Monitoring the caries risk of orthodontic patients.

Several caries activity tests were used to investigate the caries risk of patients with fixed orthodontic appliances. Twenty young individuals, with a mean age of 11 years, participated in this study. Ten subjects were free of any orthodontic appliances and formed the control group. The other 10 individuals had been wearing fixed orthodontic appliances for at least 4 months. Stimulated saliva samples were obtained from all patients. Saliva samples were used to investigate the salivary flow rate, the salivary buffer capacity, and mutans streptococci and lactobacilli counts. The orthodontic patients exhibited a significant increase in salivary flow rate. Results of statistical analyses were nonsignificant in all other tests, suggesting that fixed orthodontic appliances are not the sole factor increasing the patient's caries risk during orthodontic treatment.     

Oral conditions in patients receiving long-term treatment with cyclic antidepressant drugs

The function of the salivary glands, the caries situation, and pathological alterations of the oral mucosa of 32 patients, 20 dentulous and 12 edentulous, who had received long-term treatment (median 5.5 years) with cyclic antidepressant drugs were studied. Anamnestic information on dry mouth problems was recorded. Although a normal secretion rate for stimulated saliva was recorded in about 50% of the patients all but four complained over dry mouth. The majority of the patients had low values of salivary buffer capacity, high numbers of Streptococcus mutans and lactobacilli in the saliva, and poor oral hygiene. All except two patients had received dental care a year or less before the time of examination. Nevertheless 72% of the patients showed pathological alterations of their oral mucosa and 55% of the dentulous patients had new caries lesions. From an evaluation of the caries risk it was concluded that about half of the dentulous patients had a high caries risk, which seemed to be emphasized if combinations of psychotherapeutic drugs were used. It is recommended that patients receiving treatment with antidepressant drugs should be given an individually related dental prophylactic programme.     

Saliva, salivary micro-organisms, and oral health in the home-dwelling old elderly--a five-year longitudinal study.

High scores of chair-side salivary microbial tests have been found to be related to an increased prevalence and incidence of coronal and root caries. Many elderly face an increased risk of the growth of oral microbes, and previous studies have reported high salivary microbial counts in elderly populations. The aim of this follow-up study was to compare, at five-year intervals, stimulated salivary flow rates with the numbers of selected salivary micro-organisms (mutans streptococci, lactobacilli, and yeasts) in a group of home-dwelling elderly in Helsinki. A further aim was to study the influence of baseline microbial counts on five-year root caries increments and rates of tooth loss. The baseline study population was comprised of 270 subjects who were all participants in the population-based Helsinki Aging Study. Salivary flow rates and microbial conditions were determined as part of their dental examination at the Institute of Dentistry, University of Helsinki, in 1990-1991. Of these subjects, 110 underwent a follow-up examination in 1995-1996. Commercially available kits (Dentocult SM strip mutans for mutans streptococci, Dentocult LB for lactobacilli, and Oricult N for yeasts) were used for the enumeration of micro-organisms, after the collection of paraffin-wax-stimulated whole saliva. The stimulated whole saliva flow rates of the subjects were significantly lower at the follow-up than at baseline (paired t test, difference -0.16 mL/min; p < 0.05), whereas buffer capacity was higher (paired t test, difference 0.19 on a three-unit scale; p < 0.05). Apart from lower salivary lactobacilli counts at follow-up (paired t test, difference -0.44 CFUs/mL of saliva; p < 0.001), no changes were found in salivary microbial levels. Salivary microbial counts were clearly associated with the subjects' dentition types: More denture-wearers had high microbial counts than persons with natural dentitions. None of the salivary factors correlated with the root caries incidence or the number of teeth lost during the five-year follow-up.     

Salivary clinical data and dental caries susceptibility: is there a relationship?

Caries onset and progression is influenced by diverse bacterial, dietary, environmental, socioeconomic and physiological risk factors. The most significant markers include caries experience, the concentrations of mutans-group streptococci and lactobacilli, as well as protective factors, such as the buffering capacity of saliva. The aim of this study was to evaluate and compare caries risk factors. The salivary parameters determined include: buffer capacity, cariogenic bacteria counts, pH, flow rate and total protein content. Individual aspects including hygiene and diet habits were also considered. Results showed that the value corresponding to the difference of stimulated saliva pH and resting saliva pH is positively correlated with DMFT index. Lactobacilli were positively correlated with mutans streptococci, as previously described for caries diagnostics. However, the results of this study were inconclusive, showing that salivary tests parameters either as single test or even in combination are incapable of predicting caries emphasising the importance of saliva composition.     

