Prevalence and incidence of early childhood caries among African-American children in Alabama

Effects of Sucrose and Farnesol on Biofilm Formation by Streptococcus mutans and Candida albicans

Candida albicans (C. albicans) and Streptococcus mutans (S. mutans) are frequently detected in the plaque biofilms of children with early childhood caries. This study investigated the effects of sucrose and farnesol on biofilm formation by the oral pathogens S. mutans and C. albicans, including their synergistic interactions. Biofilm formation dynamics were monitored using the Cell Index (CI). The CI for S. mutans increased in the brain-heart infusion medium, peaking at 10 h; however, the addition of sucrose reduced the CI. For C. albicans yeast cells, the CI increased at sucrose concentrations > 0.5%, peaking at 2 h. Mixed cultures of S. mutans and C. albicans yeast cells showed significantly higher CI values in the presence of sucrose, suggesting a synergistic effect on biofilm formation. Farnesol consistently suppressed biofilm formation by C. albicans yeast cells, even in the presence of sucrose, and higher farnesol concentrations resulted in greater inhibition. Regarding C. albicans hyphal cells, sucrose did not enhance biofilm formation, whereas farnesol significantly reduced biofilm formation at all concentrations tested. These findings elucidate the complex roles of sucrose and farnesol in biofilm formation by S. mutans and C. albicans and emphasize the potential of farnesol as an effective oral biofilm inhibitor.

Intraspecies interactions of Streptococcus mutans impact biofilm architecture and virulence determinants in childhood dental caries

Early childhood dental caries (ECC) is the most common chronic disease among children, especially among low socioeconomic populations. Streptococcus mutans is most frequently associated with initiation of ECC. Although many studies report children with multiple S. mutans strains (i.e., genotypes) have greater odds of developing ECC, studies investigating intraspecies interactions in dental caries are lacking. This study investigates the impact of intraspecies interactions on cariogenic and fitness traits of clinical S. mutans isolates using in vitro and in vivo approaches. Association analysis evaluated if presence of multiple S. mutans genotypes within the first year of colonization was associated with caries. Initially, clinical S. mutans isolates from 10 children were evaluated. S. mutans strains (G09 and G18, most prevalent) isolated from one child were used for subsequent analysis. Biofilm analysis was performed for single and mixed cultures to assess cariogenic traits, including biofilm biomass, intra-polysaccharide, pH, and glucan. Confocal laser scanning microscopy (CLSM) and time-lapse imaging were used to evaluate spatial and temporal biofilm dynamics, respectively. A Drosophila model was used to assess colonization in vivo. Results showed the mean biofilm pH was significantly lower in co-cultured biofilms versus monoculture. Doubling of S. mutans biofilms was observed by CLSM and in vivo colonization in Drosophila for co-cultured S. mutans. Individual strains occupied specific domains in co-culture and G09 contributed most to increased co-culture biofilm thickness and colonization in Drosophila. Biofilm formation and acid production displayed distinct signatures in time-lapsed experiments. This study illuminates that intraspecies interactions of S. mutans significantly impacts biofilm acidity, architecture, and colonization.IMPORTANCEThis study sheds light on the complex dynamics of a key contributor to early childhood dental caries (ECC) by exploring intraspecies interactions of different S. mutans strains and their impact on cariogenic traits. Utilizing clinical isolates from children with ECC, the research highlights significant differences in biofilm architecture and acid production in mixed versus single genotype cultures. The findings reveal that co-cultured S. mutans strains exhibit increased cell density and acidity, with individual strains occupying distinct domains. These insights, enhanced by use of time-lapsed confocal laser scanning microscopy and a Drosophila model, offer a deeper understanding of ECC pathogenesis and potential avenues for targeted interventions.

sCD14 Level in Saliva of Children and Adolescents with and without Dental Caries, a Hurdle Model

