Caries-related microbiological findings in a group of teenagers and their parents

The levels of salivary Streptococcus mutans and lactobacilli and caries experience were studied in 113 teenagers and 163 adults. The study population consisted of 82 mother-child and 73 father-child pairs. The number of decayed, missing, and filled tooth surfaces (DMFS) was eightfold higher in adults than in teenagers (56.4 +/- 22.8 vs. 7.3 +/- 6.7). The percentage distribution of the level of salivary S. mutans and lactobacilli was approximately the same in both groups. The mean number of DMFS increased with increasing levels of salivary S. mutans and lactobacilli, the correlation being highly significant both in teenagers and adults. There was a significant correlation of the DMFS indices in the mother-child pairs (r = 0.364), but the correlation was not significant in the father-child pairs (r = 0.138). The salivary level of S. mutans was higher in the children of mothers with high DMFS values compared to the children of mothers with low DMFS values.     

Associations between microbiological and salivary caries activity tests and caries experience in Hungarian adolescents

The aim of the study was to assess caries prevalence in connection with salivary caries-related findings in 349 14- to 16-year-old Hungarian adolescents living in two different cities. DMFT, DMFS means, stimulated salivary flow, buffer capacity, mutans streptococci, lactobacilli and candida counts in saliva were determined. The ratio of caries-free adolescents was 4.6% in the total population sample, DMFT mean values were 7.24+/-4.86, DMFS means 10.50+/-8.35. Mean secretion rate of stimulated saliva was 0. 84+/-0.50; a low buffer capacity was found in 6.3% of the examined children. The ratio of carriers of mutans streptococci, lactobacilli and yeasts in saliva was 89.7, 73.9 and 47.7%, respectively. DMFT and DMFS values as well as mutans streptococci and candida counts were lower in the capital than in the other city. Statistically significant correlations were found between DMFT, DMFS mean values, and salivary microbiological counts.     

Salivary levels of Streptococcus mutans and lactobacilli and dental caries experiences in a US adolescent population

Dental caries exams and saliva samples were obtained from 541 adolescents, aged 10-15, initially and after 17 months as part of a 3-yr longitudinal study investigating the relationships of dietary intakes, specific microorganisms in saliva, and the prevalence and incidence of dental caries. The mean DMFS score detected in these subjects initially was 4.61, and they developed an average of 1.38 new DMFS during the first 17-month period. Initially, S. mutans and lactobacilli were detected in 64% and 56% of these subjects, respectively. Subjects with low levels of S. mutans and lactobacilli had significantly lower initial DMFS scores and developed significantly fewer new DMFS than subjects with high counts. The predictive values of a positive result for S. mutans or lactobacilli assays were low (31% and 39%), but those for a negative result were high (81% and 84%).     

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.     

Maternal caries incidence and salivary close-contacts with children affect antibody levels to Streptococcus mutans in children

Serum and salivary immunoglobulins and antibodies reactive with Streptococcus mutans were determined in 67 5-8-year-old children. The children of mothers whose caries incidence rates exceeded the median value had significantly more serum IgG antibodies to S. mutans than those with a lower maternal caries activity (p less than 0.05). The children (n = 14) who had been exposed to frequent maternal salivary close-contacts in their first year had significantly higher (p less than 0.05) serum total specific IgG antibodies but significantly lower (p less than 0.01) high-avidity IgG antibodies to S. mutans than the other children (n = 53) with less frequent close-contacts. The maternal caries incidence rates were significantly positively associated with children's dfs/DFS-indices (r = 0.41; p less than 0.001). However, the high maternal caries incidence did not increase the risk of caries in those children whose mothers' saliva contained high amounts of lactobacilli during the first nursing year, when compared with matched children with a low maternal level of lactobacilli. This was possibly due to the fact that the former children had significantly (p less than 0.05) more anti-S. mutans IgG antibodies in their sera than the latter.     

