Mutans Streptococci and Dental Caries: A New Statistical Modeling Approach

Comparison of salivary statherin and beta-defensin-2 levels, oral health behaviors, and demographic factors in children with and without early childhood caries

BACKGROUND

Early childhood caries (ECC) is a widespread pediatric dental condition that is influenced by a combination of biological, behavioral, and demographic factors. Salivary biomarkers, including beta-defensin-2 (BD-2) and statherin (STATH), offer potential as non-invasive tools for detecting and assessing the risk of ECC. This study aims to compare the levels of salivary statherin and beta-defensin-2, alongside oral health behaviors and demographic factors, in children both with and without early childhood caries.

METHODS

This case-control study involved 75 children diagnosed with ECC and 75 age- and gender-matched caries-free controls. Unstimulated saliva samples were obtained and analyzed via ELISA to quantify the levels of beta-defensin-2 and statherin. Demographic and behavioral data were gathered through structured interviews with parents. Statistical analyses included t-tests, logistic regression, and machine learning models to predict the risk of ECC.

RESULTS

Salivary beta-defensin-2 levels were significantly higher in children with ECC (9.25 ± 2.89 ng/mL) compared to caries-free controls (6.41 ± 2.45 ng/mL, p = 0.003), indicating its potential as a diagnostic biomarker. Statherin levels, although lower in the ECC group, did not differ significantly between groups (p = 0.08). Behavioral factors such as regular dental visits and parental education levels were strongly associated with ECC prevalence. Machine learning models demonstrated high accuracy in predicting ECC, with the Gradient Boosting and CatBoost achieving the highest performance.

CONCLUSIONS

Salivary beta-defensin-2 is a promising ECC risk assessment biomarker, while statherin is less effective as an independent predictor. Behavioral and demographic factors significantly influence ECC prevalence. Machine learning models integrating clinical, demographic, and salivary data provide a robust tool for detection and targeted prevention strategies. Comprehensive approaches combining salivary biomarkers and behavioral interventions are critical to managing ECC, particularly in resource-limited settings.

Novel Quaternary Ammonium Urethane-Dimethacrylates for Copolymers with Low Water Sorption and Solubility

Six novel urethane-dimethacrylates with quaternary ammonium groups (QAUDMAs) were successfully synthesized from 2-(methacryloyloxy)ethyl-2-hydroxyethylmethylalkylammonium bromide (QAHAMA-n, where n was 8 and 10) and diisocyanate (isophorone diisocyanate (IPDI), 4,4'-methylenedicyclohexyl diisocyanate (CHMDI), and 4,4'-diphenylmethane diisocyanate (MDI)). Their chemical structures were confirmed through nuclear magnetic resonance spectroscopy (NMR) and Fourier transform infrared spectroscopy (FTIR). The refractive index (RI) and density (dm) were also determined. The novel QAUDMAs were compounded with common dental dimethacrylates and subsequently photopolymerized. The resulting copolymers, comprising QAUDMA 40 wt.%, bisphenol A glycerolate dimethacrylate (Bis-GMA) 40 wt.%, and triethylene glycol dimethacrylate (TEGDMA) 20 wt.%, were tested for water sorption (WS) and solubility (SL). The WS and SL values decreased following these orderings based on the diisocyanate: IPDI > CHMDI > MDI for WS, and MDI > CHMDI > IPDI for SL. The WS values ranged from 11.50 to 13.82 µg/mm3, and were significantly lower than the recommended maximum for dental materials, 40 µg/mm3. The SL values that met the recommended maximum, 7.5 µg/mm3, ranged from 2.67 to 6.75 µg/mm3. Only the copolymer having the QAHAMA-8- and MDI-derived QAUDMA had the SL slightly exceeding 7.5 µg/mm3, at 7.89 µg/mm3.

Short-term use of Lacticaseibacillus rhamnosus SD11 and the oral microbiome: Low caries RCT study

OBJECTIVES

The objective of the study was to investigate the effect of short-term lozenges containing Lacticaseibacillus rhamnosus SD11 on cariogenic pathogens and on oral microbiota.

MATERIALS AND METHODS

This double-blind, randomized, controlled trial included 121 subjects and was randomly divided into the control and probiotic group. All subjects were blindly administered to receive the control- or probiotic L. rhamnosus SD11 lozenges every day for 4 weeks and then followed up for another 4 weeks.

