The earlier the colonization by mutans streptococci, the higher the caries prevalence at 4 years of age

Seventy-eight 4-year-old children, examined earlier for the presence of mutans streptococci at 4-month intervals from 15 months of age, were recalled for recording of dental caries and salivary sampling. The saliva samples were analysed for the presence of mutans streptococci, including the species Streptococcus mutans and Streptococcus sobrinus and lactobacilli. The results showed that the earlier the mutans streptococci had been detected in the children, the higher the caries experience. Eighty-nine percent of the children colonized at 2 years of age had experienced caries and had a mean dfs of 5.0 compared with 25% of the non-colonized 4-year-olds with a mean dfs of 0.3. S. mutans was the predominant species. S. sobrinus was usually found in combination with S. mutans , except in 2 children where S. sobrinus was the only species detected. More children with multiple species had higher numbers of total mutans streptococci and a tendency to higher caries prevalence than children with only S. mutans.     

Antimicrobial effect of fluoride mouthrinse on mutans streptococci and lactobacilli in saliva

PURPOSE: This study was designed to determine whether the long-term use of fluoride mouthrinse affects the salivary levels of mutans streptococci and lactobacilli. METHODS: The subjects consisted of 414 school children aged 7, 10, and 12 yrs. Among these subjects, 243 children had received fluoride mouthrinse since 5 years of age at nursery schools, and comprised the "mouthrinse group." The remaining 171 children, the "no mouthrinse group," had not received fluoride mouthrinse. All of the children received routine dental health education. The levels of mutans streptococci and lactobacilli for the subjects in both groups were measured using Dentocult SM Strip mutans and Dentocult LB Dip Slide, respectively. Dental examinations were conducted to obtain data on caries prevalence (dfs and DMFS). Logistic regression analysis was used to control confounding factors: age, dfs, DMFS, frequency of toothbrushing, sum of permanent tooth surfaces sealed, frequency of sweet snacks, frequency of sweet drinks, and the use of fluoridated toothpaste. RESULTS: There was a significant difference in mean DMFS between the mouthrinse group and no mouthrinse group at all ages. Children with fluoride mouthrinse had lower levels of mutans streptococci, and there was a significant association between the experience of fluoride mouthrinse and the score of Dentocult SM strip Odds ratio: 0.64, P < 0.05. However, there was no significant relation between the experience of fluoride mouthrinse and the score of Dentocult LB Dip Slide. The results of this study demonstrated that the long-term use of fluoride mouthrinse affected the detectable levels of mutans streptococci, but did not affect the levels of lactobacilli. CONCLUSIONS: These results suggest that fluoride mouthrinse might contribute to reducing the number of mutans streptococci.     

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.     

Immunoglobulin A reaction to oral streptococci in saliva of subjects with different combinations of caries and levels of mutans streptococci

The aim of this study, performed in Bangkok, was to study whether a particular salivary immunoglobulin A (IgA) antibody profile against mutans streptococci could be related to the absence or presence of caries. A group of 12-year-old individuals representing various combinations of mutans streptococci levels and caries experience was selected. Whole saliva stimulated by paraffin-chewing was collected, and the children were investigated for decayed, missing and filled surfaces (DMFS) and teeth (DMFT), following WHO criteria and methods, at baseline and after 2 years. The total amount of salivary IgA was determined by an immunobead enzyme-linked immunosorbent assay, and SDS-PAGE and Western blot analysis was performed using sonicated antigens of Streptococcus mutans and Streptococcus sobrinus strains and, as a control, a Streptococcus parasanguis strain. The results showed that Thai children with low caries prevalence had more distinct immunoblot bands to antigens from mutans streptococci than did the high-caries children. A similar picture was not seen for S. parasanguis. On the whole, the Thai children also showed fewer bands than usual Swedish saliva samples from comparable age groups. The complexity of the relationship between dental caries and IgA in saliva is highlighted.     

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.     

