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

Distribution of Streptococcus mutans and Streptococcus sobrinus in Dental Plaque of Indian Pre-School Children Using PCR and SB-20M Agar Medium

INTRODUCTION

Dental caries is one of the most common infectious diseases affecting the oral cavity. Among the oral bacteria, mutans streptococci have been implicated as major cariogenic bacteria as they can produce high levels of dental caries causing substances such as lactic acid and extracellular polysaccharides.

AIM

The aim of the study was to detect the presence of Streptococcus mutans and Streptococcus sobrinus in dental plaque by using Polymerase Chain Reaction (PCR) method, quantification of these micro-organisms using Modified Sucrose-Bacitracin (SB-20M) agar medium and to correlate their presence in Caries Active (CA) and Caries Free (CF) pre-school children.

MATERIALS AND METHODS

Sixty-eight pre-school children, in the age group of 3-5 years were divided equally into 34 CA and 34 CF children. Dental plaque samples were obtained for detection of these microorganisms by PCR method and quantification was done using SB-20M culture medium. The data was analyzed using statistical software SPSS version 16. For statistical analysis, the frequencies and means of Colony Forming Units (CFU) were used with CI = 95%. For bivariate analysis, Fisher exact test was used at 5% level of significance. The comparison of mean of number of CFU of S. mutans and S. sobrinus was made by Mann Whitney U test and Spearman's Rho test at 1% level of significance was used for correlation between dmft and CFU in CA group.

RESULTS

The results showed that S. sobrinus was significantly higher in CA group as compared to CF group whereas S. mutans showed no significant difference. On quantification of these micro-organisms, S. sobrinus was present in significantly higher numbers in CA group as compared to CF group. On correlating the CFU/ml of the micro-organisms with the dmft index, both the micro-organisms showed a positive correlation.

CONCLUSION

We conclude that S. mutans and S. sobrinus were detected in higher numbers in CA children as compared to CF children. PCR is a sensitive, specific, rapid and an effective method for the detection of oral microorganisms.

Comparing the cariogenic species Streptococcus sobrinus and S. mutans on whole genome level

Background

Two closely related species of mutans streptococci, namely Streptococcus mutans and Streptococcus sobrinus, are associated with dental caries in humans. Their acidogenic and aciduric capacity is directly associated with the cariogenic potential of these bacteria. To survive acidic and temporarily harsh conditions in the human oral cavity with hundreds of other microbial co-colonizers as competitors, both species have developed numerous mechanisms for adaptation.

Objectives

The recently published novel genome information for both species is used to elucidate genetic similarities but especially differences and to discuss the impact on cariogenicity of the corresponding phenotypic properties including adhesion, carbohydrate uptake and fermentation, acid tolerance, signaling by two component systems, competence, and oxidative stress resistance.

Conclusions

S. sobrinus can down-regulate the SpaA-mediated adherence to the pellicle. It has a smaller number of two-component signaling systems and bacteriocin-related genes than S. mutans, but all or even more immunity proteins. It lacks the central competence genes comC, comS, and comR. There are more genes coding for glucosyltransferases and a novel energy production pathway formed by lactate oxidase, which is not found in S. mutans. Both species show considerable differences in the regulation of fructan catabolism. However, both S. mutans and S. sobrinus share most of these traits and should therefore be considered as equally virulent with regard to dental caries.

Characterization of the Streptococcus sobrinus acid-stress response by interspecies microarrays and proteomics

Streptococcus mutans and Streptococcus sobrinus are considered the primary organisms responsible for human dental caries. The ability to generate acids and to adapt to low pH conditions is directly associated with the cariogenic potential of these bacteria. To survive acidic conditions, both species have been shown to mount an acid-tolerance response (ATR). However, previous characterization of the S. sobrinus ATR identified critical differences in the mechanisms of acid adaptation between S. mutans and S. sobrinus. Here, interspecies microarray and proteomic approaches were used to identify novel, previously unrecognized genes and pathways that participate in the S. sobrinus acid-stress response. The results revealed that, among other things, metabolic alterations that enhance energy generation and upregulation of the malolactic fermentation enzyme activity constitute important acid-resistance properties in S. sobrinus. Some of these acid adaptive traits are shared by S. mutans and might be considered optimal targets for therapeutic treatments designed to control dental caries.