Caries Risk Factors in Children under Treatment with Sectional Brackets

Objective:To longitudinally investigate the caries risk levels in children undergoing orthodontic treatment with sectional brackets.Materials and Methods:A total of 42 children scheduled for orthodontic treatment with sectional orthodontic appliances participated in this study. They were divided into two groups based on decayed, missing, and filled permanent and deciduous teeth (DMFT/dmft) scores and counts of mutans streptococci (MS) prior to treatment. One was the low caries risk group (n  =  26) and the other was the high caries risk group (n  =  16). Paraffin-stimulated whole saliva was collected for examination of salivary flow rate, buffer capacity, and MS and lactobacilli (LB) levels before treatment, 2 and 4 months after appliance placement, and 2, 4, and 8 months after appliance removal.Results:The pretreatment salivary flow rates, buffer capacity, and MS levels remained statistically unchanged during and after active orthodontic treatment in both groups. The levels of LB in the high caries risk group were significantly elevated by appliance placement, but upon appliance removal started to fall significantly and came a little short of the pretreatment levels. In the low caries risk group, the pretreatment levels of LB remained statistically unchanged during and after treatment. There were no significant differences in salivary flow rate or buffer capacity, but there were significant differences in MS and LB scores between the two groups at every measurement time.Conclusions:In children undergoing orthodontic treatment with sectional brackets, LB levels are an important part in making caries risk assessment.     

Can salivary composition and high flow rate explain the low caries rate in children with familial dysautonomia?

PURPOSE: Extremely low caries rate and increased major salivary gland flow rare have been previously reported in children with familial dysautonomia (FD). The purpose of this study was to explore the possibility that, in addition to increased salivary flow, children with FD have alterations in their salivary components, which may suggest an explanauon to their low caries rate. METHODS: Whole unstimulated and stimulated saliva samples were collected from 13 children with FD who were found to be caries free, and from 28 age- and ethnic-matched healthy children, 15 caries-free children and 13 caries-affected children. The electrolyte and protein content of the unstimulated saliva and the microbial count and buffering capacity of the stimulated saliva were determined. RESULTS: Children with FD had the highest salivary flow rate and the lowest levels of mutans streptococci and lactobacilli, as well as the lowest concentration of chloride, magnesium, total protein and IgA. Healthy caries-affected children displayed the highest mutans streptococci and lactobacilli levels and lysozyme concentration, concomitantly with the lowest potassium and calcium concentrations. CONCLUSIONS: The results of this investigation suggest that the caries-free state in FD may be associated with high salivary flow rate, while in healthy children, low caries rate may be associated with high salivary calcium concentration.     

Cariogenic microorganisms and oral conditions in asthmatic children

This study evaluated the caries risk of asthmatic patients on the basis of mutans streptococci (MS) and lactobacilli levels in saliva samples as well as the index of oral hygiene and dental caries (DMFT index). The study population was composed of 80 asthmatic children, aged 3-15 years, who use specific medication, and 80 matched, healthy control children. The parents were interviewed about oral health-related factors. The World Health Organization criteria were used for dental examinations. The K?hler and Bratthal methodology was used to detect salivary MS levels and dilutions of saliva were done for lactobacilli counting. No differences between asthma and control groups were observed for caries prevalence in children aged 3-6 and 7-10 years, except in severe cases in the younger group. However, higher caries prevalence for permanent dentition was observed in 11- to 15-year-old asthmatic children. An increased dental biofilm was observed in the asthma group, as well as salivary levels of MS. No differences were observed in levels of lactobacilli. No statistical correlations were found between medication, frequency of treatment, method of consumption and caries experience, dental biofilm and salivary levels of MS or lactobacilli. However, there was a correlation between MS levels and treatment duration. The logistic regression revealed that MS level is an important risk factor for increased caries experience. Asthma should be evaluated as a risk factor for caries experience because it can increase the levels of MS and the dental biofilm.     

The effect of orthodontic treatment on salivary flow, pH, buffer capacity, and levels of mutans streptococci and lactobacilli

Fixed orthodontic treatment has been shown to cause an increased incidence of enamel demineralisation. The purpose of this study was to investigate the changes in stimulated salivary flow rate, pH, buffer capacity, and the levels of mutans streptococci (MS) and lactobacilli in patients undergoing therapy with fixed orthodontic appliances. Saliva samples, plaque index scores and dietary histories were taken from 21 sequential patients before the start of treatment, and one month and three months after placement of brackets and bands. There was a statistically significant increase in stimulated salivary flow rate, pH, buffer capacity, plaque index scores, and in the levels of MS and lactobacilli after three months of active treatment. It is postulated that the balance between the cariogenic challenge posed by high levels of MS and lactobacilli, and the reparative effects of concurrent increases in salivary flow rate, pH and buffer capacity, determines the likelihood of mineral loss or gain over time. A failure to follow basic preventive measures may increase the risk for some patients of enamel decalcification during orthodontic treatment with fixed appliances.     