Effect of mixed mutans streptococci colonization on caries development

OBJECTIVE: To evaluate the clinical importance of mixed mutans streptococci colonization in predicting caries in preschool children. METHODS: Caries prevalence was examined twice, with a 6-month interval, in 410 preschool children aged 3-4 years at baseline. A commercial strip method was used to evaluate the mutans streptococci score in plaque collected from eight selected interdental spaces and in saliva. Mutans streptococci typing polymerase chain reaction (PCR) assays (Streptococcus sobrinus and Streptococcus mutans, including serotypes c, e, and f) were performed using colonies on the strips as template. RESULTS: Twenty variables were examined in a univariate analysis to predict caries development: questionnaire variables, results of clinical examination, mutans streptococci scores, and PCR detection of S. sobrinus and S. mutans (including serotypes c, e, and f). Sixteen variables showed statistically significant associations (P < 0.04) in the univariate analysis. However, when entered into a logistic regression, only five variables remained significant (P < 0.05): caries experience at baseline; mixed colonization of S. sobrinus and S. mutans including S. mutans serotypes; high plaque mutans streptococci score; habitual use of sweet drinks; and nonuse of fluoride toothpaste. CONCLUSION: 'Mixed mutans streptococci colonization' is a novel measure correlated with caries development in their primary dentition.     

Association Between Glucan Synthesis by Streptococcus mutans and Caries Incidence in Schoolchildren Receiving a Fluoride Mouth Rinse

Purpose: To determine whether variation in glucan synthesis by Streptococcus mutans isolates is associated with caries development in children receiving a fluoride mouth rinse (FMR). Materials and Methods: Of 122 children (aged 9 to 10 years), 64 had received FMR (FMR(+) group) and the remaining 58 children had not (FMR(-) group). The number of decayed and filled teeth (DFT) and increases in the number of DFT in 1 year (dDFT) were recorded. Saliva samples were collected to isolate the clinical S. mutans strains. The isolates were incubated in heart infusion broth supplemented with 1% sucrose, then the amount of water-insoluble glucan (WIG) formed on a glass tube surface was evaluated. Results: In the FMR(-) group, children carrying S. mutans had a higher DFT (P = 0.039) and tended to have a higher dDFT (P = 0.080) than the others. In the FMR(+) group, although the differences between children with and without S. mutans were not significant, children carrying S. mutans that produced a high amount of WIG had higher dDFT than the other S. mutans-positive children (P = 0.034). Conclusions: This study revealed that the variation in glucan synthesis by S. mutans is associated with caries development in children receiving a FMR.     

Antibody responses to mutans streptococci in children.

Because mutans streptococci (Streptococcus mutans, S. sobrinus) are considered the main causative bacteria in human dental caries, immune responses to these bacteria have aroused much research interest over the last two decades. Studies in man have focused mainly on salivary and serum antibodies developing naturally in response to oral colonization by mutans streptococci, or in relation to the development of dental caries. Although both salivary (IgA) and serum-derived (IgG) antibodies have been shown in many studies to protect against the adherence of and to interfere with the metabolism of mutans streptococci, no conclusive evidence relating to their clinical significance is available. In young children, serum IgG antibodies to S. mutans seem more important than salivary IgA antibodies in relation to protection against dental caries. In studies in animals and, recently, in man, monoclonal IgG antibodies to S. mutans protein antigen I/II ("adhesin") have provided effective protection against mutans streptococci. Whether they could also prevent dental caries in man is not yet known.     

Associations between salivary levels of Streptococcus mutans, Streptococcus sobrinus, lactobacilli, and caries experience in Kenyan adolescents

Salivary levels of mutans streptococci (S. mutans and S. sobrinus) and lactobacilli were determined in a random sample of rural Kenyans between 15 and 19 years of age (n = 149). It is possible for the natural history of dental caries in this population to be studied since it is characterized by a limited access to conventional dental treatment. Using a short set of biochemical tests, we identified from seven to ten presumptive mutans streptococcus colonies--cultured from the saliva of each individual--to differentiate between S. mutans and S. sobrinus. No colonies resembling S. rattus (S. mutans serotype b) were isolated. Lactobacilli were identified as Gram-positive, catalase-negative rods. The mean D1-4MFS and D3-4MFS were 7.03 +/- 6.43 and 1.46 +/- 3.44, respectively. The mean mutans streptococcus and lactobacillus levels were 8.7 x 10(4) and 6.7 x 10(4), respectively. The salivary mutans streptococcus and lactobacillus levels were significantly correlated (p less than 0.01). Of the subjects, 64% harbored only S. mutans, 4% only S. sobrinus, 30% both species, and 2% neither. Lactobacilli were ubiquitous. The caries experience of the group was significantly (p less than 0.001) correlated with both the total salivary level of mutans streptococci and the salivary S. mutans levels, but not with the salivary S. sobrinus level.     