Effect of antiplaque compounds and mouthrinses on the activity of glucosyltransferases from Streptococcus sobrinus and insoluble glucan production

INTRODUCTION

The development of therapeutic agents inhibiting the activity of glucosyltransferases (GTF) and their production of glucans is a potential strategy to reduce dental decay. The aim of this study was first to characterize a GTF preparation from Streptococcus sobrinus ATCC 33478 and then to evaluate the effects of select compounds and mouthrinses on insoluble glucan (ISG) formation by combined GTFs.

METHODS

The purity of the crude GTF mixture was assessed by electrophoresis. The effects of pH, temperature, sucrose, and dextran T10 concentrations on GTF activity were analyzed and the chemical structure of the products was investigated. Finally, the inhibition of GTF by commercial mouthrinses used in oral hygiene and their active components (chlorhexidine, polyphenolic compounds, fluoride derivatives, polyols, cetylpyridinium chloride, and povidone iodine) was analyzed through the reductions in the overall reaction rate and the quantity of ISG synthesized.

RESULTS

The S. sobrinus ATCC 33478 crude GTF preparation obtained contains a mixture of four different GTFs known for this species. For optimal adherent ISG formation, the reaction parameters were 37 degrees C, pH 6.5, sucrose 50 g/l, and dextran T10 2 g/l. Under these conditions, the most effective agents were chlorhexidine, cetylpyridinium chloride, and tannic acid. Eludril, Elmex, and Betadine were the most effective inhibitors of all the mouthrinses tested.

CONCLUSION

As the formulation of commercial products considerably influences the efficiency of active components, the fast representative ISG inhibition test developed in this study should be of great interest.

Comparative analysis of a monoclonal antibody-based Streptococcus mutans detection method with selective culture assays using polymerase chain reaction as a gold standard

The aim of this study was to compare a recently developed monoclonal antibody (MAb)-based salivary Streptococcus mutans detection method with various selective media using polymerase chain reaction (PCR) as the gold standard. Salivary S. mutans cells were enumerated with a MAb-based method, along with three commonly used selective media, mitis-salivarius-bacitracin agar (MSB), trypticase yeast-extract cystine sucrose bacitracin agar (TYCSB), and glucose-sucrose-potassium tellurite-bacitracin (GSTB) agar. Statistical analysis showed no significant correlations between each method. With PCR as the standard, a MAb-based detection method was found to provide the highest sensitivity (91%) and specificity (96%) among these four methods. This study demonstrates that the MAb-based detection method may provide more accurate enumeration of salivary S. mutans than selective media.

The scientific and public-health imperative for a vaccine against dental caries

Dental caries is caused by one of the most ubiquitous bacterial infections of humans. In many countries such as Brazil and China, this disease is reaching epidemic proportions, and it is clear that a more effective public-health measure to combat dental caries is needed, because disadvantaged children are the most severely affected. One of the main groups of oral microorganisms, the mutans streptococci, has been associated with the aetiology of dental caries, and preclinical studies of immunological interventions have shown the feasibility of interfering with this disease. Moreover, clinical trials have indicated that a mucosal immune response to a crucial antigen(s) of mutans streptococci can influence the pathogenesis of dental caries. Evidence that this antigen(s) is appropriate for use in a vaccine against dental caries, as well as evidence for an appropriate target population of individuals and a logical time of administration, has now emerged.

Longitudinal study of dental caries incidence associated with Streptococcus mutans and Streptococcus sobrinus in pre-school children

Streptococcus mutans and Streptococcus sobrinus are known to be associated with the development of dental caries. In this study these bacteria were detected in pre-school children (each with primary dentition, age range 3-5 years, n = 60) using a PCR method, and then their presence was compared with the incidence of dental caries over a 1-year period. Plaque samples were collected from all erupted tooth sites using a sterile toothbrush. Dental examinations at the beginning of the study (baseline) and after 1 year were also performed to determine decayed, missing, filled teeth (dmft) scores using WHO caries diagnostic criteria. The prevalences of S. mutans and S. sobrinus across all the subjects were 61.7% and 56.6%, respectively; 13 subjects (21.7%) were positive for S. mutans alone, 10 (16.6%) were positive for S. sobrinus alone and 24 (40.0%) were positive for both S. mutans and S. sobrinus, whereas 13 (21.7%) were negative for both S. mutans and S. sobrinus. dmft scores of subjects positive for both S. mutans and S. sobrinus at baseline and after 1 year were significantly higher than of those positive for S. mutans alone at the same stages (P < 0.01 and P < 0.001, respectively). The caries incremental increase was also significantly greater in those with both bacteria detected (P < 0.05). Our results indicate that pre-school children harbouring both S. mutans and S. sobrinus have a significantly higher incidence of dental caries than those with S. mutans alone.

