investigated for stimulated salivary cotinine level, pH, flow rate, buffering capacity and salivary Streptococcus mutans and lactobacilli colonisation. RESULTS: There were no significant differences in tooth-brushing habit, sugar exposure, family income and parental education levels between the two groups (P>0.05). The mean cotinine level of the PS subjects was 1.58+/-4.3ng/ml. The dmft scores, and salivary S. mutans and lactobacilli colonisation in PS children were significantly higher than in the control subjects (P<0.05). Statistically significant decreases in salivary pH, flow rate and buffering capacity were found in the PS subjects (P<0.05). CONCLUSION: PS children are at increased risk of caries compared with control subjects.     

Risk factors for dental caries in children with cerebral palsy

This study was conducted to examine the oral condition and the salivary and microbiological parameters associated with dental caries in 62 children with cerebral palsy, who came from households of low socioeconomic status (Study Group). This group had mixed (6 to 11 years old) and permanent (11 to 16 years old) dentition. Dental examinations were performed to measure dental caries, plaque index, salivary levels of mutans streptococci and lactobacilli, salivary flow rate, pH of stimulated saliva, and buffer capacity of saliva. A group of 67 non-handicapped children from similar socioeconomic backgrounds also were examined using these parameters (Control Group). Data were analyzed statistically by non-parametric tests and by correlation. The results showed that children with cerebral palsy who had permanent dentitions had a higher mean decayed, missing and filled surfaces index, as well as a higher plaque index for both sexes. Microbiological examination revealed higher levels of mutans streptococci among Study Group subjects with mixed dentition than in the Control Group. Also, lactobacillus counts were higher in the Study Group, regardless of sex or dentition. With respect to salivary flow rate, pH and buffering capacity, lower mean values were obtained for the Study Group.     

Salivary antioxidants and oral health in children with autism

Individuals with autism vary widely in abilities, intelligence, and behaviours. Autistic children have preferences for soft and sweetened food making them susceptible to caries. A wide spectrum of medical and behavioural symptoms is exhibited by children with autism, which makes routine dental care very difficult in them. Mental retardation is evident in approximately 70% of individuals with autism and most psychiatric disorders including autism are associated with increased oxidative stress.ObjectivesTo evaluate the oral health status of children with autism and to determine the salivary pH and total salivary antioxidant concentration (TAC).Materials and methods101 subjects with autism between age group of 6 and 12 year were part of the study and 50 normal healthy siblings of same age group were taken as control group. Oral health status was analysed using oral hygiene index-simplified and dentition status index. The salivary total anti-oxidant level was estimated using phosphomolybdic acid using spectrophotometric method and the salivary pH using the pH indicating paper. The results were statistically analyzed using Mann–Whitney U test.ResultsA statistically very highly significant difference was seen in the mean oral hygiene index scores (autistic group – 1.2 and control group – 1, P < 0.001) and the mean salivary total antioxidant concentration (autistic group – 5.7 μg/ml and control group – 38 μg/ml, P < 0.001). No statistical significant difference was observed in the dental caries status and the salivary pH of autistic group and the control group.ConclusionsSimilar dental caries status was observed in children with autism and their healthy normal siblings. Oral hygiene was poor in children with autism whereas the Salivary TAC was significantly reduced in autistic children.     

Total antioxidant levels of saliva in children related to caries, age, and gender