High prevalence of mutans streptococci in a population with extremely low prevalence of dental caries

The quantitative distribution of the mutans streptococci was investigated in populations with very low caries prevalence. Three hundred and seven school children from rural Sudan with an estimated age of 12 years were examined for dental status and salivary mutans streptococci. Forty-two isolates from the salivary cultures were determined to species level by studying the serogroup and biotype. Denial caries in permanent teeth was diagnosed in 12% of the children and the mean DMFT was 0.17 (range 0-6 DMFT). Caries was confined to fissures. Mutans streptococci were found in 96% of the children and high counts were obtained in 45%. Of 42 isolated strains, 37 belonged to Streptococcus mutans , 5 to Streptococcus sobrinus and none to Streptococcus rattus. The observations show that the mutans streptococci can be widespread in human populations with extremely low prevalence of dental caries and consequently that these bacteria may be readily propagated in human populations without association to a caries-promoting life style.     

Colonization of Streptococcus mutans and Streptococcus sobrinus genotypes and caries development in children to mothers harboring both species

The major route of early acquisition of mutans streptococci in humans is a vertical transmission from mother to child. The purpose of this longitudinal study was to examine the acquisition, distribution and persistence of Streptococcus mutans and Streptococcus sobrinus in children whose mothers harbored both species and to study the caries incidence in relation to colonization of these bacteria. Fifteen mother-child pairs were followed during the child's first 7 years. Stimulated salivary samples were taken from the mothers and the children. Plaque samples were also collected from the teeth and the tongue of the children. The samples were analyzed by cultivating techniques together with genomic fingerprinting and hybridizing. The caries experience was evaluated on the sampling occasions and retrospectively using the records of caries registrations from the community clinics. During the 7-year period 10 of the 15 children acquired mutans streptococci. Only 4 of them were colonized by both S. mutans and S. sobrinus despite the fact that their mothers harbored both species. In 2 of the children S. sobrinus was found later than S. mutans. A total of 26 genotypes were found in the children and 9 of them were identical to their mothers. New genotypes and a gain-loss pattern were noted especially in the children but also in their mothers. The groups of teeth first positive for the two species were the deciduous molars. The caries experience was low during the study period with 8 children showing no caries.     

表兄链球菌的检测与儿童猛性龋的关系

目的：探讨表兄链球菌(Streptococcus sobrinus,S. sobrinus)与儿童猛性龋的关系。方法：根据前期郑州市区猛性龋调查结果,随机抽样选择3～5岁儿童66例,其中猛性龋、普通高龋及无龋组各22例。采用TYCSB培养基作变形链球菌(Streptococcus mutans, S. mutans )及S. sobrinus初步筛选,结合生理生化鉴定,并采用聚合酶链反应作最终鉴定。采用 SPSS10.0软件包对实验组与对照组S.mutans和S.sobrinus的检出率进行χ²检验,组间均数作t检验。结果： S. sobrinus在各组儿童牙菌斑中均不能脱离S. mutans而单独检出,猛性龋组S. mutans检出率高于高龋组,差异无显著性(P>0.05),而2组儿童S. sobrinus检出率的差异有显著性(P<0.05);猛性龋组与无龋组S. mutans检出率差异显著(P<0.05),S. sobrinus检出率差异显著(P< 0.01)。同时检出S. mutans和S. sobrinus的样本,其猛性龋的发生率及龋失补牙数、龋失补牙面数和平滑面龋均数与只能检出S. mutans及2种细菌均不能检出的样本的差异有显著性(P< 0.01)。结论：S. mutans与S. sobrinus是儿童猛性龋的主要致病菌,S. sobrinus与儿童猛性龋的发生有关。S. sobrinus对儿童猛性龋的发生、发展具有协同作用。     

