Oral colonization of Streptococcus mutans in six-month-old predentate infants

Dynamics of oral microbiome acquisition in healthy infants: A pilot study

Objectives

The human oral microbiota is one of the most complex bacterial communities in the human body. However, how newborns initially acquire these bacteria remains largely unknown. In this study, we examined the dynamics of oral microbial communities in healthy infants and investigated the influence of the maternal oral microbiota on the acquisition of the infant's oral microbiota. We hypothesized that the infant oral microbial diversity increases with age.

Methods

One hundred and sixteen whole-salivary samples were collected from 32 healthy infants and their biological mothers during postpartum and 9- and 15-month well-infant visits. Bacterial genomic DNA was extracted and sequenced by Human Oral Microbe Identification using Next Generation Sequencing (HOMINGS) methods. The Shannon index was used to measure the microbial diversity of the infant-mother dyads (alpha diversity). The microbial diversity between the mother-infant dyads (beta-diversity) was calculated using the weighted non-phylogenetic Bray-Curtis distance in QIIME 1.9.1. Core microbiome analysis was performed using MicrobiomeAnalyst software. Linear discriminant analysis coupled with effect size analysis was used to identify differentially abundant features between mother and infant dyads.

Results

A total of 6,870,571 16S rRNA reads were generated from paired mother-infant saliva samples. Overall, oral microbial profiles significantly differed between the mother and infant groups (p < 0.001). The diversity of the salivary microbiomes in the infants increased in an age-dependent manner, whereas the core microbiome of the mothers remained relatively stable during the study period. Breastfeeding and gender did not affect the microbial diversity in infants. Moreover, infants had a greater relative abundance of Firmicutes and a lower abundance of Actinobacteria, Bacteroidetes, Fusobacteria, and Proteobacteria than their mothers. The SparCC correlation analysis demonstrated constant changes in infants' oral microbial community network (p < 0.05).

Conclusions

This study provides new evidence that the oral cavities of infants are colonized by a distinct group of bacterial species at birth. The acquisition and diversity of changes in oral microbial composition are dynamic during the first year of an infant's life. Before reaching the second birthday, the composition of the oral microbial community could be more similar to that of their biological mothers.

A preliminarily Investigation on Oral Colonization and Counts of Streptococcus mutans and Streptococcus mitis in a Group of Predentate Infants in Relation to Some Maternal and Infant Factors (A Longitudinal Observational study)

Aim

Bacterial colonization of infants' oral cavities is a key factor for future caries risk. This study sought to longitudinally assess oral bacterial colonization in a group of predentate infants in relation to some mother and infant factors.

Materials and methods

A total of 50 mother-infant pairs were enrolled. When infants were 3-month-old, data were collected about some infant and mother factors; additionally, maternal Decayed, Missing, and Filled Teeth (DMFT) scores and salivary samples of mothers and infants were obtained. At 6 months of infant's age, another infants' salivary samples were obtained. Saliva was cultured to detect and quantify Streptococcus mutans (S. mutans) and Streptococcus mitis (S. mitis).

Results

Streptococcus mitis (S. mitis) was detected in all infants at 3 months. 74 and 96% of infants acquired S. mutans at 3 and 6 months, respectively. S. mutans detection was significantly higher with higher maternal DMFT scores, salivary S. mutans counts, and lower S. mitis counts, as well as when infants were given sugar-containing complementary foods/drinks. At 3-6 months, infants' S. mutans counts were significantly positively correlated with maternal S. mutans counts and DMFT scores and negatively correlated with maternal S. mitis counts. The opposite was evident for infants' S. mitis counts. Regression analysis showed that increased maternal DMFT scores and S. mutans counts, and Cesarean delivery were strong predictors for increased infant's S. mutans counts. While increased DMFT scores and maternal S. mutans counts were strong predictors for reduced infant's S. mitis counts.

Conclusion

Poor maternal oral health, early introduction of sugars in the diet, and probably Cesarean delivery can negatively impact infants' oral bacterial colonization and possibly future caries risk.

Clinical significance

Understanding factors associated with oral colonization of both caries-producing and protective flora in infants of different populations is important for caries prevention. This, in turn, can aid tailoring oral health promotion programs for expectant mothers.

How to cite this article

Wassel MO, Salman NS, Metwalli NE. A preliminarily Investigation on Oral Colonization and Counts of Streptococcus mutans and Streptococcus mitis in a Group of Predentate Infants in Relation to some Maternal and Infant Factors (A Longitudinal Observational study). Int J Clin Pediatr Dent 2023;16(1):79-86.

Effects of Expression of Streptococcus pneumoniae PspC on the Ability of Streptococcus mitis to Evade Complement-Mediated Immunity

Streptococcus pneumoniae and Streptococcus mitis are genetically closely related and both frequently colonise the naso-oropharynx, yet S. pneumoniae is a common cause of invasive infections whereas S. mitis is only weakly pathogenic. We hypothesise that sensitivity to innate immunity may underlie these differences in virulence phenotype. We compared the sensitivity of S. pneumoniae and S. mitis strains to complement-mediated immunity, demonstrating S. mitis strains were susceptible to complement-mediated opsonophagocytosis. S. pneumoniae resistance to complement is partially dependent on binding of the complement regulator Factor H by the surface protein PspC. However, S. mitis was unable to bind factor H. The S. pneumoniae TIGR4 strain pspC was expressed in the S. mitis SK142 strain to create a S. mitis pspC⁺ strain. Immunoblots demonstrated the S. mitis pspC⁺ strain expressed PspC, and flow cytometry confirmed this resulted in Factor H binding to S. mitis, reduced susceptibility to complement and improved survival in whole human blood compared to the wild-type S. mitis strain. However, in mouse models the S. mitis pspC⁺ strain remained unable to establish persistent infection. Unlike S. pneumoniae strains, culture in serum or blood did not support increased CFU of the S. mitis strains. These results suggest S. mitis is highly sensitive to opsonisation with complement partially due to an inability to bind Factor H, but even when complement sensitivity was reduced by expression of pspC, poor growth in physiological fluid limited the virulence of S. mitis in mice.

