Quantitative analysis of salivary and biofilm bacteria associated with cavitated and non-cavitated carious lesions in pre-school children

Randomized clinical trial to compare three fluoride varnishes in preventing early childhood caries

OBJECTIVES

To compare the effectiveness of two 5% sodium fluoride (NaF) varnishes containing casein phosphopeptide amorphous calcium phosphate (CPP-ACP) (MI VarnishTM) or tricalcium phosphate (TCP) (ClinproTM White) to the conventional 5% NaF varnish (Duraphat®) in preventing early childhood caries (ECC) in high-risk preschool children.

METHODS

A double-blinded, randomized controlled trial recruited healthy 3-4-year-old children (N = 582) having at least one carious lesion (pre-cavitated or cavitated) after obtaining written informed consent from parents. Using a computer-generated random-number table, children were assigned to one of the 3 groups: Control group (n = 196): 5% NaF varnish (Duraphat®) or two test groups: 5% NaF with TCP (Clinpro™ White) (n = 193) and 5% NaF varnish with CPP-ACP (MI Varnish™) (n = 193) to receive quarterly (every 3 months) application over 24 months.

RESULTS

Incidence of new caries over 2 years was 59.2% in MI Varnish™ group (n = 125), 65.1% in the Clinpro™ White group (n = 129) and 66.1% in the Duraphat® group (n = 127) (p = 0.466). The mean cavitated lesions increment was not significant among the 3 groups (p = 0.714), as was the mean increment in non-cavitated carious lesions (p = 0.223). There was no significant difference (p = 0.630) in the distribution of total fluoride varnish applications among the three groups. Also, no significant difference was found in comparison of outcomes among the different number of fluoride varnish applications received by children in each group.

CONCLUSIONS

Both calcium- and phosphate-containing NaF varnishes showed similar efficacy against cavitated and non-cavitated carious lesions as compared to conventional NaF varnish in high-risk preschool children.

CLINICAL SIGNIFICANCE

Randomized trial provided a crucial opportunity to advance the understanding of the clinical effectiveness of different fluoride varnishes in preventing early childhood caries. Varnishes containing tricalcium phosphate or casein phosphopeptide amorphous calcium phosphate when compared to sodium fluoride varnish, demonstrated a similar efficacy against early childhood caries in high caries-risk preschool children.

Comparison the salivary streptococcus mutans levels between caries-active and caries-free children from Birjand, Iran: A case-control study

Objective

Dental plaque bacteria, including Streptococcus mutans (SM), play a role in the pathogenesis of the dental caries. There are conflicting results regarding the association of salivary SM level and dental caries susceptibility. Our aim was to compare salivary SM levels in colony-forming units (CFU) between children with active caries and caries-free children in Birjand, Iran.

Methods

This case-control study included 61 six-year-old children referred to health centers in Birjand city, Iran, in 2022. The children were divided into two groups: case (dmft/DMFT>0 with active caries) (including 31 children) and control (dmft/DMFT = 0 [caries-free]) (including 30 children). Demographic information and dental history were recorded. Oral examinations were also performed by the dentist. Unstimulated saliva samples were collected from children. The number of salivary SM colonies was determined using the microbial culture and confirmed using the polymerase chain reaction (PCR). The data were analyzed using Chi-square and T-tests at a significance level of p < 0.05.

Results

The mean number of SM colonies was 126.24 ± 92.78 CFU/ml and 92.38 ± 75.34 CFU/ml in case and control groups, respectively. No significant difference was found in salivary SM levels between case and control groups (P = 0.125). No significant association was observed between caries experience with gender (P = 0.363), type of school (public/private) (P = 0.296), receiving oral health education (P = 0.072) and frequency of tooth brushing (P = 0.935). The mean gingival index (P = 0.001) and plaque index (P = 0.025) in case group were significantly higher than control group.

Conclusion

There is no significant difference in salivary SM levels between caries-active and caries-free children in Birjandi children.

Effect of fluoride varnishes on oral bacteria of preschool children with cavitated and non-cavitated carious lesions: randomized clinical trial

We compare the effect of calcium and phosphate-containing sodium fluoride (NaF) varnishes to conventional NaF varnish on S. mutans and L. fermentum counts. 3-4 years old children were grouped according to their caries status (n = 45 each): caries-free, with non-cavitated and with cavitated lesions. Each group was randomly subdivided (n = 15 each) into: Group 1- 5% NaF, Group 2- 5% NaF with tricalcium phosphate, Group 3- 5% NaF with casein phosphopeptide- amorphous calcium phosphate. Biofilm and saliva were collected to quantify microorganisms at baseline (T1) and 24-months (T2). Differences between groups were compared using Kruskal-Wallis test, followed by Dunn-Bonferroni post-test, at 0.0167 α-level. Significant difference was found for percentage of children with detectable biofilm L. fermentum (p = 0.013) at T1 and salivary S. mutans (p = 0.011) at T2. Percentage of children increased from T1 to T2 in Group 2 with salivary S. mutans (p = 0.007), salivary L. fermentum (p = 0.035), and biofilm L. fermentum (p = 0.019) and in Group 3 with salivary L. fermentum (p = 0.035). Bacterial change was not significant in both samples of intervention groups, except increase in salivary S. mutans (p = 0.038) in Group 3. Both calcium- and phosphate-containing NaF varnishes demonstrated similar antibacterial effect on S. mutans and L. fermentum compared to conventional NaF varnish.

Is Mutans Streptococci count a risk predictor of Early Childhood Caries? A systematic review and meta-analysis

BACKGROUND

The review aims to determine the risk predictability of mutans streptococci in the development of carious lesions in children with primary dentition.

METHODS

Longitudinal observational studies with at least 6 months follow-up and evaluating mutans streptococci presence in caries-free children under 6 years of age for the development of any cavitated or non-cavitated carious lesion. Six databases and grey literature were searched without any restrictions. Risk of bias was evaluated using the New Castle Ottawa scale for longitudinal studies, and the certainty of the evidence was evaluated by Grading of Recommendations Assessment, Development and Evaluation using GRADEpro software. Meta-analysis was performed using a random effect (DerSimonian and Laird, DL) model, and heterogeneity was evaluated using tau-squared, I2 statistics and prediction interval. Sensitivity analysis was performed to assess the relationship between the mutans streptococci presence at baseline and the caries development, according to the sample and methods used for the microbiological assessment and the length of follow-up of the studies. Publication bias was checked by funnel plot using a random effect (DerSimonian and Laird, DL) model.

RESULTS

Twelve studies met the inclusion criteria and were included in the review. Four studies received a maximum of 9 stars, and among the remaining eight studies, six received 8 stars and the rest two studies were assigned 7 stars in the risk of bias scale. After pooling the results quantitatively, odds ratio (OR) was found to be 4.13 (95% CI: 3.33, 5.12), suggesting that children with mutans streptococci had 4 times higher odds of developing caries later (p < 0.001). Four studies were pooled to compare future caries experience among children with and without mutans streptococci at baseline, obtaining standardized mean difference (SMD) of 0.85 (95% CI: 0.33, 1.37), indicating a large effect (p < 0.001). Certainty of evidence was found to be moderate, and no publication bias was reported by the funnel plot criteria of symmetry.

CONCLUSIONS

Presence of mutans streptococci in a preschool child is a risk predictor for future caries experience. Early identification of children with increased caries-risk may facilitate in implementation of appropriate preventive strategies.