Prediction of caries in pre-school children in relation to fluoride exposure

The levels of salivary mutans streptococci and caries experience were used as predictors for caries incidence in 3 groups of pre-school children from areas with different levels of natural and topical fluoride exposure. Altogether 1022 children, 4-5 years of age at baseline, were examined according to the WHO-criteria and followed for 2 years. The low fluoride group ( n =374) had a low fluoride level in the piped water and no topical fluoride applications: the F-varnish group ( n =442) had low water fluoride but semiannual topical applications of a fluoride varnish; the optimal fluoride group ( n =206) had an optimal level of fluoride in the drinking water and semiannual F-varnish applications. The number of salivary mutans streptococci was estimated and scored at baseline with the Strip mutans chair-side method. The sampling procedure was repeated in 337 children of the low fluoride group 3 weeks after baseline. In comparison with the low fluoride group, caries incidence was 30% and 60% lower in the F-varnish and the optimal fluoride group respectively. The caries predictive ability decreased with increasing fluoride exposure. The sum of sensitivity and specificity decreased from 151% (65%+86%) in the low fluoride group to 131% (40%+91%) in the optimal fluoride group. The positive predictive value was highest (62%) in the low fluoride group. Repeated salivary samplings at baseline did not improve the caries predictive power. The results suggest that the overall fluoride exposure should be taken into account when caries risk assessment strategies for preschool children are developed and implemented.     

小沟聚合物探针实时检测变形链球菌和远缘链球菌

目的　寻求一种快速检测变形链球菌(S.mutans)和远缘链球菌(S.sobrinus)的方法,研究变形链球菌群在儿童猛性龋患者口中的分布。方法　设计并合成针对S.mutans和S.sobrinus葡糖基转移酶基因(gtf)的特异性引物和小沟聚合物探针(MGB探针),对9株变形链球菌群参考菌株直接提取DNA及扩增纯培养后提取DNA分别进行检测,比较二者检测结果的异同。采集92例猛性龋儿童菌斑样本,用MGB探针进行实时检测。结果　采用MGB 探针可以特异性地鉴别S.mutans和S.sobrinus,直接检测和扩增纯培养后的定性检测结果完全一致,前者荧光出现的时间略迟。92例猛性龋患儿中S.mutans检出率为96.7%,S.sobrinus检出率为32.6%,所有检出S.sobrinus的菌斑样本均可检出S.mutans。结论　采用特异性MGB探针方法可以对菌斑中S.mutans和S.sobrinus进行实时检测, 提高检测效率。     

Caries prevalence and salivary mutans streptococci in 0–2-year-old children of Japan

The prevalence of caries and the number and species distribution of salivary mutans streptococci in 356 children (aged 0-2 yr old) in Japan were examined twice at an interval of 1 yr. No mutans streptococci were isolated from the predentate children. The detection rate of mutans streptococci and the prevalence of caries increased with age. Mutans streptococci were isolated from 39.9% of the subjects. The majority of isolates were identified as Streptococcus mutans. The concentration of mutans streptococci correlated with the number of erupted teeth (r = 0.339). In addition, the concentration of mutans streptococci was more closely correlated to the caries prevalence of the next year (r = 0.465) than that of the year when the salivary concentration of mutans streptococci was first evaluated (r = 0.368). The children who had no caries but harbored mutans streptococci in the first year showed significantly higher caries prevalence in the next year than did the children with neither caries nor mutans streptococci. These results indicate that the establishment of mutans streptococci is associated with caries initiation in early childhood.     

Distribution of Streptococcus mutans and Streptococcus sobrinus in saliva of Mexican preschool caries-free and caries-active children by microbial and molecular (PCR) assays

The aim of the study was to investigate the distribution of mutans streptococci (MS) infection of caries-free (CF) and caries-active (CA) preschool Mexican children by microbial and molecular assays. Eighty preschool children were divided into two groups, 40 CF and 40 CA children. Saliva samples were inoculated onto MSB to identify CFU and DNA extractions were tested by PCR. Our results indicated that there was no statistical difference (p > 0.05) between groups either in age, weight, height or sex. S. sobrinus was detected by PCR twice as much in the CA group, the difference being statistically significant (p < 0.05). dmfs index was positive correlated with S. mutans (r = 0.2941, p = 0.0081), S. sobrinus (r = 0.3384, p = 0.0021) and S. mutans-S. sobrinus (r = 0.3978, p = 0.0003). ANCOVA revealed that dmfs index had a significant effect on the distribution of CFU of S. mutans (p = 0.0118) and S. sobrinus (p = 0.03). When MSB was compared with PCR to identify MS, there was no statistical difference (p > 0.05). We conclude that S. mutans and S. sobrinus were isolated in higher numbers from CA children and those harbouring both bacteria had higher dmfs scores. PCR is a useful tool in molecular epidemiology for dental caries studies; it was effective in detecting and identifying MS from saliva in children.     