Streptococcus Mutans Infections in Infants and Related Maternal/Child Factors

Objective

The aim of the study was to investigate the maternal-child S. mutans infection, mutual interaction and potential risk factors altering this interaction.

Material and methods

A total of 160 mothers who were paired with their children were recruited. Saliva from mothers and children was collected and S. mutans categorized levels were analyzed. A questionnaire was used to collect maternal and child conventional caries risk factors. A proportional odds regression model was used to investigate whether the level of infection of mothers would similarly affect the level of infection of their children, thus adjusting for other risk factors.

Results

The average age of mothers was 28.1 years and children had a median age of 5.1 months. Paired mother-child S. mutans cross-classification into non-infected and infected subjects showed no agreement in mutual contamination. Maternal infection of the child was highest when the mother was infected with 10^>3 S. mutans/ml of saliva. The results obtained by the regression model showed that none of the potential risk factors influenced the level of infection in the child.

Conclusion

Mothers with a high S. mutans level increase the risk of S. mutans acquisition for her five- month- old child but no evidence was found that other maternal/child factors may influence this.

Pregnancy and Dentistry: A Literature Review on Risk Management during Dental Surgical Procedures

Background: Pregnancy is a unique moment in a woman’s life, accompanied with several physiologic changes that have an impact on oral health. Aim of the study: The purpose of the present study was to conduct a critical review of published literature regarding pregnancy and dentistry, the most frequent oral diseases that are encountered during pregnancy, their correlation to adverse pregnancy events, and safe dental treatments that can be performed during pregnancy. Methods: A Medline/COCHRANE search was carried using specific keywords and MeSH terms, combined with the boolean operators “OR” and “AND”. Results: The search led to 146 publications including guidelines, meta-analyses, systematic and non-systematic reviews, published between 2000 and 2021. Discussion and conclusions: Due to the increased inflammatory and immune body response that characterizes pregnancy, periodontal conditions are often aggravated during pregnancy and periodontal disease encountered frequently in pregnant patients. There are conflicting study results in the literature regarding the association between periodontitis and adverse pregnancy outcomes. Periodontal treatment did not show a significant reduction in the adverse outcomes. Many dentists, often due to lack of information, are reluctant to provide dental treatment to pregnant women. However, preventive and restorative dental treatment is safe during pregnancy. Diagnostic radiographs may be performed after the first trimester if absolutely necessary. Analgesics (such as paracetamol) and anesthetics (such as lidocaine) are also considered safe. In case of infection, antibacterial drugs such as amoxicillin, ampicillin, and some cephalosporines and macrolides can also be prescribed. Organogenesis takes place in the first trimester, the time during which the fetus is susceptible to severe malformations (teratogenesis). The ideal time to perform dental treatment is the second trimester (week 17 to 28). However, acute pain or infections make the intervention of the dentist absolutely necessary and emergency treatment can be performed during the whole pregnancy period.

Acquisition and establishment of the oral microbiota

Acquisition and establishment of the oral microbiota occur in a dynamic process over various stages and involve close and continuous interactions with the host and its environment. In the present review, we discuss the stages of this process in chronological order. We start with the prenatal period and address the following questions: ‘Is the fetus exposed to maternal microbiota during pregnancy?’ and ‘If so, what is the potential role of this exposure?’ We comment on recent reports of finding bacterial DNA in placenta during pregnancies, and provide current views on the potential functions of prenatal microbial encounters. Next, we discuss the physiological adaptations that take place in the newborn during the birth process and the effect of this phase of life on the acquisition of the oral microbiota. Is it really just exposure to maternal vaginal microbes that results in the difference between vaginally and Cesarian section‐born infants? Then, we review the postnatal phase, in which we focus on transmission of microbes, the intraoral niche specificity, the effects of the host behavior and environment, as well as the role of genetic background of the host on shaping the oral microbial ecosystem. We discuss the changes in oral microbiota during the transition from deciduous to permanent dentition and during puberty. We also address the finite knowledge on colonization of the oral cavity by microbes other than the bacterial component. Finally, we identify the main outstanding questions that limit our understanding of the acquisition and establishment of a healthy microbiome at an individual level.

Evaluation of the risk factors of dental caries in children with very low birth weight and normal birth weight

Background

Health problems of premature infants can affect both general and oral health. The enamel defects, poor dietary and oral hygiene habits may predispose these children to dental caries. This study was conducted to assess the impact of very low birth weight and prematurity on caries risk in early childhood.

Methods

The study cohort consists of 189 of one year old infants. Anamnestic data were obtained from hospital records, feeding practice, bed-time sugar drinks and oral hygiene onset from questionnaires. Saliva samples of children and their mothers were collected for the detection of cariogenic pathogens.

Results

VLBW newborns had significantly shorter gestation age (29.6 vs. 38.8)) and lower mean birthweight (1124 g vs 3315 g) compared to NBW ones (p < 0.0001). Statistical significance has been found in the presence of early morbidity (p < 0.0001) and regular medication intake (p = 0.007). VLBW children got more frequently sweetened drinks during the day and night (p = 0.007). Regular oral hygiene practice was more frequent in full term group (p = 0.002). There was statistical difference in the presence of enamel hypoplasia in VLBW children (p = 0.033) but no statistical difference in the presence of hypomineralization (p = 0.0736) in comparison to NBW individuals. Proportional representation and count of S. mutans did not reveal statistical difference neither in both groups of children (p = 0.484) nor in both groups of mothers (p = 0.385).

Conclusions

The study confirmed anamnestic and medical differences between both groups. The proportional representation and count of S. mutans did not reveal statistical difference neither in VLBW and NBW children, nor in their mothers.

The Queensland Birth Cohort Study for Early Childhood Caries: Results at 7 Years

AIMS

This study investigated caries predictors in 378 children remaining from a birth cohort of 1,052 at 7 y and compared the efficacy of home visits (HVs) and telephone contacts (TCs) for early childhood caries (ECC) prevention.