Objective: Soluble CD14 (sCD14) plays an important role in the innate immune response of the oral cavity. The investigation of this biomarker for detection of carious lesions is an even more actual procedure due to its non-invasiveness and the ease of withdrawal. The purpose of the present observational case-control study was to evaluate whether the quantification of sCD14 in children and adolescent’s saliva can discriminate healthy subjects from those suffering from tooth decay. Materials and Methods: 164 subjects (6 to 17 years) were selected and divided into 2 groups: those with at least 1 decayed tooth were assigned to group Decayed (n = 82) and those free from dental caries to group Healthy (n = 82). The amount of salivary soluble CD14 was quantified. Results: Mean salivary soluble CD14 was 28.3 ± 10.8 μg/mL in the Healthy group and 22 ± 9.6 μg/mL in the Decayed group. A hurdle model was applied to the data to estimate both the probability of having carious lesions and their number in relation to sCD14 levels. sCD14 was strongly associated (p < 0.01) with an inverse relation to both the probability of having caries and their number (falling rate of 5% per unit CD14 μg/mL). Conclusions: This data confirms the relationship between sCD14 and the presence of dental caries. However, there is no clear cut off level between healthy and unhealthy subjects, so it is currently not possible to use sCD14 as a biomarker to determine the risk of decays.

Prevalence and sociobehavioural determinants of early childhood caries among 5-year-old Portuguese children: a longitudinal study

PURPOSE

To assess the prevalence of early childhood caries (ECC) and associated factors among a 5-year-old cohort.

METHODS

An observational longitudinal study was conducted with a sample of 142 preschoolers. A calibrated dentist performed intraoral examinations following International Caries Detection and Assessment System (ICDAS-II) criteria at baseline and after 6 months. A questionnaire on sociodemographic variables and oral health-related behaviours was answered by caregivers. Statistical analysis included descriptive statistics and computation of confidence intervals (95% confidence level).

RESULTS

Baseline prevalence of ECC and severe ECC (S-ECC) were 40.1% and 11.3%, respectively. After 6 months ECC and S-ECC prevalence rates were 46.5%, and 13.2%, respectively. At both evaluations most caries lesions were untreated. Parental education and occupation were significantly associated with ECC. Behaviour variables found to be significantly associated with the disease comprised: establishing toothbrushing habits before the first year, toothbrushing twice daily and with parental assistance, frequency of dental visits, age at first dental visits, daily ingestion of sweets and number of daily meals.

CONCLUSION

The prevalence of ECC was very high, with most of the lesions left untreated. ECC experience was associated with participants' socioeconomic background and several of the surveyed oral health-related behaviour variables.

Children's detailed non-water beverage consumption habits and longitudinal early childhood caries experiences

OBJECTIVES

Sugar-sweetened beverages and dental caries are prevalent among children. Measurement choices could explain their inconsistent relationships. This study evaluated associations between detailed baseline non-water beverage consumption (NWBC) behaviors and longitudinal early childhood caries (ECC) experiences in young, high-caries risk children.

METHODS

Researchers followed poor, rural, African Americans, recruited at 8-18 months old from Uniontown, Alabama, through convenience sampling, annually for 5 years (N = 66). Baseline questionnaires obtained demographics, oral hygiene, and daily dietary histories, including beverage types, frequencies, and NWBC behaviors of intake speed (intermittent/rapid), container (bottles/non-bottles), and bedtime beverages (yes/no). Dentists conducted examinations annually to determine decayed, missing, filled (carious) surfaces (dmfs) scores, producing increments (dmfs_final - dmfs_initial ). Age-adjusted logistic regressions estimated odds ratios (OR) and 95% confidence intervals (95% CI) for ECC (carious: incidence >0 versus caries-free: incidence = 0) with NWBC behavior then NWBC frequency, individually and conditional on NWBC behaviors, exposures.

RESULTS

NWBC behaviors were not associated with ECC; juice was significant (OR: 2.0, 95% CI: 1.0, 4.2). Adjusting for intake speed, juice persisted as a risk factor (OR: 2.1, 95% CI: 1.0, 4.3), remaining suggestive after controlling for container or bedtime beverages (OR: 2.0, 95% CI: 0.9, 4.3; OR: 1.9, 95% CI: 0.9, 4.0, respectively). Container could be an effect modifier (OR_bottle : 3.5, 95% CI: 0.8, 16.2 vs. OR_non-bottle : 1.5, 95% CI: 0.6, 3.7). Milk was not associated with ECC.

CONCLUSIONS

Independently, NWBC behaviors are insufficient in evaluating NWBC/ECC relationships; beverage type, frequency, and consumption behaviors, collectively, can better evaluate associations.

