Prevention of caries in children by preventive and operative dental care for mothers in rural Anatolia, Turkey

The aim of this study was to prevent or delay the transmission of cariogenic bacteria, and hence the early development of caries in children, by preventive methods targeted at the mother. This field study was carried out in rural southeastern Anatolia, Turkey, where access to dental care is limited. Twenty-seven mother-infant pairs were followed for 2 years. The infants were between 2 and 18 months old when the study began. Mothers in the control group (n = 12) received a simple care and advice program, and those in the test group (n = 15) followed a preventive and operative regimen. The occurrence and the incremental occurrence of caries in the mothers and children in both groups were determined annually. Using a commercial kit, levels of mutans streptococci and lactobacilli in saliva and plaque were measured in the children at 6-month intervals. The microbial data demonstrated that the children of mothers in the test group had significant reductions in mutans streptococci and lactobacilli in plaque (P< 0.001), whereas no such trend was observed in control children during the 24-month monitoring period (P> 0.05). After 12 months, the occurrence of caries (dfs) was significantly lower in the test group than in the control group (0.13+/-0.35 vs 1.67+/-1.30, respectively; P< 0.001). A similar difference was observed after 24 months (0.2+/-0.56 vs 3.17+/-1.70, respectively; P< 0.001). The results of this 2-year study demonstrate that a preventive and operative regimen designed to reduce oral bacterial levels in mothers can be remarkably effective in reducing the incidence of caries in infants in rural southeastern Anatolia. Owing to the prevalence of a traditional lifestyle based on close-knit families and clans, this region is an advantageous environment for the reduction of bacterial transmission from mother to child, while largely excluding other sources of infection for the child.     

Dental caries and caries-associated microorganisms in Uruguayan preschool children

The prevalence of dental caries was studied in 3-5-year-old Uruguayan children (n = 76) living in 2 areas with different socioeconomic and cultural conditions. More children from the low socioeconomic area of Las Acacias had caries (68%) than children from the middle- to high-class neighborhood of Pocitos (19%). They also had poorer oral hygiene and a significantly higher caries prevalence (P &lt; 0.05) than those from Pocitos. The occurrence of mutans streptococci and lactobacilli was determined in whole unstimulated saliva and compared with that in debris collected with a loop from the dorsum of the tongue. Mutans streptococci were detected in 42% of the children with significant correlations between the salivary levels of the microorganism and caries experience. Lactobacilli were recovered less frequently (18%). The detection of mutans streptococci in the tongue-loop samples was significantly correlated with that in whole saliva.     

Mutans streptococci and lactobacilli in saliva after the application of fissure sealants

Because dental fissures may serve as reservoirs for mutans streptococci, preventive measures should be taken to control microbial concentrations at these sites. This study estimated the influence that sealing permanent first molars would have on the levels of mutans streptococci and lactobacilli in saliva of healthy seven-year-old schoolchildren. Permanent first molars were sealed in 31 children without caries (NC group) and in 32 children with caries (C group). None of the children had caries in their permanent first molars. Conventional methods were used to count mutans streptococci and lactobacilli in saliva before applying the sealant and again at 4 and 12 weeks after application. Baseline counts of lactobacilli and mutans streptococci were significantly higher in the C group. A significant reduction in mutans streptococci was observed in the NC group at 4 and 12 weeks. It was concluded that fissure sealants in permanent first molars can help reduce salivary levels of mutans streptococci in children without caries.     