METHODS

The HVs or TCs were made at ages 6, 12, 18, 30, and 42 mo with annual dental clinic examinations at ages 2 to 7 y. At every visit, the parents completed validated questionnaires regarding the children's family, medical, dental, and dietary histories.

RESULTS

The caries prevalence increased from 2% and 6% at ages 2 and 3 y to 15%, 33%, 42%, and 52% at ages 4 to 7 y. The mean caries experience (decayed, missing, and teeth extracted due to caries) of the total cohort increased from 0.1 ± 0.5 at age 2 y to 0.2 ± 1.1 at 3 y, 0.5 ± 1.6 at 4 y, 1.1 ± 2.4 at 5 y, 1.6 ± 2.6 at 6 y, and 2.0 ± 2.7 at 7 y. The prevalence of mutans streptococci (MS) in the total cohort at years 2 to 7 was 22%, 36%, 42%, 42%, 39%, and 44%, respectively. MS was strongly correlated with caries prevalence for all years (all P < 0.001). Statistical modeling employing the generalized estimating equations identified caries predictors as holding a Health Care Card (low socioeconomic status) (P = 0.009; odds ratio [OR] = 2.05; confidence interval [CI]: 1.20-3.52), developmental defects of enamel (DDEs) (P < 0.001; OR = 1.09; CI: 1.05-1.14), and MS counts ≤10⁵/mL (P = 0.001; OR = 1.63; CI: 1.24-2.14). By contrast, HVs were more protective than TCs for caries (P = 0.008; OR = 0.42; CI: 0.22-0.80).

CONCLUSIONS

This study provides prospective, clinical evidence that MS, DDEs, and low socioeconomic status are strongly correlated with early childhood caries and that HVs are more efficacious than TCs in ECC prevention.

KNOWLEDGE TRANSFER STATEMENT

This 7-y birth cohort study provides longitudinal clinical evidence that mutans streptococci, developmental defects of enamel, and low socioeconomic status are key risk indicators of early childhood caries.

Systematic review suggests a relationship between moderate to late preterm birth and early childhood caries

AIM

The aim was to examine the association between moderate to late preterm birth and the prevalence of early childhood caries.

METHODS

We searched the PubMed, Scopus, Cochrane Trials Register databases up to February 28, 2020. Two independent reviewers screened the papers for relevance, extracted data and assessed the risk of bias. A random-effects meta-analysis was performed to pool the prevalence of early childhood caries by gestational age.

RESULTS

The authors identified 14 studies covering 210,691 children. They were published from 2007-2020 and included birth cohorts, cross-sectional, register-based and case-control studies. We assessed eight of them as having low or moderate risk of bias. The median caries prevalence was 48.8% among children born moderate to late preterm compared to 20.5% for those born full term. The pooled overall odds ratio was 1.48 (95% confidence interval 1.16-1.89; P < .001). The certainty of this finding was low due to heterogeneity and inconsistencies across the studies.

CONCLUSION

This systematic review and meta-analysis displayed a significantly higher prevalence of early childhood caries in children born moderate to late preterm compared to full term children. The finding suggests that the gestational age should be collected as a risk factor in the paediatric dental records.

Vertical and Horizontal Transmission of Streptococcus Mutans and Effective Factors: An In Vivo Study

Aim:

The degree of vertical (intrafamilial) and horizontal (extrafamilial) transfer of Streptococcus mutans ( S. mutans) to a child shows differences according to cultures. The wrong care habits may result in transfer of S. mutans. The aim of this study was to determine the vertical and horizontal transmission of S. mutans to a child and effective factors.

Materials and Methods:

Mothers and kindergarten staff of 37 children aged between 4 and 5 years who initially started in two kindergartens (Group 1, n = 19; Group 2, n = 18) were included in this in vivo study according to 95% reliability and 80% theoretical power. Intraoral examination of mothers and children made according to the World Health Organization criteria (dmf-t/DMF-T) was done, following which mothers were asked to fill questionnaire forms including knowledge and attitudes of them about oral/dental health care. 1 mL saliva samples received from children/mothers/staff were examined microbiologically in order to isolate and quantify S. mutans. Arbitrarily primed polymerase chain reaction analysis was done to determine the genetic characteristics of S. mutans. All examinations were repeated to evaluate the horizontal transmission in the fifth month. Parametric tests ( t-test and two-way analysis of variance) were employed for comparison of the variables that meet the normality assumption and nonparametric tests (Mann–Whitney) were also used.

Results:

It was observed that there is a statistically significant correlation between mother DMF-T values and mother–child S. mutans similarity level ( P < .05). There is a statistically positive correlation between the habits of using a common fork, spoon, glass, and mother–child similarity level.

Conclusion:

Vertical and horizontal transfers occurred in Turkish families in order to prevent the transfer of S. mutans; wrong baby care habits that may lead to the transfer of S. mutans, which is the main factor in case of tooth decay, should be avoided.

In Vivo Relationship between the Nano-Biomechanical Properties of Streptococcal Polysaccharide Capsules and Virulence Phenotype

In common with many bacterial pathogens, Streptococcus pneumoniae has a polysaccharide capsule which facilitates immune evasion and determines virulence. Recent data have shown that the closely related Streptococcus mitis also expresses polysaccharide capsules including those with an identical chemical structure to S. pneumoniae capsular serotypes. We utilized atomic force microscopy (AFM) techniques to investigate the biophysical properties of S. mitis and S. pneumoniae strains expressing the same capsular serotypes that might relate to differences in virulence potential. When comparing S. mitis and S. pneumoniae strains with identical capsule serotypes, S. mitis strains were susceptible to neutrophil killing, and electron microscopy and AFM demonstrated significant morphological differences. Force-volume mapping using AFM showed distinct force-curve profiles for the center and edge areas of encapsulated streptococcal strains. This "edge effect" was not observed in unencapsulated bacteria and therefore was a direct representation of the mechanical properties of the bacterial capsule. When two strains of S. mitis and S. pneumoniae expressed an identical capsular serotype, they presented similar biomechanical characteristics. This infers a potential relationship between capsule biochemistry and nanomechanics, independent of bacterial strain. Overall, this study demonstrates that it is possible to investigate reproducibly the mechanistic, structural, and mechanical properties of both the capsule and the body of individual living bacterial cells and relate the data to virulence phenotypes. We have demonstrated that using nanomechanics to investigate individual bacterial cells we can now begin to identify the surface properties bacterial pathogens require to avoid host-mediated immunity.

