Czytelnia Medyczna » Nowa Stomatologia » 2/2004 » Is a bacterial factor crucial in caries development of the youngest children?
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© Borgis - Nowa Stomatologia 2/2004, s. 51-55
Patrycja Proc, Renata Filipińska-Skąpska, Magdalena Wochna-Sobańska
Is a bacterial factor crucial in caries development of the youngest children?
Czy występowanie bakterii próchnicogennych ma wpływ na intensywność próchnicy u najmłodszych dzieci?
Department of Paediatric Dentistry, Medical University in Lodz
Head of Department: prof. Magdalena Wochna-Sobańska
Head of Department: prof. Magdalena Wochna-Sobańska
Polecane książki z księgarni medycznej BORGIS:
 Zarys chorób wewnętrznych dla stomatologów |
 Chirurgia stomatologiczna i szczękowo-twarzowa |
 Zbiór wskaźników stomatologicznych klasyfikacji i testów |
The degree of risk of caries developing in children can be assessed by the count of salivary mutans streptococci (MS) and lactobacilli (LB). The sensitivity of these and of other predictive tests has been reasonably high in people with a high disease prevalence found in Poland. Mutans streptococci are the principal micro-organisms associated with the development of caries. Colonisation by mutans streptococci at an early age has been correlated with higher caries activity during childhood. In caries lesions both mutans streptococci (MS) and lactobacilli (LB) are often found. MS play an important role in both initation and progression of caries lesions, LB only in progressing cavitation. On the other hand the high levels of MS observed in some caries-free children indicated that simple presence of this bacteria is not sufficient for the development of caries (1, 2, 3).
The aim of the study is to determine the prevalence of mutans streptococci and lactobacilli in the population of Polish toddlers and its relationship with caries incidence.
MATERIALS AND METHODS
The dental investigation embraced 927 children between the ages of eight and sixty two months. 75 children, 38 girls and 37 boys, were randomly selected from the whole group. The structure of population is presented in Tab. 1. Mean age of selected group was 33,8 months. The investigation took place in four kindergartens choosen from the total number of 31 such institutions in Lodz.
Table 1. Structure of the population and mean dmft in each group of age. ± standard devation.
| Age (in years) | Girls | Boys | Both | Mean dmft | |
| n | n | n | % | ||
| 2 | 7 | 8 | 15 | 19.9% | 0.33?0.72 |
| 3 | 16 | 14 | 30 | 39.9% | 2.75?3.41 |
| 4 | 9 | 11 | 20 | 26.7% | 4.46?5.04 |
| 5 | 6 | 4 | 10 | 13.4% | 4.68?4.88 |
| Total: | 38 | 37 | 75 | 100% | 3.12?3.36 |
A sample of non-stimulated saliva (about 2 ml) was taken from each child using the disposable syringe, and a CRT bacteria(r) test (Vivadent) was performed. The samples were transported to Dental School. The preparation of sampling and incubation were carried out according to the step-by-step procedure described in the instruction:
1. collection of saliva in a suitable container;
2. removing the agar carrier from the test vial;
3. placing a NaHCO3- tablet at the bottom of the vial;
4. wetting both agar surface with saliva, using a pipette;
5. placing the test vial in the incubator, and incubate at 37 grad C for 48 hours;
6. comparing the density of mutans streptococci and lactobacilli colonies with the corresponding evaluation pictures in the enclosed model chart (Fig. 1).
Fig. 1. Prevalence of MS bacteria in 2-3-4-5-year-olds in the investigated group.
CRT test is used to determine the mutans streptococci and lactobacilli count in saliva by means of selective culture media. Findings of 1 mln CFU or more of MS or LB per ml saliva indicate a high caries risk.
RESULTS
In the investigated group 33 children were caries-free, 42 of them had caries. Mean dmft according to the age was as follows: 0.33, 2.75, 4.46, 4.68. Total mean dmft for the hole group was 3.12 (Tab. 1).
High level of mutans streptococci were present in 51 (68%) cases, 24 (32%) of them were free from the bacteria. Lactobacilli were present in the saliva of 35 (46%) children, so in 40 (54%) children the bacteria was not present.
In the group of caries-free children, 51.5% were highly infected by MS (17 children) and 30.3% of them had high level of LB (10 children). In the group of children with caries prevalence, high levels of bacteria had respectively: 80.9% (34 children) of MS and 59.5% (25 children) of LB (Tab. 2 and Tab. 3).
