Salivary proteins and microbiota as biomarkers for early childhood caries risk assessment

Core Microbiota Promotes the Development of Dental Caries

A previous longitudinal study about using microbiome as a caries indicator has successfully predicted early childhood caries (ECC) in healthy individuals, but there is no evidence to verify the composition of core microbiota and its pathogenicity in vitro and in vivo. Biofilm acidogenicity, S. mutans count, and biofilm composition were estimated by pH evaluation, colony-forming unit, and quantitative PCR, respectively. Extracellular polysaccharide production and enamel demineralization were observed by confocal laser scanning microscopy (CLSM) and transverse microradiography (TMR), respectively. A rat caries model was established for dental caries formation in vivo, and caries lesions were quantified by Keyes Scoring. We put forward that microbiota including Veillonella parvula, Fusobacterium nucleatum, Prevotella denticola, and Leptotrichia wadei served as the predictors for ECC may be the core microbiota in ECC. This study found that the core microbiota of ECC produced limited acid, but promoted growth and acidogenic ability of S. mutans. Besides, core microbiota could help to promote the development of biofilms. Moreover, the core microbiota enhanced the enamel demineralization in vitro and increased cariogenic potential in vivo. These results proved that core microbiota could promote the development of dental caries and plays an important role in the development of ECC.

High abundance of sugar metabolisers in saliva of children with caries

Dental caries is a biofilm-mediated, dynamic disease with early onset. A balanced salivary microbiota is a foundation of oral health, while dysbiosis causes tooth decay. We compared the saliva microbiota profiles in children with and without caries. The study consisted of 617 children aged 9–12 years from the Finnish Health in Teens (Fin-HIT) study with available register data on oral health. Caries status was summarised based on Decayed, Missing, and Filled Teeth (DMFT) index in permanent dentition. The children were then classified into the following two groups: DMFT value ≥ 1 was considered as cavitated caries lesions (hereafter called ‘caries’) (n = 208) and DMFT = 0 as ‘cavity free’ (n = 409). Bacterial 16S rRNA gene (V3–V4 regions) was amplified using PCR and sequenced by Illumina HiSeq. The mean age (SD) of the children was 11.7 (0.4) years and 56% were girls. The children had relatively good dental health with mean DMFT of 0.86 (1.97). Since sex was the key determinant of microbiota composition (p = 0.014), we focused on sex-stratified analysis. Alpha diversity indexes did not differ between caries and cavity free groups in either sexes (Shannon: p = 0.40 and 0.58; Inverse Simpson: p = 0.51 and 0.60, in boys and girls, respectively); neither did the composition differ between the groups (p = 0.070 for boys and p = 0.230 for girls). At the genus level, Paludibacter and Labrenzia had higher abundances in the caries group compared to cavity free group in both sexes (p < 0.001). Taken together, there were minor differences in saliva microbiota between children with and without caries. Potential biomarkers of caries were the sugar metabolisers Paludibacter and Labrenzia. These bacteria presumably enhance salivary acidification, which contributes to progression of dental caries. The clinical relevance of our findings warrants further studies.

The role of sugar-rich diet and salivary proteins in dental plaque formation and oral health

BACKGROUND

Dental plaque is a complex colorless film of bacteria that develops on the surfaces of teeth. Different mechanisms of microbial adhesion to tooth surfaces exist. Both non-specific and specific types of adherence have been anticipated.

HIGHLIGHT

The present review evaluated the effect of sugar-rich diet and salivary proteins on oral hygiene and dental plaque development.

CONCLUSION

The oral microbiota is essential for maintaining and reestablishing a healthy oral cavity. Different types of sugars have different effects on the inhibition and formation of dental plaque. The peptides, proteins, and amino acids secreted by parotid glands in the oral cavity facilitate neutralizing the acidity in dental plaque and preventing dental caries. A properly balanced diet is crucial for both a healthy oral cavity and the oral microbiome.

Dysbiosis in the Salivary Microbiome Associated with IgA Nephropathy-‍A‍ ‍Japanese Cohort Study

IgA nephropathy is one of the leading causes of chronic kidney disease in Japan. Since the origin and mechanisms by which IgA nephropathy develops currently remain unclear, a confirmed disease diagnosis is currently only possible by highly invasive renal biopsy. With the background of the salivary microbiome as a rich source of biomarkers for systemic diseases, we herein primarily aimed to investigate the salivary microbiome as a tool for the non-invasive diagnosis of IgA nephropathy. In a comparison of salivary microbiome profiles using 16S rRNA amplicon sequencing, significant differences were observed in microbial diversity and richness between IgA nephropathy patients and healthy controls. Furthermore, recent studies reported that patients with IgA nephropathy are more likely to develop inflammatory bowel diseases and that chronic inflammation of the tonsils triggered the recurrence of IgA nephropathy. Therefore, we compared the salivary microbiome of IgA nephropathy patients with chronic tonsillitis and ulcerative colitis patients. By combining the genera selected by the random forest algorithm, we were able to distinguish IgA nephropathy from healthy controls with an area under the curve (AUC) of 0.90, from the ulcerative colitis group with AUC of 0.88, and from the chronic tonsillitis group with AUC of 0.70. Additionally, the genus Neisseria was common among the selected genera that facilitated the separation of the IgA nephropathy group from healthy controls and the chronic tonsillitis group. The present results indicate the potential of the salivary microbiome as a biomarker for the non-invasive diagnosis of IgA nephropathy.

S. mutans Serotype c, C. albicans, Oral Hygiene, and Decayed, Missing, and Filled Teeth in Early Childhood Caries

Purpose:

The purpose of this study was to determine the quantity of Streptococcus mutans serotype c and Candida albicans antigens from dental plaque and their relationship with the Oral Hygiene Index Score (OHI-S) and Decayed, Missing, and Filled Teeth (DMFT) in Early Childhood Caries (ECC) and Severe Early Childhood Caries (S-ECC).