Plaque biofilm microbial diversity in infants aged 12 months and their mothers with or without dental caries: a pilot study

Background

A number of studies on oral microbial diversity of early childhood caries (ECC) have tended to focus on mid- or late-stage of ECC, with a lack of research into early stage of tooth eruption and maternal influence. The aims of this study are to compare the supragingival plaque biofilm microbiota diversity between mothers with or without dental caries and their 12-month-old infants, and to explore the relationship of microbial diversity between infants and their mothers, using sequencing analysis.

Methods

Supragingival plaque biofilm samples were collected from 20 pairs of mothers and their infants aged 12 months (10 mothers with dental caries and their 10 infants vs. 10 caries-free mothers and their 10 infants). The basic information of the mothers and infants had been collected through self-completed questionnaire. Pooled plaque biofilm DNA was extracted and DNA amplicons of the V4-V5 hypervariable region of the bacterial 16S rRNA gene were generated. Ilumina Miseq PE300 was used for 16S rRNA sequencing.

Results

The results showed that high bacterial diversity was noted in the plaque biofilm of infants and their mothers with or without dental caries (dental caries mothers vs. caries-free mothers: 774 operational taxonomical units (OTUs) vs. 761 OTUs at a 3% divergence; infants whose mothers have dental caries vs. infants whose mothers are caries-free: 815 OTUs vs. 684 OTUs at 3% divergence). The Shannon microbial diversity index showed no statistically significant differences both on infants and their mothers between two groups (p > 0.05). Mother’s microbial diversity was higher than infants’ based on Shannon index (p < 0.05). Significant positive correlations were found between mothers’ and their infants’ Shannon index (r = 0.656, p = 0.002).

Conclusion

Oral microbial diversity is significantly different between mothers and infants regardless of dental caries status, but no significant difference was found between mothers with and without dental caries or between their infants. Mother’s oral microbial diversity has an overall impact on the infants aged 12 months.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0699-8) contains supplementary material, which is available to authorized users.

Large Follicular Odontogenic Keratocyst affecting Maxillary Sinus mimicking Dentigerous Cyst in an 8-year-old Boy: A Case Report and Review

Cyst with relatively high recurrence and having nature to invade the underlying tissue is “odontogenic keratocyst (OKC).” Radiographically, OKC can appear as different varieties, such as follicular, replacemental, extraneous, envelopmental, and collateral. Each radiographic variety of OKC varies in biological behavior, prognosis, recurrence, and therapeutic approaches.

Many studies done till date have not established any relationship between markers of proliferation and aggressiveness in regard to radiographic varieties of OKC. The present article reports a case of follicular OKC in an 8-year-old boy which was concluded as a dentigerous cyst by radiographic features.

How to cite this article: Madhireddy MR, Prakash AJ, Mahanthi V, Chalapathi KV. Large Follicular Odontogenic Keratocyst affecting Maxillary Sinus mimicking Dentigerous Cyst in an 8-year-old Boy: A Case Report and Review. Int J Clin Pediatr Dent 2018;11(4):349-351.

Multidisciplinary Clinical Management of a Localized Aggressive Periodontitis diagnosed in a Child with Glanzmann's Thrombasthenia

Localized aggressive periodontitis (LAP) in child involving primary dentition is a rare disease. The main characteristics of LAP are deep periodontal pockets, bone loss, tooth mobility, and, sometimes, spontaneous tooth loss. The LAP involves only some specific teeth. Glanzmann’s thrombasthenia (GT) is a rare autosomal recessive bleeding disorder. The paper’s aim is to present the case of a 5-year-old girl with GT presenting LAP, and discuss her clinical management.

How to cite this article: Prud’homme T, Roy E, Soueidan A, Fouassier M, Dajean-Trutaud S, Badran Z. Multidisciplinary Clinical Management of a Localized Aggressive Periodontitis diagnosed in a Child with Glanzmann’s Thrombasthenia. Int J Clin Pediatr Dent 2018;11(4):344-348.

Early Childhood Caries

Early childhood caries (ECC) is a common childhood disease with highest prevalence found in poor, socially disadvantaged, and minority groups. The main risk factors for ECC are frequent sugar consumption, lack of tooth brushing, and enamel hypoplasia. Contributory factors include environmental and psychosocial stresses that modify caregiver behaviors. Strategies for prevention include preventing mutans streptococci transmission, restricting dietary sugars, tooth brushing, topical fluoride applications, and early dental examinations. This article provides an overview of ECC based on current understanding of its cause, prevention, and management.

Knowledge, Attitude, and Practice of Mothers regarding Oral Hygiene of Primary School children in Chennai, Tamil Nadu, India

Introduction

Children depend on their parents and caretakers for maintenance of their oral health. Parents play a major role in both preventive and treatment regime in these children. This study was conducted with the aim of evaluating the influence of parental education on knowledge, attitude, and practice of mothers regarding oral health of primary schoolchildren in Chennai.

Materials and methods

A 15-item self-administered questionnaire was used among 465 parents of preschool children in Chennai, of which 432 mothers returned the filled questionnaire. The data collected were subjected to statistical analysis using frequency of responses and chi-square test (p < 0.01). Data were analyzed using statistical package.

Results

Of the 432 mothers who participated in the study, 150 (35%) have studied up to school level and 282 (65%) have completed diploma/degree. The knowledge of mothers regarding the knowledge of importance of oral health for general health is appreciable, but the awareness of proper brushing habit, treatment of caries, and importance of dental visits is less in mothers who have school education when compared with graduate mothers.

