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Powell AM, Ali Khan FZ, Ravel J, Elovitz MA. Untangling Associations of Microbiomes of Pregnancy and Preterm Birth. Clin Perinatol 2024; 51:425-439. [PMID: 38705650 PMCID: PMC11070640 DOI: 10.1016/j.clp.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
This review illuminates the complex interplay between various maternal microbiomes and their influence on preterm birth (PTB), a driving and persistent contributor to neonatal morbidity and mortality. Here, we examine the dynamics of oral, gastrointestinal (gut), placental, and vaginal microbiomes, dissecting their roles in the pathogenesis of PTB. Importantly, focusing on the vaginal microbiome and PTB, the review highlights (1) a protective role of Lactobacillus species; (2) an increased risk with select anaerobes; and (3) the influence of social health determinants on the composition of vaginal microbial communities.
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Affiliation(s)
- Anna Maya Powell
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 249, Baltimore, MD 21287, USA
| | - Fouzia Zahid Ali Khan
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 249, Baltimore, MD 21287, USA
| | - Jacques Ravel
- Department of Microbiology and Immunology, Institute for Genome Sciences, 670 West Baltimore Street, 3rd Floor, Room 3173, Baltimore, MD 21201, USA
| | - Michal A Elovitz
- Department of Obstetrics and Gynecology, Women's Health Research, Icahn School of Medicine at Mount Sinai, Women's Biomedical Research Institute, 1468 Madison Avenue, New York, NY 10029, USA.
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Yang R, Lu X, Alomeir N, Quataert S, Wu T, Xiao J. Association between Salivary Hormones, Dental Caries, and Cariogenic Microorganisms during Pregnancy. J Clin Med 2024; 13:3183. [PMID: 38892893 PMCID: PMC11173116 DOI: 10.3390/jcm13113183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/08/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Objective: This study aimed to identify the salivary levels of six hormones (progesterone, estradiol, testosterone, cortisol, thyroxine T3, and triiodothyronine T4) in pregnant women, and to assess the association between salivary hormones, dental caries, and cariogenic microorganisms. Methods: This cross-sectional study included 181 low-income US pregnant women who were in their third trimester. Demographic details, oral hygiene practices, and medical backgrounds were obtained via questionnaires and medical records. Calibrated dentists obtained data on plaque index and caries status through comprehensive oral examinations. Unstimulated saliva was collected 2 h before eating and brushing. Salivary hormones were measured with a multiplex assay. Oral Streptococcus mutans (S. mutans) and Candida albicans (C. albicans) were quantified via colony-forming unit (CFU) counts. A latent model was used to generate clusters of pregnant women based on salivary hormone levels, followed by post-clustering analysis. Factors associated with salivary cariogenic microorganisms were further evaluated via multiple regression analyses. Results: Estradiol, progesterone, testosterone, cortisol, T3, and T4 in saliva were detectable at rates of 92%, 97%, 77%, 99%, 71%, and 50%, respectively. Three distinct participant clusters (high, intermediate, and low) were identified based on salivary hormone levels. Intermediate-level and high-level clusters had increased numbers of decayed teeth, decayed surfaces, ICDAS scores, and salivary S. mutans and C. albicans, compared to the low-level cluster (p < 0.05). Covariate analysis demonstrated that the high-level cluster was positively associated with salivary carriage of S. mutans (CFU/mL) (p < 0.05). Participants with higher levels of progesterone, estradiol, testosterone, and cortisol were associated with a high carriage status of S. mutans in saliva (>105 CFU/mL) (p < 0.05). Conclusions: This study demonstrated the feasibility of detecting salivary hormones during pregnancy and revealed the positive association between salivary steroid hormones and cariogenic pathogens.
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Affiliation(s)
- Ruqian Yang
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY 14620, USA; (R.Y.); (N.A.)
| | - Xingyi Lu
- Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY 14620, USA; (X.L.); (T.W.)
| | - Nora Alomeir
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY 14620, USA; (R.Y.); (N.A.)
| | - Sally Quataert
- Immunology and Microbiology, University of Rochester Medical Center, Rochester, NY 14620, USA;
| | - Tongtong Wu
- Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY 14620, USA; (X.L.); (T.W.)
| | - Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY 14620, USA; (R.Y.); (N.A.)