Materials and Methods:

This was a cross-sectional study, including 5 ECC and 32 S-ECC subjects. ECC was classified as a DMFT score < 4, and S-ECC was classified as a DMFT score ≥ 4 at 71 months of age. S. mutans serotype c and C. albicans antigens from dental plaque of ECC and S-ECC patients were measured using enzyme-linked immunosorbent assays. The optical density ​​of S. mutans serotype c and C. albicans antigens was determined at 450 nm. Correlations between S. mutans serotype c and C. albicans antigens and OHI-S in ECC and S-ECC were analyzed.

Results:

There were no significant differences in S. mutans serotype c and C. albicans antigens between ECC and S-ECC patients or between patients with moderate and good OHI-S scores. There was a negative correlation between S. mutans serotype c and C. albicans antigens in ECC patients (r = -0,62; p < 0.05).

Conclusion:

The increase in C. albicans suppresses S. mutans serotype c growth in ECC but not in S-ECC. The findings of this study could be used to discover the molecular mechanisms involved in bacterial-fungal relationships and the contribution of new technologies to reduce ECC.

Oral Microbiota Composition Predicts Early Childhood Caries Onset

As the most common chronic disease in preschool children in the United States, early childhood caries (ECC) has a profound impact on a child's quality of life, represents a tremendous human and economic burden to society, and disproportionately affects those living in poverty. Caries risk assessment (CRA) is a critical component of ECC management, yet the accuracy, consistency, reproducibility, and longitudinal validation of the available risk assessment techniques are lacking. Molecular and microbial biomarkers represent a potential source for accurate and reliable dental caries risk and onset. Next-generation nucleotide-sequencing technology has made it feasible to profile the composition of the oral microbiota. In the present study, 16S ribosomal RNA (rRNA) gene sequencing was applied to saliva samples that were collected at 6-mo intervals for 24 mo from a subset of 56 initially caries-free children from an ongoing cohort of 189 children, aged 1 to 3 y, over the 2-y study period; 36 children developed ECC and 20 remained caries free. Analyses from machine learning models of microbiota composition, across the study period, distinguished between affected and nonaffected groups at the time of their initial study visits with an area under the receiver operating characteristic curve (AUC) of 0.71 and discriminated ECC-converted from healthy controls at the visit immediately preceding ECC diagnosis with an AUC of 0.89, as assessed by nested cross-validation. Rothia mucilaginosa, Streptococcus sp., and Veillonella parvula were selected as important discriminatory features in all models and represent biomarkers of risk for ECC onset. These findings indicate that oral microbiota as profiled by high-throughput 16S rRNA gene sequencing is predictive of ECC onset.

Factors Affecting High Caries Risk in Children With and Without Cleft Lip and/or Palate: A Cross-Sectional Study

OBJECTIVE

The aim of the study was to analyze the caries protective factors, salivary parameters, and microbial counts in high caries risk children with cleft lip and/or palate (CL/P).

DESIGN

This was a cross-sectional study.

SETTING

This study was conducted in a tertiary health care teaching hospital in New Delhi, India.

PARTICIPANTS

The study was conducted in 40 children, 20 with CL/P and 20 without aged between 5 and 12 years.

METHODS

Children with 2 or more caries lesions in both groups were included in this study. Demographic details, dental caries of affected teeth (World Health Organization criteria for Decayed Missing Filled Teeth [WHO-DMFT] and International Caries Detection and Assessment System [ICDAS II]), caries protective factors, salivary parameters, and microbial counts were recorded by one calibrated investigator.

MAIN OUTCOME MEASURES

Caries protective factors, salivary parameters, and microbial profile.

RESULTS

The Chi-square (χ²) test and Pearson correlation were used for statistical analysis. All the children participating in the study brushed their teeth only once in a day and consumed sweets more than twice a day. None of the children had ever received fluoride varnish. Resting saliva had a low buffering capacity in 80% of children with CL/P and 95% of children without CL/P. Microbial assessment of stimulated saliva showed that with the increases in the numbers (DMFT scores ≥4) and severity (ICDAS codes from 1-2 to 5-6) of caries lesions, both Streptococci and Lactobacilli counts were ≥10⁵ colony-forming units/mL of saliva in the both groups.

CONCLUSIONS

Children with CL/P showed limited access to caries protective measures and low buffering capacity in resting saliva, along with elevated levels of salivary Streptococci and Lactobacilli in stimulated saliva.

Association between salivary s-IgA concentration and dental caries: A systematic review and meta-analysis

OBJECTIVE

To determine the levels of s-IgA in saliva of caries patients and healthy controls, and to evaluate whether there is a correlation between it and caries by systematic review and meta-analysis.

METHODS

 Eight databases were searched initially in April 2020 and repeated in August 2020. Two independent evaluators screened the literature and extracted the data according to the inclusion and exclusion criteria. I2 test was commonly reflected the heterogeneity. Subgroup analysis and meta-regression analysis explore the sources of heterogeneity. Sensitivity analysis, funnel diagram, Begg's rank correlation and Egger's linear regression were used to determine the possibility of publication bias.

RESULTS

A total of 30 case-control studies were included, with a total sample size of 1545 patients, including 918 caries patients and 627 healthy controls. Salivary s-IgA levels in caries patients were significantly lower than those in healthy controls. In addition, the results of subgroup analysis showed that the significant decrease of salivary s-IgA level was correlated with children patients, mixed dentition and Asian people. The funnel diagram included in the study was symmetrically distributed, and the sensitivity analysis confirmed the robustness of the results.  Conclusion: Salivary s-IgA levels in caries patients were significantly lower than in healthy controls. It has also been demonstrated that salivary s-IgA may be used as an alternative measure to identify subjects at risk of caries susceptibility, suggesting that salivary s-IgA may be a protective factor for dental caries.

Association of severe early childhood caries with salivary ferritin

Aim:

To evaluate salivary ferritin levels in children with severe early childhood caries (ECC).

Materials and Methods:

One hundred twenty participants were split into a study group that consisted of 60 children with severe ECC (dmft ≥5) and a control group that was free of caries. Both groups were age and gender-matched. Saliva was collected from both groups. Salivary ferritin was assessed using chemiluminescence microparticle immunoassay. The data obtained were statistically analyzed.