Short-term effect of mastic gum on salivary concentrations of cariogenic bacteria in orthodontic patients

OBJECTIVE: To determine antibacterial activity of chewing mastic gum against the salivary levels of Streptococcus mutans, the total number of viable bacteria, and lactobacilli in patients undergoing therapy with fixed orthodontic appliances. MATERIALS AND METHODS: In this study, the levels of S mutans, lactobacilli, and total cultivated bacteria were measured before and after chewing mastic gum. The antibacterial effects of chewing mastic gum against these microorganisms in saliva were compared with a placebo gum. The counts for orthodontically treated patients were evaluated before chewing gum; just after chewing gum; and after 45, 75, 105, and 135 minutes. Saliva samples taken from the patients were inoculated onto trypticase-yeast-cystine-bacitracin agar for mutans streptococci and onto Rogosa agar for lactobacilli. The agar plates were incubated for 48 hours anaerobically at 37 degrees C. The total number of viable bacteria was then counted. RESULTS: Just after chewing the mastic gum for 15 minutes, a significant decrease of total bacteria and S mutans was observed (P < .001). The reduction in lactobacilli was not significant at later first stage (P > .05). However, at the end of 135 minutes, there were significantly fewer S mutans (P < .001), total viable bacteria (P < .001), and lactobacilli (P < .001) in the oral cavity after chewing mastic gum than after chewing paraffin (P < .001). The results show that chewing mastic gum decreased the total viable bacteria, S mutans, and lactobacilli in saliva in orthodontically treated patients with fixed appliances. CONCLUSION: Chewing mastic gum might be useful in preventing caries lesions.     

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.     

Salivary lactobacillus counts in the prediction of caries activity

Abstract The aim of the study was lo investigate the reliability and clinical value for prediction of caries activity of determining the number of lactobacilli in saliva, the salivary secretion rate and the presence of yeasts in the saliva. For this purpose one entire age group of pupils (115 14-year-olds) attending one of the compulsory 9-year comprehensive schools in Örebro was selected for longitudinal examination. Over a period of 64 weeks three clinical recordings were made and seven salivary samples were collected. The correlations between caries activity, caries frequency (DFS), lactobacillus counts, yeasts in saliva, salivary secretion rate and gingivitis were examined. The results showed that in spite of a well-organized dental health service, including adequate preventive measures, a pronounced variation in caries activity remained and thus a means of predicting the onset of caries would be a valuable asset. Statistically significant correlations were found between caries activity on the one hand and caries frequency and lactobacillus counts on the other. The lactobacillus count was found to be a suitable measure in predicting caries activity. It was concluded that the lactobacillus count should be used for caries prediction in healthy, properly treated patients. It is important that there are no areas of microbial retention on the teeth such as open carious lesions, poorly executed restorations, dentures or orthodontic bands. In such situations, the lactobacillus count seems to relied the frequency of ingested fermentable carbohydrates and thus, indirectly, the risk of initiating carious lesions.     

6-month use of 0.2% delmopinol hydrochloride in comparison with 0.2% chlorhexidine digluconate and placebo (II). Effect on plaque and salivary microflora