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Gomersall JC, Slack-Smith L, Kilpatrick N, Muthu MS, Riggs E. Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries. Cochrane Database Syst Rev 2024; 5:CD012155. [PMID: 38753314 PMCID: PMC11098061 DOI: 10.1002/14651858.cd012155.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Dental caries, a common chronic disease of childhood, is associated with adverse health and economic consequences for infants and their families. Socioeconomically disadvantaged children have a higher risk of early childhood caries (ECC). This review updates one published in 2019. OBJECTIVES To assess the effects of interventions undertaken with pregnant women, new mothers or other primary caregivers of infants in the first year of life, for preventing ECC (from birth to six years). SEARCH METHODS We searched Cochrane Oral Health's Trials Register, Cochrane Pregnancy and Childbirth's Trials Register, CENTRAL, MEDLINE (Ovid), Embase (Ovid), CINAHL EBSCO, the US National Institutes of Health Ongoing Trials Register (clinicaltrials.gov) and WHO International Clinical Trials Registry Platform (apps.who.int/trialsearch). The latest searches were run on 3 January, 2023. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing interventions with pregnant women, or new mothers and other primary caregivers of infants in the first year of life, against standard care, placebo or another intervention, reporting on a primary outcome: caries presence in primary teeth, dmfs (decayed, missing, filled primary surfaces index), or dmft (decayed, missing, filled teeth index), in children up to six years of age. Intervention types include clinical, oral health promotion/education (hygiene education, breastfeeding and other dietary advice) and policy or service. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, assessed risk of bias, and assessed certainty of evidence (GRADE). MAIN RESULTS We included 23 RCTs (5 cluster-randomised), involving 25,953 caregivers (mainly mothers) and their children. Fifteen trials assessed oral health education/promotion interventions against standard care. Six trials assessed a clinical intervention for mother dentition, against placebo, or a different type of clinical intervention. Two trials assessed oral health/education promotion plus clinical intervention (for mother's dentition) against standard care. At most, five trials (maximum of 1326 children and 130 mothers) contributed data to any comparison. Enamel-only caries were included in the diagnosis of caries in some studies. For many trials, the risk of bias was unclear due to lack of methodological details reported. In thirteen trials, participants were socioeconomically disadvantaged. No trial indicated receiving funding that was likely to have influenced their results. Oral health education/promotion interventions Child diet and feeding practice advice versus standard care: We observed a probable 15 per cent reduced risk of caries presence in primary teeth with the intervention (RR 0.85, 95% CI 0.75 to 0.97; 3 trials; 782 participants; moderate-certainty evidence), and there may be a slightly lower mean dmfs (MD -0.29, 95% CI -0.58 to 0; 2 trials; 757 participants; low-certainty evidence); however, the evidence is very uncertain regarding the difference between groups in mean dmft (MD -0.90, 95% CI -1.85 to 0.05; 1 trial; 340 participants; very low-certainty evidence). Breastfeeding promotion and support versus standard care: We observed little or no difference between groups in the risk of caries presence in primary teeth (RR 0.96, 95% CI 0.89 to 1.03; 2 trials; 1148 participants; low-certainty evidence) and in mean dmft (MD -0.12, 95% CI -0.59 to 0.36; 2 trials; 652 participants; low-certainty evidence). dmfs was not reported. Child diet advice compared with standard care: We are very uncertain about the effect on the risk of caries presence in primary teeth (RR 1.08, 95% CI 0.34 to 3.37; 1 trial; 148 participants; very low-certainty evidence). dmfs and dmft were not reported. Oral hygiene, child diet and feeding practice advice versus standard care: The evidence is very uncertain about the effect on the risk of caries presence in primary teeth (RR 0.73, 95% CI 0.50 to 1.07; 5 trials; 1326 participants; very low-certainty evidence) and there maybe little to no difference in mean dmfs (MD -0.87, 95% CI -2.18 to 0.43; 2 trials; 657 participants; low-certainty evidence) and mean dmft (MD -0.30, 95% CI -0.96 to 0.36; 1 trial; 187 participants; low-certainty evidence). High-dose versus low-dose vitamin D supplementation during pregnancy: We are very uncertain about the effect on risk of caries presence