Results:

Salivary ferritin levels were higher in children with severe ECC (159.53 ± 18.65 μg/dl) compared to children with no caries (92.16 ± 12.91 μg/dl) and a highly significant statistical difference was seen (P < 0.001).

Conclusions:

Salivary ferritin levels were high with children having severe ECC.

Levels of procalcitonin in saliva and peri-implant crevicular fluid in patients with peri-implant diseases and health

OBJECTIVE

To evaluate the levels of procalcitonin in saliva and peri-implant crevicular fluid (PICF) among healthy and peri-implant disease patients and correlate these levels with clinical and radiographic peri-implant parameters.

DESIGN

Three groups of 20 participants each [Group-1: healthy, Group-2: peri-implant mucositis, and Group-3: peri-implantitis] were selected. Peri-implant plaque index, bleeding on probing, probing depth and crestal bone loss was assessed. PICF and saliva samples were evaluated for procalcitonin levels and analyzed using enzyme-linked immunosorbent assay. Kruskal-Wallis test was performed for comparisons among the study groups. Multiple comparisons were considered for Post hoc two-group comparisons using Bonferroni-corrections. The Spearman rank correlation coefficient analysis was used to analyze the correlation between procalcitonin levels of both fluids and clinical peri-implant parameters.

RESULTS

Group-3 demonstrated significantly higher values for peri-implant plaque index, bleeding on probing, probing depth, and crestal bone loss as compared to Group-1 and Group-2. Participants of both Group-2 and Group-3 reported significantly increased procalcitonin levels in saliva and PICF in comparison to Group-1. Significant positive correlations were found between PICF procalcitonin levels and bleeding on probing, probing depth, and crestal bone loss in Group-3 and significant positive correlation was found between PICF and bleeding on probing in Group-2. For salivary procalcitonin levels, a significant positive correlation was observed between procalcitonin and bleeding on probing in Group-3.

CONCLUSIONS

The outcome of this study suggests that procalcitonin might play a role in peri-implant inflammation, and higher procalcitonin levels is suggestive of a probable surrogate biomarker for peri-implant diseases.

The oral microbiome and salivary proteins influence caries in children aged 6 to 8 years

BACKGROUND

Oral microbiome and salivary proteins play a critical role in the occurrence and development of caries. In this study, we used metagenomic and metaproteomic analyses to explore the microbiological and proteinic biomarkers and investigate the etiology of caries in 6-8 years old children. Our study aims to offer a better comprehension of these factors and the relationship with caries, and these findings might facilitate caries risk assessment and provide a basis for future prevention strategies.

METHODS

Children 6 to 8 years old living in rural isolated areas including 40 caries-active subjects and 40 caries-free subjects were recruited. Supragingival plaque and unstimulated saliva were collected for 16S rDNA pyrosequencing and isobaric tags for relative and absolute quantitation (iTRAQ) technique coupled with quantitative nano-flow liquid chromatography-tandem mass spectrometry (LC-MS/MS), respectively.

RESULTS

We found 6 phyla and 13 genera predominant in all the samples, and differences in relative abundances can be observed. The Alpha diversity analysis demonstrated that the richness and diversity of the bacterial communities were similar between children with caries-free and caries-active groups; LEfSe detected differences in the bacterial community including Dialister, Selenomonas, Actinomyces, and Mogibacterium in the caries-active group (P < 0.05) and Capnocytophaga, Fusobacterium, Desulfuromonadales, Haemophilus, and Porphyromonas in the caries-free group(P < 0.05). The core microbiome was defined as 18 predominant genera in children with caries. The results of the salivary proteome identified 9135 unique peptides and 1662 proteins group from 20 salivary samples. Two hundred fifty-eight proteins were differentially expressed between the caries-free and caries-active groups.

CONCLUSIONS

The diversity of the microbial community has little effect on caries but some bacteria with different relative abundance between the caries-active and caries-free group could be considered as potential biomarkers for children with caries. In addition, as a critical host factor of caries, the salivary proteins are different in caries-free and caries-active groups.

Significant elevation of salivary human neutrophil peptides 1-3 levels by probiotic milk in preschool children with severe early childhood caries: a randomized controlled trial

OBJECTIVES

To determine salivary human neutrophil peptides 1-3 (HNP1-3) levels in caries-free preschool children and in those with early childhood caries (ECC) or severe-ECC, in a daily probiotic group, receiving reconstituted milk with the probiotic Lactobacillus paracasei SD1 once daily; a triweekly probiotic group, receiving the probiotic milk 3 days a week; and a placebo group.

MATERIALS AND METHODS

Oral examination and unstimulated whole saliva collection were conducted in 354 children at baseline, 6 months after intervention (T6), and after probiotic discontinuation (T12). Of the 354, adequate volume of saliva samples from 268 children were simultaneously analyzed for Streptococcus mutans and total lactobacilli levels using qPCR and for HNP1-3 levels using ELISA.

RESULTS

In the severe-ECC status, significant increases in the median HNP1-3 levels at T12 were found in both daily and triweekly probiotic groups (p < 0.001). The median S. mutans levels in the daily group were significantly decreased at T6 and T12 (p < 0.01), whereas the median total lactobacilli levels were significantly increased at T6 (p < 0.001). Significantly inverse correlations between altered HNP1-3 and S. mutans levels and significant decreases in caries progression were found in both probiotic groups (p < 0.05).

CONCLUSIONS

In the severe-ECC status, daily or triweekly consumption of L. paracasei SD1 significantly enhanced salivary HNP1-3 levels, but reduced S. mutans levels, possibly resulting in reduction of caries progression.

CLINICAL RELEVANCE

Significant enhancement of salivary HNP1-3 levels by probiotic consumption is associated with reduction in S. mutans levels, consistent with diminished caries progression in children with severe-ECC.