Table 2. Prevalence of mutans streptococci in caries-free children and in children with caries.
| Caries-free (dmft=0) | Caries (dmft ≠ 0) | Total | ||||
| MS = 0 | 16 | 48.5% | 8 | 19.1% | 24 | 32% |
| MS = 1 | 17 | 51.5% | 34 | 80.9% | 51 | 68% |
| Total | 33 | 100% | 42 | 100% | 75 | 100% |
Table 3. Prevalence of lactobacilli in caries-free children and in children with caries.
| Caries-free (dmft=0) | Caries (dmft ≠ 0) | Total | ||||
| LB = 0 | 23 | 69.7% | 17 | 40.5% | 40 | 53.4% |
| LB = 1 | 10 | 30.3% | 25 | 59.5% | 35 | 46.6% |
| Total | 33 | 100% | 42 | 100% | 75 | 100% |
The presence of high counts of mutans streptococci changes with age (Fig. 1). Almost 50% of 2-year-olds were highly infected by mutans streptococci, in 3-year-olds there were 66.7% children with high counts of this bacteria and it was comparable with the group of children of 4-years-old (65%). Then the amount of infection increased greatly and 90% of five-year-old children in the investigated group had high levels of this bacteria. The presence of lactobacilli also correlates with age but less so (Fig. 2). High levels of bacteria in children of 2-3-4-5 year-old were respectively present in: 35.7%, 46.7%, 50% and 60% of children.
Fig. 2. Prevalence of LB bacteria in 2-3-4-5-year-olds in the investigated group.
The children were divided into 4 groups according to the presence of bacteria (0 – not present, 1 – present): group 1 – MS=0, LB=0, group 2 – MS=0, LB=1, group 3 – MS=1, LB=0, group 4 – MS=1 and LB=1. Caries incidence (dmft) in these groups was as follows: 0.6, 1.6, 2.6, 5.5. There was a strict correlation between the high levels of bacteria and caries incidence (Tab. 4).
Table 4. Relationship between the distribution of MS or/and LB and caries incidence.
| Group | Number of children | Mean age (in months) | dmft girls | dmft boys | Total mean dmft |
| 1 MS = 0 LB = 0 | 17(22.6%) | 29.8?9.2 | 0* | 1.1?1.7* | 0.6?1.1* |
| 2 MS = 0 LB = 1 | 7(9.4%) | 33.4?9.7 | 2.0?2.4* | 0.5?0.7 | 1.6?2.13 |
| 3 MS = 1 LB = 0 | 23(30.6%) | 35.4?12.1 | 3.6?4.8* | 1.8?2.9 | 2.6?3.8* |
| 4 MS = 1 LB = 1 | 28(37.4%) | 36.6?11.5 | 4.7?4.5* | 6.4?5.8 | 5.5?5.1* |
| Total: | 75(100%) | 33.8?10.6 | 3.06?3.45 | 3.17?3.05 | 3.12?3.56 |
*p<0.05, statistically significant in Mann-Whitney test ± standard deviation
In the investigated group there was no correlation between the counts of bacteria and the gender of the child. Both the girls and the boys were similarily infected (Tab. 5).
Table 5. Relationship between the sex and the prevalence of bacteria MS and LB.
| Group | Girls | Boys | Both |
| 1 MS = 0, LB = 0 | 8(21.1%) | 9(24.3%) | 17(22.7%) |
| 2 MS = 0, LB = 1 | 5(13.2%) | 2(5.4%) | 7(9.3%) |
| 3 MS = 1, LB = 0 | 10(26.3%) | 13(35.1%) | 23(30.7%) |
| 4 MS = 1, LB = 1 | 15(39.5%) | 13(35.1%) | 28(37.3%) |
| Total: | 38(100%) | 37(100%) | 75(100%) |
x2 = 1.866; p>0,05
x2 – the value of statistics in Chi-square test.
Neither was there found any relationship between the hygiene and the levels of bacteria. The visible plaque was present only in 9 children, and it did not correlate with the count of MS or/and LB (Tab. 6).
Table 6. Relationship between the hygiene scores and the prevalence of bacteria.
| MS = 0 | MS = 1 | Total: | |
| DI = 0 | 22(33.3%) | 44(66.7%) | 66(100%) |
| DI = 1 | 2 (22.2%) | 7(87.8%) | 9(100%) |
x2y = 1,47; p>0,05-not significant
x2y – the value of statistics in the Chi-square test, with Yates modification DI- debris index.
DISCUSSION
In infants, toddlers and pre-school children, caries remains the most common oral disease. There is a strong correlation between the number of mutans streptococci and dental caries prevalence. Present investigation supports previous findings (3) that subjects who are highly infected with MS develop more caries than those with low levels of MS. Children in whom MS are detected soon after tooth eruption and children with high levels of infection also have high numbers of LB. In the present study most children infected by LB had also high number of MS. For LB the high number indicating high risk is considered to be associated with a high carbohydrate intake (4, 5). In both groups of caries and non-caries, there was a relatively high percentage of children with high levels of this bacteria. This may be explained by high sugar consumption in both groups but in non-caries children the percentage with high level of LB was statistically lower.
Yet there was a group of children which were highly infected by MS and did not develop caries. This may be attributed to the widespread distribution and to the increasing effectivness of caries-preventive measures, such as oral hygiene procedures, flouride exposure and finally because the cariogenic activity of MS strains is strictly sucrose dependent. It has been sugessted (5, 6, 7) that changes in sugar consumption may affect cariogenicity more then MS count per se.