Salivary levels of Bifidobacteria in caries‐free and caries‐active children

International Journal of Paediatric Dentistry 2013; 23: 32–38 Background Salivary levels of Bifidobacteria have been shown to be significantly correlated with caries experience in adults but not as yet in children. Hypothesis. Salivary levels of Bifidobacteria are positively associated with caries experience in children. Aim. To compare the salivary concentrations of Bifidobacteria of caries‐free and caries‐active children. Design. Saliva was collected using the tongue‐loop method from 38 caries‐active children and from 22 clinically caries‐free children, and the numbers of Bifidobacteria, mutans streptococci, lactobacilli and yeasts were determined. Additionally, the age and gender of the children, a plaque index, sugar amount in diet, sugar frequency in diet, hygiene practice and fluoride toothpaste usage were recorded. Results. Bifidobacteria were isolated from 95% of the caries‐active children and from only 9% of the caries‐free children (P < 0.001). Salivary levels of Bifidobacteria were significantly correlated with amount of sugar in the diet, frequency of sugar consumption and oral hygiene practice. The significant variables that discriminated between the caries‐free and caries‐active subjects were salivary levels of Bifidobacteria, salivary levels of mutans streptococci and oral hygiene practice (χ² = 72.57, P < 0.001) and overall 90.0% of cases were correctly classified. Conclusions. Salivary levels of Bifidobacteria are significantly associated with caries experience in children. The salivary levels of this genus may be a useful marker of caries risk.     

Dental health and oral mutans streptococci in 2-4-year-old Estonian children

Objective. The aim of this study was to assess the dental health and presence of mutans streptococci (MS) in 2–4‐year‐old Estonian children. Methods. The dental health of 472 2–4‐year‐old children was examined using a mirror and a penlight in 14 daycare centres representing seven communities around Estonia. The mean (± SD) age of the children was 41.4 ± 4.1 months (n = 222). Plaque samples of 222 children were employed to determine the presence of MS using the Dentocult® SM Strip mutans test. Results. Caries was diagnosed in 42% of the children, and the average (± SD) dmft index was 1.6 ± 2.5, ranging from 1.1 ± 1.2 in Tartu to 2.4 ± 3.1 in Võru. The proportion of caries‐free children decreased from 82% in the younger to 63% in the older group (P = 0.001). Among the tested subjects, 58% were colonized with MS, and those with caries were colonized more often than children with no visible caries (80% and 51%, respectively; P = 0.001). Conclusions. The prevalence of dental caries in Estonian 2–4‐year‐olds is higher than in the Nordic countries, but similar to other Baltic nations. Colonization by MS was associated with dental caries.     

Mutans streptococci, lactobacilli and caries experience in 12-year-old Icelandic urban children, 1984 and 1991

Abstract In order to evaluate changes in salivary counts of cariogenic bacteria and relate these to trends in caries experience, stimulated saliva was collected from a 20% random sample of 12-yr-old residents of Reykjavik. Iceland (252 children) in 1991 under conditions consistent with those of a survey conducted in 1984. The mean and median counts of salivary mutans streptococci and lactobacilli remained similar in the two studies. However, the frequency distribution at lower levels of mutans streptococci differed significantly between 1991 and 1984, e.g. in the present study 25.8% of the children had < 10⁵ compared with 13.8% in the study 1984. The mean caries prevalence in the permanent dentition (DFS_tot) was 11.0, which is significantly lower than in 1984 (mean DFS_tot 28.8). A significant difference in caries prevalence was found at various levels of salivary mutans streptococci. Strep. mutans (serotype c/e/f) was carried by all mutans streptococci-positive children, save one child, who carried only Strep. sobrinus. The proportion of 12-yr-olds who carried Strep, sobrinus had decreased significantly to 15.7% from 34.0% in 1984. Significantly more children with Strep. sobrinus showed high levels of total mutans streptococci than children with only Strep. mutans. As the case was in 1984 significantly more Strep. sobrinus carriers had a high level of salivary lactobacilli as well as higher caries prevalence than the children who did not carry this species.     

Caries experience and streptococci and lactobacilli salivary levels in 6-8-year-old Sardinians

Objectives. The aim of this investigation was to compare clinical data regarding oral status (DMFT/DMFS indices) and streptococci or lactobacilli counts in stimulated whole saliva in two groups of children, aged 6 and 8 years. Methods. Seventy‐nine boys and 93 girls aged 6 (84 subjects) and 8 (88 subjects) years old were selected. DMFT/dmft, DMFS/dmfs and OHI‐S indices were recorded. Mutans streptococci (Sm) and lactobacilli (Lb) salivary levels were assessed using commercially available strip tests and were rated from 0 to 3 and from 0 to 4 in the group as a whole. Results. Mean dmfs was 9·06 ± 10·80, made up of ds = 7·28 ± 9·54, fs = 1·19 ± 3·64 and ms = 0·59 ± 3·47. Mean DMFS was 0·73 ± 1·91, made of DS = 0·54 ± 1·29, FS = 0·08 ± 0·56 and MS = 0·11 ± 0·56. Statistically significant differences were found for both Sm and Lb scores between those with and without caries in the primary teeth (P < 0·05). The different Lb scores were also significant in relation to caries in permanent teeth in older children. Conclusion. A high proportion of children had some caries experience, and were in need of treatment.     