Quantify the Protein-Protein Interaction Effects on Adsorption Related Lubricating Behaviors of α-Amylase on a Glass Surface

Dental ceramic material is one of the widely preferred restorative materials to mimic the natural tooth enamel surface. However, it has continuously been degraded because of low wear resistance during mastication in the oral cavity. The friction involved was reduced by introducing the lubricant saliva protein layers to improve the wear resistance of the dental materials. However, little is understood regarding how the protein-protein interactions (PPI) influence the adsorbed-state structures and lubricating behaviors of saliva proteins on the ceramic material surface. The objective of this study is to quantify the influences of PPI effects on the structural changes and corresponding oral lubrications of adsorbed α-amylase, one of the abundant proteins in the saliva, on the dental ceramic material with glass as a model surface. α-Amylase was first adsorbed to glass surface under varying protein solution concentrations to saturate the surface to vary the PPI effects over a wide range. The areal density of the adsorbed protein was measured as an indicator of the level of PPI effects within the layer, and these values were then correlated with the measurements of the adsorbed protein's secondary structure and corresponding friction coefficient. The decreased friction coefficient value was an indicator of the lubricated surfaces with higher wear resistance. Our results indicate that PPI effects help stabilize the structure of α-amylase adsorbed on glass, and the correlation observed between the friction coefficient and the conformational state of adsorbed α-amylase was apparent. This study thus provides new molecular-level insights into how PPI influences the structure and lubricating behaviors of adsorbed protein, which is critical for the innovations of dental ceramic material designs with improved wear resistance.

Can Salivary Biomarkers Be Used as Predictors of Dental Caries in Young Adolescents?

Background

Identifying caries predictors in the subpopulation at risk is one of the preconditions for developing effective caries prevention measures. The present exploratory study aimed to examine the significance of socio-demographic characteristics, dietary-hygiene habits, salivary pH, and salivary antimicrobial HNP-1, hBD-2, and LL-37 peptides as potential caries risk predictors in children ages 11–13 years.

Material/Methods

This prospective 1-year study enrolled 213 children ages 11–13 years. The subjects underwent a dental examination and their mothers were interviewed. Unstimulated saliva was collected from the subjects to determine its pH value, as well as the salivary levels of HNP-1, hBD-2, and LL-37 peptides in 85 of the subjects. After 12 months, the 1-year caries incidence rate was recorded. Logistic regression analysis was used to estimate the ability of selected variables to predict caries risk.

Results

The univariable logistic regression analysis determined that the most significant independent caries risk predictors were: sex (female) (OR=2.132, p=0.007), mothers’ education (OR=1.986, p=0.020), salivary pH (OR=0.270, p=0.043), oral hygiene index (OR=1.886, p=0.015), and daily tooth brushing frequency (OR=0.565, p=0.042). The multivariable model showed that sex and oral hygiene-related variables were the most important caries predictors.

Conclusions

Salivary HNP-1, hBD-2, and LL-37 peptides were not found to have a significant predictive value. Therefore, socio-demographic and oral hygiene variables remain important caries predictors in early adolescents, suggesting the importance of the mechanical control of biofilm as the key measure for preventing caries. However, there is still a need for effective caries risk biomarkers, and additional research is needed in this area of caries risk prediction.

Vitamin D Deficiency and Oral Health: A Comprehensive Review

Vitamin D (VD) levels have been gaining growing attention in Oral Health. During growth and adulthood, VD deficiency (VDD) is associated with a wide variety of oral health disorders, and impaired VD synthesis may expedite some of these conditions. In children, severe VDD can induce defective tooth mineralization, resulting in dentin and enamel defects. As a consequence, these defects may increase the risk of the onset and progression of dental caries. Further, VDD has been associated with higher prevalence of periodontitis and gingival inflammation, and several recent preclinical and clinical studies have unveiled potential pathways through which Vitamin D may interact with the periodontium. VDD correction through supplementation may contribute to a successful treatment of periodontitis; however, alveolar bone regeneration procedures performed in baseline VDD patients seem more prone to failure. Vitamin D may also be linked with some oral pathology entities such as certain oral cancers and events of osteonecrosis of the jaw. This review aims to provide comprehensive evidence of how VD levels should be considered to promote good oral health, and to summarize how VDD may hamper oral development and its role in certain oral conditions.

Quantitative Analysis of Salivary Oral Bacteria Associated with Severe Early Childhood Caries and Construction of Caries Assessment Model

To construct a saliva-based caries risk assessment model, saliva samples from 176 severe early childhood caries (S-ECC) children and 178 healthy (H) children were screened by real-time PCR-based quantification of the selected species, including Streptococcus mutans, Prevotella pallens, Prevotella denticola and Lactobacillus fermentum. Host factors including caries status, dmft indices, age, gender, and geographic origin were assessed in their influence on abundance of the targeted species, which revealed host caries status as the dominant factor, followed by dmft indices (both P < 0.01). Moreover, levels of S. mutans and P. denticola in the S-ECC group were significantly higher than those in the healthy group (P < 0.001 for S. mutans and P < 0.01 for P. denticola). Interestingly, the co-occurrence network of these targeted species in the S-ECC group differed from that from the healthy group. Finally, based on the combined change pattern of S. mutans and P. pallens, we constructed an S-ECC diagnosis model with an accuracy of 72%. This saliva-based caries diagnosis model is of potential value for circumstances where sampling dental plague is difficult.

Saliva as a diagnostic tool for dental caries, periodontal disease and cancer: is there a need for more biomarkers?

Introduction: A biomarker is a biological indicator of normal or pathogenic processes. Identification of biomarkers is useful for the prevention, diagnosis and prognosis of diseases as well as for monitoring the progression of pathological disorders. Several types of molecules present in biological fluids can act as biomarkers such as DNA, coding and non-coding RNA, lipids, metabolites, proteins and even microbes. In this context, saliva emerges as a useful diagnostic tool for the detection of biomarkers involved with oral and systemic diseases, since it reflects the pathophysiological conditions of the organism and allows early, rapid, practical and noninvasive detection of biomarkers.Areas covered: This review discusses the properties of saliva as a diagnostic tool and addresses the main identified biomarkers related to dental caries, periodontal disease, head and neck cancer and other types of cancer of considerable incidence among the world population.Expert commentary: Despite extensive efforts which have been directed toward the identification of one or a combination of biomarkers with good predictive values for the early detection of dental caries, periodontal disease and cancer, these biomarkers still need validation before chairside point-of-care devices can be widely used in the clinic.