Overestimation of Early Childhood Caries Using the dmfs Index

Purpose: The preferred epidemiological caries assessment method is the decayed, missing, and filled surfaces (dmfs) score, which records all crowned/missing primary teeth's surfaces as carious. The purpose of this study was to evaluate the dmfs score's accuracy in capturing caries-affected (versus treated) surfaces of crowned/extracted teeth. Methods: A high-caries risk cohort of children, eight to 18 months old at baseline, were recruited from a nonfluoridated, rural, minority, and low-income community. Oral examinations occurred every 12 months for five years, identifying children with at least one caries-related crown/extraction (N equals 45). Observed scoring counted all crowned/extracted surfaces as carious. Private dentists' clinical records were also reviewed to determine how many surfaces were carious at crown/extraction appointments (53 actual scores for n equals 19). Differences in actual and observed scoring were evaluated (sign test; α equals 0.05 with two-tailed P-values). Results: Most children in the study group had more than one crown/extraction. Actual scoring revealed two to three fewer carious surfaces per tooth than observed scoring; cumulatively, observed scoring added two to 27 more surface counts per participant (P<0.001). Conclusions: Observed scoring exaggerated early childhood caries burdens when crowns/extractions were prevalent. Modified dmfs scoring, individualized or population-corrected crown/extraction counts, could more accurately estimate disease.

Average area under the curve: An alternative method for quantifying the dental caries experience in longitudinal studies

OBJECTIVES

Field-traditional decayed, missing, filled surfaces (dmfs) increments require complete follow-up, only using initial and final visits. Repeated dmfs scores complicate sophisticated statistical models, limiting their utility. Elsewhere, area under the curve (AUC) uses all repeated measures to summarize data. This study applied AUC methodology to caries data, creating average AUCs for dmfs trajectories (dmfs^aAUC ) and comparing increments and dmfs^aAUC values.

METHODS

Longitudinal data were obtained from high-caries risk (i.e. poor, rural, African American community in Perry County, Alabama) infants, 8 to 18 months at baseline. Baseline and five annual visual oral examinations provided dmfs scores. Differences in baseline and final dmfs scores constituted increments. The trapezoidal rule was applied to dmfs trajectories to calculate AUC values which were adjusted for varying follow-up times, producing dmfs^aAUC values. Participants sharing incremental or dmfs^aAUC values had their trajectories and second caries measurements compared. Within-participant increment and dmfs^aAUC differences were evaluated (paired t test, α = 0.05). Comparative analyses required complete follow-up.

RESULTS

The dmfs^aAUC provided forty-eight additional person-years, increasing the potential sample size by 20% (N = 85). Sixty-six children, 5.7 to 6.3 year-olds at study's end, contributed 121 331 person-days to five-year increment and dmfs^aAUC calculations. Trajectories and dmfs^aAUC values varied for participants with equivalent increments; comparable trajectories and different increments resulted from participants with similar dmfs^aAUC values. Within-participant disease amounts were similar.

CONCLUSIONS

When desired, dmfs^aAUC can replace increments as a more data-inclusive summary of longitudinal caries burden, incorporating intermediate visits, incomplete follow-up and time.

Streptococcus mutans serotypes and collagen-binding proteins Cnm/Cbm in children with caries analysed by PCR

Streptococcus mutans, a primary bacterium associated with dental caries, has four known clinical serotypes (c, e, fand k). Certain serotypes, the presence of multiple serotypes and strains with collagen-binding proteins (CBP, Cnm and Cbm) have been linked with systemic disease. Evaluation of S mutans serotype distribution and caries association is needed in the United States. The purpose of this study was to evaluate the prevalence of S mutans serotypes from two cohorts of African-American children in rural Alabama using three sample types (saliva, plaque and individual S mutans isolates) by PCR detection for association with caries. Detection of CBP was also performed by PCR. In total, 129 children were evaluated and overall prevalence of serotypes were: serotype c(98%), e(26%), f(7%) and k(52%). Serotype c was statistically associated with higher caries scores in older children (P < 0.001) and serotype k was statistically more likely in females (P = 0.004). Fourteen per cent of children had CBP. Thirteen S mutans isolates from five children tested positive for both CBP. This study is the first to report on the prevalence of S mutans serotypes in a US population using the PCR-based approach. The frequency of serotype k in this study is the highest reported in any population, illustrating the need for further study to determine the prevalence of this clinically relevant serotype in the US. This is the first study to report S mutans isolates with both Cnm and Cbm in the same strain, and further analysis is needed to determine the clinical significance of these strains.