奥丽汀健齿露对龋病活跃性的影响

目的 通过检测龋病活跃性的变化,了解奥丽汀健齿露(主要成分为鸡卵黄抗体-IgY)的被动免疫防龋效果。方法 将72名3-4岁健康幼儿随机分为2组:使用奥丽汀健齿露组和使用安慰剂组。健齿露组每日晚上睡前喷服,连服2个月为1疗程。安慰剂组同法进行。实验前、后各进行1次变形链球菌菌落的测定(Dentocult SM)、乳酸杆菌计数(Dentocult LB)和变形链球菌产酸能力的测定(Cariostat,CAT)3种龋病活跃性的检测,观察龋病活跃性的变化情况。结果 健齿露组自身实验前、后龋病活跃性的减弱差异有显著性(P<0.01);与安慰剂组比较,实验后龋病活跃性的差异有显著性(P<0.01)。结论奥丽汀健齿露能有效降低机体的龋病活跃性,在预防龋病的发生、发展中能起到一定的作用;对幼儿为一种操作简便、见效快捷的防龋新方法。     

Mother and youth access (MAYA) maternal chlorhexidine, counselling and paediatric fluoride varnish randomized clinical trial to prevent early childhood caries

International Journal of Paediatric Dentistry 2012; 22: 169–179 Background. Mexican‐American children have a higher caries prevalence than the US average. The Mothers and Youth Access (MAYA) study was a randomized clinical trial initiated to address this problem. Aim. Comparison of the efficacy of two prevention interventions in reducing early childhood caries (ECC). Design. All 361 randomized mother–child dyads received oral health counselling. Beginning at 4 months postpartum, intervention mothers received chlorhexidine (CHX) mouthrinse for 3 months beginning 4 months postpartum and children received fluoride varnish (FV) every 6 months from age 12–36 months. Control group children received FV if precavitated lesions developed. Salivary mutans streptococci (MS) and lactobacilli were assessed. Results. No significant difference in children’s 36‐month caries incidence between groups; 34% in each group developed caries [(d₂₊fs) > 0]. About half of control group developed precavitated lesions and received therapeutic FV. Maternal MS levels declined during CHX use, but increased when discontinued. Conclusions. Maternal postpartum CHX regimen, oral health counselling and preventive child FV applications were not more efficacious than maternal counselling with child therapeutic FV for precavitated lesions for ECC prevention. FV for young children with brief maternal CHX use and oral health counselling may need to be combined with additional or longer‐term therapies to significantly reduce ECC in high‐risk populations.     

Lactobacillus-mediated interference of mutans streptococci in caries-free vs. caries-active subjects

In order to assess whether naturally occurring oral lactobacilli have probiotic properties, lactobacilli were isolated from saliva and plaque from children and adolescents, with or without caries lesions. The interference capacities of these lactobacilli were investigated against a panel of 13 clinical isolates and reference strains of Streptococcus mutans and Streptococcus sobrinus, as well as against the subject's autologous mutans streptococci, using the agar-overlay technique. Lactobacillus-mediated inhibition differed significantly between the three subject groups (no caries, arrested caries, or active caries), demonstrating increased inhibition in subjects without present or previous caries experience compared to subjects with arrested caries or subjects presenting with frank lesions. Lactobacilli from subjects lacking S. mutans inhibited the growth of the test panel of mutans streptococci significantly better than lactobacilli from subjects who were colonized. Furthermore, subjects without caries experience harbored lactobacilli that more effectively repressed the growth of their autologous mutans streptococci. Twenty-three Lactobacillus spp. completely inhibited the growth of all mutans streptococci tested. Species with maximum interference capacity against mutans streptococci included Lactobacillus paracasei, Lactobacillus plantarum, and Lactobacillus rhamnosus. Naturally occurring oral lactobacilli significantly inhibited the growth of both test strains of mutans streptococci and the subject's autologous mutans streptococci in vitro, and this effect was more pronounced in caries-free subjects.     