The role of salivary contents and modern technologies in the remineralization of dental enamel: a narrative review

Human enamel once formed cannot be biologically repaired or replaced. Saliva has a significant role in remineralization of dental enamel. It not only has a buffering capacity to neutralize the oral cavity’s low pH generated after acidic encounters, but also acts as a carrier of essential ions, such as fluoride, calcium and phosphate, which have a positive role in enamel’s remineralization. This review discusses how salivary contents, like proteins and enzymes, have a natural role in enamel’s mineralization. In addition, the presence of ions, such as fluoride, calcium and phosphate, in saliva further enhances its capability to remineralize the demineralized enamel surface. The review further examines modern innovative technologies, based on biomimetic regeneration systems, including dentin phosphoproteins, aspartate-serine-serine, recombinant porcine amelogenin, leucine-rich amelogenin peptide and nano-hydroxyapatite, that promote enamel remineralization. Fluoride boosters like calcium phosphates, polyphosphates, and certain natural products can also play an important role in enamel remineralization.

The role of salivary contents and modern technologies in the remineralization of dental enamel: a narrative review

Human enamel once formed cannot be biologically repaired or replaced. Saliva has a significant role in remineralization of dental enamel. It not only has a buffering capacity to neutralize the oral cavity's low pH generated after acidic encounters, but also acts as a carrier of essential ions, such as fluoride, calcium and phosphate, which have a positive role in enamel's remineralization. This review discusses how salivary contents, like proteins and enzymes, have a natural role in enamel's mineralization. In addition, the presence of ions, such as fluoride, calcium and phosphate, in saliva further enhances its capability to remineralize the demineralized enamel surface. The review further examines modern innovative technologies, based on biomimetic regeneration systems, including dentin phosphoproteins, aspartate-serine-serine, recombinant porcine amelogenin, leucine-rich amelogenin peptide and nano-hydroxyapatite, that promote enamel remineralization. Fluoride boosters like calcium phosphates, polyphosphates, and certain natural products can also play an important role in enamel remineralization.

Targeted metabolomics of pellicle and saliva in children with different caries activity

Pellicle is the initial proteinaceous layer that is formed almost instantaneously on all solid surfaces in the oral cavity. It is of essential relevance for any interactions and metabolism on the tooth surface. Up to now, there is no information on the metabolome of this structure. Accordingly, the present study aims to characterise the metabolomic profile of in-situ pellicle in children with different caries activity for the first time in comparison to saliva. Small molecules such as carbohydrates, amino acids, organic acids, and fatty acids, putatively involved in the formation of caries were quantified using mass spectrometry (MS)-based techniques, such as (stable isotope dilution analysis)-ultra-performance liquid chromatography-tandem MS and gas chromatography/electron ionisation-MS. Pellicle and corresponding saliva samples were collected from caries-active, caries-free and caries-rehabilitated 4- to 6-year-old children. The most abundant analytes in pellicle were acetic acid (1.2-10.5 nmol/cm2), propionic acid (0.1-8.5 nmol/cm2), glycine (0.7-3.5 nmol/cm2), serine (0.08-2.3 nmol/cm2), galactose (galactose + mannose; 0.035-0.078 nmol/cm2), lactose (0.002-0.086 nmol/cm2), glucose (0.018-0.953 nmol/cm2), palmitic acid (0.26-2.03 nmol/cm2), and stearic acid (0.34-1.81 nmol/cm2). Significant differences depending on caries activity were detected neither in saliva nor in the corresponding pellicle samples.

Tracking the functional meaning of the human oral-microbiome protein-protein interactions

The interactome - the network of protein-protein interactions (PPIs) within a cell or organism - is technically difficult to assess. Bioinformatic tools can, not only, identify potential PPIs that can be later experimentally validated, but also be used to assign functional meaning to PPIs. Saliva's potential as a non-invasive diagnostic fluid is currently being explored by several research groups. But, in order to fully attain its potential, it is necessary to achieve the full characterization of the mechanisms that take place within this ecosystem. The onset of omics technologies, and specifically of proteomics, delivered a huge set of data that is largely underexplored. Quantitative information relative to proteins within a given context (for example a given disease) can be used by computational algorithms to generate information regarding PPIs. These PPIs can be further analyzed concerning their functional meaning and used to identify potential biomarkers, therapeutic targets, defense and pathogenicity mechanisms. We describe a computational pipeline that can be used to identify and analyze PPIs between human and microbial proteins. The pipeline was tested within the scenario of human PPIs of systemic (Zika Virus infection) and of oral conditions (Periodontal disease) and also in the context of microbial interactions (Candida-Streptococcus) and showed to successfully predict functionally relevant PPIs. The pipeline can be applied to different scientific areas, such as pharmacological research, since a functional meaningful PPI network can provide insights on potential drug targets, and even new uses for existing drugs on the market.

Multifunctional antibacterial dental sealants suppress biofilms derived from children at high risk of caries

Dental sealant containing antibacterial and bioactive agents decreased biofilm formation due to the saliva of children at low and high risk of caries.

Relationship Between Mutans Streptococci and Lactobacilli in the Oral Cavity and Intestine of Obese and Eutrophic Children With Early Childhood Caries-Preliminary Findings of a Cross-Sectional Study

This brief communication assessed whether there was any relationship between the counts of lactobacilli (LB) and mutans streptococci (MS) in the oral cavity and intestine of obese and eutrophic children with early childhood caries (ECC). Seventy-eight preschoolers were assigned into the following groups: 1. obese children with ECC (OECC), 2. eutrophic children with ECC (EECC), 3. obese caries-free children (OCF), and 4. eutrophic caries-free children (ECF). The diagnosis of obesity and ECC was based on the World Health Organization criteria. Dental plaque and fecal samples were collected to assess the counts of MS and LB using selective media. Data were evaluated by Poisson regression analysis, Wilcoxon test, and Sign test. Microbial indicators of ECC in obese children were MS counts in the intestine [rate ratio (RR): 4.38] and presence of LB in the oral cavity (RR: 2.12). The indicators in eutrophic children were MS levels and the presence of LB, both in the oral cavity (RR: 6.35/1.50) and intestine (RR: 2.35/2.38) (p < 0.05). The comparison between MS levels in the mouth and in the intestine revealed significant differences only in the ECF group (p = 0.04). Regarding LB presence in the mouth vs. in the intestine, except for the OCF group (p = 0.03), no other statistical differences were found. Our preliminary findings highlighted that the levels of MS and the presence of LB in the oral cavity, as well as in the lower gastrointestinal tract were associated with ECC. Moreover, obesity was found to influence this relationship.

