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© Borgis - Nowa Stomatologia 2/2017, s. 63-72
Natalia Dacyna1, Magdalena Trzaska1, Anna Zawadzka1, Dariusz Gozdowski2, Weronika Jończyk3, *Angelika Kobylińska3
Indicators of high levels of cariogenic bacteria in pregnant women
Wskaźniki wysokiej liczebności bakterii kariogennych u kobiet ciężarnych
1Student’s Scientific Club, Department of Paediatric Dentistry, Medical University of Warsaw
Student’s Scientific Club supervisor: Anna Turska-Szybka, MD, PhD
2Department of Experimental Design and Bioinformatics, Faculty of Agriculture and Biology, Warsaw University of Life Sciences
Head of Department: Krzysztof Pawłowski, PhD
3Department of Paediatric Dentistry, Medical University of Warsaw
Head of Department: Professor Dorota Olczak-Kowalczyk, MD, PhD
Streszczenie
Wstęp. Wysokie miano bakterii próchnicotwórczych Streptococcus mutans (SM) i Lactobacillus spp. (LA) w ślinie matki jest czynnikiem ryzyka próchnicy wczesnego dzieciństwa. Ocena liczebności kolonii bakterii próchnicotwórczych nie jest rutynowym elementem badania stomatologicznego, dlatego ważne jest podjęcie próby wyodrębnienia klinicznych i behawioralnych wskaźników ich wysokiej liczebności.
Cel pracy. Określenie klinicznych i behawioralnych wskaźników wysokiej liczebności kariopatogenów w ślinie kobiet ciężarnych.
Materiał i metody. Do badania włączono 47 spośród 91 kobiet, które wyraziły świadomą zgodę. Wszystkie pochodziły z dużego miasta. Kobiety były w wieku od 20 do 39 lat (średnio 29,9 ± 4,4 roku); średni wiek ciążowy – 27,96 ± 8,48 tygodnia. Uzyskano zgodę Komisji Bioetycznej WUM nr KB/93/2015 z dn. 5/05/2015 roku. Badanie obejmowało: kwestionariusz (dane demograficzne, nawyki higieniczne i żywieniowe, historia leczenia stomatologicznego), przedmiotowe badanie kliniczne (stan błony śluzowej, uzębienia, dziąseł, higieny) oraz oznaczenie miana SM i LA w ślinie przy użyciu testu CRT Bacteria (Ivoclar Vivadent). Wysokie miano stwierdzano przy wartościach SM > 105 i/lub LA > 105 CFU. Zebrane dane poddano analizie statystycznej (współczynnik korelacji rang Spearmana; STATISTICA 10, Statsoft; p < 0,05).
Wyniki. Wysokie miano bakterii SM odnotowano u 15 (31,91%) kobiet, LA u 21 (44,68%). Wykazano dodatnią korelację SM > 105 z wartością wskaźnika PUWZ oraz jego składowymi PZ i UZ oraz ujemną ze spożyciem substytutów cukru, żuciem gumy z ksylitolem i stosowaniem szczoteczki elektrycznej oraz odbyciem kontrolnej wizyty stomatologicznej w ciągu 6 miesięcy poprzedzających ciążę. LA > 105 było ujemnie skorelowane ze stosowaniem nici dentystycznych i dodatnio z SM > 105.
Wnioski. Klinicznym wskaźnikiem wysokiej liczebności SM jest obecność ubytków próchnicowych. Stosowanie suplementów cukru oraz właściwe zabiegi higieniczne, zwłaszcza z użyciem szczoteczki elektrycznej i nici dentystycznej, są wskaźnikami niskiej liczebności kariopatogenów.
Summary
Introduction. High maternal salivary levels of cariogenic bacteria, Streptococcus mutans (SM) and Lactobacillus spp. (LA), are a risk factor of early childhood caries. Routine dental examination does not involve an evaluation of cariogenic bacteria counts; therefore it is important to try to specify clinical and behavioural indicators of their high levels.
Aim. The aim of the study was to determine clinical and behavioural indicators of high salivary levels of cariopathogens in pregnant women.