Mutans streptococci and lactobacilli in breast-fed children with rampant caries.

This study aimed to investigate the prevalence of selected components of the oral microflora in breast-fed children who developed rampant caries (resembling nursing caries) under hitherto unexplained circumstances. Dental plaque and saliva samples were collected from breast-fed children, aged between 1 and 2.5 years, with and without rampant caries. Mutans streptococci and lactobacilli were isolated from dental plaque of all children with rampant caries and from most caries-free children. None of the colonies of mutans streptococci resembled those of Streptococcus sobrinus. The mean counts of the mutans streptococci and lactobacilli were 100-fold higher in plaque samples from children with rampant caries as compared with caries-free children. No difference could be found between the numbers of mutans streptococci in plaque overlaying cavities and that from adjacent sound enamel. In contrast, the counts of lactobacilli in plaque were approximately 100-fold higher from cavities than from sound surfaces. The levels of mutans streptococci in saliva were directly related to the presence of rampant caries. The results show that caries-free and caries-active breast-fed children, aged 1 to 2.5 years, harbour mutans streptococci and lactobacilli on their teeth. Rampant caries in these children can occur in the absence of nursing bottles or any other feeding abuse during weaning and in the presence of an aciduric plaque microflora, as has been reported for children with nursing bottle caries.     

Streptococcus mutans establishment and dental caries experience in children from 2 to 4 years old

Abstract – 39 children were studied longitudinally at the age of 2, 3, and 4 yr for the colonization of S. mutans in plaque and saliva and for caries experience. S. mutans was found in 38% of the children, and the predominant serotype group was c/e/f. A total of 16 children got caries before the age of 4. Children who harbored S. mutans in their plaque at the age of 2, appeared to be the most caries-active individuals. Their caries index values (number of decayed, missed and filled surfaces, dmfs = 10.6±5.3) at the age of 4 differed significantly from the values of children who harbored S. mutans later (dmfs = 3.4±1.8,P<0.005) or remained free from S. mutans infection (dmfs = 0.3±1.1, P<0.0003). It was thus concluded that the early establishment of S. mutans in the plaque of primary incisors indicated early and extensive caries attack in young primary dentition.     

A controlled,longitudinal study of home visits compared to telephone contacts to prevent early childhood caries

International Journal of Paediatric Dentistry 2013; 23: 23–31 Background. Home visits (HV) provide excellent opportunities for health promotion. Aim. This longitudinal study compared the effects of HV and telephone contacts (TC) in preventing early childhood caries (ECC) and colonisation of mutans streptococci (MS) and lactobacilli (LB) from 0 to 24 months. Design. A total of 325 children were recruited from community health centres at mean age of 42 days, and randomly assigned to receive either HV or TC. A total of 188 children completed three, 6 monthly HV, and another 58 had three, 6 monthly TC. An additional 40 age‐matched children from childcare facilities served as reference controls (RC). At 24 months, all groups were examined at a community dental clinic. Results. At 24 months, three HV children of 188 (1.5%) had caries, compared to four TC of 58 (6.8%) and nine RC of 40 (22.5%) (P < 0.001 for HV versus RC; P = 0.05 for HV versus TC and P = 0.03 for TC versus RC). There were also more children with MS in the TC (47%) and RC (35%) compared to HV (28%) group (P = 0.01 and P = 0.02). Conclusions. Home visits and telephone contacts conducted 6 monthly from birth are effective in reducing ECC prevalence by 24 months.     