Severity of dental caries among 12-year-old Sudanese children with different fluoride exposure

The aim of this study was to assess the effect of fluoride on the severity of caries among children exposed to different concentrations of fluoride in the drinking water and living in rural areas in the Sudan. Permanently resident schoolchildren (n = 299) aged 11-13 years from three villages were clinically examined under field conditions. The caries criterion was teeth in need of extraction or extracted; only molars were recorded. Dental fluorosis was scored on all buccal tooth surfaces by the Thylstrup and Fejerskov index. The fluoride concentrations of the drinking water were assessed in samples (n = 25) collected from wells and households. Predictors of caries were assessed by logistic regression analyses. There was no significant difference regarding age and gender distribution between the areas (P > 0.05, df = 2, Kruskal-Wallis test). The socio-economic conditions in these villages were presumed to be equal. Significantly different fluoride concentrations in the drinking water were verified by the severity of dental fluorosis. Children in Abu Delaig, drinking water with 1.0-2.0 mg fluoride/L (median = 1.8), had significantly higher caries prevalence (21% versus 8%) than in a 0.4 mg fluoride area. Area was the only significant predictor for caries; odds ratio 3.7 for children in Abu Delaig compared with the low fluoride area. There was no difference in caries prevalence between the lowest and the highest fluoride (2.9 mg) area. This study failed to demonstrate an effect of fluoride in drinking water on caries experience when the end point was molars indicated for extraction or missing because of caries.

Adaptive acid tolerance response of Streptococcus sobrinus

Streptococcus mutans and Streptococcus sobrinus are the bacteria most commonly associated with human dental caries. A major virulence attribute of these and other cariogenic bacteria is acid tolerance. The acid tolerance mechanisms of S. mutans have begun to be investigated in detail, including the adaptive acid tolerance response (ATR), but this is not the case for S. sobrinus. An analysis of the ATR of two S. sobrinus strains was conducted with cells grown to steady state in continuous chemostat cultures. Compared with cells grown at neutral pH, S. sobrinus cells grown at pH 5.0 showed an increased resistance to acid killing and were able to drive down the pH through glycolysis to lower values. Unlike what is found for S. mutans, the enhanced acid tolerance and glycolytic capacities of acid-adapted S. sobrinus were not due to increased F-ATPase activities. Interestingly though, S. sobrinus cells grown at pH 5.0 had twofold more glucose phosphoenolpyruvate:sugar phosphotransferase system (PTS) activity than cells grown at pH 7.0. In contrast, glucose PTS activity was actually higher in S. mutans grown at pH 7.0 than in cells grown at pH 5.0. Silver staining of two-dimensional gels of whole-cell lysates of S. sobrinus 6715 revealed that at least 9 proteins were up-regulated and 22 proteins were down-regulated in pH 5.0-grown cells compared with cells grown at pH 7.0. Our results demonstrate that S. sobrinus is capable of mounting an ATR but that there are critical differences between the mechanisms of acid adaptation used by S. sobrinus and S. mutans.

Analyses of Streptococcus mutans in saliva with species-specific monoclonal antibodies

Three species-specific monoclonal antibodies (MAbs) against Streptococcus mutans were used to detect and quantify S. mutans levels in saliva. This study shows that MAb-based salivary S. mutans tests exhibit significantly higher specificity and sensitivity than the commonly used selective culture method. Examination of nearly 2,000 human saliva samples shows that S. mutans counts in human saliva vary from less than 10,000 to a high 36 million cells/mL. Over 15% of the saliva samples examined have salivary S. mutans counts over 500,000 cells/mL. When saliva samples were collected at different time points during a day, the number of salivary S. mutans in the same human subject varied, especially before and after sugar uptake. Additionally, data obtained from stimulated versus unstimulated saliva in the same human subjects differed greatly and appear to be completely uncorrelated. This study provides useful information and tools for analyzing the role of S. mutans in human dental caries.

Salivary microbiota levels in relation to periodontal status, experience of caries and miswak use in Sudanese adults

OBJECTIVES

The purpose of the present investigation was to assess the salivary levels of 25 oral bacteria in relation to periodontal status and experience of caries, and to compare the levels of these bacteria between habitual miswak and toothbrush users in adult Sudanese subjects.

