Dietary habits and dental health over the first 18 months of life

OBJECTIVES: The main objective of this study was to describe the dental health of infants and toddlers with special reference to their dietary habits and oral hygiene behaviour over the first 18 months of life. METHODS: The longitudinal dietary data were obtained at 6, 12 and 18 months of age by using a 3-day weighed diet diary. Dental examinations were carried out at 12, and again at 18 months of age. The information on demographic factors and oral hygiene behaviours over the first 18 months of life was gathered by using a structured questionnaire at 12 and 18 months. RESULTS: 163 children were studied. Visible dental plaque was present in 18% and 25% of children at 12 and 18 months of age, respectively. No child had dental caries at either 12 or 18 months of age. There was a statistically significant correlation between visible plaque measured as plaque index at 12 months and the mean daily eating/drinking episodes at 6 months (r=0.25, P=0.001) and 12 months (r=0.15, P=0.05). The correlations between plaque index at 18 months and the mean eating/drinking episodes at both 12 months (r=0.2, P=0.04) and 18 months (r=0.2, P=0.02) were low but statistically significant. Nevertheless, there was no significant correlation between accumulation of plaque at either 12 or 18 months and the mean daily frequency consumption of food and drink containing non-milk extrinsic sugars (NMES) at any age. Children who brushed their teeth themselves were more likely to have visible plaque compared with children whose teeth were cleaned by their parents. The partial correlation showed that positive relation between mean daily eating/drinking episodes and plaque was not influenced by tooth brushing.     

Oral health, sociodemographic factors, dietary and oral hygiene practices in Jordanian children

OBJECTIVES: To investigate the association between oral health, in terms of dental caries and gingivitis, and sociodemographic factors, dental plaque, oral hygiene behaviours, infant feeding and dietary practices in 4-5-year-old Jordanian children. METHODS: Two-stage random sampling procedure was used to select children enrolled in kindergartens in Amman, Jordan. Clinical examinations were carried out by one examiner. Mothers completed questionnaires relating to sociodemographic factors, oral hygiene behaviours, infant feeding and dietary practices of the children. RESULTS: About 67% of the children had caries, 31% had dmft greater than 4 and 66% had gingivitis. Of the children who had been wholly breast-fed, 86% had been fed on demand. Mothers of children attending kindergartens with the lowest tuition fees were more likely to have breast-fed their children on demand and for more than 18 months (prolonged breast feeding) compared to those attending kindergartens with higher fees. Savory snacks were consumed by 82%, confectionery by 76% and teas with sugar by 42% of the children. Multivariate analysis showed age, dental plaque, sleeping beside the mother, use of comforters and selected dietary habits to have an independent effect on caries prevalence. Dental plaque and prolonged breast feeding exerted an independent effect on caries severity and gingivitis. The strongest association with gingivitis was dental plaque. CONCLUSIONS: In Jordan as elsewhere health promotion strategies need to be targeted to mothers from less advantaged backgrounds. Messages about infant breast feeding should emphasise that the method is beneficial to the oral health of the children if appropriately used.     

学龄前儿童乳牙龋相关因素的分析

目的 评价学龄前儿童的唾液变形链球菌、唾液流速和缓冲力、口腔卫生状况、饮食和口腔卫生习惯、母亲文化程度和职业等因素在乳牙龋发生中的意义.方法 采用病例对照研究方法,对1018名4岁和5岁儿童进行龋齿检查,其中dmft≥6的204人构成高龋组,dmft=0的237人为无龋组.测定两组儿童唾液变形链球菌水平、唾液流速和缓冲力、软垢指数,并由儿童母亲回答统一问卷.结果 共有417名儿童纳入结果的统计中.Logistic回归分析结果显示,唾液变形链球菌(OR=3.019)、软垢指数(OR=2.263)、每天吃甜食次数(OR=1.729)、每天喝甜饮料次数(OR=1.496)、奶瓶内容物含糖(OR=2.255)等因素有意义.结论 唾液变形链球菌水平高、口腔卫生差、高频率摄入甜食、奶瓶喂养时内容物含糖是乳牙龋的重要危险因素.     