Abstract. This double-blind, randomised, 6-month clinical trial with parallel group design in 68 subjects with gingivitis was conducted to study the effects on the oral flora of delmopinol hydrochloride 2 mg/ml (0.2% w/v, Decapinol Mouthwash), when used for partly supervised mouthrinsing in comparison with placebo and chlorhexidine digluconate 2 mg/ml (0.2% w/v, Hibitane Dental, ICI Pharmaceuticals, UK). Apart from estimating the total cultivable microbial dental plaque flora and salivary flora, analyses were focused on bacterial groups associated with gingivitis/periodontitis and dental caries. Furthermore, the presence of staphylococci, Gram-negative enteric bacteria and yeasts in saliva were evaluated. The minimal inhibitory concentration (MIC) was determined for isolates belonging to the predominating micro-organisms in samples of both dental plaque and saliva. In relation to the findings in the placebo group, the use of delmopinol during the rinsing period did not produce an undesirable shift in the bacterial populations considered to be related to dental caries or periodontal diseases. These groups remained virtually unchanged during the study. In relation to the observations in the placebo group, slight reductions in the total cultivable plaque and salivary flora were observed during the study and no change was found in the ratio total anaerobically/aerobically cultivable microbial flora. Furthermore, no increased growth in staphylococci, enteric bacteria or yeasts was observed in the saliva samples. The pattern of changes taking place in the composition of the plaque and salivary microbial flora in samples from the participants rinsing with chlorhexidine were in most aspects similar to that observed in the delmopinol group. In the delmopinol group, no microbiologically significant changes were observed over time in the MIC-values for the isolates, neither in the plaque nor in the saliva samples, which indicates that no adaptation to delmopinol had taken place during the rinsing period. Similar observations were made for the plaque isolates in samples from the participants in the chlorhexidine group. On the other hand, when Gram-positive and catalase-negative cocci from the saliva samples of the latter group were tested against chlorhexidine, 4–6 times higher MIC-values were obtained at 3 and 6 months both when compared to baseline and in comparison with the other two rinsing groups (p<0.01 or p<0.05). Neither delmopinol nor chlorhexidine showed any residual effect on the studied microbial groups in the plaque and the saliva samples 3 months after the end of treatment. In conclusion, delmopinol was accompanied by a composition of the plaque and salivary flora associated with healthy conditions in the oral cavity.     

Short term effect of mechanical plaque control on salivary concentration of S. mutans and lactobacilli

Abstract — All visible plaque was professionally removed from teeth of 40 children who were highly infected with S. mutans and lactobacilli. Shortly before and after the removal of plaque the concentrations of those bacteria were assessed in saliva stimulated by chewing. S. mutans and lactobacilli correlated well at baseline but not after plaque elimination, e.g. more than 80% of children who were heavily infected with S. mutans could be identified by a lactobacillus test at baseline. After the elimination of plaque, the mean concentration of S. mutans dropped by 64% but lactobacilli remained unchanged. The results indicate that oral hygiene measures taken by the patient prior to sampling of saliva may mask the true concentration of salivary S. mutans and complicate the identification of high caries risk patients.     

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.     

Salivary lead in relation to caries,salivary factors and cariogenic bacteria in children

Background: Saliva has been suggested as a useful biomarker of environmental contamination, including exposure to lead. Aims: The study examined the associations between salivary lead level and the following factors: blood lead level, the number of decayed and filled surfaces (dfs) on deciduous and permanent teeth (DMFS), salivary flow rate, pH, buffer capacity, lactobacilli and mutans streptococci counts. Materials and Methods: One hundred and twenty saliva samples of children living in a shipyard area (known to be an area contaminated with lead) were analysed for lead. Clinical oral examination was conducted to define carious lesions in accordance with the criteria of the World Health Organisation. Results: The analysis revealed detectable levels of lead in a range of 0.16–28.52 μg/dl with a mean concentration of 2.26 ± 3.67 μg/dl. No significant differences in salivary lead concentrations were found in relation to gender and age. The salivary lead level significantly correlated with the blood lead level (Rs = 0.18, P = 0.05). There was no association between the salivary lead levels and dfs or DMFS. The results indicated that children with high salivary lead levels did not differ in flow rate, pH, buffer capacity of saliva from those with low lead levels. However, the number of mutans streptococci were reduced in the high salivary lead groups, while the lactobacilli count was not associated with the salivary lead levels. Conclusions: The current finding suggests that saliva may not have potential to be an appropriate alternative for biological monitoring of lead exposure.Key words: Salivary lead, dental caries, salivary flow rate, salivary pH, buffer capacity, cariogenic bacteria     

Caries and saliva in 12–18-year-old diabetics and controls

Eighty-five 12–18-yr-old adolescents suffering from insulin-dependent diabetes mellitus (IDDM) and their healthy age- and sex-matched controls were investigated with respect to dental caries, salivary flow rate, pH and buffering capacity of saliva, counts for lactobacilli and mutans streptococci, and salivary glucose content. The diabetics had their disease well controlled according to the HbA₁ levels. The results showed no statistically significant difference between diabetics and controls in DMF and DMFS indexes and the number of initial caries lesions. Mean number of initial caries lesions was 3.2 in diabetics, 2.3 in controls. Mean stimulated salivary flow rate was 1.2 ml/min in the patients, 1.4 ml/min in the controls. The pH and buffering capacity values were 7.3 and 4.8 in the patients, 7.4 and 5.1 in the controls, respectively. High counts of mutans streptococci (> 10⁶ CFU/ml) and lactobacilli (> 10⁵ CFU/ml) were observed more often, but not significantly so, among the patients than in the controls. The mean concentration of glucose in saliva was 10.3 μg/ml in the patients, 9.7 lμg/ml in the controls. Thus, if the patients' IDDM is well controlled, their salivary and caries data does not differ from that of healthy controls.     

