低龄儿童龋与其相关致病菌的研究进展

低龄儿童龋(ECC)是一种早期累及幼儿上颌乳前牙的严重龋损,预防其发生发展是世界卫生组织在全球范围内进行龋病预防的重要工作。致龋菌在ECC发生中起主要作用,其中变异链球菌是ECC重要的致病菌,研究主要集中在该类微生物的定植、传播和基因型;放线菌和乳杆菌是ECC儿童口腔的优势菌群,白色假丝酵母菌和双歧杆菌在儿童口腔的定植...     

一例低龄儿童龋的综合防治

低龄儿童龋（early childhood caries,ECC）包含两个主要因素,一个是年龄,即小于6岁的儿童,另外一个是任何一个乳牙的龋（无论是否成为龋洞）、失（因龋所致）、补牙数/牙面数≥1。做好ECC的早期预防,是儿童口腔保健的重要组成部分,对于ECC的综合治疗,结合儿童的生长发育特点,目的是使得患儿患龋高风险的口腔卫生状况得到有效的改善,从而恢复其口腔健康微生态,控制龋病进展和恢复牙齿的结构与功能。本文报道一例低龄儿童龋的综合防治。     

基于唾液宏蛋白质组学的重度低龄儿童龋患者唾液微生物群落分析

［摘要］ 目的 采用宏蛋白质组学技术研究重度低龄儿童龋患者唾液微生物群落的特征。方法 采集重度低龄儿童龋及无龋儿童非刺激性唾液,提取唾液中的蛋白质、酶解形成多肽后进行质谱分析,对比微生物库分析唾液微生物群落的特征。结果 无龋儿童唾液微生物来源于19个门1 216个种,高丰度的微生物以变形菌门、厚壁菌门、拟杆菌门、放线菌门、梭杆菌门以及乳糖奈瑟氏菌、肺炎链球菌、干燥奈瑟氏菌、副流感嗜血杆菌、脑膜炎奈瑟氏菌、流感嗜血杆菌、浅黄奈瑟氏菌、淋病奈瑟氏菌、金氏金菌、黏膜奈瑟氏菌、多糖奈瑟氏菌等11种细菌为主;重度低龄儿童龋儿童唾液微生物来源于24个门1 698个种,高丰度的微生物以变形菌门、厚壁菌门、拟杆菌门、放线菌门、蓝藻菌门以及肺炎链球菌、乳糖奈瑟氏菌、干燥奈瑟氏菌、流感嗜血杆菌等4种细菌为主。结论 宏蛋白质组技术可以全面、快速分析口腔唾液微生物群落的构成。重度低龄儿童龋儿童唾液微生物群落结构相比无龋儿童更加复杂,这种复杂性可能与龋病的产生及唾液微生态失衡有关。     

海淀区0～3岁婴幼儿龋危险因素的分析研究

目的 探讨低龄儿童龋(early childhood caries,ECC)与口腔健康行为的相关关系,为0～3岁婴幼儿龋病的综合防治提供科学依据.方法 纳入395名1岁以下无龋儿童进行2年的纵向观察,每半年定期口腔检查和问卷调查,对家长进行口腔健康指导.统计分析喂养、口腔卫生状况、定期口腔检查等因素与ECC的相关性.结果 进入课题观察终点253人,平均月龄(27.67±5.98)个月,患龋率36.76％,龋均1.04±1.68.口腔卫生状况、检查次数、奶瓶喂养、夜间喂养、睡前进食后清洁和刷牙频率是ECC的影响因素(P<0.05).口腔检查次数是婴幼儿龋的重要负相关影响因素(P<0.05),每增加1次口腔检查,患龋风险降低61.6％.结论 定期口腔检查和菌斑控制是预防婴幼儿龋的关键因素.     

北京市海淀区13所幼儿园3岁儿童龋病患病趋势调查

目的了解北京市海淀区3岁儿童2012～2015年间乳牙龋病的患病趋势,为海淀区低龄儿童龋病防治工作提供依据。方法 2012～2015年间对北京市海淀区13所幼儿园3岁儿童,连续4年进行口腔健康状况调查,采用WHO推荐的检查方法和龋病诊断标准,调查海淀区3岁儿童乳牙龋病的患病趋势。口腔检查由2年以上工作经验的儿童口腔医生进行,所有的检查者都经过培训和校准。结果 4年来13所幼儿园3岁儿童的患龋率为46.26%～51.62%,逐年上升(P<0.05),平均48.78%。龋均(dft)2.06～2.57,龋面均(dfs)2.63～3.37,重度低龄儿童龋(SECC)患病率为22.09%～29.54%,龋均、龋面均和SECC患病率从2012年到2014年呈上升的趋势,2015年略有下降,差异有统计学意义(P<0.01)。患龋儿童接受治疗的百分比为79.14%～41.46%,龋补充填比(ft/dft)为65.09%～31.45%,二者从2012年到2014年呈下降的趋势,2015年明显有回升,差异有统计学意义(P<0.01)。结论近年来3岁儿童患龋率逐年上升,低龄化趋势明显,患龋严重程度呈上升趋势。     