in primary teeth (RR 0.99, 95% CI 0.70 to 1.41; 1 trial; 496 participants; very low-certainty evidence). dmfs and dmft were not reported. Clinical interventions (for mother dentition) Chlorhexidine (CHX, a commonly prescribed antiseptic agent) or iodine-NaF application and prophylaxis versus placebo: We are very uncertain regarding the difference in risk of caries presence in primary teeth between antimicrobial and placebo treatment for mother dentition (RR 0.97, 95% CI 0.80 to 1.19; 3 trials; 479 participants; very low-certainty evidence). No trial reported dmfs or dmft. Xylitol compared with CHX antimicrobial treatment: We are very uncertain about the effect on caries presence in primary teeth (RR 0.62, 95% CI 0.27 to 1.39; 1 trial, 96 participants; very low-certainty evidence), but we observed there may be a lower mean dmft with xylitol (MD -2.39; 95% CI -4.10 to -0.68; 1 trial, 113 participants; low-certainty evidence). No trial reported dmfs. Oral health education/promotion plus clinical interventions (for mother dentition) Diet and feeding practice advice for infants and young children plus basic dental care for mothers compared with standard care: We are very uncertain about the effect on risk of caries presence in primary teeth (RR 0.44, 95% CI 0.05 to 3.95; 2 trials, 324 participants; very low-certainty evidence) or on mean dmft (1 study, not estimable). No trial reported dmfs. No trials evaluated policy or health service interventions. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that providing advice on diet and feeding to pregnant women, mothers or other caregivers with children up to the age of one year probably leads to a slightly reduced risk of early childhood caries (ECC). The remaining evidence is low to very-low certainty and is insufficient for determining which, if any, other intervention types and features may be effective for preventing ECC, and in which settings. Large, high-quality RCTs of oral health education/promotion, clinical, and policy and service access interventions, are warranted to determine the effects and relative effects of different interventions and inform practice. We have identified 13 ongoing studies. Future studies should consider if and how effects are modified by intervention features and participant characteristics (including socioeconomic status).
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Affiliation(s)
- Judith C Gomersall
- Life Course and Intergenerational Health Research Group, Robinson Research Institute and School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Linda Slack-Smith
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Nicky Kilpatrick
- Vascular Biology, Murdoch Children's Research Institute, Melbourne, Australia
- Plastic and Maxillofacial Surgery, Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Carlton, Australia
| | - M S Muthu
- Centre for Early Childhood Caries Research, Department of Pediatric and Preventive Dentistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
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Meto A, Sula A, Peppoloni S, Meto A, Blasi E. Leveraging Dental Stem Cells for Oral Health during Pregnancy: A Concise Review. Dent J (Basel) 2024; 12:127. [PMID: 38786525 PMCID: PMC11120089 DOI: 10.3390/dj12050127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/12/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
Pregnancy induces significant changes in oral health because of hormonal fluctuations, making it a crucial period for preventive measures. Dental stem cells (DSCs), particularly those derived from the dental pulp and periodontal ligaments, offer promising avenues for regenerative therapies and, possibly, preventive interventions. While the use of DSCs already includes various applications in regenerative dentistry in the general population, their use during pregnancy requires careful consideration. This review explores recent advancements, challenges, and prospects in using DSCs to address oral health issues, possibly during pregnancy. Critical aspects of the responsible use of DSCs in pregnant women are discussed, including safety, ethical issues, regulatory frameworks, and the need for interdisciplinary collaborations. We aimed to provide a comprehensive understanding of leveraging DSCs to improve maternal oral health.
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Affiliation(s)
- Aida Meto
- Department of Dentistry, Faculty of Dental Sciences, University of Aldent, 1007 Tirana, Albania;
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, Laboratory of Microbiology and Virology, University of Modena and Reggio Emilia, 41125 Modena, Italy; (S.P.); (E.B.)