Short term effect of mechanical plaque control on salivary concentration of S. mutans and lactobacilli

All visible plaque was professionally removed from teeth of 40 children who were highly infected with S. mutans and lactobacilli. Shortly before and after the removal of plaque the concentrations of those bacteria were assessed in saliva stimulated by chewing. S. mutans and lactobacilli correlated well at baseline but not after plaque elimination, e.g. more than 80% of children who were heavily infected with S. mutans could be identified by a lactobacillus test at baseline. After the elimination of plaque, the mean concentration of S. mutans dropped by 64% but lactobacilli remained unchanged. The results indicate that oral hygiene measures taken by the patient prior to sampling of saliva may mask the true concentration of salivary S. mutans and complicate the identification of high caries risk patients.     

Dietary and salivary factors associated with root caries

In this pilot study, dietary habits, microbial factors, and salivary factors in 20 older adults who had active decay on root surfaces were compared with those of 20 adults who had inactive or no root caries. In this case-control study, the groups were matched by sex and were of similar age. Subjects using medications known to induce dry mouth were excluded. Subjects completed a nutrition interview and a four-day food diary. Stimulated whole saliva flow rate, buffering capacity, levels of salivary lactobacilli with use of the Dentocult method, and S. mutans cultured on MSB agar were determined. The root caries group had a greater mean number of eating occasions per day (6.1 vs. 4.6), more frequent exposures to fermentable carbohydrates (5.8 vs. 4.2), and higher average daily sugars intake (133 g/day vs. 105 g/day) than the control group. Root caries subjects had significantly higher lactobacilli counts and less salivary buffering capacity. Within the root caries group, significant correlations were found with Root Caries Index and lactobacilli (r = 0.56) and S. mutans counts (r_S= 0.50). These results show that frequent intake of simple sugars, high lactobacilli counts, and low saliva buffering capacity may be risk factors associated with root caries in older adults.     

Number of mutans streptococci or lactobacilli in a total dental plaque sample does not explain the variation in caries better than the numbers in stimulated whole saliva

Abstract For practical reasons the numbers of mutans streptococci (MS) and lactobacilli (LB) in plaque are commonly estimated from saliva samples. The saliva counts are considered to be a reasonable indicator of the entire dentition's total microbial load. However, the value of salivary counts for explaining and predicting caries have been found to be low. There was therefore reason to compare the relationships between caries on the one hand and, on the other, the number of MS or LB in plaque and in saliva, respectively, in order to assess their relative merits for explaining the variation in caries, both in a total material and in subgroups with less favourable oral hygiene. Sixty children aged 14–15 years participated in the study. Caries and plaque were registered and the number of MS and LB was estimated in total plaque and in stimulated saliva samples. The results showed that the number of MS or LB in plaque did not explain the variation in caries to a greater degree than did the salivary counts. For both bacteria the explanatory values increased, as expected, in subgroups with less favourable oral hygiene, but not even at this higher level of explanation was there any difference between plaque and saliva. The LB count was a stronger explanatory variable than the MS count. It was concluded that the number of MS and LB, estimated in total plaque as well as in saliva samples, is not a useful tool in prediction.     

Antimicrobial systems of human whole saliva in relation to dental caries, cariogenic bacteria, and gingival inflammation in young adults

The association of salivary antibody (total IgA, IgG, and IgM and antibodies reactive with Streptococcus mutans) and non-antibody (lysozyme, lactoferrin, salivary peroxidase, myeloperoxidase, hypothiocyanite, thiocyanate) defense factors with oral health (past and present dental caries, gingival bleeding, the number of salivary S. mutans and lactobacilli) were studied in 50 naval recruits. Dental caries was significantly associated with large amounts of S. mutans, lactobacilli, and total salivary immunoglobulins and with low salivary flow rate and buffer capacity. Salivary anti-S. mutans antibodies did not correlate with dental caries or S. mutans levels. Moreover, none of the salivary non-antibody factors alone had any strong relationship to dental caries or S. mutans levels. Gingival inflammation was associated with elevated levels of lysozyme in whole saliva. It is concluded that in adults the associations between single-point measurements of most salivary antimicrobial constituents and the factors describing oral health are weak.