AIM: The purpose of this study was to evaluate the relationship between the physicochemical properties of saliva such as flow rate, buffering capacity, pH, calcium level, total protein, total antioxidant status, and dental caries, age, and gender. MATERIAL AND METHODS: The antioxidant activity of saliva was investigated in 80 healthy children aged 7-15 years. They were divided into subgroups according to gender, age (7-10 years and 11-15 years), and caries activity (caries active=CA and caries free=CF). Unstimulated saliva samples were collected from all groups. Flow rates were determined, and samples analysed for pH, buffer capacity, calcium, total proteins, and total antioxidant status. Salivary total antioxidant activity (TAA) was estimated by an adaptation of the ABTS (2,2-azino-di (3-ethylbenzthiazoline-6-sulphonate)) assay. RESULTS: The results indicated that in general, although there was no linear association between salivary flow rate pH and buffering capacity values obtained from different groups, salivary calcium concentration values were found to be higher in caries free groups. Total protein and total antioxidant values were higher in caries active groups except those in the 11- to 15-year-old girls group. CONCLUSION: In general, total protein and total antioxidant insaliva were increased with caries activity. Calcium concentrations in saliva were higher in caries-free children. In addition, calcium concentration increased with age. Thus, it can be concluded that a linear association exists between calcium concentration age and caries activity. More clinical and laboratory studies are needed to determine the exact relationship between the physicochemical properties of saliva such as flow rate, buffering capacity, pH, calcium level, total protein, total antioxidant status, and dental caries, age, and gender.     

The impact of glass ionomer cement and composite resin on microscale pH in cariogenic biofilms and demineralization of dental tissues

ObjectiveSecondary caries is among the most frequent reasons for the failure of dental restorations. Glass ionomer cement (GIC) restorations have been proposed to protect the surrounding dental tissues from demineralization through the release of fluoride and by buffering the acid attack from dental biofilms. In contrast, the lack of buffering by composite resin (CR) restorations has been suggested as a promoting factor for the development of secondary caries.MethodsThe present study employed transversal microradiography and confocal microscopy based pH ratiometry to quantify mineral loss and map microscale pH gradients inside Streptococcus mutans biofilms grown on compound specimens consisting of enamel, dentin and either GIC or CR.ResultsMineral loss in dentin was significantly lower next to GIC than next to CR, but no significant differences in local biofilm pH were observed between the two restorative materials.SignificanceThe cariostatic effect of GIC relies predominantly on the provision of fluoride and not on a direct buffering action. The lack of buffering by CR did not affect local biofilm pH and may therefore be of minor importance for secondary caries development.     

Longitudinal research on the oral environment of elderly wearing fixed or removable prostheses

PurposeThe purpose of this study was to investigate oral environmental risk factors involved in caries incidence in the elderly. We investigated the relationship between the oral environment factors of the elderly with both fixed prostheses and removable prostheses at baseline and at follow-up and examined time-course changes of each oral environmental factor by prosthesis type.Materials and methodsThe subject group consisted 11 elderly patients with fixed prostheses and 11 who wore removable prostheses. We examined oral environmental factors by saliva tests. Five oral environmental factors were examined: the stimulated salivary flow rate, buffering capacity, and the counts of mutans streptococci (SM), lactobacilli (LB), and Candida (CA). We compared these factors for subjects with fixed prostheses and those wearing removable prostheses at baseline and at follow-up. Furthermore, 3-year changes in the factors of each oral environment were compared and evaluated.ResultsSignificant differences were observed between the two groups in the salivary microbial counts of SM and LB at baseline and at follow-up. The LB counts increased in the Denture group during the 3-year period and significant differences were noted.ConclusionsWe found that fixed prostheses are less cariogenic, and removable prostheses cause an increase in the cariogenic bacterial count. Regarding time-course changes by the type of prosthesis, the LB count tended to increase in the subjects with removable prostheses. The risk of caries due to a fixed prosthesis may be lower than that of removable prostheses.     

正畸与正常儿童龋活性比较

目的 :本实验通过检测 61名 12～ 16岁正畸与正常儿童的龋活性 ,以了解固定矫治与龋活性的关系。方法 :行变形链球菌计数、乳酸杆菌计数、细菌产酸能力测定和唾液缓冲能力测定 ,用t检验进行统计。结果 :正常儿童组口腔内变链菌和乳杆菌数目明显少于正畸儿童组 ;而唾液 pH值和缓冲能力及细菌产酸能力 ,两组间无显著性差异 (P >0 .0 5 )。结论 :结果提示正畸儿童对龋病的易感性增加