- Department of Conservative Dentistry and Endodontics, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune 411018, Maharashtra, India
| | - Ana Sula
- Department of Obstetrics and Gynecology, American Hospital, 1060 Tirana, Albania;
| | - Samuele Peppoloni
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, Laboratory of Microbiology and Virology, University of Modena and Reggio Emilia, 41125 Modena, Italy; (S.P.); (E.B.)
| | - Agron Meto
- Department of Dentistry, Faculty of Dental Sciences, University of Aldent, 1007 Tirana, Albania;
| | - Elisabetta Blasi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, Laboratory of Microbiology and Virology, University of Modena and Reggio Emilia, 41125 Modena, Italy; (S.P.); (E.B.)
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Alkadi A, Alkhars N, Manning S, Xu H, Sohn M, Xiao J, Meng Y. The Associations between Snack Intake and Cariogenic Oral Microorganism Colonization in Young Children of a Low Socioeconomic Status. Nutrients 2024; 16:1113. [PMID: 38674804 PMCID: PMC11054055 DOI: 10.3390/nu16081113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Cariogenic microorganisms are crucial pathogens contributing to the development of early childhood caries. Snacks provide fermentable carbohydrates, altering oral pH levels and potentially affecting microorganism colonization. However, the relationship between snack intake and cariogenic microorganisms like Candida and Streptococcus mutans in young children is still unclear. This study aimed to assess this association in a prospective underserved birth cohort. Data from children aged 12 to 24 months, including oral microbial assays and snack intake information, were analyzed. Sweet and non-sweet indices based on the cariogenic potential of 15 snacks/drinks were created. Mixed-effects models were used to assess the associations between sweet and non-sweet indices and S. mutans and Candida carriage. Random forest identified predictive factors of microorganism carriage. Higher non-sweet index scores were linked to increased S. mutans carriage in plaques (OR = 1.67, p = 0.01), potentially strengthening with age. Higher sweet index scores at 12 months were associated with increased Candida carriage, reversing at 24 months. Both indices were top predictors of S. mutans and Candida carriage. These findings underscore the associations between snack intake and cariogenic microorganism carriage and highlight the importance of dietary factors in oral health management for underserved young children with limited access to dental care and healthy foods.
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Affiliation(s)
- Ahmed Alkadi
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY 14642, USA; (A.A.)
- Dental Department, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Naemah Alkhars
- Department of General Dental Practice, College of Dentistry, Health Science Center, Kuwait University, P.O. Box 24923, Kuwait City 13110, Kuwait;
| | - Samantha Manning
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Hongzhe Xu
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Michael Sohn
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY 14642, USA; (A.A.)
| | - Ying Meng
- School of Nursing, University of Rochester, Rochester, NY 14642, USA
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Pecci-Lloret MP, Linares-Pérez C, Pecci-Lloret MR, Rodríguez-Lozano FJ, Oñate-Sánchez RE. Oral Manifestations in Pregnant Women: A Systematic Review. J Clin Med 2024; 13:707. [PMID: 38337401 PMCID: PMC10856094 DOI: 10.3390/jcm13030707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Background: The period of pregnancy is characterized by a multitude of diverse changes that exert a notable impact on the oral cavity of women. During this gestational phase, patients necessitate tailored oral care and specific recommendations to preempt and address potential oral diseases. This systematic review aimed to perform a detailed analysis of the research studies that focused on the oral manifestations observed in pregnant women. Methods: A meticulous search was conducted in the databases Medline, Scopus, and Scielo by employing the following search terms: ((pregnant OR pregnancy)) AND (("oral manifestation*") OR ("oral health")). Articles that were published between 2013 and 2023 and written in English or Spanish and studies that scrutinized oral manifestations in pregnant women and included a diagnosis conducted by a qualified dentist were selected; we excluded articles published before 2013, articles that could not be accessed in full text, studies whose patients were not pregnant women at the time of the study, studies where patients were selected because they had a specific disease, studies where the clinical examination was not performed by a dentist, and articles written in languages other than English or Spanish. Subsequently, the risk of bias in the chosen articles was assessed in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) scale. Results: A total of 20 studies were included in the analysis, following the exclusion and inclusion criteria. These studies were categorized as cross-sectional, cohort, longitudinal, or case-control. Various oral manifestations in pregnant women were examined, with five studies comparing these manifestations with those observed in nonpregnant women. Conclusions: The most prevalent oral manifestations associated with pregnancy encompass dental caries, periodontitis, gingivitis, pyogenic granuloma, and candidiasis. Nonetheless, less common lesions may also emerge during the course of pregnancy.