Development of a prognostic model for caries onset and progression from early childhood caries incidence in urban preschool children

AIM

Of this prospective cohort study was to assess early childhood caries (ECC) incidence and, based on the data, build a model that not only predicts future ECC onset in clinically caries-free children, but also is prognostic for children with ECC.

METHODS

ECC incidence was assessed at the 12-month follow-up examination on a cohort of 291 preschool children. Weighted general estimation equation (WGEE) was used to estimate the effects of covariates on ds (decayed primary tooth surfaces) and dfs (decayed and filled primary tooth surfaces).

RESULTS

The mean dfs at the baseline examination was 0.81. Of the 116 children who completed the study, approximately 22% examined at baseline had ECC (dfs > 0). At 12-months, 36% had ECC with a mean dfs of 2.22. Children with dfs = 0 at baseline had 2.95 fewer ds in the primary dentition at the end of the study than children who had ECC at the baseline examination (dfs > 0) (p < 0.0001). Children with dfs = 0 at baseline had 5.49 fewer ds and dfs in the primary dentition at the end of the study than children who had ECC at the baseline examination (dfs > 0) (p < 0.0001).

CONCLUSIONS

ECC incidence at 1 year was 14%. The prevalence of ECC at the 12-month follow-up examination was approximately 36%. The model developed from these data strongly indicate that past caries experience in the primary dentition is a significant predictor of future caries activity and severity, as well as a predictor of future caries onset in clinically caries-free children.

Mutans Streptococci and Dental Caries: A New Statistical Modeling Approach

Survival analyses have been used to overcome some of the limitations encountered with other statistical analyses. Although extended Cox hazard modeling with time-dependent variables has been utilized in several medical studies, it has never been utilized in assessing the complex relationship between mutans streptococci (MS) acquisition (time-dependent covariate) and time to having dental caries (outcome). This study involved secondary analyses of data from a prospective study conducted at the University of Alabama at Birmingham. Low socioeconomic status, African-American preschool children from Perry County, AL, USA (n = 95) had dental examinations at age 1 year and annually thereafter until age 6 years by three calibrated dentists. Salivary MS tests were done at ages 1, 1.5, 2, 2.5, 3, and 4 years. The patterns of and relationship between initial MS detection (time-dependent covariate) and dental caries experience occurrence were assessed, using extended Cox hazard modeling. The median time without MS acquisition (50% of the children not having positive MS test) was 2 years. Approximately 79% of the children had positive salivary MS tests by the age of 4 years. The median caries experience survival (50% of the children not having dental caries) was 4 years. During the follow-up period, 65 of the children (68.4%) had their initial primary caries experience. Results of the extended Cox hazard modeling showed a significant overall/global relationship between initial caries experience event at any given time during the follow-up period and having a positive salivary MS test at any time during the follow-up period (hazard ratio = 2.25, 95% CI 1.06-4.75). In conclusion, the extended Cox modeling was used for the first time and its results showed a significant global/overall relationship between MS acquisition and dental caries. Further research using causal mediation analysis with survival data is necessary, where the mediator "presence of MS" is treated as a time-dependent variable.

A longitudinal study of early childhood caries incidence in Wenzhou preschool children

Background

Early childhood caries (ECC) is a serious public health problem in China. Few studies, however, have described the incidence of ECC in China. The purpose of this study was to assess the prevalence and incidence of ECC among preschool children in Wenzhou China.

Methods

Preschool children aged 3–4 years old were surveyed and followed up when they reached 5–6 years of age in the city of Wenzhou in southeast China. The rates of dental caries were determined with prevalence, and incidence density for risk of caries of a person (ID_p) and of a tooth surface (ID_s).