A long-term effect of caries-related factors in initially caries-free children

Aim.  The aim of this study was to examine the rate and pattern of early childhood caries development in caries-free children based on their dental plaque accumulations, salivary Streptococcus mutans levels, maternal sharing, oral hygiene, and feeding attitudes at baseline and at 24-month follow-up period.
Design.  A total of 92 children, aged between 15 to 35 months, comprised the study group. The children's dental examinations were first carried out at baseline, and 56 of them were re-examined 24 months later to determine the changes in dental status. The mothers were also interviewed at each examination based on a prepared questionnaire.
Results.  The prevalence of caries incidence was 45% at 24-month evaluation period among initially caries-free children. The new caries formation was mostly observed on occlusal and aproximal surfaces of maxillary molars (28% and 26%) followed by mesial, distal and buccal surfaces of anterior teeth, respectively. Significant correlations between dental caries formation and maternal sharing, S. mutans levels, and plaque scores were found.
Conclusion.  The results indicated that early S. mutans colonization, high plaque accumulation, and maternal sharing were important factors on a child's caries development.     

Presence of mutans streptococci and Candida spp. in dental plaque/dentine of carious teeth and early childhood caries

This study determined the presence of mutans streptococci and Candida spp. in supragingival dental plaque and infected dentine of caries-free children, with early childhood caries and caries. Pooled samples of dental plaque and infected dentine were collected from 56 children aged 1-5 years, which were divided into 3 groups: early childhood caries (ECC); caries and caries-free. Infected dentine was collected in ECC and caries groups to compare the frequency of these microorganisms in the collected sites. The samples were inoculated in SB20 and SA medium, for mutans streptococci and Candida spp., respectively, and incubated at 37 degrees C for 48 h. Colony growth was verified and the identification was performed by biochemical tests and CHROMagar Candida. Fisher's test or chi-square (chi(2)) were applied (p=0.05). The more prevalent species were S. mutans and Candida albicans in ECC (85.4% and 60.4%, respectively), independently of the sample site. S. mutans only was significantly associated with carious teeth, whether in early childhood caries or not. However, the frequency of C. albicans in ECC was higher when compared to caries and caries-free groups. There is a significant association between the presence of C. albicans and early childhood caries.     

Determinants of early childhood caries in a group of inner-city children.

OBJECTIVE: This study aimed to determine the prevalence of early childhood caries (ECC) and severe early childhood caries (s-ECC) in inner-city children in Ghent, Belgium, and to investigate the independent impact of its determinants. METHOD AND MATERIALS: In a non-randomized cross-sectional research design, all children between 24 and 34 months of age attending the final consultation at a participating Child and Family Health Clinic were included (n = 385). Data on oral hygiene and caries were collected by oral examination. Caries prevalence and oral hygiene were determined according to established criteria. Data on oral health habits and socioeconomic status were obtained by a validated questionnaire. All analyses were performed with ECC and s-ECC as response variables. RESULTS: The mean DMFS was 0.83 (SEM = 0.14). ECC was diagnosed in 18.5% of the children and s-ECC was found in 12.2%. Treatment need was 100%. From the multiple regression analysis it became clear that ethnicity and neighborhood significantly determined ECC. From all oral health-related behavioral variables, only daily use of a bottle with sweetened drinks other than milk or water, frequency of brushing, and quality of oral hygiene as expressed by Plaque Index scores remained significantly associated with ECC. CONCLUSION: Children whose mothers had an Eastern European nationality at birth and who live in a deprived neighborhood, daily use a bottle with sweetened drinks other than milk or water, brush less than once a day, and have plaque are at higher risk for ECC and s-ECC.     

Causes,treatment and prevention of early childhood caries: a microbiologic perspective

Early childhood caries (ECC) is a virulent form of dental caries that can destroy the primary dentition of toddlers and preschool children. It occurs worldwide, afflicting predominantly disadvantaged children. High-risk North American populations include Hispanic and Native American children, as well as children enrolled in Head Start, a federally funded program for preschool children living in poverty. The prevalence of EEC among these children ranges from 11% to 72%. ECC is an infectious disease, and Streptococcus mutans is the most likely causative agent; diet also plays a critical role in the acquisition and clinical expression of this infection. Early acquisition of S. mutans is a key event in the natural history of the disease. Acquisition may occur via vertical or horizontal transmission. Primary oral colonization by S. mutans coupled with caries-promoting feeding behaviours results in accumulation of these organisms to levels exceeding 30% of the total cultivable plaque flora which in turn leads to rapid demineralization of tooth structure. Treatment of ECC is costly because the cooperative capacity of babies and preschool children usually necessitates the use of general anesthesia. Treatment usually consists of restoration or surgical removal of carious teeth along with recommendations regarding feeding habits. However, this approach has resulted in unacceptable clinical outcomes, and relapse rates of approximately 40% have been reported within the first year after dental surgery. Primary prevention of ECC has largely been restricted to counselling parents about caries-promoting feeding behaviours. This approach has also had minimal success. Newer strategies addressing the infectious component through use of topical antimicrobial therapy appear promising.     