Conclusion

Mothers who are graduates are more aware of the importance of oral health in children, treatment of dental caries, and brushing technique than mothers with school education. Hence, it is essential that government and health care providers impart oral health knowledge to mothers, as they are the role-models for their children.

How to cite this article: Gurunathan D, Moses J, Arunachalam SK. Knowledge, Attitude, and Practice of Mothers regarding Oral Hygiene of Primary School children in Chennai, Tamil Nadu, India. Int J Clin Pediatr Dent 2018;11(4):338-343.

Prenatal Maternal Factors, Intergenerational Transmission of Disease, and Child Oral Health Outcomes

This article reviews maternal prenatal risk factors for caries in children and intergenerational transmission of caries, emphasizing early interventions for pregnant women and mother-infant pairs. A growing body of evidence focuses on maternal interventions. Studies suggest that early prenatal clinical and educational interventions are effective at reducing mother-child mutans streptococci (MS) transmission and delaying colonization and caries in young children. Dental screenings and anticipatory guidance about maternal and infant oral health should be included in prenatal care and pediatric well visits. Dental care during pregnancy is safe and recommended and can reduce maternal MS levels. Infants should visit a dentist by age 1.

Oral microbiome development during childhood: an ecological succession influenced by postnatal factors and associated with tooth decay

Information on how the oral microbiome develops during early childhood and how external factors influence this ecological process is scarce. We used high-throughput sequencing to characterize bacterial composition in saliva samples collected at 3, 6, 12, 24 months and 7 years of age in 90 longitudinally followed children, for whom clinical, dietary and health data were collected. Bacterial composition patterns changed through time, starting with "early colonizers", including Streptococcus and Veillonella; other bacterial genera such as Neisseria settled after 1 or 2 years of age. Dental caries development was associated with diverging microbial composition through time. Streptococcus cristatus appeared to be associated with increased risk of developing tooth decay and its role as potential biomarker of the disease should be studied with species-specific probes. Infants born by C-section had initially skewed bacterial content compared with vaginally delivered infants, but this was recovered with age. Shorter breastfeeding habits and antibiotic treatment during the first 2 years of age were associated with a distinct bacterial composition at later age. The findings presented describe oral microbiota development as an ecological succession where altered colonization pattern during the first year of life may have long-term consequences for child´s oral and systemic health.

Study of Viridans Streptococci and Staphylococcus Species in Cleft Lip and Palate Patients before and after Surgery

Objective

To determine the effect of surgery on types and colony count of Streptococcus and Staphylococcus species in cleft lip and palate (CLP) patients.

Design

Saliva samples were collected after the morning meal by placing a sterile cotton swab in the vestibule of the oral cavity from cleft lip and palate patients immediately preoperative and 12 weeks postoperative. Normal children were examined as a control group. Samples were cultured; Staphylococcus and Streptococcus isolates were identified and quantified.

Patients

Fifteen cleft lip and palate patients and 22 normal children, aged 3 to 39 months were examined.

Results

Streptococcus mitis biovar 1, Streptococcus salivarius and Streptococcus oralis of the viridans group of streptococci were the most commonly found in normal children, as well as in cleft lip and palate children. In the cleft lip and palate group, mean streptococcal count was 32.41 (29.80) and 46.46 (42.80) in the pre- and postoperative periods, respectively; in the normal group, the count was 20.93 (27.93) and 49.92 (34.72) at 0 week and 12 weeks, respectively. Staphylococcus aureus was the most common Staphylococcus species found in CLP patients, representing 47.4% postoperatively. In the cleft lip and palate children, mean staphylococcal count was 5.34 (8.13) and 0.56 (0.92) in the pre- and postoperative periods, respectively; in normal children, the count was 0.82 (1.98) and 0.60 (2.55) at 0 and 12 weeks, respectively. The differences were statistically significant only for the staphylococcal count between pre- and postoperative periods in children with cleft lip and palate as tested by analysis of variance (p < .05).

Conclusions

Cleft lip and palate patients had more colonization by S. aureus compared with normal children, and the colony count decreased significantly following surgical repair of the cleft lip and palate.

Predisposing Factors to Dental Caries in Children with Cleft Lip and Palate: A Review and Strategies for Early Prevention

Objective:

To review predisposing factors contributing to dental caries in patients with cleft lip, cleft palate, or both (CL/P).

Design:

Patients with CL/P have a higher susceptibility to caries compared with the population group without clefts. A review of the literature was undertaken to determine factors that could account for the compromised oral hygiene and the high caries prevalence in patients with CL/P.

Results:

After a literature review, modern strategies for the prevention of early childhood caries were developed and should be considered for integration into the overall management protocol of patients with CL/P.

Conclusions:

Preventive dental care is ever more so important in patients with CL/P compared with patients without clefts.

Transmission of mutans streptococci in mother-child pairs

BACKGROUND & OBJECTIVES

Dental caries is an infectious, transmissible disease. Maternal transfer of mutans streptococci (MS) has been a subject of research. The aim of this study was to evaluate the transmission of MS from mother to children through genetic analysis.

METHODS

Thirty mother-child pairs were included and divided into three groups according to the age of the children. Saliva samples were collected and MS colonies from each mother-child pair were isolated. After inoculation and incubation, MS colonies were submitted to amplification technique by polymerase chain reaction (PCR) for identification and arbitrarily primed PCRs (AP-PCRs) to determine various MS genotypes.

RESULTS

From birth to six months of age, 30 per cent of children exhibited MS colonization, and by the age of 30 months, 100 per cent harboured the bacteria (P < 0.001). Factors associated with MS colonization were eruption of teeth (P < 0.001), feeding habits with mean colony count being significantly lower in breast-fed as compared to bottle-fed children (P < 0.001) and a significant association between mean MS count of child and mother's practice of sharing spoon with child (P < 0.001). The AP-PCR fingerprinting profile analysis showed 17 MS groups (clusters) containing identical or highly related isolates in mother-child pairs with a high level of similarity (77.27 %).