Comparison of levels of mutans streptococci and lactobacilli in children with nursing bottle caries,rampant caries,healthy children with 3-5 dmft/DMFT and healthy caries free children

Ten children from each group of nursing caries, rampant caries, 3-5 dmft/DMFT and caries free children were selected and plaque samples from carious lesion, early carious lesion, sound tooth surface as well as salivary sample were collected. The levels of mutans streptococci and lactobacilli were estimated at all the sample sites. The result further supported the role of mutans streptococci in the initiation and of lactobacilli in the progression of the dental caries.     

Dental caries and caries-associated microorganisms in Uruguayan preschool children

The prevalence of dental caries was studied in 3-5-year-old Uruguayan children (n = 76) living in 2 areas with different socioeconomic and cultural conditions. More children from the low socioeconomic area of Las Acacias had caries (68%) than children from the middle- to high-class neighborhood of Pocitos (19%). They also had poorer oral hygiene and a significantly higher caries prevalence (P < 0.05) than those from Pocitos. The occurrence of mutans streptococci and lactobacilli was determined in whole unstimulated saliva and compared with that in debris collected with a loop from the dorsum of the tongue. Mutans streptococci were detected in 42% of the children with significant correlations between the salivary levels of the microorganism and caries experience. Lactobacilli were recovered less frequently (18%). The detection of mutans streptococci in the tongue-loop samples was significantly correlated with that in whole saliva.     

Mutans streptococci, lactobacilli and caries prevalence in 11-and 12-year-old Icelandic children

Since the caries prevalence has not declined in Iceland as it has in other European countries, it was of interest to study the presence of cariogenic bacteria in Icelandic children. The prevalence of salivary mutans streptococci and lactobacilli was examined in 217 11- and 12-yr-old Icelandic children and was related to their caries prevalence. In 2% of the children mutans streptococci were not found whereas 31% and 35% of the 11-yr-olds and 12-yr-olds respectively carried more than 10(6) CFU per ml saliva. Lactobacilli were not detected in 8% of the children whereas 28% of the 11-yr-olds and 23% of the 12-yr-olds had more than 10(5) CFU per ml saliva. The mean caries prevalence (DFS), initial caries included, for 11-yr-olds was 21.6 and for 12-yr-olds 28.8. Both mutans streptococci and lactobacilli were significantly correlated to each other as well as to caries prevalence. An increased number of these microorganisms, especially the mutans streptococci, were associated with an increased DFS. Children with high salivary counts of mutans streptococci and lactobacilli showed four times higher DFS than children with low numbers. The magnitude of salivary cariogenic bacteria as well as caries prevalence was found to resemble the situation in Sweden 10 yr ago. S. mutans (serotype c/e/f) was carried by all mutans streptococci positive children. S. sobrinus (serotype d/g) was found in 60 children (30.2%). Children with both S. mutans and S. sobrinus had significantly higher salivary counts of mutans streptococci and lactobacilli as well as caries prevalence than children with only S. mutans.     

Lactobacillus paracasei SD1, a novel probiotic,reduces mutans streptococci in human volunteers: a randomized placebo-controlled trial

Objectives

The present study investigates the effect of an oral Lactobacillus paracasei SD1 isolate on a number of salivary mutans streptococci, lactobacilli, and yeasts and to examine whether the strain could persist in the oral cavity after a short period of consumption. The potential side effect of the probiotic was also evaluated.

Material and methods

After informed consent, 40 healthy young adults were recruited and randomly assigned to either the test (A) or placebo (B) groups. Group A received milk powder contained L. paracasei SD1, and group B received standard milk powder once daily for 4 weeks. Salivary mutans streptococci, lactobacilli, and yeasts were enumerated using quantitative differential culture at the baseline and then once a week for 4 weeks after the administration period. The persistence of L. paracasei SD1 was also investigated using AP-PCR for the DNA fingerprinting.

Results

A statistically significant reduction in mutans streptococci counts occurred within group A compared to the baseline B (P?<?0.05) along with a non-statistically significant reduction in yeast counts. A significant increase in lactobacilli numbers occurred in group A (P?<?0.05), and the probiotic strain could be detected up to 4 weeks following cessation of dosing.