High-throughput DNA sequencing of microbiota at interproximal sites

Objective: The oral microbiota has been deeply studied by high-throughput sequencing techniques. However, although the interproximal regions have one of the highest caries rates in the oral cavity, information about the bacterial composition at those sites is scarce.

Methods: In this study, we used 16S rRNA Illumina sequencing to describe the microbiota associated to interproximal regions at two time points. In addition, dental plaque samples at the vestibular and lingual surfaces from the same teeth were also analysed at the two time points.

Results: Interproximal-associated microbiota was found to be similar to already described bacterial communities in other mouth niches. Streptoccocus, Veillonella, Rothia, Actinomyces, Neisseria, Haemophilus and Fusobacterium were the most abundant genera in this oral region. Statistical analyses showed that the microbiota from interproximal sites was more similar to that sampled from the vestibular surfaces than to the lingual surfaces. Interestingly, many potentially cariogenic bacteria such as Scardovia, Atopobium or Selenomonas were over-represented in the interproximal regions in comparison with vestibular and lingual sites.

Conclusion: The microbiota at interproximal regions appears to be specific and stable through time. Potentially pathogenic bacteria may increase caries development risk and gingival inflammation at those sites.

Label-Free Electrochemical Detection of S. mutans Exploiting Commercially Fabricated Printed Circuit Board Sensing Electrodes

This paper reports for the first time printed-circuit-board (PCB)-based label-free electrochemical detection of bacteria. The demonstrated immunosensor was implemented on a PCB sensing platform which was designed and fabricated in a standard PCB manufacturing facility. Bacteria were directly captured on the PCB sensing surface using a specific, pre-immobilized antibody. Electrochemical impedance spectra (EIS) were recorded and used to extract the charge transfer resistance (R_ct) value for the different bacteria concentrations under investigation. As a proof-of-concept, Streptococcus mutans (S. mutans) bacteria were quantified in a phosphate buffered saline (PBS) buffer, achieving a limit of detection of 10³ CFU/mL. Therefore, the proposed biosensor is an attractive candidate for the development of a simple and robust point-of-care diagnostic platform for bacteria identification, exhibiting good sensitivity, high selectivity, and excellent reproducibility.

Estimation of Salivary sCD14 in Children with Early Childhood Caries in Association with Pneumonia

BACKGROUND

Dental caries is a chronic disease among children and pneumonia is often seen in young children. Soluble CD14 (sCD14) protein is released by monocytes and changes in periodontal infection. The study aimed to estimate the level of salivary sCD14 in children with early childhood caries in association with pneumonia.

METHODS

This case-control study was conducted on 52 children aged between 2 to 5 years. A total of 17 children who were caries free, with no past systemic illness; 17 children with dental caries with no history of systemic illness or dental treatment for caries, and 18 children with caries and pneumonia were included in the control and test groups respectively. Unstimulated saliva of all children was collected. All samples were tested using a commercial available sCD14 ELISA kit.

RESULTS

The sCD14 level was elevated in all three groups. One-way ANOVA was used to compare the mean level of sCD14 values between the groups. Control group had the highest mean sCD14 values (15070.99 ± 4296.44), followed by the caries group (13629.83 ± 5603.76) and pneumonia group (8566.86 ± 4778.81). There is a significant difference between the groups with p=0.001.

CONCLUSION

Based on the results of the study, it can be concluded that sCD14 can be used as an indicator of the healthy functioning of the oral cavity.

Saliva NMR metabolomics: Analytical issues in pediatric oral health research

OBJECTIVES

Saliva metabolome is a promising diagnostic tool concerning oral and systemic diseases. We aimed at establishing a suitable protocol for saliva collection and gauging the relative impacts of gender, dentition stage, and caries on the saliva metabolome of a small children cohort.

SUBJECTS AND METHODS

A nuclear magnetic resonance-based metabolomics cross-sectional study of children saliva (n = 38) compared the effects of: (a) stimulation and unstimulation conditions, and (b) collection through passive drool and using an absorbing device. Multivariate and univariate statistical analyses were applied to evaluate such effects and those related to gender, dentition stage and caries.

RESULTS

No significant differences were found between unstimulated and stimulated saliva, and the former was used for subsequent studies. Swab collection induced significant changes in sample composition, indicating passive drool as preferential. The impacts of gender and dentition stage were not significant compared to that of caries, which induced variations in the levels of 21 metabolites. These comprised amino acids and monosaccharides observed for the first time to our knowledge regarding children caries, suggesting protein hydrolysis and deglycosylation.

CONCLUSIONS

Unstimulated passive drool saliva metabolome may carry a caries signature.

Increasing salivary IgA and reducing Streptococcus mutans by probiotic Lactobacillus paracasei SD1: A double-blind, randomized, controlled study

Background/purpose

Our previous study revealed that probiotic Lactobacillus paracasei SD1 could reduce mutans streptococci as evaluated by cultivation-method as well as stimulate innate immunity. This study aimed to further investigate the effect of the probiotic on various oral bacteria by real-time PCR and salivary IgA levels.

Materials and methods

Forty children were included by randomization from either probiotic or control group in the previous study. The probiotic or control received milk-powder with or without L. paracasei SD1, respectively once daily for 6 months. Saliva were collected at baseline 3-, 6-, and 12-months and were evaluated for total bacteria, total lactobacilli (TL), L. paracasei/L. casei (LP/LC), total streptococci (TS) and Streptococcus mutans using the real-time PCR. The salivary IgA (sIgA) was examined using the ELISA method.

