The comparative evaluation of the effects of tongue cleaning on salivary levels of mutans streptococci in children

Oral Health and Caries Prevention: How Tongue Hygiene Helps Maintain Balance of Microbiota and Overall Health in Pediatric Patients

BACKGROUND/OBJECTIVES

The tongue harbors about two-thirds of the microorganisms present in the mouth; the stable bacterial population consists mainly of aerobic and facultative anaerobic streptococci. These bacterial colonies, found more frequently on the tongue than on the outside of the hard part of the dental enamel in children younger than 18 months, suggest that the tongue is a potential bacterial reservoir. The aim of this review is to examine the scientific literature to clarify whether the mechanical removal of bacterial biofilm on the tongue can have a positive effect on caries prevention, with the reduction in colony-forming unit (CFU) of salivary streptococcus and the whole-mouth plaque index (FMPS).

METHODS

An open literature search was conducted by using PubMed (MEDLINE), Cochrane Library and Google Scholar. The most studied age range was 9 to 12 years, with groups of children with no caries and groups with a minimum number of two teeth that were reconstructed, decayed and/or missing (DMFS/dmfs > 2) who experienced different tongue hygiene methods for the first time.

RESULTS

Four randomized trials met the search criteria and were included in this review.

CONCLUSIONS

The results obtained suggest that specific tongue hygiene protocols, combined with a healthy diet and lifestyle, could be considered the gold standard to enable more effective primary prevention and improve the health of pediatric patients. This review improves the understanding of the impact of tongue hygiene in controlling the bacteria responsible for the onset of carious disease and its systemic correlates; however, further research with more data is needed to further confirm the findings of this research.

Evaluation of the effect of three supplementary oral hygiene measures on salivary mutans streptococci levels in children: A randomized comparative clinical trial

OBJECTIVE

The aim of this study was to evaluate and compare the effect of tongue scraping, tongue brushing, and saturated saline on salivary MS levels.

MATERIALS AND METHODS

A single-blinded, randomized, parallel group clinical trial was conducted in children aged 9-12 years. Total sample of 45 subjects were randomly assigned to three groups, that is, Group A, Group B, and Group C comprised of 15 each. Group A, Group B, and Group C were asked to do tongue scraping, tongue brushing and saturated saline rinsing twice daily, respectively for 21 days. Saliva samples, collected from the subjects on the baseline, 7(th) day and 21(st) day, were inoculated on mitis salivarius bacitracin agar and incubated at 37°C for 48 h. The mean streptococcal colony forming counts were enumerated. The data were subjected to statistical analysis using Wilcoxon signed rank sum test for intragroup comparisons and Mann-Whitney U-test for intergroup comparisons.

RESULTS

Intragroup comparisons showed statistically significant reduction in MS levels (P < 0.01). However, the intergroup comparisons showed no statistically significant difference (P > 0.05).

CONCLUSION

The oral hygiene measures evaluated proved equal efficacy in reducing the colony counts. Hence, there is a need to emphasize the importance of incorporating supplementary oral hygiene measures in daily oral care.

Impact of tongue biofilm removal on mechanically ventilated patients

Objective

To evaluate the effectiveness of a tongue cleaner in the removal of tongue biofilm in mechanically ventilated patients.

Methods

Tongue biofilm and tracheal secretion samples were collected from a total of 50 patients: 27 in the study group (SG) who were intubated or tracheostomized under assisted ventilation and treated with the tongue cleaner and 23 in the control group (CG) who did not undergo tongue cleaning. Oral and tracheal secretion cultures of the SG (initially and after 5 days) and the CG (at a single time-point) were performed to evaluate the changes in bacterial flora.

Results

The median age of the SG patients was 77 years (45-99 years), and that of the CG patients was 79 years (21-94 years). The length of hospital stay ranged from 17-1,370 days for the SG with a median stay of 425 days and from 4-240 days for the CG with a median stay of 120 days. No significant differences were found when the dental plaque indexes were compared between the SG and the CG. There was no correlation between the index and the length of hospital stay. The same bacterial flora was found in the dental plaque of 9 of the 27 SG patients before and after the tongue scraper was used for 5 days compared with the CG (p=0.683). Overall, 7 of the 27 SG patients had positive bacterial cultures for the same strains in both tongue biofilm and tracheal secretions compared with the CG (p=0.003). Significant similarities in strain resistance and susceptibility of the assessed microorganisms were observed between oral and tracheal microflora in 6/23 cases in the CG (p=0.006).

Conclusion

The use of a tongue cleaner is effective at reducing tongue biofilm in patients on mechanical ventilation and facilitates oral hygiene interventions performed by caregivers.

Clinical Trials Registry NCT01294943

The comparative evaluation of the effects of tongue cleaning on existing plaque levels in children

The present study compared and evaluated the effects of tongue scraping and tongue brushing on existing plaque levels in children. The investigation was a single blind, stratified comparison of three parallel groups of children who performed either tongue scraping or tongue brushing along with tooth brushing or only tooth brushing twice daily under professional supervision for a 21 day period. Dental plaque was recorded using the plaque index described by Silness and Loe at baseline, on day 10 and on day 21. All data was subjected to statistical analysis using Wilcoxon's Signed Ranks Sum Test and Mann-Whitney U-test. The results of the present study show that the tongue scraping and tongue brushing groups showed statistically significant reductions in plaque levels after 10 days and also after 21 days. It was also noted that both tongue scraping and tongue brushing were equally effective in reducing the plaque load in children.

How to cite this article: Winnier JJ, Rupesh S, Nayak UA, Reddy V, Rao AP. The Comparative Evaluation of the Effects of Tongue Cleaning on Existing Plaque Levels in Children. Int J Clin Pediatr Dent 2013;6(3):188-192.