儿童猛性龋病原菌母子传播研究

目的 :探讨幼儿猛性龋病原菌母子传播途径。方法 :随机选择可获得变形链球菌群 (MS)纯培养的 2～ 5岁猛性龋、非猛性龋及无龋儿童母子各 10对 ,进行DNA指纹实验 ,检测儿童牙菌斑和母亲唾液中MS菌株的遗传相似性 ,并检查母亲唾液MS水平。结果 :猛性龋儿童MS菌株基因型与母亲的一致性为 70 % ,与非猛性龋和无龋儿童(均为 6 0 % )无显著差异 ;但猛性龋儿童MS基因型数目显著多于非猛性龋和无龋儿童 (P <0 0 5 )。猛性龋儿童母亲唾液变链菌水平与非猛性龋和无龋儿童母亲相似 ,但唾液远缘链球菌水平及DMFT均数显著高于无龋儿童母亲。结论 :母亲是儿童MS的主要来源 ;幼儿猛性龋与母亲的DMFT计数及唾液远缘链球菌水平成正相关 ,母子传播对幼儿猛性龋的发生具有一定作用。     

Caries predicting factors in adult patients participating in a dental health program

The main purpose was to study various factors with respect to predicting dental caries. From a population of 442 employees at a shipyard, 68 patients with an average age of 56 yr were selected for the present investigation. They were examined once a year during a 2-yr period with respect to: 1) number of new caries lesions, and 2) a series of caries related factors, i.e., DMFS, oral hygiene status, dietary habits, numbers of Streptococcus mutans and lactobacilli in saliva, and secretion rate and buffer effect of saliva. The median values of all studied variables as found at the baseline examination were more favorable in the caries inactive (n = 30) than in the caries active group (n = 38), but only DMFS (P less than 0.001), dietary score (P less than 0.05), and number of S. mutans in saliva (P less than 0.05) differed significantly between the two groups. Number of S. mutans showed the highest sensitivity value, followed by dietary score. The main conclusion from this study is, however, that in spite of a relationship between caries activity and unfavorable values, especially for DMFS, dietary score, and number of S. mutans in saliva, it would have been difficult to predict the caries active patients on an individual level.     

Dietary habits, gingival status and occurrence of Streptococcus mutans and lactobacilli as predictors of caries in 3-year-olds in Sweden

The aim was to study whether dietary habits, oral hygiene expressed as gingival status, and presence/absence of S. mutans and lactobacilli, singly or in combinations, could be used as caries predictors. Sensitivity, specificity and predictive values for positive (PV+) and negative tests (PV-) were calculated. 133 children, 3 yr of age, were examined for caries and presence/absence of S. mutans and lactobacilli. Three levels of gingival status and dietary habits, respectively, were registered. Two groups in respect of dietary habits and oral hygiene were formed by stepwise pooling of the caries data for the nine possible combinations of oral hygiene and dietary habits, setting the most discriminating border (screening level) where sensitivity (0.86) and specificity (0.69) simultaneously reached their highest value. PV + was 0.58 and PV- 0.91. Higher predictive values were obtained when presence/absence of lactobacilli and of S. mutans were combined. Combinations of defined levels of dietary habits, gingival status and presence/absence of lactobacilli showed sensitivity 0.87, specificity 0.95, PV + 0.87 and PV- 0.95, presence/absence of S. mutans sensitivity 0.94, specificity 0.76, PV + 0.74 and PV- 0.95. A two-step prediction, with gingival status as the first predictor and presence/absence of lactobacilli or S. mutans as the second, was the most efficient when lactobacilli were involved.     