Results

All target bacterial levels were not significantly different at baseline in both groups. After milk-powder consumption, TL and LP/LC levels were significantly increased in the probiotic group, whereas TS and S. mutans levels were significantly decreased compared to baseline. TS and S. mutans levels were significantly lower, while the sIgA was greater in the probiotic compared to the control group. In the probiotic group, a positive correlation was found between LP/LC and sIgA, while negative correlations were observed between TS or S. mutans levels and sIgA.

Conclusion

L. paracasei SD1 could control S. mutans level and could stimulate sIgA. Results indicate that the L. paracasei SD1 strain may have a benefit for prevention of dental caries.

Risk factors of early childhood caries (ECC) among children in Beijing - a prospective cohort study

BACKGROUND

Early childhood caries (ECC) was a serious oral health concern with high prevalence and a low treatment rate in China, and few researches have focused on preschool children. This study aimed to explore the risk factors of ECC in Beijing, China.

METHODS

Totle of 712 children (mean age: 46.37 ± 5.44 months) participated in this prospective cohort study. Questionnaires and the levels of mutans streptococci in dental plaques and non-stimulated saliva, assessed using Dentocult SM strips, were collected at baseline, respectively. Two calibrated examiners checked for dental caries according to the WHO 1997 criteria at baseline and 1-year follow-up. Negative binomial regression was used for multivariate analysis of factors related to caries development.

RESULTS

For caries-free children at baseline, only plaque mutans streptococci (PMS) levels were associated with caries development (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 1.08-2.61, P = 0.02). Children with high PMS levels (scored 2 and 3) had higher caries incidence (46.2% vs. 33.8%) and more caries increment (1.87 ± 3.17 vs. 0.90 ± 1.89) than those with low levels (scored 0 and 1). Among all participants, PMS (OR = 1.69, 95% CI: 1.32-2.23, P < 0.001) and previous caries experience (OR = 2.80, 95% CI: 2.20-3.56, P < 0.001) were related to caries increment.

CONCLUSIONS

For caries-free children, the only significant risk factor for ECC was high PMS levels. For all participants, besides high PMS levels, previous caries experience was another significant risk factor for caries development.

TRIAL REGISTRATION

The study design, protocol, and informed consent forms were undertaken with the understanding of Declaration of Helsinki and were approved by the Human Research Ethics Committee of the School of Stomatology, Peking University, China (PKUSSIRB-2012042).

Saliva as a biomarker for dental caries: A systematic review

AIM

The aim of the present review article is to establish a systematic review to describe the role of various salivary components such as pH, buffering capacity, proteins, electrolyte, antioxidant, enzymes, and minerals in occurrence and initiation of dental caries in participants with and without dental caries.

METHODOLOGY

An electronic search was conducted in the PubMed, Scopus, Web of Science, and Google Scholar databases. The MESH terms (Medical Subject Headings) were "dental caries susceptibility," "caries risk assessment, "Salivary Biomarker," "saliva," "Proteins," "electrolytes," "biomarker," "Anti-oxidant's." The database search was limited to the studies published between 2008 and 2018 and only human studies were included. Furthermore, the STROBE criteria checklist was used to analyze the studies which had to be included in the systematic review.

RESULTS

A total of 150 articles were retrieved through electronic database. After evaluating the title, abstract, and full text of these articles, only 11 were selected for the present systematic review. However, two articles were excluded because they were classified as high risk of bias according to the STROBE criteria. Out of 9 studies selected, 5 were classified as low-risk bias and 4 were classified as moderate-risk bias.

CONCLUSION

Based on the results of the systematic review, out of 11 studies, 7 found to have a statistically significant difference between individuals with and without caries experience. Hence, it can be concluded that there is an association between various components of saliva and dental caries.

The Predictive Potentiality of Salivary Microbiome for the Recurrence of Early Childhood Caries

The aim of this study was to investigate the variation of the salivary microbiota in the recurrence of early childhood caries (ECC), and to explore and verify the potential microbial indicators of ECC recurrence. Saliva samples from kindergarten children were tracked every 6 months for 1 year. Finally, in total 28 children and 84 samples were placed on the analysis phase: 7 children with ECC recurrence made up the ECC-recurrence (ER) group, 6 children without ECC recurrence constituted the non-ECC-recurrence (NER) group, and 15 children who kept ECC-free were set as the ECC-free (EF) group. DNA amplicons of the V3-V4 hypervariable region of the bacterial 16S rDNA were generated and sequencing was performed using Illumina MiSeq PE250 platform. No statistically significant differences of the Shannon indices were found in both cross-sectional and longitudinal comparisons. Furthermore, both principal coordinates analysis (PCoA) and heatmap plots demonstrated that the salivary microbial community structure might have potentiality to predict ECC recurrence at an early phase. The relative abundance of Fusobacterium, Prevotella, Leptotrichia, and Capnocytophaga differed significantly between the ER and NER groups at baseline. The values of area under the curve (AUC) of the four genera and their combined synthesis in the prediction for ECC recurrence were 0.857, 0.833, 0.786, 0.833, and 0.952, respectively. The relative abundance of Fusobacterium, Prevotella, Leptotrichia, and Capnocytophaga and their combination showed satisfactory accuracy in the prediction for ECC recurrence, indicating that salivary microbiome had predictive potentiality for recurrence of this disease. These findings might facilitate more effective strategy to be taken in the management of the recurrence of ECC.

Protein-Based Salivary Profiles as Novel Biomarkers for Oral Diseases

The Global Burden of Oral Diseases affects 3.5 billion people worldwide, representing the number of people affected by the burden of untreated dental caries, severe periodontal disease, and edentulism. Thus, much more efforts in terms of diagnostics and treatments must be provided in the fight of these outcomes. In this sense, recently, the study of saliva as biological matrix has been identified as a new landmark initiative in the search of novel and useful biomarkers to prevent and diagnose these conditions. Specifically, saliva is a rich reservoir of different proteins and peptides and accessible due to recent advances in molecular biology and specially in targeted and unbiased proteomics technologies. Nonetheless, emerging barriers are an obstacle to the study of the salivary proteome in an effective way. This review aims at giving an overall perspective of salivary biomarkers identified in several oral diseases by means of molecular biology approaches.