家庭口腔健康行为对儿童龋齿危险因素的影响

龋齿危险因素包括唾液及菌斑中致龋微生物的计数、唾液及菌斑中无机离子的含量、宿主牙的再矿化能力等,可在一定程度上预测龋病的发生,口腔健康行为密切影响儿童龋病的发生,儿童的行为在很大程度上又受家长的影响,作者就父母及儿童的口腔健康行为对儿童龋齿危险因素的影响作一综述,以助有效地预测儿童龋病的发生。     

常用分子检测技术在儿童龋病微生物多样性研究中的应用

龋病是口内常见的慢性、感染性疾病,在儿童中的发病率呈上升趋势。微生物是引起龋病的主要因素之一,对于致龋微生物的种类、致龋机制及其多样性是目前口腔微生物学的研究热点。随着现代分子生物学技术的不断发展,分子检测技术被广泛用于微生物的研究中,早期检测及预防对降低儿童龋病发病率有重要作用。本综述着重论述常用分子检测技术在儿童龋病微生物多样性研究方面的应用,并对未来儿童口腔微生物多样性方面的研究进行展望。     

与重症低龄儿童龋病相关的唾液微生物群落研究

目的通过高通量测序技术研究重症低龄儿童龋病和健康者唾液的菌群结构及其差异。方法 在青岛市崂山区儿童中,经口腔检查选取健康（H组）和重症低龄龋病（C组）儿童各24名,采取唾液样本,提取其DNA进行聚合酶链式反应扩增,利用454测序平台对16S rRNA V1—V3区进行双端测序,对细菌群落结构及多样性进行差异分析。结果 C组唾液菌群物种丰度高于H组（P<0.05）,两组唾液菌群结构的差异有统计学意义（P<0.01）,且C组的群落结构更为相似和保守（P<0.001）;鉴别出C组高表达的可疑致龋微生物（P<0.1）及H组高表达的健康相关微生物（P<0.1）;基于唾液菌属图谱建立的龋病风险评估模型区分健康和龋病者的准确率可高达70%以上。结论 唾液菌群和特定细菌种类,如比例升高的Prevotella菌属有助于评估和筛选低龄儿童龋病风险。     

基于慢性疾病管理理念的重度低龄儿童龋管理方法

重度低龄儿童龋是威胁中国儿童口腔健康的主要疾病。目前中国龋病治疗的主要手段是充填修复,对重度低龄儿童龋患者,充填修复具有患儿难配合、新发龋多、经济及医疗负担重等局限之处。随着对龋病病因学和疾病过程的深入理解,学界提出了基于慢性疾病管理思路的龋病管理模式,通过对致龋因子和保护因子的干预来改善口腔环境,由单纯的去除龋坏组织转向控制龋病的疾病进程,由此来改善龋病的治疗效果。本文以龋病的慢性疾病管理方法及国外本专业学术组织发布的指南进行回顾综述,为中国重度低龄儿童龋防治提供参考。     

唾液蛋白作为低龄儿童龋预测标志物的研究进展

低龄儿童龋(ECC)进展迅速,早期诊断困难,严重影响儿童的身心健康.实现对龋高危儿童的早期预测和预防干预是控制ECC的有效手段.随着蛋白质组学技术的发展,唾液蛋白正展现出用于疾病预测和早期诊断的强大优势.唾液蛋白通过多种天然防御机制调节口腔微生态环境,在ECC的控制中发挥重要作用;其水平高低与宿主龋易感性相关,是潜在的...     