Material and methods. The study enrolled 47 out of 91 recruited women from a large urban area, who gave an informed consent to participate in the research. They were aged between 20 and 39 years (mean age 29.9 ± 4.4 years); the mean gestational age was 27.96 ± 8.48 weeks. Approval of the WUM Bioethics Committee was obtained (no. KB/93/2015 dated 5/05/2015). The study used a self-administered questionnaire (demographic data, hygienic and nutritional habits, dental treatment history), clinical examination (condition of the oral mucosa, dentition, gingivae and hygiene) and an assessment of SM and LA salivary levels using CRT Bacteria test (Ivoclar Vivadent). High counts of bacteria were found at SM > 105 and/or LA > 105 CFU. The collected data were analysed statistically (Spearman correlation coefficient; STATISTICA 10, Statsoft; p < 0.05).
Results. High levels of SM were observed in 15 (31.91%), while high LA levels were observed in 21 (44.68%) women. A positive correlation was shown between SM > 105 and the DMFT value and its components, DT and MT. A negative correlation was found with the consumption of dietary sugar substitutes, xylitol chewing gum, the use of powered toothbrush and a dental check-up within 6 months prior to pregnancy. LA > 105 was negatively correlated with the use of dental floss and positively correlated with SM > 105.
Conclusions. The presence of carious cavities is a clinical indicator of high SM levels. The use of dietary sugar substitutes and proper oral hygiene, especially with the use of powered toothbrush and dental floss, are indicators of low cariopathogen counts.
Introduction
Pregnancy involves multiple physiological changes in the woman’s body, which are mainly due to fluctuating levels of hormones – estrogen and progesterone. It also predisposes to caries, enamel erosion and periodontal diseases. It was demonstrated that the number of salivary cariopathogens increases in the third trimester to later decrease in the puerperium and finally return to baseline values (1, 2).
Changes in the oral cavity are not only a consequence of the increased number of bacteria and immune hyperresponsiveness, but they also result from changes in hygiene and nutritional habits of pregnant women. An increased number of meals, frequent snacking, gastrointestinal symptoms, such as gastroesophageal reflux, increased gastric acid secretion, dyspepsia and vomiting, as well as changes in salivary composition, pH, and buffering capacity, which are most pronounced in the first and the second trimester, may increase the risk of caries and acid erosion of mineralised tissues (3-6).
Prevention or elimination of already existing oral inflammatory foci in the form of periodontal diseases in a pregnant woman promotes normal course of pregnancy and reduces the risk of preterm birth and low neonatal birth weight (7, 8). Reducing the number of cariogenic bacterial colonies decreases the risk of their early transmission to the oral cavity of the child. Both, low birth weight and early mother-to-child transmission of cariogenic pathogens are risk factors for early childhood caries (9-17). Berkowitz et al. demonstrated that the percentage of SM-infected children with maternal bacterial burden of > 105 CFU was 9-fold higher compared to mothers with SM < 103 (18). Chaffee et al. showed in their prospective study of mother and child pairs that high maternal SM and LA levels are not only determinants of an increased risk of early childhood colonisation, but also of an increased prevalence of early childhood caries (19). Therefore, identification of a group of women at an increased risk of SM > 105 and LA > 105 based on medical history and physical examination would allow an introduction of preventive and therapeutic measures to reduce the risk of early colonisation of the child’s oral cavity and early childhood caries.
Aim
The aim of the study was to determine indicators of high salivary levels of cariogenic Streptococcus mutans and Lactobacillus spp. in pregnant women.
Material and methods
The study was conducted in the Department of Paediatric Dentistry at the Medical University of Warsaw as well as at the Pregnancy Pathology Unit in the First Department of Obstetrics and Gynecology at the Medical University of Warsaw. Approval of the Medical University of Warsaw Bioethics Committee was obtained (no. KB/93/2015 dated 5/05/2015). The research was conducted between December 2015 and April 2016.
The study enrolled women between the 12th and 40th week of gestation who gave informed written consent to participate in the study.
The study consisted of three parts: a questionnaire, dental examination and an assessment of Streptococcus mutans and Lactobacillus spp. salivary levels. The obtained results were analysed statistically (STATISTICA10, Statsoft, Spearman correlation coefficient; p < 0.05). Each patient was provided with hygiene and dietary instructions during the study.
The questionnaire included questions regarding socio-demographic data, general health status, the course of pregnancy, nutritional and oral hygiene habits, as well as dental treatment history.