On the other hand there was no correlation found between the hygiene scores and the prevalence of bacteria. It is proved however that in children of that age the number of bacteria depends greatly on the intake of sugar, prolonged breast-feeding, and habits which allowed saliva transfer from mother to child. At that age these factors seemed to be even more important that the hygiene procedures.
By contrast non-colonization of mutans streptococci is associated with multiple courses of antibiotics (3, 7, 8, 9). All children with caries in the investigated group exhibited the colony of MS but in some of them the intake of antibiotics may reduce the levels to minimum.
In children the initial acquisition of MS occurs during a period between the age 19-31 months, called "window of infectivity” when the teeth appear. Wan et all (8) observed transitial colonisation of MS despite of the lack of teeth. The authors sugessted that the colonisation may occur prior to tooth eruption because of presence of developmental noduls (Bohn´s nodules). They estimated that almost 55% of infants have such noduls and in 30% of them high levels of mutans streptococci were found.
In the present study the youngest children were 2-year-old and in that group the levels of the infection was the lowest. In similar examination of children in Lodz in 1991 performed by Krzeminski et all (10), it was observed that 77.4% of children of 2-3-year-old, 81.6% of 5-6-year-old and 81.6% of 11-12-year-olds were highly infected by mutans streptococci.
The results from 1991 are slightly higher than reached in the present study but there was also no diferrence in levels of infection between the sexes as in most of the papers of other authors (6, 12).
By most authors the level of MS remained unchanged in the ages of 3-4, till the new permament teeth appeared (2, 11). In the present study 3-4-year-old children have almost the same level of infection, but most of ten 5-year-olds had high level of MS. It may be explained that the samples of children were comparatively low and all of them had high caries incidence.
Krzemiński et al (10) also found that the levels of lactobacilli were the same in each age-group and reached only 2.4% of the hole investigated population. Nevertheless some authors (12) state that the levels of MS and LB increase constantly with the age of children.
CONCLUSION
The aquisition of cariogenic bacteria play an important role in caries outcome. Using the test to evaluate the levels of bacteria may help to indicate children in risk, as those who should be included in intensive prophylaxis programms.
Polecane książki z księgarni medycznej BORGIS:
 Chirurgia szczękowo-twarzowa |
 Radiologia Stomatologiczna |
 Stomatologia zachowawcza tom 1 |
Piśmiennictwo
1. Alaluusua S. et al.: Streptococcus mutans Infection Level and Caries in a Group of 5-year-Old Children. Caries Res. 1989, 23,190-194. 2. Caufield P.W. et al.: Initial Aquisition of Mutans Streptococci by Infants: Evidence for a Discrete Window of Infectivity. J Dent Res. 1993; 72(1), 37-45. 3. Li Y. et al.: The fidelity of Mutans Streptococci Transmission and Caries Status Correlate with Breast-Feeding Experience among Chinese Families. Caries Res. 2000, 34, 123-132. 4. Llene-Puy M.C. et al.: Cariogenic oral flora and its relation to dental caries. J. Dent. Child. 2000, Jan-Feb, 42-46. 5. van Lunsen D.M. et al.: Effects of Dental Treatment and Single Application of 40% Chlorhexidine Varnish on Mutans Streptococci in Young Children under Intravenous Anaestesia. Caries Res. 2000, 34, 268-274. 6. Mattos-Graner R.O. et al.: Water-insoluble Glucan Synthesis by Mutans Streptococcal Strains Correlates with Caries Incidence in 12-to 30-month Children. J Dent Res, 2000, 79(6), 1371-1377. 7. Petti S. et al.: Caries Prediction by Multiple Salivary Mutans Streptococcal Counts in Caries-Free Children with Different Levels of Exposure, Oral Hygiene and Sucros Intake. Caries Res 2000, 34, 380-387. 8. Wan A.K.L,. et al.: Association of Streptococcus mutans Infection and Oral developmental Nodules in Pre-Dentate Infants. J. Dent. Res. 2001, 80(10), 1945-1948. 9. Wan A.K.L. et al.: Oral Colonisation of Streptococcus Mutans in Six-month-old Predentate Infants. J. Dent. Res. 2001, 80(12), 2060-2065. 10. Krzemiński Z. et al.: Streptococcus mutans i Lactobacillus sp. w ślinie i w płytce nazębnej dzieci łódzkich. Czas. Stomat. 1991, XLIV, 11, 759-765. 11. Tenevuo J. et al.: Effects of Chlorhexidine-Fluoride Gel Treatmens in Mothers on the Establishment of Mutans Streptococci in Primary Teeth and the Development of Dental Caries in Children. Caries Res. 1992, 26, 275-280. 12. Roeters F. J. M. et al.: Lactobacilli, Mutans streptococci and Dental Caries: A Longitudinal Study in 2-Year-Old Children up to the Age of 5 Years. Caries Res. 1995, 29, 272-279.
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