Cariogenic microbiome and microbiota of the early primary dentition: A contemporary overview

Recent advances in the field of molecular microbiology provide an unprecedented opportunity to decipher the vast diversity of the oral microbiome in health and disease. Here, we provide a contemporary overview of the oral microbiome and the microbiota of early childhood caries (ECC) with particular reference to newer analytical techniques. A MEDLINE search revealed a total of 20 metagenomic studies describing cariogenic microbiomes of ECC, 10 of which also detailed the healthy microbiomes. In addition, seven studies on site‐specific microbiomes, focusing on acidogenic and aciduric microbiota of deep‐dentinal lesions, were also reviewed. These studies evaluated plaque and saliva of children aged 1.5–11 years, in cohorts of 12–485 individuals. These studies reveal a very rich and diverse microbial communities, with hundreds of different phylotypes and microbial species, including novel species and phyla such as Scardovia wiggsiae, Slackia exigua, Granulicatella elegans, Firmicutes in the plaque biofilms of children with ECC. On the contrary, bacteria such as Streptococcus cristatus, S. gordonii, S. sanguinis, Corynebacterium matruchotii, and Neisseria flavescens were common in plaque biofilm of noncarious, healthy, tooth surfaces in subjects with caries. The review illustrates the immense complexity and the diversity of the human oral microbiota of the cariogenic plaque microbiome in ECC, and the daunting prospect of its demystification.     

菌斑微生物群落构成变化与儿童龋病相关研究进展

龋病作为多因素影响的疾病,细菌是龋病发生的始动因素,生态菌斑学说的提出以及现代分子生物学手段的应用,使得学者们能够从微生物角度对菌斑生物膜中细菌的种群分布、菌群多样性、菌斑微生物群落变化与儿童龋病之间的联系进行了更深入的探讨.菌群多样性的降低与龋病发生密切相关,早于龋病发生前的6个月就可以检测到菌群多样性水平的降低,这...     

A comparative study of Streptococcus mutans and lactobacilli in mothers and children with severe early childhood caries (SECC) versus a caries free group of children and their corresponding mothers

Early childhood caries (ECC) is recognized as an infectious disease. The first step in its development is primary infection by the bacterium S. mutans which has been identified as the primary etiologic factors in dental caries. Lactobacilli were also found to play a role in the progression of the disease. However, the underlying mechanism of immune response to caries is still unclear. The purpose of this study was to assess the level of cariogenic bacteria namely S. mutans and lactobacilli in caries free children, and children with SECC and their corresponding mothers. he study also aims at correlating the children's levels to their mothers. Sixty children and their mothers attending the dental clinic in King Abdulaziz University participated in our study. Their age ranged from 3 - 5 years. The study groups consisted of 30 children with SECC and a control group comprising of 30 caries free children. Children together with their mothers were examined and their caries level was recorded. Stimulated saliva was collected from each participant for bacterial, immunological assessment, and Lactobacilli counts in each sample were determined Children with SECC had higher levels of S. mutans and Lactobacilli than caries free children. The mothers of children with SECC had a statistically higher count of Lactobacilli than caries free children's mothers. However, the difference was not statistically significant with respect to their S. mutans counts. A significant relationship exists among the mother-child pair in the SECC group with respect to S. mutans level in saliva.     

pH-responsive DMAEM Monomer for dental caries inhibition

Previous research indicated that there is an aggregate of microorganism in oral cavity which takes part in promoting the occurrence of dental caries, but few studies on anticaries materials for these ‘core microbiome’ were developed. And We’ve found that DMAEM monomer has an obvious inhibitory effect on the growth of Streptococcus mutans and saliva biofilm, but the effect of that on the "core microbiome" of caries need further research. Thus, the objectives of this study were to explore the effect of DMAEM monomer on the core microbiota of dental caries, and to further study its anticaries effect. The changes of microbial structure and metabolic activity of the core microbiota biofilm were detected through measuring lactic acid yield, viable bacteria counts and demineralization depth, et al., and the anticaries potential in vivo of DMAEM monomer was evaluated by rat caries model. Meanwhile, high-throughput sequencing was used to analyze the microbial diversity change of saliva samples of rats. The results showed that DMAEM monomer could inhibit the growth of the core microbiota biofilm, decrease the metabolic activity and the acid production, as well as reduce the ability of demineralization under acidic conditions. Moreover, the degree of caries in the DMAEM group was significantly reduced, and the diversity and the evenness of oral microecology in the rats were statistically higher. In summary, DMAEM monomer could respond to acidic environment, significantly inhibit the cariogenic ability of the ‘core microbiome’ of caries, and help to maintain the microecological balance of oral cavity.     