RESULTS

After probiotic consumption, the probiotic group had significantly lower levels of Streptococcus mutans and significantly higher levels of total lactobacilli at 4 and 8 weeks compared with the baseline. The 16S rRNA sequencing revealed an increase in bacterial diversity and beneficial bacteria in the Firmicutes phylum, Bacilli class, and a reduction in the mutans streptococci group in the probiotic group. The opposite results were found in the control group. This study did not find any caries increment, nor did the subjects have any side effects after product consumption.

CONCLUSION

With the limitation of a short-time study in low caries children, it showed that L. rhamnosus SD11 could increase beneficial bacteria in the Firmicutes phylum and Bacilli class that might support good oral health in children.

Risk Factors of Dental Caries in the Thai Population: The Retrospective Cohort Study

Aim

The aim of this retrospective cohort study was to determine the risk factors associated with the occurrence of dental caries increments in Thai dental patients.

Materials and Methods

The dental chart records of 500 patients who visited the Department of Advanced General Dentistry, Mahidol University during 2003-2013 were included in this research. Risk factors such as age, gender, medical history, marital status, routine oral checkup, oral appliance usage, initial and final records of decayed (DT)-missing-filled (DMF-T), dental history of tooth extraction due to caries, xerostomia, presence of visible plaque, presence of interproximal restoration, and caries risk level were retrieved from dental records. Cox proportional hazard regression model was used to determine the association of caries risk factors and new dental caries increments.

Results

The results indicated that the rate of incidence of new dental caries was 2.1 per 100 person-month. In the multivariate hazard model, past caries experience in more than three teeth (adjusted hazard ratio: 2.29, 95%CI: 1.53-3.44) and xerostomia (adjusted hazard ratio: 4.47, 95%CI: 1.82-10.98) were independent risk factors of dental caries increments. Other factors, such as demographic data, physical factors, clinical factors, and other contributing factors, were not associated with the incidence of new dental caries.

Conclusion

The presence of past caries experience and xerostomia were predictors of the occurrence of new dental caries.

Dental Caries a Risk Factor for Intracerebral Hemorrhage

INTRODUCTION

Streptococcus mutans is a known cause of dental caries that contains a collagen-binding protein, Cnm, and exhibits inhibition of platelet aggregation and matrix metalloproteinase-9 activation. This strain has been linked to aggravation of experimental intracerebral hemorrhage (ICH) and may be a risk factor for ICH. The purpose of this study was to test the association between dental caries and incident ICH.

METHODS

The presence of dental caries and periodontal disease was assessed in subjects from the Dental Atherosclerosis Risk in Communities (DARIC) study without prior stroke or ICH. This cohort was followed for incident ICH over a period of 10 years. Cox regression was used to compute crude and adjusted hazards ratio from the dental assessment.

RESULTS

Among 6,315 subjects, dental surface caries and/or root caries were recorded in 1,338 (27%) subjects. Of those, 7 (0.5%) had incident ICH over a period of 10 years following the visit 4 assessment. Of the remaining 4,977 subjects, 10 (0.2%) had incident ICH. Those with dental caries versus those without dental caries were slightly younger (mean age 62.0 ± 5.7 vs. 62.4 ± 5.6, p = 0.012), had a greater proportion of males (51 vs. 44%, p < 0.001), African Americans (44 vs. 10%, p < 0.001), and were hypertensive (42 vs. 31%, p < 0.001). The association between caries and ICH was significant (crude HR 2.69, 95% CI 1.02-7.06) and strengthened after adjustment for age, gender, race, education level, hypertension, and periodontal disease (adjusted HR 3.88, 95% CI 1.34-11.24).

CONCLUSION

Dental caries is a potential risk for incident ICH after caries detection. Future studies are needed to determine if treatment of dental caries can reduce the risk of ICH.

Randomized Clinical Trial of Oral Probiotic Streptococcus salivarius M18 on Salivary Streptococcus mutans in Preprimary Children

The oral probiotic Streptococcus salivarius M18 (S M18) offers the potential to confer oral health benefits as it produces bacteriocins which are targeting Streptococcus mutans.

Aims

The purpose of this clinical trial was to assess the effect of S M18 probiotics on salivary S. mutans and to identify the correlation between dental caries with salivary S. mutans count.