The following parameters were assessed during dental examination in artificial lighting, using dental mirror and periodontal probe:
– the state of dentition based on the DMFT index (20), where: DT – number of decayed teeth; MT – number of missing teeth (due to carries), and FT – number of properly filled teeth,
– the state of oral hygiene based on the OHI-S (Oral Hygiene Index-Simplified) in accordance with Greene and Vermillion (21) and PLI (Plaque Index) according to Silness and Löe (22),
– gingival health using the Gingival Index (GI) according to Silness and Löe (23).
The CRT Bacteria assay (Ivoclar Vivadent) was used to evaluate cariogenic Streptococcus mutans and Lactobacillus spp. salivary levels in pregnant women. Saliva samples were collected in the morning before brushing the teeth, up to 2 hrs after last meal, and at least 12 hrs after oral rinsing. Stimulated saliva obtained by chewing a paraffin block for 5 minutes was applied on microbiological medium, and then incubated under anaerobic conditions for 48 hrs at 37°C. The obtained samples were compared with reference figures supplied by the manufacturer.
The collected data were analysed statistically: descriptive statistics, Spearman correlation coefficient, significance level p < 0.05 (STATISTICA 10, Statsoft).
Results
The study enrolled 47 out of 91 pregnant women (44 women refused to participate in the study) aged between 20 and 39 years (mean age 29.9 ± 4.4 years), including 2 (4.26%) women in the first trimester, 16 (34.04%) women in the second trimester and 29 (61.70%) women in the third trimester (mean gestational age 27.96 ± 8.48 weeks). Normal course of pregnancy was reported in 45 (95.75%) women, while pregnancy toxemia (gestosis) was reported in 2 (4.26%) patients.
Higher education was declared by 29 (61.7%), incomplete higher education by 10 (21.28%), secondary education by 7 (14.89%) respondents, and primary education by 1 (2.13%) respondent. The women described their economic status as satisfactory (39; 82.98%) or high (8; 17.02%). Hygienic behaviours and oral hygiene agents used by the patients are shown in figure 1, dietary habits are presented in table 1.
Fig. 1. Hygiene habits of the respondents
Tab. 1. Dietary habits of the respondents
Dietary habitsN (%)
Number of main meals during the day316 (34.04)
417 (36.17)
518 (38.30)
Eating between meals (snacking)34 (72.34)
Number of snacks containing sugar during the daynone6 (17.77)
1-233 (70.21)
3-48 (17.02)
Frequency of consumption of carbonated drinks during the daynone41 (87.23)
1-26 (12.77)
3-40 (0.00)
Using sugar substitutes45 (95.74)
A total of 40 (80.1%) respondents had a dental appointment in the last 6 months preceding pregnancy. Dental scaling was performed in 30 (63.83%), sandblasting in 24 (51.06%) and fluoride varnish application in 18 (38.3%) patients. Proper hygiene (OHI-S < 1.2) was found in 43 (91.5%) women, sufficient hygiene in 3 (6.4%) and insufficient hygiene in 1 (2%) woman. Mean OHI-S score was 0.5 (± 0.52), mean PLI was 0.33 (± 0.25). Mild gingivitis (GI = 0.1-1.0) was reported in 27 (57.45%) women, moderate gingivitis (GI = 1.1-2.0) in 1 (2.13%) patient. The mean GI value was 0.18 (± 0.31). Caries was detected in all subjects (mean DMFT = 12.25 ± 4.13), including 33 (70.21%) women with active caries lesions (DT ≥ 1). Mean values of the individual components of the DMFT were as follows: DT = 2.04 (± 2.2), MT = 0.49 (± 1.25) and FT = 9.74 (± 3.91).
High S. mutans levels were reported in 15 (31.91%) women, and high Lactobacillus spp. levels in 21 (44.68%) women.

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otrzymano: 2017-04-20
zaakceptowano do druku: 2017-05-12

Adres do korespondencji:
*Angelika Kobylińska
Zakład Stomatologii Dziecięcej Warszawski Uniwersytet Medyczny
ul. Miodowa 18, 00-246 Warszawa
tel. +48 (22) 502-20-31
kobylinska.angelika@gmail.com

Nowa Stomatologia 2/2017
Strona internetowa czasopisma Nowa Stomatologia