Results

The prevalence and decayed, missing, and filled primary teeth (dmft) score of 3–4, 4–5, and 5-6 years old children were 59.8% and 2.9, 71.8% and 4.2, and 76.4% and 4.6, respectively. The ID_p was 29.7 and 14.8 persons/100 person-year during the first and second year. The ID_s was 5.9 and 2.7 newly affected surfaces/100 surface-year, respectively. The percentage of molars with caries experience increased obviously; the percentage of maxillary central incisors and mandibular incisors with caries experience increased during the first follow-up, whereas it declined during the second follow-up; the others increased gradually.

Conclusions

The prevalence and incidence of dental caries in Wenzhou preschool children were very high with most of the carious teeth left untreated. The molars were the most affected teeth during the observation period.

Association Between Early Childhood Caries and Colonization with Streptococcus mutans Genotypes From Mothers

PURPOSE

The purpose of this study was to evaluate Streptococcus mutans genotypes (GT) between mother and child (M-C) in a high caries risk cohort to explore the association with early childhood caries (ECC).

METHODS

Sixty-nine infants (each approximately one year old) had periodic oral examinations (dmfs) and microbial samples collected from dental plaque, saliva, and other oral surfaces. Their mothers had an examination and plaque collected. S mutans isolates were genotyped using repetitive extragenic palindromic-PCR (rep-PCR). Statistical analyses were conducted for associations of S mutans in M-C dyads with caries outcomes.

RESULTS

Twenty-seven S mutans genotypes (GT) from 3,414 isolates were identified. M-C were categorized as GT match (n equals 40) or no-match (n equals 29). When modeling the severity of ECC at 36 months (approximately four years old), the estimated dmfs in the match group was 2.61 times that of the no-match group (P=.014).

CONCLUSIONS

Colonization of children with Streptococcus mutans genotypes that matched with mothers was shown to be highly associated with early childhood caries. Although the data suggest vertical transmission of S mutans in 40 of 69 children that shared GT with their mother, it is possible that other individuals transmitted the S mutans. Nonetheless, these findings support the importance of the mother's oral microbial status as a contributing influence to their children's oral health.

Framing Young Childrens Oral Health: A Participatory Action Research Project

BACKGROUND AND OBJECTIVES

Despite the widespread acknowledgement of the importance of childhood oral health, little progress has been made in preventing early childhood caries. Limited information exists regarding specific daily-life and community-related factors that impede optimal oral hygiene, diet, care, and ultimately oral health for children. We sought to understand what parents of young children consider important and potentially modifiable factors and resources influencing their children's oral health, within the contexts of the family and the community.

METHODS

This qualitative study employed Photovoice among 10 English-speaking parents of infants and toddlers who were clients of an urban WIC clinic in North Carolina. The primary research question was: "What do you consider as important behaviors, as well as family and community resources to prevent cavities among young children?" Five group sessions were conducted and they were recorded, transcribed verbatim and analyzed using qualitative research methodology. Inductive analyses were based on analytical summaries, double-coding, and summary matrices and were done using Atlas.ti.7.5.9 software.

FINDINGS

Good oral health was associated with avoidance of problems or restorations for the participants. Financial constraints affected healthy food and beverage choices, as well as access to oral health care. Time constraints and occasional frustration related to children's oral hygiene emerged as additional barriers. Establishment of rules/routines and commitment to them was a successful strategy to promote their children's oral health, as well as modeling of older siblings, cooperation among caregivers and peer support. Community programs and organizations, social hubs including playgrounds, grocery stores and social media emerged as promising avenues for gaining support and sharing resources.

CONCLUSIONS

Low-income parents of young children are faced with daily life struggles that interfere with oral health and care. Financial constraints are pervasive, but parents identified several strategies involving home care and community agents that can be helpful. Future interventions aimed to improve children's oral health must take into consideration the role of families and the communities in which they live.