Materials and methods

This clinical trial was conducted in 40 children between the age-group 3-6 years, subjects were randomly selected and the decay extracted filled (due to caries) (def score) was recorded. The presalivary unstimulated saliva was collected and subjected to microbiological examination for S. mutans counts, salivary pH, and buffering capacity. Children were divided into two groups as the control and the experimental group. bacteriocin like inhibitory substances M18 (M18 is a strain number) (BLIS M18) probiotic was administered in the experimental group, and unsweetened lozenge as a placebo in the control group for 7 days and postsalivary samples were collected and subjected to microbiological examinations for S. mutans count, salivary pH, and buffering capacity.

Results

A significant decrease in the S. mutans counts were noticed, an increase in buffering capacity, and no significant change in pH was observed after the intervention of S M18. A linear correlation was observed between the def score and S. mutans count.

Conclusion

This clinical trial revealed that S M18 in its 7 days regime can lead to the inhibition of S. mutans counts favorably in the oral cavity by affecting salivary pH and buffering capacity.

How to cite this article

Salim HP, Mallikarjun SB, Raju S, et al. Randomized Clinical Trial of Oral Probiotic Streptococcus salivarius M18 on Salivary Streptococcus mutans in Preprimary Children. Int J Clin Pediatr Dent 2023;16(2):259-263.

Inhibitory Activity of Essential Oils of Mentha spicata and Eucalyptus globulus on Biofilms of Streptococcus mutans in an In Vitro Model

The aim of this study was to evaluate the inhibitory activity of the commercially available essential oils of Mentha spicata (spearmint) and Eucalyptus globulus (eucalyptus) on Streptococcus mutans ATCC 25175 biofilms in vitro, emulating dental plaque conditions. The composition of the essential oils (EOs) was determined using gas chromatography coupled with mass spectrometry (GC-MS), with the main metabolites being Carvone (57.93%) and Limonene (12.91%) for Mentha spicata and 1,8-Cineole (Eucalyptol) (65.83%) for Eucalyptus globulus. The inhibitory activity was evaluated using the methods of agar-well diffusion and colorimetric microdilution. The inhibition halos were 18.3 ± 0.47 mm and 27.0 ± 0.82 mm, and the MICs were 1.8484 mg/mL and 1.9168 mg/mL for the EOs of Mentha spicata and Eucalyptus globulus, respectively. The activity against the biofilms was evaluated on a substrate of bovine enamel pieces using a basal mucin medium (BMM) in anaerobic conditions with daily sucrose exposition cycles in order to emulate oral cavity conditions. The EOs were applied in a concentration of 0.5% in a sterile saline vehicle with 1% polysorbate 20. After 72 h of cultivation, a significant reduction was observed (p < 0.001%) on the biofilm biomass, which was evaluated by its turbidity in suspension and using a count of the recoverable organisms with regards to the control. The effects of the Eos were not significantly distinct from each other. The EOs showed antimicrobial activity against both the Streptococcus mutans planktonic and biofilm cultures. Thus, EOs may have great potential for the development of pharmaceutical and sanitary products for oral health.

Effect of titanium dioxide on Streptococcus mutans biofilm

BACKGROUND

Streptococcus mutans (S. mutans) participates in the dental caries process. Titanium dioxide (TiO₂) nanoparticles produce reactive oxygen species capable of disrupting bacterial DNA synthesis by creating pores in cell walls and membranes.

OBJECTIVE

The objective of this study was to determine the effect of TiO₂ on the disruption of S. mutans biofilm.

METHODS

This study was conducted in four phases involving a TiO₂-containing toothbrush and TiO₂ nanoparticles. Each phase was completed using 24 h established S. mutans biofilm growth. Phase one data was collected through a bacterial plating study, assessing biofilm viability. Biofilm mass was evaluated in phase two of the study by measuring S. mutans biofilm grown on microtiter plates following crystal violet staining. The third phase of the study involved a generalized oxygen radical assay to determine the relative amount of oxygen radicals released intracellularly. Phase four of the study included the measurement of insoluble glucan/extracellular polysaccharide (EPS) synthesis using a phenol-sulfuric acid assay.

RESULTS

Both exposure time and time intervals had a significant effect on bacterial viability counts (p = 0.0323 and p = 0.0014, respectively). Bacterial counts after 6 min of exposure were significantly lower than after 2 min (p = 0.034), compared to the no treatment control (p = 0.0056). As exposure time increased, the amount of remaining biofilm mass was statistically lower than the no treatment control. Exposure time had a significant effect on oxygen radical production. Both the 30 and 100 nm TiO₂ nanoparticles had a significant effect on bacterial mass. The silver nanoparticles and the 30 and 100 nm TiO₂ nanoparticles significantly inhibited EPS production.