Diet intake and caries prevalence in four-year-old children living in a low-prevalence country

Preventive measures have dramatically decreased the prevalence of dental caries in children. However, risk factors for the disease in children living in low-prevalence areas remain elusive. In the present study we evaluated associations between dental caries, saliva levels of mutans streptococci and lactobacilli, and diet with special emphasis on the intake of fermentable carbohydrates and dairy products in 4-year-old children living in an area where the overall caries prevalence was low. Dietary intake was recorded in 234 infants as part of the Study of Infant Nutrition in Ume?, Sweden (SINUS). Of these the parents of 124 children gave consent to participate in a follow-up at 4 years of age. Dietary intake, height and weight, dental caries, oral hygiene, including tooth brushing habits, presence of plaque and gingival inflammation, fluoride habits and numbers of mutans streptococci and lactobacilli in saliva were recorded. Using multivariate stepwise logistic regression, caries experience was negatively associated with intake frequency of cheese (OR = 0.67; 95% CI = 0.44-0.98) and positively associated with the salivary level of mutans streptococci (OR = 1.57; 95% CI = 1.21-2.03). Caries experience was not correlated with intake frequency or amounts of carbohydrate-containing foods, with any other particular food, or with daily intake of energy, carbohydrate or any other macro- or micronutrient. We conclude that cheese intake may have a caries-protective effect in childhood populations where the overall caries prevalence and caries experience are low and the children are regularly exposed to fluoride from toothpaste.     

Effect of caries preventive measures directed to expectant mothers on caries experience in their children

The aim of this prospective study was to determine the effectiveness of caries preventive measures started during pregnancy on the caries experience of first-time mothers and their infants. Eighty-one pregnant women with low social background were selected on the basis of the presence of active carious lesions and were randomly divided into control (38) and experimental (43) groups. The initial dental status (DMFS and white spot lesions) was established through clinical examination. The prophylactic measures were repeated during pregnancy and 6 and 12 months after delivery. Both groups received primary care intervention. They were instructed in relation to the etiologic factors of dental caries and received oral hygiene kits. Oral hygiene instructions were reinforced through interactive brushing. The experimental group also received antimicrobial treatment (topical application of NaF and iodine solution immediately after prophylaxis and 3 and 5 days later) and restorative care using glass ionomer cement. By the time the children were 2 years of age, 33.3% of the infants in the control group and 14.7% in the experimental group had caries activity. A significant difference in caries prevalence was observed between children with and without visible dental plaque. The mean number of tooth surfaces with carious lesions (including areas of demineralization) was higher among the children in the control group compared to the experimental group (6.3 x 3.2), however, with no statistical significance. Maternal caries increase was a significant factor influencing the caries experience of the children. These data support the evidence of an association between caries prevalence in young children and clinical (dental plaque) and maternal factors.     

The effects of chlorhexidine gel on Streptococcus mutans infection in 10-month-old infants: a longitudinal,placebo-controlled,double-blind trial

PURPOSE: This study investigated the long-term effects of 0.2% chlorhexidine gel, used as a weekly brush-on gel, on Streptoccocus mutans infection in 10-month-old infants. METHODS: The investigation followed the criteria of a placebo-controlled, double-blind, longitudinal clinical trial. Infants were recruited at birth and oral microbiological swabs were taken at 3 monthly intervals, together with medical, dental, dietary and brushing histories. Children who were found to be colonized with S. mutans were randomly assigned to either the chlorhexidine-gel group (N = 50) or placebo gel group (N = 46), and parents were instructed to brush the gel on the teeth once per week for 12 weeks. In another control group (N = 210), infants did not use either chlorhexidine or placebo gels. Saliva samples were cultured using S. mutans-selective tryptone-yeast extract-cysteine-sucrose-bacitracin (TYCSB) agar. The mean age of the children was 10.2 +/- 2.6 months at the start of the trial and subjects were followed until the ages of 18 months. RESULTS: In the children with initial low S. mutans counts of < 300 CFU/mL, there was a significant percentage reduction in S. mutans counts in the chlorhexidine-gel group compared to the placebo gel and no-gel control groups after 3 months of weekly gel brushing. However, no significant differences with the placebo group were observed after 15 months of follow-up. There were 39 children (41%) who achieved reduction of their S. mutans to 0 CFU/mL. Compared to those who remained infected with S. mutans, these children had higher toothbrushing frequencies (P < .001) and toothpaste use (P < .001), as well as lower frequencies of daily feeds (P < .01), and lesser weekly frequencies of sweet solids and liquids (P < .001). CONCLUSIONS: Children with relatively low initial S. mutans counts (< 300 CFU/mL) showed a reduction in S. mutans counts in the first 3 months when 0.2% chlorhexidine gel was brushed on the teeth weekly. No differences were observed when compared with the placebo and no-treatment groups at later follow-up periods.     