INTERPRETATION & CONCLUSIONS

The presence of matching MS genotypes suggested vertical transmission from mothers to children. Feeding habits, gum cleaning and number of erupted teeth in children had significant effect on MS colonization. There is a need to develop strategies to present MS colonization in children.

The Oral Microbiome of Children: Development, Disease, and Implications Beyond Oral Health

In the era of applied meta-omics and personalized medicine, the oral microbiome is a valuable asset. From biomarker discovery to being a powerful source of therapeutic targets and to presenting an opportunity for developing non-invasive approaches to health care, it has become clear that oral microbes may hold the answer for understanding disease, even beyond the oral cavity. Although our understanding of oral microbiome diversity has come a long way in the past 50 years, there are still many areas that need to be fine-tuned for better risk assessment and diagnosis, especially in early developmental stages of human life. Here, we discuss the factors that impact development of the oral microbiome and explore oral markers of disease, with a focus on the early oral cavity. Our ultimate goal is to put different experimental and methodological views into perspective for better assessment of early oral and systemic disease at an early age and discuss how oral microbiomes-at the community level-could provide improved assessment in individuals and populations at risk.

The Role of Feeding Practices as a Determinant of the pufa Index in Children with Early Childhood Caries

OBJECTIVE

To evaluate the prevalence and severity of untreated dental caries among young children (aged <6 years) with early childhood caries (ECC) using the pufa index and to examine the relationship between caries and feeding practices.

STUDY DESIGN

A cross-sectional study of children with ECC was undertaken in two stages: a questionnaire survey based on interviews and an intraoral examination using the defs and pufa indices.

RESULTS

The overall prevalence of untreated dental caries in our sample of 238 ECC-affected children was 72.3%. The abscess component (code a) was the most common condition. There was an increase in the ECC patterns and the severity of untreated dental caries with increasing age for all teeth groups. ECC and untreated caries lesions for the various teeth groups and study sites varied inversely with current feeding status. The majority of the children had posterior ECC, and the fewest were affected by ulceration (code u) as a consequence of untreated dental caries. Except for the posterior caries pattern, all other caries patterns and pufa components (code u alone, p<0.05) had a significantly higher prevalence among children with nocturnal feeding practices (p<0.001). Binary logistic regression analyses revealed that older age (p<0.05) and nocturnal feeding practices (p<0.001) were significantly associated with pufa scores>0.

CONCLUSION

These data provide valuable evidence of the effect of nocturnal feeding as an important determinant of the increased prevalence of untreated caries lesions among children with ECC.

The Special Needs of Preterm Children - An Oral Health Perspective

Preterm births are defined as those before 37 weeks of gestation. With advances in fertility medicine and neonatal medicine, the numbers of preterm children in the community have significantly increased. Developmental delays and complications among preterm children are well recognized. Much less consideration is given to the dental complications of preterm children. Manifestations include palatal deformations, enamel defects, tooth size variations and tooth shape deformities, malocclusions, and increased risks of early childhood caries and tooth wear. This article explores orodental risks and orodental needs of preterm children and suggests preventive and management strategies for optimizing the oral health of special needs children.

Mother-to-child transmission of mutans streptococci

Mutans streptococci (MS) are the major group of pathogens implicated in dental caries. Like other infectious diseases, transmission of the causative microorganisms is the initial and essential step that should be understood relative to disease control and prevention. This review summarizes current knowledge regarding MS transmission, especially from mothers to their children. Included are methods used to study transmission, sources of MS, initial acquisition, factors concerning transmission and prevention of transmission. Information accumulated over many decades showed the involvement of MS transmission in the pathogenesis of caries, hence several preventive measurements have been proposed. Nevertheless, some essential aspects remain to be elucidated for more benefits of practical application.

Maternal oral mutans streptococci (MS) status, not breastfeeding, predicts predentate infant oral MS status

The purpose of this study was to investigate infant oral mutans streptococci (MS) by feeding method and by the mother's oral MS status. For this cross-sectional data collection, full-term infants at 4-6 weeks of age and their mothers were tested for oral MS using the Dentocult(®) SM chairside test (Orion Diagnostica, Espoo, Finland). For the 104 mother-infant pairs (68 breastfed, 36 formula-fed), the two groups differed by mother's race/ethnicity (p=0.006) but not by delivery mode, level of care at birth, or MS in the mothers or the infants. Thirty-one percent of mothers and 12% of infants were MS positive. Infant MS was not predicted by mother's race/ethnicity, delivery mode, feeding method, or MS status. When stratified by feeding method, the mother's MS status did significantly predict the infant's MS status in the breastfed group (odds ratio=5.97; 95% confidence interval, 1.06-33.7; p=0.043). In conclusion, oral MS at >10(4) colony-forming units/mL were detected in 12% of the 4-6-week-old infants, and the effect of the mothers' oral MS status was modified by the feeding method. Future research is needed to clarify the modifiable perinatal and maternal risks associated with the development of the infant's predentate oral microbial environment, before the introduction of the first tooth.

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.

The presence of cariogenic and periodontal pathogens in the oral cavity of one-year-old infants delivered pre-term with very low birthweights: a case control study

Background

Recently, the dental literature has focused mainly on the microbial colonization of healthy full-term infants and their mothers or caretakers. However, oral microbial acquisition by premature infants has not been adequately investigated, and the correlation between pre-term birth and the presence of cariogenic and periodontal pathogens has not been determined. The aim of this study was to identify the presence and quantities of representative cariogenic and periodontal pathogens in the oral cavities of 12-month-old infants and compare the occurrence of these microbes between a cohort of pre-term infants with very low birthweights and a control cohort comprising full-term infants.

Methods

The research cohort was composed of 69 one-year-old infants, of whom 24 were born prematurely with very low birthweights and 45 of whom were carried to full term. Information regarding the infants’ gestational age, mode of delivery, general health status, birthweight and antibiotic use were obtained from hospital records and through oral interviews. At 12 months of age, both groups of infants were examined, and unstimulated saliva samples from the dorsum of the tongue and dental plaque samples were collected. The microorganisms (Streptococcus mutans, Lactobacillus spp., Actinomyces spp., Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Peptostreptococcus micros, Prevotella intermedia, Fusobacterium nucleatum) were identified and their quantities were evaluated using a PCR-based method. The chi-squared and Fisher’s factorial tests were used for the statistical evaluations.