CONCLUSION

The TiO₂-containing toothbrush kills, disrupts, and produces oxygen radicals that disrupt established S. mutans biofilm. TiO₂ and silver nanoparticles inhibit EPS production and reduce biofilm mass. The addition of TiO₂ to dental products may be effective in reducing cariogenic dental biofilm.

The Assessment of Sealants' Effectiveness in Arresting Non-Cavitated Caries Lesion-A 24-Month Follow-Up

Dental sealants are excellent means to prevent pits and fissure caries. Nowadays, the application of sealants is extended to therapeutic use in arresting non-cavitated carious lesions. This relatively new concept still lacks evidence to support its routine use. The aim of this study was to evaluate the effectiveness of a resin-based sealant applied on first permanent molars with carious lesions (ICDAS 1−3), in comparison with its effectiveness when applied on sound surfaces (ICDAS 0). Included in the study were 114 children aged between six and eight years old, with a high caries risk (according to the CAMBRA system), with all four permanent molars erupted and with deep pits and fissures. A total number of 407 molars were sealed and assessed. A total of 49 were excluded (they had caries, which according to the ICDAS II classification were classified with code 4−6 or had older sealants or fillings). Out of these 407 molars, 213 were sound (code 0) and 194 had caries lesions as follows: 56 teeth classified as code 1, 79 teeth classified as code 2, and 59 teeth classified as code 3 according to the ICDAS II classification. The retention of the sealant and carious lesions were assessed clinically at 6, 12, 18, and 24 months. Regarding sealant retention, a statistically significant difference (p < 0.05) among the two types of sealed teeth, sound (ICDAS 0) and decayed (ICDAS 3), showed at 18- and 24-month follow-up intervals. Regarding caries lesions, a statistically significant difference (p < 0.05) showed between sound (ICDAS 0) and decayed (ICDAS 3) molars at 24-month follow-up. Our study results supported the resin-based sealant effectiveness in arresting incipient carious lesions, which according to the ICDAS II classification have received codes 1 and 2 but did not support sealant effectiveness in arresting caries lesions classified according to the same classification with code 3.

Comparison of the Anti-bacterial Efficacy of Saussurea costus and Melaleuca alternifolia Against Porphyromonas gingivalis, Streptococcus mutans, and Enterococcus faecalis: An in-vitro Study

The aim was to compare the in-vitro antibacterial effectiveness of two herbal extracts (a) Saussurea-costus (S. costus) and (b) Melaleuca-alternifolia (M. alternifolia) against Porphyromonas gingivalis (P. gingivalis), Streptococcus mutans (S. mutans) and Enterococcus faecalis (E. faecalis). Aqueous extracts from M. alternifolia were prepared by adding 2 grams of S. costus and M. alternifolia, respectively to 100 ml distilled water. Bacterial strains of P. gingivalis, E. faecalis and S. mutans were treated into 3 groups. In groups 1 and 2, bacterial strains were treated with aqueous extracts of S. costus and M. alternifolia, respectively. In the control-group, bacterial strains were exposed to distilled water. Antibacterial activity of the samples and nanoparticles was determined. The minimum-inhibitory-concentration (MIC) values were determined using the microdilution method. P < 0.01 was considered statistically significant. The MIC for all bacterial strains treated with S. costus was significantly higher than that of M. alternifolia (P < 0.001). There was no significant difference in MIC for strains of P. gingivalis, E. faecalis and S. mutans treated with S. costus. For bacterial strains treated with M. alternifolia, the MIC was significantly higher for P. gingivalis compared with E. faecalis and S. mutans strains (P < 0.01). There was no difference in MIC for E. faecalis and S. mutans strains treated with M. alternifolia. The in-vitro antibacterial efficacy of M. alternifolia is higher than S. costus against P. gingivalis, E. faecalis and S. mutans.