Human strains of mutans streptococci show different cariogenic potential in the hamster model

The cariogenic potential of fresh humans strains of Streptococcus mutans and Streptococcus sobrinus was examined in hamsters maintained on a high sucrose diet. The strains 1B 16 (S. mutans) and B13 (S. sobrinus) isolated 20-25 yrs ago served as positive controls. Three series of experiments were run. Some strains were tested once and some strains were tested in all 3 experiments. The animals infected with S. sobrinus strains generally showed lower caries scores than those infected with S. mutans strains. Among the groups infected with the different strains of S. mutans the caries scores varied. In one of the experiments the caries score of the animals infected with one of the Icelandic S. mutans strains was significantly higher than that of the positive control group and the group infected with one of the fresh Swedish isolates. Thus, different strains of mutans streptococci where shown to induce varying caries activity in the hamster model.     

Dental caries and mutans streptococci in selected groups of urban and native Indian schoolchildren in Mexico

Two groups of Mexican children aged 12-14 yr were examined for dental caries and salivary mutans streptococci counts. One hundred lived in Mexico City and 100 belonged to a native Mazahua Indian population. The prevalence of caries, diagnosed according to WHO, was 90% in Mexico City and 82% in the Indian community. Mean DMFT was 5.98 and 3.57 respectively. Saliva samples were analyzed for mutans streptococci by the "Strip mutans" method. Further identification of the biotype/serotype was done. Mutans streptococci were found in 95% of the urban children and 75% of the Indians. There was a statistically significant difference in the prevalence of mutans streptococci between the city and the rural samples. Streptococcus mutans was more frequently found than Streptococcus sobrinus.     

Prevalence of mutans streptococci and lactobacilli in elderly Swedish individuals

The number of Streptococcus mutans, Streptococcus sobrinus, and lactobacilli in stimulated whole saliva was examined in 149 elderly persons. More than 10(6) CFU/ml of mutans streptococci were found in 57% of the subjects and 85% had more than 10(5) lactobacilli per ml of saliva. There was no difference in the prevalence of mutans streptococci between edentulous and dentate subjects whereas significantly more lactobacilli were detected in denture wearers. S. mutans was most frequent and was found in 72% of the subjects. S. sobrinus, which was carried by 44% of the persons, was found proportionally in more subjects with dentures than in dentate individuals. In most persons with S. sobrinus, S. mutans was also present but in 8% of the subjects only S. sobrinus was detected. The subjects with both S. mutans and S. sobrinus had higher salivary levels of mutans streptococci than individuals with only S. mutans or S. sobrinus.     

Hydrophobicity test in mutans streptococci

Kinetic hydrophobic measurements were performed by confronting 40 mutans streptococci from thirty 10- to 20-year-old patients with 200 ml hexadecane (Sigma). Fourteen patients had high dental caries risk (Group A), dmft + DMFT > 5 with 3 or more active caries, and 16 had low dental caries risk (Group B), dmft + DMFT < 3 without active caries. Twenty bacteria from Group A and 20 bacteria from Group B were typed using De La Higuera's procedure and confirmed by API strip (bio-Merieux). From the 14 patients in Group A we obtained 12 S. mutans (8 hydrophobic/4 non-hydrophobic), 5 S. sobrinus (4 hydrophobic/1 non-hydrophobic) and 3 S. rattus (hydrophobic). From the 16 patients in Group B we obtained 11 Streptococcus mutans (10 non-hydrophobic/1 hydrophobic), 7 Streptococcus sobrinus (6 non-hydrophobic/ 1 hydrophobic) and 2 Streptococcus rattus (hydrophobic). Patients with high dental caries risk have a higher prevalence of hydrophobic bacteria than patients with low dental caries risk (p = 0.0003). All typed S. rattus were hydrophobic.