Cariogenic microbiome and microbiota of the early primary dentition: A contemporary overview

Recent advances in the field of molecular microbiology provide an unprecedented opportunity to decipher the vast diversity of the oral microbiome in health and disease. Here, we provide a contemporary overview of the oral microbiome and the microbiota of early childhood caries (ECC) with particular reference to newer analytical techniques. A MEDLINE search revealed a total of 20 metagenomic studies describing cariogenic microbiomes of ECC, 10 of which also detailed the healthy microbiomes. In addition, seven studies on site-specific microbiomes, focusing on acidogenic and aciduric microbiota of deep-dentinal lesions, were also reviewed. These studies evaluated plaque and saliva of children aged 1.5-11 years, in cohorts of 12-485 individuals. These studies reveal a very rich and diverse microbial communities, with hundreds of different phylotypes and microbial species, including novel species and phyla such as Scardovia wiggsiae, Slackia exigua, Granulicatella elegans, Firmicutes in the plaque biofilms of children with ECC. On the contrary, bacteria such as Streptococcus cristatus, S. gordonii, S. sanguinis, Corynebacterium matruchotii, and Neisseria flavescens were common in plaque biofilm of noncarious, healthy, tooth surfaces in subjects with caries. The review illustrates the immense complexity and the diversity of the human oral microbiota of the cariogenic plaque microbiome in ECC, and the daunting prospect of its demystification.

Distinctions and associations between the microbiota of saliva and supragingival plaque of permanent and deciduous teeth

BACKGROUND

Using salivary microbiota as an accurate proxy for monitoring supragingival microbiota remains controversial because their relationship remains unclear. The eruption of permanent teeth and the exfoliation of primary teeth in mixed dentition greatly alter microbial habitats, which may cause compositional shifts of oral microbiota from childhood to adults.

OBJECTIVE

This study's purpose was to assess whether saliva represents a suitable sample for monitoring supragingival microbiota in healthy people, and to explore how the replacement process of deciduous teeth with permanent teeth in mixed dentition influences microbiota within the oral cavity.

DESIGN

Samples of saliva and of supragingival plaque from permanent and deciduous teeth were collected separately from 20 healthy children with mixed dentition. To characterize their microbial communities, we used the V3-V4 hypervariable region of the bacterial 16S rRNA gene sequence.

RESULTS

Saliva harbored a less even and less diverse community than did the plaque. Discriminating genera, namely Rothia and Streptococcus, contributed to the saliva and plaque differentiation. About half of predicted KEGG pathways varied between the plaque and saliva communities. Oral bacteria showed significantly associations between their supragingival and salivary states. We identified 20 supragingival plaque-related genera in saliva, such as Corynebacterium, Capnocytophaga, Fusobacterium, and Neisseria. Additionally, the relative abundance of Actinobacteria peaked in the permanent teeth plaque but subsided in deciduous teeth plaque and saliva. The exfoliation of deciduous teeth and eruption of permanent teeth might be related to the reported fluctuation in the relative abundance of Actinobacteria from primary dentition to permanent dentition within the oral cavity. The variation between PT and DT was due mainly to permanent teeth being enriched in Actinomyces and deciduous teeth in Treponema.

CONCLUSION

These results suggested that the supragingival plaque-related bacteria could be suitable candidates when sampling saliva for monitoring supragingival microbiota. The replacement process of deciduous teeth with permanent teeth in mixed dentition might be related to the reported age-maturation of phylum Actinobacteria in the oral cavity.

Saliva in the "Omics" era: A promising tool in paediatrics

In vulnerable populations, such as infants and children, saliva makes the perfect diagnostic medium because of its noninvasive collection, easy handling and storage of samples. Its unique biomarker profiles help tremendously in the diagnosis of many diseases and conditions. In fact, saliva genomics, proteomics, transcriptomics, metabolomics and microbiome-based discoveries have led to complementary and powerful diagnostic information. In children and neonates, saliva is the preferred medium not only for diagnosis of caries and aggressive periodontitis but also for a number of systemic conditions, metabolic diseases, cognitive functions, stress assessment and evaluation of immunological and inflammatory responses to vaccination. In this review, we provide an overview of current and future applications of saliva diagnostics to various diseases and conditions and highlight studies in paediatrics across the "omic" spectrum. Emerging frontiers in salivary diagnostics research that may significantly advance the field are also highlighted.

Age and gender related changes of salivary total protein levels for forensic application

Saliva is one of the most commonly encountered biological fluids found at the crime scene. Forensic science including forensic odontology is focused on the positive identification of individuals. The salivary protein profiling can help in personalization by the changes associated with age throughout life and gender. These changes also seem to vary with the dietary habits, environmental factors and geographical areas. Thus, the aim of present study is to estimate these changes in salivary total protein concentration and profiling in individuals of Gujarat, India. The association of total protein concentration and protein content with the age, gender, tooth eruption, functions of the protein and its physiological significance are also intended for study in this population. One hundred unstimulated whole saliva samples from study subjects of Gujarat population were collected and grouped based on age and gender. Total protein concentration was determined by Bradford assay; also protein was separated and analyzed using Sodium dodecylsulphate polyacrylamide gel electrophoresis (SDS PAGE). T Test and ANOVA were used for statistical analysis. The concentration of Total Protein was found to be between 2-4 mg/ml. It showed a positive correlation with age and gender. It can be concluded more protein bands were prominently present in the adolescents group followed by children and lastly in the adults groups.More high (more than 80 kDa) and low (less than 30 kDa) molecular weight proteins are seen in children and adolescents than adults. SDS PAGE allowed identification and comparison of group variabilities in protein profiles. The total salivary protein showed an association between the parameters under this study which will aid in the individual identification in the field of forensics.