Genetic Diversity and Evidence for Transmission of Streptococcus mutans by DiversiLab rep-PCR

This two-part study investigated the genetic diversity and transmission of Streptococcus mutans using the DiversiLab repetitive extragenic palindromic PCR (rep-PCR) approach. For children with S. mutans and participating household members, analysis for evidence of unrelated child-to-child as well as intra-familial transmission was evaluated based on commonality of genotypes. A total of 169 index children and 425 household family members from Uniontown, Alabama were evaluated for genetic diversity using rep-PCR. Thirty-four unique rep-PCR genotypes were observed for 13,906 S. mutans isolates. For transmission, 117 child and household isolates were evaluated for shared genotype (by child and by genotype cases, multiple matches possible for each child). Overall, children had 1-9 genotypes and those with multiple genotypes were 2.3 times more likely to have caries experience (decayed, missing and filled teeth/surfaces>0). Only 28% of children shared all genotypes within the household, while 72% had at least 1 genotype not shared with anyone in the household. Children had genotype(s) not shared with any household members in 157 cases. In 158 cases children and household members shared a genotype in which 55% (87/158 cases) were shared with more than one family member. Children most frequently shared genotypes with their mothers (54%; 85/158), siblings (46%; 72/158) and cousins (23%; 37/158). A reference library for S. mutans for epidemiological surveillance using the DiversiLab rep-PCR approach is detailed. The genetic diversity of S. mutans in this population demonstrated frequent commonality of genotypes. Evidence for both child-to-child and intra-familial transmission of S. mutans was observed by rep-PCR.

Dental Caries in High-risk, School-age African American Children in Alabama: A Six-year Prospective

PURPOSE

The purpose of this study was to assess the prevalence and incidence of dental caries in school-age African American children who received semi-annual fluoride varnish applications.

METHODS

A cohort of six-year-old high caries-risk African American children (n equals 98) was recruited in Uniontown, Ala., USA, and followed for six years. Oral examinations were done annually by three trained/calibrated dentists. Tooth surfaces with cavitated caries, teeth missing due to caries, and teeth with filled surfaces were recorded using World Health Organization criteria. Also, as part of the study, children received periodic oral health instruction, fluoride varnish applications, and referrals to dentists starting at baseline.

RESULTS

The person-level prevalence of decayed, missing, and filled surfaces of primary and permanent teeth (dmfs/DMFS) was: 61.2 percent at mean age of 5.9 years old (n equals 98, mean dmfs/DMFS equals 11.6); 63.8 percent at 6.7 years old (n equals 80, mean dmfs/ DMFS equals 13.2); 70.6 percent at 7.8 years old (n equals 68, mean dmfs/DMFS equals 14.2); 65.7 percent at 8.8 years old (n equals 68, mean dmfs/DMFS equals 11.8); 55.6 percent at 9.7 years old (n equals 63, mean dmfs/DMFS equals 8.8); 40.3 percent at 10.7 years old (n equals 62, mean dmfs/DMFS equals 3.4); and 37.1 percent at 11.7 years old (n equals 62, mean dmfs/DMFS equals 2.3). The six-year person-level incidence of dmfs/DMFS was 32.3 percent (mean dmfs/DMFS equals 1.6) from 5.9 to 11.7 years old (<small>N</small> equals 62).

CONCLUSIONS

In spite of the oral health education and fluoride varnish applications, there was substantial new dental caries in this high-risk sample. Additional studies evaluating risk factors for caries development are ongoing.

Assessment of clonality and serotypes of Streptococcus mutans among children by multilocus sequence typing

Studies using multilocus sequence typing (MLST) have demonstrated that Streptococcus mutans isolates are genetically diverse. Our laboratory previously demonstrated clonality of S. mutans using MLST but could not discount the possibility of sampling bias. In this study, the clonality of randomly selected S. mutans plaque isolates from African-American children was examined using MLST. Serotype and the presence of collagen-binding proteins (CBPs) encoded by cnm/cbm were also assessed. One-hundred S. mutans isolates were randomly selected for MLST analysis. Sequence analysis was performed and phylogenetic trees were generated using start2 and mega. Thirty-four sequence types were identified, of which 27 were unique to this population. Seventy-five per cent of the isolates clustered into 16 clonal groups. The serotypes observed were c (n = 84), e (n = 3), and k (n = 11). The prevalence of S. mutans isolates of serotype k was notably high, at 17.5%. All isolates were cnm/cbm negative. The clonality of S. mutans demonstrated in this study illustrates the importance of localized population studies and are consistent with transmission. The prevalence of serotype k, a recently proposed systemic pathogen, observed in this study, is higher than reported in most populations and is the first report of S. mutans serotype k in a United States population.