磨牙-切牙釉质矿化不全的研究进展

磨牙-切牙釉质矿化不全（MIH）是釉质矿化不全的一种,系指全身因素引起一个或一个以上的第一恒磨牙釉质矿化不全,常伴切牙受累。MIH病因不明,一般认为与患儿3岁以前的全身情况或环境相关,也有人认为与遗传相关。其患病率因诊断标准、人群数量和年龄范围以及不同国家和地区而变化较大。临床表现主要为磨牙和切牙釉质颜色变化,釉质崩解,易患龋,高敏感性等,有些第一恒磨牙甚至因龋坏严重而早期拔除。治疗上,根据患牙的不同发育阶段、病变的严重程度,所偏重的方法不同,需要综合考虑,选择最适合的方法,但需注意患儿的敏感性问题和行为管理问题。本文就磨牙-切牙釉质矿化不全的患病率、病因、理化特点、临床表现、诊断和治疗作一综述。     

A comparative study of the secretory IgA immunoglobulins (s.IgA) in mothers and children with SECC versus a caries free group children and their mothers

Early childhood caries (ECC) is recognized as an infectious disease. The first step in its development is primary infection by the bacterium S. mutans which has been identified as the primary etiologic factors in dental caries. Lactobacilli were also found to play a role in the progression of disease. However the underlying mechanism of immune response to caries is unclear. The association between secretory IgA (s.IgA) and cariogenic microorganisms is still controversial. The purpose of this study was to assess the level of salivary IgA in caries free children, and children with SECC and their corresponding mothers. The study also aims at correlating the children's levels to their mothers'. Sixty children and their mothers attending the dental clinic in King Abdulaziz University participated in our study. Their age ranged from 3 - 5 years. The study groups consisted of thirty children with SECC and a control group consisting of thirty caries free children. Children together with their mothers were examined and their caries level was recorded. Stimulated saliva was collected from each participant for immunological assessment. The secretory IgA (s. IgA) level was assessed by ELISA test. Our study has shown that children with SECC and their mothers had higher levels of s. IgA than the caries free children and their mothers. A positive high correlation was found between secretory IgA of mothers and children in both groups.     

Early childhood caries: an overview with reference to our experience in California

Dental caries in young children frequently appears first on the maxillary primary incisors, where the liquids ingested by the infant sucking on a bottle or breast remain pooled away from salivary flow. This so-called early childhood caries can rapidly progress to result in rampant destruction of the primary dentition. ECC can affect children from all socioeconomic classes but is most often found in children of new immigrants or those with lower socioeconomic status. The treatment of ECC is costly, and treatment relapses are frequent. Prevention and treatment of ECC focus on inhibition of the growth of oral bacteria. Strategies include reducing the frequency of exposure to bacterial substrates, as well as controlling the growth of oral bacteria. Topical antibacterials such as 10 percent povidone iodine show promise for future use in the inhibition of ECC in young children.     

Biological mechanisms of early childhood caries

The present paper reviews biological issues in early childhood caries (ECC) in light of the current understanding of the field. Despite the general global decline in dental caries in the past decades, ECC has become a significant problem in many developing countries and some minority communities in western industrialized nations. Like other types of caries, ECC is caused by mutans streptococci that ferment dietary carbohydrates to produce acid attacks on susceptible teeth over a period of time. However, while the general etiology of ECC appears similar to that of other types of caries, the predisposing factors are still unclear. The biology of ECC may be modified by several factors unique to young children, related to the implantation of cariogenic bacteria, immaturity of the host defense systems, as well as behavioral patterns associated with feeding and oral hygiene in early childhood.     

Genotypic diversity of Streptococcus mutans and Streptococcus sobrinus in 3-4-year-old children with severe caries or without caries

International Journal of Paediatric Dentistry 2011; 21: 422–431 Background. The genotypic diversity of both Streptococcus mutans and Streptococcus sobrinus in children with different caries experience remains unclear. Aim. To investigate the genotypic diversity of S. mutans and S. sobrinus in children with severe early childhood caries (SECC) and in caries‐free (CF) children. Methods. Stimulated saliva of 87 SECC and 91 CF children aged 3–4 years was collected and submitted to cultivation, and MS colonies were enumerated. The genomic fingerprint analysis of S. mutans and S. sobrinus was carried out using AP‐PCR. Results. One to five genotypes of S. mutans were colonized in an oral cavity of SECC and CF children; 85.5% SECC children and 57.9% CF children harboured more than one genotype of S. mutans. One to three genotypes of S. sobrinus were detected from each SECC child; 31.25% SECC children harboured more than one genotype of S. sobrinus. And one genotype was colonized in each CF child. S. mutans isolates from different individuals displayed distinctive DNA fingerprints. Conclusions. DNA fingerprints of S. mutans and S. sobrinus isolates from 3‐ to 4‐year‐old children displayed genetic polymorphism, and S. mutans has greater genetic diversity than S. sobrinus. SECC children harboured more genotypes of S. mutans and S. sobrinus than CF children.