MATERIAL AND METHODS

The study subjects consisted of 56 individuals with age range 19-53 years (mean 35.2 years) and included 30 miswak and 26 toothbrush users. The periodontal status and presence of dental caries were assessed clinically. Whole saliva was collected from all subjects, and the levels of 25 selected bacterial species in saliva were assessed by the checkerboard DNA-DNA hybridization method using whole genomic DNA probes.

RESULTS

A high percentage of the subjects had detectable levels (> or = 105 bacterial cells) of several bacterial species in saliva. Between 12% and 16% of the subjects showed high (> or = 106 cells) salivary levels of the periodontitis-associated bacteria A. actinomycetemcomitans, P. melaninogenica, P. intermedia, C. rectus and E. corrodens, whereas only two (3.6%) and four (7.1%) subjects had high levels of P. gingivalis and F. nucleatum, respectively. There were no significant differences in the levels of all or most bacterial species by age group, gender or periodontal status. Presence of > or = 105 L. acidophilus bacterial cells in saliva was associated with high caries scores (p = 0.02). There were significantly higher levels of A. actinomycetemcomitans, P. melaninogenica, C. rectus, P. micros, V. parvula, S. mutans, S. anginosus, A. israelii, C. sputigena, and C. gingivalis, and significantly lower levels of P. intermedia, F. nucleatum, S. sputigena, E. corrodens, L. acidophilus, S. sanguis, S. salivarius, S. oralis, and S. mitis in the miswak than in the toothbrush group.

CONCLUSIONS

: The findings suggest that miswak may have a selective inhibitory effect on the level of certain bacteria in saliva, particularly several oral streptococci species. This is the first report that the checkerboard DNA-DNA hybridization method can be useful for assessing the levels of a wide range of bacterial taxa in saliva.

Mutans streptococci and other caries-associated acidogenic bacteria in five-year-old children in South Africa

Correlations between mutans streptococci and caries are inconsistent; some studies show that early caries may occur with other bacterial species possessing the ability to survive, interact and compete with mutans streptococci. This study looked at the relationship between mutans streptococci, Lactobacillus, Actinomyces and Veillonella in saliva and plaque collected from four tooth sites in two ethnic groups, with and without caries. All samples were collected and cultured onto selective media. Colonies were enumerated and identified using biochemical tests. Pearson correlations showed low yet statistically significant correlations between plaque mutans streptococci counts and the number of decayed surfaces (ds) and decayed, missing and filled surfaces (dmfs) of primary teeth in blacks and in coloreds (historical race classification). Salivary mutans streptococci counts correlated with ds and dmfs in coloreds. No relationship was found between ds, dmfs and Lactobacillus, Actinomyces or Veillonella numbers. Significant associations were evident between plaque mutans streptococci and Veillonella and Lactobacillus in black children with caries and between plaque mutans streptococci and Actinomyces and Lactobacillus and Veillonella in colored children. Hence, oral microbes are in constant flux but have interrelationships in children with caries.

A DNA probe specific to Streptococcus sobrinus

Three DNA fragments (SSB-1, -2 and -3) in the dextranase gene (dex) of Streptococcus sobrinus were amplified by polymerase chain reaction and used as DNA probes. The probes were examined for the specificity and the sensitivity of hybridization with DNA of oral streptococcal species. While probes SSB-1 and SSB-2 were specific to both S. sobrinus and Streptococcus downei, SSB-3 was specific only to S. sobrinus. SSB-3 was able to detect 5 ng of chromosomal DNA purified from S. sobrinus NIDR6715 and DNA extracted from 1 x 10(5) cells of the strain. In addition, SSB-3 could differentiate clinical isolates of S. sobrinus from Streptococcus mutans. These results suggest that SSB-3 is an effective DNA-probe to detect and to identify S. sobrinus.