Relationship among dental plaque composition,daily sugar exposure and caries in the primary dentition

The relationship among daily sugar exposure, dental plaque composition and caries patterns in the primary dentition is not known. Three groups of 20 children (18-48 months old) were studied: (1) caries-free (CF), (2) presenting pit and fissure caries (PFC), and (3) with nursing caries (NC). Dental caries index (dmfs) was assessed and the frequency of daily sugar exposure (TS) and its forms were estimated by questionnaires. Fluoride (F), calcium (Ca), inorganic phosphorus (P(i)), insoluble polysaccharide (IP) and mutans streptococci were quantified in dental plaque. The three groups of children were statistically different regarding daily sugar exposure. Concentrations of F, Ca and P(i) were lower and the IP and mutans streptococci statistically higher in dental plaque from NC children than those from CF children. PFC children also showed statistically lower F and P levels in their plaque than CF children. Statistically significant correlations were found between IP, TS and dmfs from NC and PFC children. A statistically significant correlation between mutans streptococci in plaque from anterior teeth and dmfs for NC children was also observed. These results suggest that the dietary sugar experience changes the biochemical and microbiological composition of dental plaque, which could partly explain the different caries patterns observed in primary dentition.     

Effects of oral health education and tooth-brushing on mutans streptococci infection in young children

PURPOSE: The purpose of this study was to examine the effects of maternal dental health education and tooth-brushing instruction on the levels of mutans streptococci in pre-school children. METHODS: One hundred and seven children (44 boys and 63 girls) with a mean age of 20.5 months, randomly selected from a community child health clinic within a 2-week period, participated in this study. Medical, dental, and dietary information was obtained through a questionnaire. The children's mouths were examined, and plaque samples were obtained by swabbing the teeth and mucosa. A commercial microbiological kit was used to determine the presence of mutans streptococci. The mothers were instructed in tooth-brushing using a soft-scrub method. The children were recalled to the same clinic after a period of 4 weeks to obtain a second evaluation of the mutans streptococci levels. RESULTS: At the first visit, 69 of the 107 children (64%) showed positive infection with mutans streptococci. Ninety (84%) children returned for the recall examination. In the second examination, only 44 (49%) of the 90 children showed positive results for mutans streptococci. The difference in number of children who tested positive is statistically significant (P < .01). At the first visit, children who did not show infection with mutans streptococci were those who reported greater frequency of tooth-brushing (P < .05) and less snacking (P < .05). There were 26 children (29%) who converted from positive to negative results for mutans streptococci infection between the first and second visits (P < .01). This conversion from positive to negative infection was attributed mainly to increased tooth-brushing, as other dental health habits remained the same. CONCLUSIONS: Infection with mutans streptococci in young children is associated with increased snacking frequency and inadequate tooth-brushing. A single dental health education session and tooth-brushing instruction to mothers results in approximately a 25% reduction in mutans streptococci infection in young children from a relatively high socioeconomic status.     