母子口腔中变形链球菌基因型的对照研究

目的：分析高龋、无龋儿童及其母亲口腔中变形链球菌（S．mutans）菌株的基因型，探讨S．mutans基因型与致龋活性的关系。方法：试剂盒法提取细菌染色体DNA，对20名儿童（高龋组10名，无龋组10名）及其母亲的共800株S．mutans临床分离株进行AP—PCR基因型分析。结果：高龋儿童携带的S．mutans基因型数目多于无龋儿童（P〈0．05），高龋儿童的母亲携带的S．mutans基因型数目显著多于无龋儿童的母亲（P〈0．01），高龋儿童母亲的DMFT值显著高于无龋儿童母亲（P〈0．01），高龋组和无龋组的共有基因型数目无统计学差异（P〉0．05）。结论：高龋个体比无龋个体携带更多的S．mutans基因型，个体携带的S．mutnm基因型数目与其致龋活性有关。     

Early childhood caries in children aged 6-19 months

OBJECTIVES: To investigate the relationship between socioeconomic factors, behaviors and the severity of early childhood caries (ECC) in 6-19 month-old Thai children. The severity of ECC was estimated using the proportion of ECC teeth to erupted teeth. This was termed the 'Intensity of ECC' (I-ECC) index. METHODS: Cross-sectional questionnaire survey, dental examinations, and mutans streptococci counts were obtained from children and mothers/caregivers who participated in the ECC prevention program. RESULTS: The 520 children from rural areas were categorized into four age groups by the mean number of erupted teeth. In the 15-19-month-old children, the prevalence of ECC was 82.8% (cavitated caries, 40.8%; noncavitated caries, 42.0%) with a mean ECC teeth score of 4.18 +/- 3.19. The mean I-ECC severity score was 0.45 +/- 0.30 in these toddlers. Children from low-income families, those with low education, and mothers/caregivers with decayed teeth had higher I-ECC scores (P < 0.05). Children who were breast fed or had high counts of mutans streptococci also had higher I-ECC scores (P < 0.05). The logistic regression model revealed that only children's mutans streptococci level was a statistically significant predictor of ECC, with an odds ratio = 4.5 (95% CI = 1.8, 11.7). CONCLUSIONS: ECC is not only a public health problem but also a social problem in Thailand, because it relates to family income and education level. The community development approach to assisting disadvantaged Thai children should be combined with an effective preventive program at a very young age. Future longitudinal research should be performed to improve the I-ECC for measuring the severity of ECC.     

Effects of chlorhexidine-fluoride gel treatments in mothers on the establishment of mutans streptococci in primary teeth and the development of dental caries in children.

In a longitudinal 3-year study, 151 children were followed for the colonization of the primary dentition by mutans streptococci (MS) and for the development of dental caries. At the age of 1 year, the child-mother pairs were divided into three groups on the basis of the levels of MS in maternal saliva. In the experimental group, the mothers had MS levels higher than 10(5) CFU/ml, and they were given chlorhexidine (1%)-sodium fluoride (0.2%) gel treatments twice a year for 3 years. Two control groups were formed. In control group 1, the mothers also had high levels of MS, but no gel was given. In control group 2, the mothers had low (< 10(5) CFU/ml) baseline levels of salivary MS, and no chlorhexidine-fluoride gel was used. In the total study population, 16, 42, and 54% of the children were colonized by MS by the age of 2, 3, and 4 years, respectively. Most children harbored only Streptococcus mutans, but 2 had both S. mutans and Streptococcus sobrinus, and 2 had only S. sobrinus. Twenty-eight percent of the MS-positive children developed caries by the age of 4 years, whereas 4 out of 27 children with dental caries did not have any detectable MS in their plaque samples. Both the colonization by MS and the caries incidence were highest in control group 1 and lower in the experimental group and in control group 2. These observations suggest that the reduction of maternal salivary MS at the time of tooth emergence may delay, or perhaps even prevent, the colonization of MS in the children's primary dentition with a concomitant decline in caries incidence, even in a population with an already low prevalence of dental caries.     

Identifying children who will experience high caries increments

An 18-month longitudinal study of 197 5 to 18-yr-old children was conducted to assess the performance of multiple baseline variables in predicting which children would experience high increments of caries. Nine predictors were assessed; DMFS and defs scores, number of permanent teeth, indices of fissure retentiveness and occlusal morphology, S. mutans and lactobacilli levels, and sex and race. Discriminant analyses were applied to data for children in five age groups to identify the 30% who would have the largest 18-month DMFS increments. Prediction performance was assessed by comparisons with the actual high increment group, defined as those children with increments in the upper quartiles of the DMFS distributions within age groups. The analyses predicted between 56% and 91% of actual high increment children depending on age group. The children identified in the analyses experienced between 59% and 91% of the disease experienced by the actual high increment groups.     