[Prevalence of dental caries in children from 0 to 6 years old attending nursery: the influence of socioeconomic factors]

Oral health condition in samples of children from zero to six years old, examined in day nurseries for children from Bauru and S. Paulo County (Brazil) by the caries indicator in primary dentition-dmfs, is assessed. The first group did not receive oral health care where any as the second group received the standard oral care provided by the institution. Variables related to way of life and their relationship to the presence of caries were evaluated. Multiple regression analysis showed a statistically significant association of age and frequency of dental visits with the prevalence of dental caries (p < 0.05). The data also showed that 23.3% of the children from Bauru, and 9.3% of those from S. Paulo were free of caries, numbers that are very far from the 50% proposed by WHO for the year 2000. The overall prevalence of dental caries was greater for the Bauru group than for the S. Paulo group; however, statistical significance was only found in the 3-4 age-group (p < 0.05). Sex differences in the occurrence of dental caries were not statistically significant.

Dental caries in relation to diet, saliva and cariogenic microorganisms in Tanzanians of selected age groups

The relationship between diet and dental caries in a Tanzanian population was studied. Mutans streptococci, lactobacilli, yeasts, salivary flow rate as well as buffer effect were also analyzed. A random sample of 12-, 35-44- and 65- to 74- year olds was drawn from Msongola (rural) and Ukombozi (urban), Dar-es-Salaam. The mean of two 24-h recalls was used for the assessment of food intake. The percentage of those with at least one carious tooth ranged from 30% in the 12-year-olds to 80% in the oldest age group. The mean number of decayed teeth (DT) increased significantly with age (P = 0.000) but was not significantly associated with the area of residence. DT increased significantly (P = 0.048) with the number of snacks per day and was also associated with dietary sucrose (P = 0.025), total carbohydrates (P = 0.002) and fiber (P = 0.002). Among salivary variables lactobacilli (P = 0.000) correlated positively with DT. Our study did not reveal any strong association between total energy intake and dental caries in rural or urban populations in Tanzania but snacking and sucrose intake were significantly associated with caries, in particular in the urban area.

Cariogenicity depends more on diet than the prevailing mutans streptococcal species

This review aims to compare the occurrence and distribution of mutans streptococci in Africa, Europe, and North America and in addition will try to offer explanations for existing relationships among salivary mutans streptococci counts, dietary patterns, and dental caries. The literature reveals that salivary mutans streptococci counts in child populations of the three continents are comparable. The distribution of mutans streptococci species, with a predominance of S. mutans followed by S. sobrinus, and the virtual absence of other mutans streptococci species are also comparable. Although it is widely believed that diet has an important effect on mutans streptococci counts, this review provides evidence that this does not hold true when variations in dietary patterns are moderate, as they normally are in real-life situations. Since the diets of the child populations in the three continents vary moderately, a strong dietary-induced effect on salivary mutans streptococci counts cannot be expected. The observed analogous salivary mutans streptococci counts in these child populations are thus 'not surprising' but are in accordance with the conceptual expectation. The differences in caries experience in children of the three continents cannot be explained by the prevailing mutans streptococci species but instead should be attributed to differences in the cariogenicity of the various diets. The fact that the cariogenicity of the diet determines the development of dental caries while hardly affecting the mutans streptococci counts explains the limited value of the latter as an indicator of dental caries. The reviewed literature shows that mutans streptococci are ubiquitous in children aged 7 years and older in Africa, Europe, and North America. Mutans streptococci should therefore be considered as belonging to the indigenous microflora of the human mouth.

Dental caries and microbial and salivary conditions in Uruguayan children from two different socioeconomic areas

Dental caries, microbial and salivary conditions, dietary habits, and socioeconomic conditions were studied in 100 12- to 13-year-old children from 2 different socioeconomic areas in Montevideo: Pocitos and Piedras Blancas. The residents of Pocitos had a higher educational level, better housing conditions, and occupations involving higher earnings than those of Piedras Blancas. The caries prevalence in the two areas was about the same, but the children in Piedras Blancas had more decayed surfaces and fewer filled surfaces than the children in Pocitos. The mean values for caries in Piedras Blancas and Pocitos were, DMFT, 4.2 and 4.2; DMFS, 8.1 and 7.8; DS, 4.7 and 2.5; and FS, 1.7 and 4.7, respectively. The differences in DS and FS were statistically significant. The frequency of sugar intake and the salivary secretion rate were similar, but the buffer capacity was significantly higher in Pocitos than in Piedras Blancas. The plaque index was the same, but the distribution of cariogenic microorganisms differed significantly. Fifty-eight per cent of the children in Piedras Blancas had more than 10(6) CFU of mutans streptococci per milliliter saliva, compared with 17% of the children in Pocitos. Similar differences were found with regard to the lactobacilli. The percentage of children with high numbers of mutans streptococci was higher in Piedras Blancas and lower in Pocitos than in previous epidemiologic studies in Scandinavia. It was, however, higher than that recently noted in Finland.