Oral candidosis in long-term hospital care: comparison of edentulous and dentate subjects

OBJECTIVE: To obtain information on the oral health status of the elderly living in a medicalized, geriatric institution.
DESIGN: A cross-sectional clinical investigation with complementary microbiological studies.
SUBJECTS AND METHODS: A cohort of 233 elderly in one long-term care ward; collection of demographic data; clinical examination to determine dental and prosthetic status and health of the oral mucosae; swabs for detection of mucosal and denture colonization by Condido; paraffin stimulated saliva for detection of colonization by mutans streptococci and lactobacilli.
MAIN OUTCOME MEASURES: Oral and denture hygiene; oral mucosal health; degree of colonization by Condida , mutans streptococci and lactobacilli.
RESULTS: Mean age of the 233 patients was 85.6 ± 6.9 years; 61% were totally dependent, 62.7% were wearing one or two complete dentures; 19.7% had natural teeth and no denture and 17.6% neither teeth nor denture. Of those wearing dentures 72% had denture stomatitis. Of those with natural teeth 72% were affected by active caries. Yeast counts were significantly correlated with the intensity of the erythema of the palatal mucosa, plaque score of the natural teeth, denture plaque score, and salivary counts of mutans streptococci and lactobacilli.
CONCLUSIONS: High oral yeast counts and frequent prevalence of oral candidosis in elderly subjects living in institutions are associated with poor oral hygiene and neglect of denture care.     

A longitudinal study of 0.2% chlorhexidine gel for removal of mutans streptococci infection in preschool children

BACKGROUND: The purpose of the present longitudinal study was to determine the effectiveness of 0.2% chlorhexidine (CHX) in removing mutans streptococci (MS) in a treatment cohort of caries-free, preschool children. METHODS: Thirty-six children with mean age 38.6 +/- 15.9 months who had MS infection brushed once daily with 0.2% chlorhexidine (CHX) gel for a period of 6-12 months. The children were examined every three months to assess their oral hygiene and dietary habits and MS status using a commercial microbiological kit. RESULTS: The percentages of children who eliminated MS from their mouths increased from 28 per cent after three months to 48 per cent after six months and over 70 per cent after 12 months of gel use (p = 0.039). Compliance of brushing with CHX gel was significantly associated with MS removal after six months gel use (p < 0.02). At the three and six month recalls, sugar snacks and increased sugar frequency were associated with continued presence of MS (p = 0.03 and p = 0.007). After three months cessation of CHX use, 13 (45 per cent) remained MS free (p = 0.003). CONCLUSIONS: This pilot study involving caries-free preschoolers with MS shows the potential of chlorhexidine gel to remove MS for the limited duration of study.     

Teaching oral hygiene to children with autism

BACKGROUND: The need for improved oral hygiene routines in individuals with disabilities has been documented in many reports. The aim of this study was to evaluate whether visual pedagogy is a suitable way to teach children with autism how to brush their teeth. METHODS: The investigation took the form of a prospective study including clinical examinations and structured interviews. Based on visual pedagogy, a series of pictures were produced that showed a structured method and technique of tooth brushing. The pictures were placed in the bathroom or wherever tooth brushing was performed. Fourteen children with autism aged between 5 and 13 years (mean age = 9.3 years), and their parents participated. RESULTS: Before the study, all parents found it difficult/very difficult to maintain good oral hygiene in their child. All children had visible plaque on their maxillary incisors and canines. After 12 months, the amount of visible plaque was reduced. After 18 months, most parents found maintaining good oral hygiene easier than before the study. All but one child/parent adopted the programme. CONCLUSIONS: Visual pedagogy is a useful tool in helping people with autism to improve their oral hygiene.     

Inhibitory effects of cacao bean husk extract on plaque formation in vitro and in vivo

Cacao bean husk extract (CBH) has been shown to possess antibacterial and antiglucosyltransferase activities through its unsaturated fatty acids and epicatechin polymers, respectively. In the present study, the antiplaque activities of CBH were examined in vitro and in vivo. The extract inhibited the adherence of Streptococcus mutans MT8148 to saliva-coated hydroxyapatite and reduced the accumulation of artificial dental plaque by S. mutans MT8148 on orthodontic wire. The number of mutans streptococci in dental plaque was also significantly reduced when human dental plaque was exposed to CBH from 21 children at 37 degrees C for 1 h. For the in vivo study, 28 volunteers aged 19-29 yr old rinsed their mouth with CBH, before and after each intake of food and before sleeping at night for 4 d without using other oral hygiene procedures. Plaque depositions and the numbers of mutans streptococci were reduced in the subjects, compared with rinsing with 1% ethanol alone. These results indicate that CBH possesses significant antiplaque activity in vitro and in vivo.     