Conclusions

Our results demonstrate that short-term daily ingestion of the human-derived probiotic L. paracasei SD1 reduces the number of oral mutans streptococci.

Clinical Relevance

L. paracasei SD1 may help to decrease the risk of dental caries, and this organism may be a useful probiotic organism for dairy products.     

Mutans streptococci and lactobacilli in saliva from children with insulin-dependent diabetes mellitus

The quantitative distribution of mutans streptococci and lactobacilli in saliva of insulin-dependent diabetic children was compared with a group of healthy children and related to the metabolic control of the disease. The study group, consisting of 94 boys and girls (age 4-19) with type 1 diabetes was matched by sex and age with a non-diabetic control group. Stimulated whole saliva was collected and flow rate, buffer capacity and the levels of mutans streptococci and lactobacilli were analysed in all children. In the diabetic group, total salivary proteins and glucose content of saliva were determined. Data on caries experience were recorded from the dental cards of all children. There were no difference in the distribution or number of mutans streptococci between the groups, but significantly (p less than 0.05) lower levels of lactobacilli were found among the diabetic children. The number of lactobacilli was positively correlated (p less than 0.05) to glucose concentration in saliva. There was no difference in the prevalence of caries between the groups. The present findings suggest that the dietary treatment of young insulin dependent diabetics gives rise to a reduced number of lactobacilli in saliva but does not affect the mutans streptococci.     

Dental caries and prolonged breast-feeding in 18-month-old Swedish children

Summary. Three thousand children aged 18 months were screened for dental caries and ongoing breast-feeding at 46 child welfare centres in different parts of Sweden. Of these, 200 children were selected for a more comprehensive examination, involving investigation of dietary, toothbrushing and sucking habits, use of fluoride, and determination of salivary levels of mutans streptococci and lactobacilli. The children were divided into four groups: group 1: children with caries not being breast-fed; group 2: children with caries being breast-fed; group 3: caries-free children being breast-fed; group 4: caries-free gender- and age-matched reference children not being breast-fed. The results showed that 63 of the children (2.1%) had caries and 61 (2.0%) were still being breast-fed. Twelve (19.7%) of the 61 children still being breast-fed had caries compared with 51 (1.7%) of the 2939 children not being breast-fed; the difference was statistically significant. Children with caries and still being breast-fed had a mean defs of 5.3, and those with caries not being breast-fed 4.9; the difference was not statistically significant. Children with caries, irrespective of whether they were being breast-fed or not, had significantly higher numbers of cariogenic food intakes per day than caries-free children. Mutans streptococci were detected in 67% of the children and lactobacilli in 13%. Children with detectable mutans streptococci and lactobacilli had significantly more caries than those without. The results indicate that Swedish children with prolonged breast-feeding have a tendency to establish unsuitable dietary habits which constitutes a risk situation for developing caries at an early age.     

Association of the microbial flora of dental plaque and saliva with human root-surface caries

Dental plaque was obtained from one or two sound root surfaces of subjects with different degrees of root-surface caries experience. From subjects with root-surface caries, plaque samples were also obtained from either one incipient or one more advanced lesion. Proportions of the total flora were determined for total streptococci and different streptococcal species, total and different Actinomyces species, and lactobacilli. A sample of saliva was obtained from about one-third of the subjects for determination of the concentrations of mutans streptococci and lactobacilli. The main observations were: (1) Subjects without root-surface caries or restorations (group I), as compared with subjects with root-surface caries with or without restorations (group II), were characterized by having a lower prevalence and proportion of mutans streptococci and a higher prevalence and proportion of A. naeslundii in plaque on sound root surfaces; (2) subjects in group I also tended to have a lower salivary concentration of mutans streptococci and lactobacilli than subjects in group II; (3) dental plaque on sound surfaces in group II subjects contained a lower proportion of mutans streptococci than plaque associated with incipient or advanced lesions; and (4) the prevalence and proportion of lactobacilli in plaque associated with sound as well as carious root surfaces were very low. The data reinforce findings from other studies and indicate that, as for coronal caries, the plaque and saliva populations of mutans streptococci specifically are correlated positively with the presence of root-surface caries.