Microbiological predictors of caries risk

The prediction of caries risk has been of long-standing interest. Generally, few of the tests involving oral bacteria or their products have become accepted. Presently, the main focus is on counts of lactobacilli (L) and mutans streptococci (MS). Due to their positive numerical association with human caries and the linkage of this association to carbohydrate consumption, counts of L and MS may, potentially, serve not only as a caries risk predictor but also as an indicator of carbohydrate consumption, another caries-risk factor. The value of counts of L and MS as caries-risk predictors has been evaluated by means of studies providing data on test sensitivity, specificity, and predictive values. These and other studies indicate that their use for the prediction of caries risk of individuals is not possible but is more promising for that of the caries risk of groups (e.g., identification of high-caries-risk subjects); further, the prediction of low caries risk may be more reliable than that of high caries risk. The influence of test variables on the test results has been discussed. These include the level of caries increment, subject age, methods of caries evaluation, use of saliva or dental plaque as test sample, sampling frequency, type of bacterial growth medium, and the use of simplified methods rather than conventional laboratory procedures for microbial enumeration. An approach to optimize the use of microbiological caries-risk predictors in different populations as well as their use in conjunction with other caries-risk predictors has been discussed. The latter include the incipient caries lesion or past caries experience and salivary buffering capacity and flow rate. Due to the multifactorial nature of caries etiology, it is expected that multivariate approaches rather than the use of single parameters may improve caries risk prediction for individuals as well as groups of subjects.

Prevalence of dental caries in 4- to 5-year-old children partly explained by presence of salivary mutans streptococci

The correlation between dental caries and the number of oral mutans group streptococci (ms) present has been shown to be weak. The aim of this investigation was to study associations between caries experience (decayed, missing, and filled surfaces [dmfs]) and the number of ms in stimulated saliva, with emphasis on the level of disease and the confounding effect of regular intake of sweets, the presence of salivary lactobacilli, and oral hygiene. In some 2,700 4- to 5-year-old South African children of different ethnic origins, caries was diagnosed on the basis of World Health Organization criteria and saliva samples were analyzed for ms after cultivation on mitis salivarius-bacitracin agar and for lactobacilli by using the Dentocult kit. Oral hygiene was scored on the basis of the Greene and Vermillion simplified debris index, while data on intake of sweets were derived from extensive interviews. Pearson's coefficient of correlation was computed, and multiple regression analysis was performed to correct for confounding factors. The distribution of the children in the eight caries classes was strongly associated with the ms class (P < 0.001), with those in the lower ms classes generally having low dmfs scores and those in the higher ms classes having dmfs scores distributed over the whole range. The r value for the two variables was 0.25 for the total material; this was reduced to 0.18 by correction for confounding factors. The corresponding values for children with caries were 0.21 and 0.17, for those in the 1 to 6 dmfs interval they were 0.07 and 0.03, and for those in the 7 to 81 dmfs interval they were 0.16 and 0.14. The data imply that the explanatory values for ms, those for the lower caries interval not counted, ranged from 6 to 2%. The unexpected results for children with caries might be due to their distribution pattern. It is concluded that there is a need for reevaluation of ms as a risk factor in dental caries.

Dental caries and its determinants among recent immigrants from rural Ethiopia

Adults (35-45 yr old) and children (5 and 12 yr old) recently arrived in Israel from rural areas in Ethiopia were examined. Caries levels were low: e.g. DMFT = 0.31 among 12-yr-olds, and 1.27 amongst adults. The 5-yr-olds were 86.8% caries-free, while 12-yr-olds were 81.8% and adults 54% caries-free respectively. According to interview data, the diet in Ethiopia had been based on local agricultural products and was almost sugar-free. The mean total count of salivary bacteria, as determined on blood agar, was 3.4 x 10(8); mean count of Streptococcus viridans, on mitis salivarius, was 6.7 x 10(7); and mean count of S. mutans, as determined on mitis salivarius with bacitracin, was 1.7 x 10(7). These levels were all high and were not significantly different from a control group of 20 Israelis. The mean number of lactobacilli, on Rogosa agar, was 2.75 x 10(4), which was significantly higher than among the controls (3.6 x 10(3). Salivary pH levels were generally similar between the Ethiopian group and the controls. Salivary flow was significantly higher for the Ethiopians (1.93 ml/min) than for controls (1.16 ml/min). Low levels of caries in this population can be attributed to an almost sugar-free diet and high salivary flow, but not to the composition of oral microflora.