Novel Antibacterial Copolymers Based on Quaternary Ammonium Urethane-Dimethacrylate Analogues and Triethylene Glycol Dimethacrylate

The growing scale of secondary caries and occurrence of antibiotic-resistant bacterial strains require the development of antibacterial dental composites. It can be achieved by the chemical introduction of quaternary ammonium dimethacrylates into dental composites. In this study, physicochemical and antibacterial properties of six novel copolymers consisting of 60 wt. % quaternary ammonium urethane-dimethacrylate analogues (QAUDMA) and 40 wt. % triethylene glycol dimethacrylate (TEGDMA) were investigated. Uncured compositions had suitable refractive index (RI), density (d_m), and glass transition temperature (Tg_m). Copolymers had low polymerization shrinkage (S), high degree of conversion (DC) and high glass transition temperature (Tg_p). They also showed high antibacterial effectiveness against S. aureus and E. coli bacterial strains. It was manifested by the reduction in cell proliferation, decrease in the number of bacteria adhered on their surfaces, and presence of growth inhibition zones. It can be concluded that the copolymerization of bioactive QAUDMAs with TEGDMA provided copolymers with high antibacterial activity and rewarding physicochemical properties.

Assessment of Streptococcus mutans biofilm formation on calcium phosphate ceramics: The role of crystalline composition and microstructure

Streptococcus mutans is one of the bacteria that initiates the colonization of the pellicle at the tooth surface. It forms a plaque, together with other bacteria, which gradually dissolves the pellicle and leaves the tooth surface unprotected against the acidic oral environment. Calcium phosphate ceramics are excellent synthetic materials for the study of biofilm formation in dentistry because they are comparable to teeth in chemical composition and structure. Calcium phosphates can be processed to achieve a variety of crystalline compounds with biologically relevant ionic substitutions and structures that allow study of the effect of the surface chemistry and the topography independently. In this article, we describe the preparation and characterization of three types of calcium phosphate-based materials as a suitable surface for the formation of the S. mutans biofilm: beta-tricalcium phosphate (β-TCP); sintered hydroxyapatite (SHA); and calcium-deficient hydroxyapatite (CDHA). The densest biofilms were formed on the surfaces of SHA and CDHA, with no significant differences due to the stoichiometry or microstructure. In contrast, β-TCP showed a lower susceptibility to S. mutans biofilm formation, suggesting that the crystalline structure is the controlling parameter. Subsequently, SHA was selected to develop a dental biofilm model that allowed study of S. mutans biofilm susceptibility to chlorhexidine and ethanol.

Streptococcus Mutans Infections in Infants and Related Maternal/Child Factors

Objective

The aim of the study was to investigate the maternal-child S. mutans infection, mutual interaction and potential risk factors altering this interaction.

Material and methods

A total of 160 mothers who were paired with their children were recruited. Saliva from mothers and children was collected and S. mutans categorized levels were analyzed. A questionnaire was used to collect maternal and child conventional caries risk factors. A proportional odds regression model was used to investigate whether the level of infection of mothers would similarly affect the level of infection of their children, thus adjusting for other risk factors.

Results

The average age of mothers was 28.1 years and children had a median age of 5.1 months. Paired mother-child S. mutans cross-classification into non-infected and infected subjects showed no agreement in mutual contamination. Maternal infection of the child was highest when the mother was infected with 10^>3 S. mutans/ml of saliva. The results obtained by the regression model showed that none of the potential risk factors influenced the level of infection in the child.

Conclusion

Mothers with a high S. mutans level increase the risk of S. mutans acquisition for her five- month- old child but no evidence was found that other maternal/child factors may influence this.

Microbiome Analysis of Carious Lesions in Pre-School Children with Early Childhood Caries and Congenital Heart Disease

Oral bacteria have been associated with several systemic diseases. Moreover, the abundance of bacteria associated with caries has been found to be higher in patients with congenital heart disease (CHD) than in healthy control groups (HCGs). Therefore, this study aimed to evaluate the dental microbiota in children with CHD compared to a HCG. The aim was to describe and compare the carious microbiome regarding the composition, diversity, and taxonomic patterns in these two groups. Twenty children with CHD and a HCG aged between two and six years participated. All of them were affected by early childhood caries. Microbiome profiling indicated that Fusobacterium, Prevotella, Capnocytophaga, and Oribacterium were more abundant in the CHD group, whereas Lactobacillus and Rothia were predominant in the HCG. Furthermore, microbiome analysis revealed three distinct clusters for the CHD and HCG samples. In the first cluster, we found mainly the genera Lactobacillus and Coriobacteriaceae. The second cluster showed a higher relative abundance of the genus Actinomyces and a more diverse composition consisting of more genera with a smaller relative lot. The third cluster was characterized by two genera, Streptococcus and Veillonella. These data can help us to understand the oral microbial community structures involved in caries and endodontic infections of pre-school children in relation to the general health of these high-risk patients.