Results

The infants had a high prevalence of cariogenic microbes and of Fusosbacterium nucleatum and Aggregatibacter actinomycetemcomitans. Cariogenic microbes were detected in 91.7% of the very low birthweight infants and in all full-term infants. Periodontal pathogens were present in 83% of the pre-term infants and in 96% of the full-term infants. A significant difference was found between the cohorts in terms of the presence of S. mutans. Most of the very low birthweight infants had negative values of this microbe, while the full-term infants had positive values.

Conclusions

This study confirms the early transmission of representative cariogenic and periodontal pathogens to the oral cavity of one-year-old infants and a higher prevalence of S. mutans in full-term infants than in premature infants.

Dental cleaning before and during pregnancy among Maryland mothers

Despite increasing recognition of the importance of oral health to overall health, dental care utilization remains low in the US. Given the established link between maternal oral health and child oral health, this study examined factors related to preventive dental care utilization at two critical time points, before and during pregnancy. Data were obtained from a sample of 6,171 women who delivered a live birth during 2004-2008 and completed the Maryland Pregnancy Risk Assessment Monitoring System postpartum survey. Multinomial logistic analyses examined associations between predisposing and enabling factors with dental cleaning before and during pregnancy. Women with less than a high school education or a history of physical abuse and non-Hispanic black and Hispanic women were less likely to report teeth cleaning before and during pregnancy. Having no insurance at the start of pregnancy was associated with significantly lower risk of teeth cleaning before pregnancy and both before and during pregnancy. Receipt of oral health counseling during pregnancy was positively related to teeth cleaning during pregnancy. Dental cleaning is associated with insurance, oral health counseling and maternal factors such as race, ethnicity, education and history of physical abuse. Better integration of oral health into prenatal health care, particularly among ethnic and racial minority groups, may be beneficial to maternal and infant well-being. Oral health promotion, disease prevention and health care should be a part of the local, state and national health policy agendas.

Prevalence of early childhood caries in 8 - 48 month old preschool children of Bangalore city, South India

Early Childhood Caries (ECC) is a devastating form of dental decay having a multi - factorial origin. This study was undertaken to determine the prevalence of ECC in Bangalore city, South India, and also to study its associated risk factors. Random sample of 1500 children, aged between 8 - 48 months, was selected from play homes and nursing homes of various parts of the city. Dental caries was recorded according to World Health Organization criteria. Information regarding risk factors for caries was obtained through a structured questionnaire given to mothers or caretakers. The data was subjected to statistical analysis. The prevalence of ECC was 27.5% and the mean decayed, extracted and filled tooth index was 0.854. There was a strong association of ECC with the risk factors studied.

Caries prevalence associated with Streptococcus mutans and Streptococcus sobrinus in Japanese schoolchildren

BACKGROUND

Streptococcus mutans and Streptococcus sobrinus are known to be associated with dental caries in humans.

AIM

We used a polymerase chain reaction method to detect S. mutans and S. sobrinus in 128 Japanese schoolchildren and then compared their presence with the dental caries experience.

DESIGN

Plaque samples were collected from all erupted tooth sites with a sterile toothbrush, and dental examinations were performed to determine the numbers of decayed and filled teeth in primary (dft) and permanent (DFT) dentition using the WHO caries diagnostic criteria. Fisher's PLSD test was employed to compare caries scores between combinations of the detected bacteria.

RESULTS

Streptococcus mutans and S. sobrinus were present in 38.3% and 68.0%, respectively, whereas 14.8% were positive for S. mutans alone, 44.5% for S. sobrinus alone, and 23.5% for both S. mutans and S. sobrinus, with 17.2% negative for both. The DFT, dft, and total (DFT + dft) scores for subjects positive for both S. mutans and S. sobrinus were significantly higher than those positive for S. mutans alone (P < 0.05, in triplicate).

CONCLUSION

These results suggest that schoolchildren harbouring both S. mutans and S. sobrinus have a significant higher dental caries experience in both permanent and primary teeth as compared to those with S. mutans alone.

Environmental, maternal, and child factors which contribute to early childhood caries: a unifying conceptual model

OBJECTIVES

Although the general pathways connecting the external social environment and child risk factors of early childhood caries (ECC) have been previously identified, the maternal and other links to ECC are not well understood. The aim of this paper is to propose a unifying conceptual model that ties together the broad social environmental, maternal, and child factors that are commonly associated with ECC.

METHODS

The aetiological factors of ECC are first reviewed individually to demonstrate their connections with ECC risk followed by presentation of the unifying conceptual model.

RESULTS

In severe ECC cases, there is usually a background of social disadvantage associated with low socioeconomic status, ethnicity or immigrant status, and low maternal educational level. These factors are commonly associated with economic and familial stresses which may in turn result in maternal psychological distress. The distress may be compounded by difficult temperaments of the children and can lead to dysfunctional parenting behaviours that place a child at risk for ECC.

CONCLUSIONS

The proposed conceptual model provides a framework that connects the social, psychological, and behavioural mediating factors involved in ECC. It demonstrates that the causative pathways involved are best explored using a combination of quantitative and qualitative research.

Effect of mode of delivery and feeding practices on acquisition of oral Streptococcus mutans in infants

OBJECTIVE

It is a well-established fact that colonization of S. mutans occurs early in life. The purpose of this study is to determine the correlation between mode of delivery and other associating factors with colonization of oral S. mutans in the infants.

METHODS

The newborns were divided into two groups according to the mode of delivery: Infants who were delivered by either caesarean section (Group-C) or vaginally (Group-V). A total number of 60 mother-infant pairs were included and followed for 1 year. The swab samples were collected for the detection of S. mutans.