东乡族、保安族、裕固族12岁儿童龋齿及相关因素研究

目的了解东乡族、保安族、裕固族12岁儿童龋齿的流行病学情况及相关因素。方法采用2005年第三次全国口腔健康流行病学调查制定的口腔健康调查方法,随机抽取448名东乡族、保安族、裕固族12岁儿童进行龋齿流行病学调查、口腔细菌学检测及口腔卫生行为的调查。结果1）东乡族、保安族、裕固族12岁儿童的患龋率分别为40.52％、44.29％、46.45％,龋均分别为0.92、0.90、1.13。2）东乡族和保安族12岁儿童唾液变异链球菌以2级和3级为主,裕固族儿童则以0级和1级为主;东乡族和保安族儿童菌斑变异链球菌的水平高于裕固族。3）裕固族12岁儿童的每天刷牙率高于东乡族和保安族（P＜0.01）,东乡族和保安族儿童每天刷牙率之间的差异无统计学意义（P＞0.05）。结论东乡族、保安族、裕固族12岁儿童的患龋率较高,有效刷牙率低、牙菌斑不能有效清除可能是儿童患龋率高的主要原因之一。今后在这3个少数民族地区要加强口腔健康教育工作,增加儿童的口腔健康知识。     

Increased number of teeth predict acquisition of mutans streptococci in infants

This longitudinal study of 194 very‐low birthweight (VLBW) and 184 normal birthweight (NBW) infants hypothesized that the causal pathway between birth group (VLBW or NBW) and mutans streptococci (MS) acquisition (presence) at 18–20 months is mediated by biological, behavioral, and caregiver MS levels. Biological (number of teeth at 8 and 18–20 months and enamel hypoplasia) and behavioral (brushing/cleaning, sweet snacks, breastfeeding, and dental access) factors were assessed using dental examinations and caregiver questionnaire responses at 8 and 18–20 months. Infant MS acquisition and caregiver MS levels were assessed from saliva and plaque samples collected at 8 and 18–20 months. Structural equation modeling evaluated the causal pathway with latent variables for biology and behavior. Mutans streptococci presence was similar between birth groups at 18–20 months (40% in VLBW infants and 49% in NBW infants), but was significantly higher for NBW infants at 8 months. Increased number of teeth at 8 and 18–20 months was associated with biological risk. Infants whose caregivers had a 1‐point higher score on MS had a significantly (1.5) higher odds of MS presence. Caregiver behavior was not associated with MS presence. Early‐intervention efforts should focus on delaying initial acquisition and improving caregiver awareness of taking care of erupting primary teeth.     

Effect of self-brushing with acidulated phosphate fluoride (pH 5.6) on dental caries in children

The aim of this work was to study the effect of a preventive program on the dental plaque and on the caries incidence in school children. The program comprised weekly supervised self brushing with acidulated phosphate fluoride (APF) gel (pH 5.6; concentration: 4520 ppm of ion F-). The program involved 240 children of 1st., 3rd and 5th grade of a primary school in the City of Buenos Aires (Argentina). The population was divided in 2 groups: A (experimental) and B (control). Ninety children from both groups (45 experimental and 45 control) were submitted to baseline clinical examination (DMFT and plaque index) and microbiological analysis (total streptococci, St mutans and St. mutans and St. mutans percentage). Group A was then submitted to a preventive program which included self brushing with APF gel (4520 ppm of ion F-). The 90-children sample was monitored after 1 and 2 years of program. Results were statistically processed and they revealed the following: a--DMFT was significantly greater in the control group than in the experimental group after 1 and 2 years of program; b--an 81.43% reduction in caries increment rate at the end of the 2-years program in the experimental group as compared to the control group; c--a rise in the number of colonies of total streptococci and of St. Mutans; d--a reduction in the % of St. mutans in the total streptococci flora in the plaque of children in the experimental group; e--the presence of St. mutans colonies featuring a rough surface; f--the effectiveness of the program in the modifying the profile of the diagnosed dental pathology.     