The Queensland Birth Cohort Study for Early Childhood Caries: Results at 7 Years

AIMS

This study investigated caries predictors in 378 children remaining from a birth cohort of 1,052 at 7 y and compared the efficacy of home visits (HVs) and telephone contacts (TCs) for early childhood caries (ECC) prevention.

METHODS

The HVs or TCs were made at ages 6, 12, 18, 30, and 42 mo with annual dental clinic examinations at ages 2 to 7 y. At every visit, the parents completed validated questionnaires regarding the children's family, medical, dental, and dietary histories.

RESULTS

The caries prevalence increased from 2% and 6% at ages 2 and 3 y to 15%, 33%, 42%, and 52% at ages 4 to 7 y. The mean caries experience (decayed, missing, and teeth extracted due to caries) of the total cohort increased from 0.1 ± 0.5 at age 2 y to 0.2 ± 1.1 at 3 y, 0.5 ± 1.6 at 4 y, 1.1 ± 2.4 at 5 y, 1.6 ± 2.6 at 6 y, and 2.0 ± 2.7 at 7 y. The prevalence of mutans streptococci (MS) in the total cohort at years 2 to 7 was 22%, 36%, 42%, 42%, 39%, and 44%, respectively. MS was strongly correlated with caries prevalence for all years (all P < 0.001). Statistical modeling employing the generalized estimating equations identified caries predictors as holding a Health Care Card (low socioeconomic status) (P = 0.009; odds ratio [OR] = 2.05; confidence interval [CI]: 1.20-3.52), developmental defects of enamel (DDEs) (P < 0.001; OR = 1.09; CI: 1.05-1.14), and MS counts ≤10⁵/mL (P = 0.001; OR = 1.63; CI: 1.24-2.14). By contrast, HVs were more protective than TCs for caries (P = 0.008; OR = 0.42; CI: 0.22-0.80).

CONCLUSIONS

This study provides prospective, clinical evidence that MS, DDEs, and low socioeconomic status are strongly correlated with early childhood caries and that HVs are more efficacious than TCs in ECC prevention.

KNOWLEDGE TRANSFER STATEMENT

This 7-y birth cohort study provides longitudinal clinical evidence that mutans streptococci, developmental defects of enamel, and low socioeconomic status are key risk indicators of early childhood caries.

Sealing Proximal Non- and Micro-Cavitated Carious Lesions Using a One-Session Separator Technique: A 2-Year Randomised Clinical Study

The presence of initial caries accounts for the majority of approximal carious lesions in many countries. The aim of this clustered, split-mouth, randomised, controlled clinical trial was to use a metal separator to widen the approximal space in a one-visit session before sealing and to evaluate patient acceptance, together with the efficacy of the proximal sealing in arresting incipient carious lesions after 2 years. A total of 48 patients with a mean age of 41.9 years were selected. They had at least one pair of proximal initial carious lesions, including the distal surface of the canines to the mesial surface of the third molars (bite-wing score D1-D3). The patient's caries risk at baseline was analyzed using a Cariogram. All surfaces were examined for mutans streptococci (ms) counts. The separator technique made it possible to diagnose whether or not a microcavity was present. After 2 years, 212 surfaces in 45 subjects were examined using the same as baseline standardized digital follow-up radiographs. Two analyses were performed, one sensitive, where a progression or a regression was assessed if one of the examiners made one of those diagnoses, and one conservative, where unchanged. For both analyses, the sealed test surfaces showed a significantly higher regression (67 and 29%) compared to the control group (13 and 2%) p < 0.0001. It did not appear that the baseline variables, such as the caries risk, surface diagnoses, or ms counts, influenced the caries outcome. In the test group, there was no difference in caries progression if there was a microcavity or not. The separation treatment was well accepted by the patients. The method of separation for diagnosis and sealing treatment in a single session appears to be a clinically applicable method for the control of proximal carious lesions.