Prevalence of mutans streptococci in one-year-old children

Colonization with mutans streptococci was studied in 1095 1-year-old children living in suburban Stockholm. During a scheduled vaccination appointment at a child health centre, a bacterial sample was obtained from the child's tongue and a structured questionnaire was completed by the accompanying parent. Six percent of the subjects were colonized with mutans streptococci. The variables most strongly correlated with presence of mutans streptococci were: non-Swedish background, consumption of sugar-containing beverages at night and total consumption of sugar-containing beverages. The results indicate that, by the age of 1 year, maternally influenced behaviour patterns such as dietary habits that may predispose to early colonization of mutans streptococci are already established. Such early colonization with mutans streptococci may predict high caries risk in the primary dentition.

Caries in the preschool child: aetiology

Although a substantial number of preschool children are caries free at 5 years of age, there remain a small proportion with caries who require a considerable amount of effort and time invested in them. Therefore, the multifactorial nature and ramifications of dental caries are considered in turn. The evidence cited is pertinent, especially in relation to our multiracial society and current disease levels for this age group.

Effects of fluoride on the microbial ecology of dental plaque

In order to survive in a community such as dental plaque, bacteria must be able to resist changes in the environment. These changes may be the result of differences in the host or the activities of the bacteria within the community. Bacteria which cannot resist these environmental pressures may cease metabolism but survive, or be eliminated from the community. Fluoride is only one of numerous environmental pressures which impact on oral bacterial communities, yet its beneficial effect on caries is such that it could be proposed that in addition to its effects on enamel and remineralization, fluoride would affect the bacteria. It has been shown on many occasions that fluoride can affect bacterial carbohydrate fermentation; however, are there other effects of fluoride on the bacteriology of dental plaque? Although very high levels of fluoride (0.16-0.3 mol/L) will kill bacteria, there is little evidence that fluoride causes dramatic changes in the number of species found in plaque or their relative concentrations. The survival of the populations in the plaque community in the presence of fluoride could result from: (1) the fact that all the organisms are unaffected, (2) selection of mutant strains resistant to fluoride, or (3) adaptation of strains to fluoride resistance. Examples of these phenomena can be found among members of the oral flora. Some species are unaffected (Veillonella), but Streptococcus can be mutated to fluoride resistance and also adapt phenotypically to increasing levels of fluoride in the environment. Which of these mechanisms operates in vivo, and does resistance, mutation, or phenotypic adaptation of these bacteria reduce the effectiveness of fluoride, in controlling caries?(ABSTRACT TRUNCATED AT 250 WORDS)

Dental caries in developing countries in relation to the appropriate use of fluoride

Although it is widely believed that caries prevalence in developing countries is increasing rapidly, a review of studies from Africa and China provides equivocal evidence. Data from child and adult populations indicate that the disease is almost ubiquitous but with a slow rate of progression. Theoretically, administration of fluoride in such populations should result in reducing caries progression rates, but too little is known about the magnitude of the effect, and therefore about the cost-effectiveness of different methods of fluoride administration. The lack of a developed infrastructure and of trained personnel in many developing countries limits the applicability of many strategies. Methods of fluoride administration that minimize systemic exposure are to be recommended where affordable or practical. In the light of economic constraints and slow caries lesion progression rates, however, improvements in oral hygiene practices may be the most important method of controlling the disease whether or not fluoride is available or accessible.

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.

Why is sucrose so cariogenic? The role of glucosyltransferase and polysaccharides

Some aspects of the cariogenicity of sucrose are discussed, in particular the data indicating that glucosyltransferase (GTF) mediates the well known stickiness of sucrose exposed S. mutans and plaque in vivo. The non-sucrose dependent colonization of teeth, which has been studied extensively, is judged to be of less importance because S. mutans is only pathogenic in combination with sucrose. Strong evidence from several laboratories show that free GTF is present in saliva and that it adsorbs to the pellicle and is able to form glucan in the adsorbed state. Glucan-glucan interaction between 1-3 linked glucans gives a strong sucrose dependent interaction between glucan chains originating from the GTF adsorbed to the pellicle and from GTF on the bacterial surface.