RESULTS

Analysis of data demonstrated the possible influence of prolonged bottle feeding (P = 0.007), socioeconomic status (P = 0.00030) and tasting of food by the mothers (P = 0.0065) on the initial acquisition of S. mutans in the oral cavity of infants.

CONCLUSION

The causes for initial acquisition of oral S. mutans in infants were postnatal factors like feeding and oral hygiene practices.

Five questions about Streptococcus mutans: theoretical study of its transmission and colonisation

PURPOSE

This theoretical study aimed to identify the decisive (and controllable) factors involved in Streptococcus mutans (Sm) infection through addressing questions about (i) the time and prevalence pattern (including the raison d'etre of the discrete period for the infection or WI) of initial Sm colonisation and (ii) the infant's selection of bacterial types and their diversity, which are not yet definitely answered by empirical works.

METHOD

A model of Sm infection (within-host type) was developed. For questions (i): using the basic model, stochastic simulation was performed to reproduce longitudinal observations of the initial colonisation time. A symmetrical or right-skewed gamma distribution was assumed for the maximum colonisable area (K(max)) and transmission rate (mx). Additionally, 3 or 4 developmental modes of colonisable area [K(t)] were assigned based on the K(max) value. For (ii): by extending the basic model to the two-bacterial type model, intraspecific competition analysis focusing on the differences in mx (received by the infancy) and colonisation ability (θD) was performed.

RESULTS

The basic model simulation showed that mx and K(t) played a pivotal role in determining the individual time of initial colonisation and their variations among infants in forming its prevalence patterns (with or without WI). The competition model simulation showed that higher mx could be more advantageous in competitive colonisation than higher θD under repeated invasions. Accordingly, it played a decisive role in infant's selection of initially, persistently and transiently colonising bacterial types, and thus in their diversity.

CONCLUSIONS

(i) The mx is the primary and controllable (risk) factor that extensively affects various aspects of the Sm infection process. (ii) Also, the growing carrying capacity, i.e., K(t) is another important factor when considering how to effectively delay the onset of the colonisation. (iii) Thus, currently, the most feasible and effective control measure for the infection should be microbiological interventions in the primary host with concurrent oral hygiene and dietary control in the exposed child.

Timing of colonization of caries-producing bacteria: an approach based on studying monozygotic twin pairs

Findings are presented from a prospective cohort study of timing of primary tooth emergence and timing of oral colonization of Streptococcus mutans (S. mutans) in Australian twins. The paper focuses on differences in colonization timing in genetically identical monozygotic (MZ) twins. Timing of tooth emergence was based on parental report. Colonization timing of S. mutans were established by plating samples of plaque and saliva on selective media at 3 monthly intervals and assessing colony morphology. In 25% of individuals colonization occurred prior to emergence of the first tooth. A significant proportion of MZ pairs (21%) was discordant for colonization occurring before or after first tooth emergence, suggesting a role of environmental or epigenetic factors in timing of tooth emergence, colonization by S. mutans, or both. These findings and further application of the MZ co-twin model should assist in development of strategies to prevent or delay infection with S. mutans in children.

Change in dental caries status over 2 years in children of Panchkula, Haryana: A longitudinal study

Background:

Despite credible scientific advances and the fact that it is preventable, dental caries continues to be a major public health problem in developing countries like India. The first step toward disease prevention at community level is assessment of the disease activity.

Aim:

Hence this study was conducted to evaluate the change in dental caries status over 2 years in children of Panchkula, Haryana.

Materials and Methods:

207 school children having mixed dentition (age 7-8 years) and 103 children (age 12-13 years) were assessed for change in their dmf/DMF status over 2 years.

Results and Conclusion:

Results revealed that 81% of 7-8-year-old children and 83 % 12-13-year-olds had caries. There was a statistically significant increase in DMFT score of children over 2 years; thus necessitating implementation of rigorous preventive strategies at community level.

Risk factors for early childhood caries in disadvantaged populations

Early childhood caries is a significant international public health problem. The aim of this paper was to review the current evidence of the risk factors for dental caries in disadvantaged children under 6 years of age. Medline, Cochrane, and PubMed database searches were conducted. Systematic reviews were used where available, or meta-analyses; randomized, controlled trials; and cohort, case-control, and cross-sectional studies (in that order). Studies were restricted to those published in English from 1990 to October 2010. Early childhood caries has a complex etiology with biological, behavioral, and sociodemographic influences. Evidence suggests that young children are most likely to develop caries if Streptococcus mutans is acquired at an early age, although this is influenced by other factors, such as oral hygiene, fluoride, diet, dental visit patterns, socioeconomic status, ethnicity, and health literacy. Etiological pathways should be taken into consideration when designing interventions to prevent dental caries in disadvantaged preschool children.

Association between caregiver behaviours to prevent vertical transmission and dental caries in their 3-year-old children

BACKGROUND

It has been suggested that oral organisms in children are mainly those transmitted from their mothers. That may account for the relationship between caries levels in children and their parents. However, few studies have investigated the effect of trying to prevent vertical transmission of oral organisms on dental caries levels in children, and the findings in the studies are controversial. The aim of this study was to investigate the association between measures to prevent vertical transmission of oral organisms and the caries experience in 3-year-old children.

METHODS

Data were collected from dental examinations for 3-year-old children and a self-administered questionnaire for their caregivers. Absence of maternal sharing of utensils and mouth-to-mouth feeding between caregivers and children was used as the variable about behaviour to prevent vertical transmission of oral organisms. Sex, age in months, dietary behaviour, oral health behaviour and sociodemographic factors were used as covariates.

RESULTS AND CONCLUSION

Data for 3,035 children (73.5% of the subjects) were analysed. Caregivers who practised vertical transmission prevention tended to have better oral health behaviours. Multivariate logistic regression analysis did not show any significant association between behaviour to prevent vertical transmission and caries experience (OR = 1.10, 95% CI = 0.86-1.41). This study suggests that caregiver behaviour to prevent vertical transmission was not effective in reducing levels of childhood caries.