JUSTIFICATION OF SELECTION OF MEANS AND METHODS OF THE ORAL CAVITY HYGIENE IN CHILDREN WITH CYSTIC FIBROSIS

Cystic fibrosis (CF) promotes the development of gingivitis in children. The high prevalence and early manifestation of gingivitis is due to a combination of many factors. The pathogenic mechanisms of cystic fibrosis lead to disruption of normal physiological processes in the oral cavity, in particular, to a decrease in the level of salivation, to an increase in the viscosity of saliva, to a suppression of local immunity. Therefore, poor oral hygiene contributes to oral diseases. The aim of the study was to determine the level of oral hygiene in children with CF as one of the reasons for the development of gingivitis, and to select dental hygiene products that active towards factors that affect plaque. Material and methods. A total of 24 children with CF in the Ukrainian population participated in the study. The hygienic index OHI-S (J. C. Green, J. R. Wermillion, 1964) was calculated. The data were analyzed using Student’s criterions. The analysis was performed with a confidence level of 95 %. Results. The level of hygiene of the oral cavity was unsatisfactory among patients (OHI-S=2.19±0.11). Hygiene methods and dental hygiene products, to taking into account the manifestation of the pathogenesis of somatic disease, were selected. A follow-up study after 3 months revealed a significant positive trend in indicators of oral hygiene. Conclusions. This study has shown the low level of oral hygiene in children with CF. Hygienic education and motivation of these patients could help them achieve a higher level of oral health knowledge and are important starting points for the treatment and prevention of gingivitis. There was a significant improvement of the oral hygiene level after training children and after the proper selection of hygiene products. The dentists should use means and methods that have not contraindicate in patients of this category. It is recommended to monitore the hygiene indices to establish the effectiveness of the measures and necessity for individually therapy correction.

Temporal development of the oral microbiome and prediction of early childhood caries

Human microbiomes are predicted to assemble in a reproducible and ordered manner yet there is limited knowledge on the development of the complex bacterial communities that constitute the oral microbiome. The oral microbiome plays major roles in many oral diseases including early childhood caries (ECC), which afflicts up to 70% of children in some countries. Saliva contains oral bacteria that are indicative of the whole oral microbiome and may have the ability to reflect the dysbiosis in supragingival plaque communities that initiates the clinical manifestations of ECC. The aim of this study was to determine the assembly of the oral microbiome during the first four years of life and compare it with the clinical development of ECC. The oral microbiomes of 134 children enrolled in a birth cohort study were determined at six ages between two months and four years-of-age and their mother's oral microbiome was determined at a single time point. We identified and quantified 356 operational taxonomic units (OTUs) of bacteria in saliva by sequencing the V4 region of the bacterial 16S RNA genes. Bacterial alpha diversity increased from a mean of 31 OTUs in the saliva of infants at 1.9 months-of-age to 84 OTUs at 39 months-of-age. The oral microbiome showed a distinct shift in composition as the children matured. The microbiome data were compared with the clinical development of ECC in the cohort at 39, 48, and 60 months-of-age as determined by ICDAS-II assessment. Streptococcus mutans was the most discriminatory oral bacterial species between health and current disease, with an increased abundance in disease. Overall our study demonstrates an ordered temporal development of the oral microbiome, describes a limited core oral microbiome and indicates that saliva testing of infants may help predict ECC risk.

Estimating a Dynamic Effect of Soda Intake on Pediatric Dental Caries Using Targeted Maximum Likelihood Estimation Method

An effect of soda intake on dental caries in young children (birth to 5 years) may vary over time. Estimating a dynamic effect may be challenging due to time-varying confounding and loss to follow-up. The purpose of this paper is to demonstrate utility of targeted maximum likelihood estimation (TMLE) method in addressing longitudinal data analysis challenges and estimating a dynamic effect of soda intake on pediatric caries. Data came from the Detroit Dental Health Project, a 4-year cohort study of low-income -African-American children and caregivers. The sample included 995 child-caregiver pairs who participated in 2002-03 (W1) and were followed up in 2004-05 (W2) and 2007 (W3). The outcome was counts of caries surfaces at W3, and the exposure was child's soda intake at W1 and W2. Time-varying covariates included caregiver's smoking status, oral health fatalism, and social support. Forty-three percent of children consistently consumed soda at W1 and W2, whereas 21% were nonconsumers throughout 2 surveys. The remaining 35% switched intake status between W1 and W2. Association between soda intake patterns and caries was tested using TMLE. Children with a consistent soda intake had 1.03 more caries lesions at W3 than those with consistently no soda intake (95% CI 0.09-1.97) on average. If soda was consumed only at W1 or W2, an estimated effect of soda on caries development at W3 was no longer statistically significant. In conclusion, consistent soda intake during the early childhood led to one additional caries tooth surface. The study highlights utility of TMLE in pediatric caries research as it can handle modeling challenges associated with longitudinal data.