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.     

A cluster analysis model for caries risk assessment

Cluster analysis was applied to determine, the natural grouping of individuals, among sixty 8-10-year-old children, and to identify the most significant set of markers for risk assessment. The risk clusters were obtained with initial clinical and bacteriological measurements including dmf + DMFS, active caries, mutans streptococci and lactobacilli counts in plaque or saliva on two media, and Snyder's test results. The morbidity clusters were constructed with the final clinical indexes and incidence after 18 months (dependent variables). A risk cluster was identified that included the following significant initial variables; dmf + DMFS, active caries, counts of mutans streptococci from plaque on TSY20B and lactobacilli in saliva, and Snyder's test results. This set of markers identified 86% of the children at high risk who developed high morbidity, as well as 94% of children in the low-risk cluster who developed low or no caries. The results of this investigation provide the basis to develop a system for caries risk assessment.     

Mutans streptococci oral colonization in 12-30-month-old Brazilian children over a one-year follow-up period

OBJECTIVES: The infection levels of mutans streptococci were investigated during a one-year follow-up in children aged 12 to 30 months attending school nurseries where a sucrose-rich diet was provided. METHODS: Oral levels of mutans streptococci obtained from 101 children at baseline and after a one-year follow-up were compared by age, number of teeth, feeding habits, and presence of visible plaque at baseline. Baseline predictors and changes in mutans streptococci levels during the study were compared to caries incidence after one year. RESULTS: Fluctuations in mutans streptococci levels during the follow-up period were not related to feeding habits or presence of visible plaque. Mutans streptococci levels increased after one year among children aged 12 to 24 months, while a significantly higher proportion of those aged 25-30 months showed a decrease in mutans streptococci levels during the study. Multiple logistic regression analysis suggested that high levels of mutans streptococci (> or = 100 cfu) at baseline were associated with a higher caries increment, while reduction in mutans streptococci was negatively associated with caries incidence. CONCLUSIONS: Our data suggest that despite early mutans streptococci infection and high exposure to sucrose, mutans streptococci may achieve relatively stable levels after 2 years of age. Heavy colonization by mutans streptococci in an early age was related to an extremely high caries incidence during childhood, while decreasing levels of mutans streptococci can be associated to the decrease in caries activity.     

Psychosocial factors and early childhood caries among low-income African-American children in Detroit

Objectives: This study sought to advance knowledge of the social determinants of oral health, by examining how several specific maternal health beliefs, behaviors, and psychosocial factors relate to young children's early childhood caries (ECC) status in a lower‐income African–American population. Methods: Data were collected by the Detroit Dental Health Project (NIDCR grant), a population‐based study of 1021 African–American families with at least one child under 6 years of age and living in 39 low‐income Census tracts in Detroit, Michigan. Analyses were limited to 719 children aged 1–5 years and their biological mothers, and conducted in SUDAAN to account for the complex sampling design. Survey data included health belief scales on mothers’ self‐efficacy, feelings of fatalism, knowledge about appropriate bottle use and children's oral hygiene needs, brushing habits, psychosocial measures of depressive symptoms (CES‐D), parenting stress, and availability of instrumental social support. The child's age, dental insurance status, dental visit history, and 1‐week brushing frequency were also included in the model. Children's ECC status, based on a dental examination, was the main outcome. The dental team used the International Caries Detection and Assessment System (ICDAS) criteria for caries detection. Each child was classified as either caries‐free or having ECC or severe ECC (S‐ECC) based on the case definition of ECC proposed by an expert panel for research purposes with preschool‐aged children. Results: The dental team followed a specific examination protocol and established reliable and consistent ratings of ECC based on the ICDAS criteria. The inter‐rater reliability kappa was 0.83 overall, and the intra‐rater reliability kappa was 0.74 overall. One‐third of the children had ECC, and 20% had severe ECC. Age of the child and lower parenting stress scores were each positively associated with ECC, while higher education and income were protective. Maternal oral health fatalism and knowledge of children's hygiene needs were associated with ECC among preschool‐aged children. ECC was higher among younger children who had past restorative care. Conclusions: These findings call attention to the high prevalence of ECC in this population and the need to consider psychosocial as well as traditional risk factors in developing interventions to reduce oral health disparities.