Effect of an essential oil-containing antiseptic mouthrinse on plaque and salivary Streptococcus mutans levels

BACKGROUND: Clinical studies in which antimicrobial mouthrinses were shown to have significant antiplaque activity most frequently have used gingivitis as the clinically relevant endpoint. However, there is evidence to suggest that mouthrinses containing active agents effective against Streptococcus mutans, such as chlorhexidine, may also have a role in inhibiting dental caries. This clinical study was conducted to determine the effect of 2x-daily rinsing with an essential oil-containing antiseptic mouthrinse (Listerine Antiseptic) on levels of recoverable S. mutans and total streptococci in supragingival interproximal plaque and in saliva. Additionally, a follow-up in vitro study is reported which determined whether a differential susceptibility to the antiseptic mouthrinse exists among different strains of streptococci. METHOD: Following baseline saliva and plaque sampling for quantification of recoverable S. mutans and total streptococci, 29 qualifying subjects were randomly assigned either the essential oil mouthrinse or a sterile water control. They rinsed with 20 ml for 30s 2 x daily for 11 days and once on the 12th day, in addition to their usual oral hygiene procedures. On day 12, saliva and plaque samples were again collected and microbiological quantification performed. The procedures were repeated with the alternate rinse after a 1-week washout period. RESULTS: The essential oil mouthrinse produced respective reductions of 69.9% and 75.4% in total recoverable streptococci and in S. mutans in plaque, and corresponding reductions of 50.8% and 39.2% in saliva. The in vitro study revealed that streptococci from the mutans group were more susceptible to the bactericidal activity of the essential oil mouthrinse than streptococci from the mitis group. CONCLUSIONS: As antimicrobial mouthrinses are most frequently recommended to patients whose mechanical oral hygiene procedures are not adequate for the control of supragingival plaque and gingivitis, this study provides an additional rationale for the inclusion of the essential-oil mouthrinse as an adjunct to daily oral hygiene procedures.     

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.     

Oral hygiene practices and periodontal health in primary school children in Nairobi, Kenya.

The purpose of this study was to obtain data on the oral hygiene practices, oral hygiene status, and periodontal health among primary school children in Nairobi. The study group consisted of 513 children, 262 aged 6-8 years and 251 aged 13-15 years. The children were from 6 schools randomly selected among the 154 public primary schools in the city. The clinical examination was performed in a room with natural daylight, using the WHO (1980) criteria. Although most of the children reported brushing habits, 75% of the index tooth surfaces in the younger and 55% in the older age group had visible plaque. In both age groups about 25% of the index sites had gingivitis. Moderate amounts of calculus were recorded among the older children. Only two children had periodontal pockets greater than or equal to 4 mm. There was no statistically significant difference (p greater than 0.05) between males and females recorded with plaque and gingivitis in the younger age group. In the older group, however, a significantly higher proportion of males (p less than 0.05) were recorded with plaque and gingivitis. The oral hygiene practices and oral hygiene status were poorer among children from low than from high socioeconomic status. Provision of dental health education for children in Nairobi is recommended.     

Failure of intense preventive efforts to arrest early childhood and rampant caries: three case reports.

This report presents the first three children who developed dental caries despite being enrolled in a randomized, control trial to test methods to prevent early childhood caries. The children's caretakers received education on decreasing frequent and prolonged feeding with a nursing bottle and other sugar containing foods, as well as brushing the children's teeth daily with 0.4% SnF2 gel. One of the child's caretaker additionally received training sessions to improve confidence in eliminating the child's nursing bottle habit and in performing daily tooth brushing. The two other children received monthly topical fluoride treatments with 2% NaF. Despite these intensive preventive efforts, these three children developed dental caries. Two of the children had mutans streptococci colonization at the time of initial visit, (12 and 14 months of age, respectively). All had high mutans streptococci levels at the time that caries was detected. Incorrigible, high-frequency sugar consumption from a bottle or from solid foods was suggested in all three cases. In one case, dental caries was associated with defects of the tooth enamel. Conceivably, the cariogenic challenge and harmful behaviors in certain children may be so extreme that they can overwhelm even extraordinary preventive efforts.     

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.