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Affiliation(s)
| | | | - Miguel Ramón Pecci-Lloret
- Gerodontology and Special Care Dentistry Unit, Morales Meseguer Hospital, Faculty of Medicine, IMIB-Arrixaca, University of Murcia, 30008 Murcia, Spain; (M.P.P.-L.); (C.L.-P.); (F.J.R.-L.); (R.E.O.-S.)
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Alkhars N, Al Jallad N, Wu TT, Xiao J. Multilocus sequence typing of Candida albicans oral isolates reveals high genetic relatedness of mother-child dyads in early life. PLoS One 2024; 19:e0290938. [PMID: 38232064 PMCID: PMC10793898 DOI: 10.1371/journal.pone.0290938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/14/2023] [Indexed: 01/19/2024] Open
Abstract
Candida albicans is a pathogenic fungus recently recognized for its role in severe early childhood caries development (S-ECC). C. albicans oral colonization begins at birth, but the extent of the mother's involvement in yeast transmission to their children is unclear, therefore, this study used a prospective mother-infant cohort to investigate the maternal contribution of C. albicans oral colonization in early life. Oral samples were collected from 160 mother-child dyads during pregnancy and from birth to two years of life. We used whole-genome sequencing to obtain the genetic information of C. albicans isolates and examined the genetic relatedness of C. albicans between mothers and their children using Multilocus Sequence Typing. Multivariate statistical methods were used to identify factors associated with C. albicans' acquisition (horizontal and vertical transmissions). Overall, 227 C. albicans oral isolates were obtained from 93 (58.1%) of mother-child pairs. eBURST analysis revealed 16 clonal complexes, and UPGMA analysis identified 6 clades, with clade 1 being the most populated 124 isolates (54.6%). Significantly, 94% of mothers and children with oral C. albicans had highly genetically related strains, highlighting a strong maternal influence on children's C. albicans acquisition. Although factors such as race, ethnicity, delivery method, and feeding behaviors did not show a significant association with C. albicans vertical transmission, the mother's oral hygiene status reflected by plaque index (PI) emerged as a significant factor; Mothers with higher dental plaque accumulation (PI >=2) had a significantly increased risk of vertically transmitting C. albicans to their infants [odds ratio (95% confidence interval) of 8.02 (1.21, 53.24), p=0.03]. Furthermore, Black infants and those who attended daycare had an elevated risk of acquiring C. albicans through horizontal transmission (p <0.01). These findings highlight the substantial role of maternal transmission in the oral acquisition of C. albicans during early life. Incorporating screening for maternal fungal oral carriage and implementing oral health education programs during the perinatal stage may prove valuable in preventing fungal transmission in early infancy.
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Affiliation(s)
- Naemah Alkhars
- Department of General Dental Practice, College of Dentistry, Health Science Center, Kuwait University, Safat, Kuwait
- Translational Biomedical Science Program, Clinical and Translational Science Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Nisreen Al Jallad
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Tong Tong Wu
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, United States of America
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Dias S, Pheiffer C, Adam S. The Maternal Microbiome and Gestational Diabetes Mellitus: Cause and Effect. Microorganisms 2023; 11:2217. [PMID: 37764061 PMCID: PMC10535124 DOI: 10.3390/microorganisms11092217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is a growing public health concern that affects many pregnancies globally. The condition is associated with adverse maternal and neonatal outcomes including gestational hypertension, preeclampsia, placental abruption, preterm birth, stillbirth, and fetal growth restriction. In the long-term, mothers and children have an increased risk of developing metabolic diseases such as type 2 diabetes and cardiovascular disease. Accumulating evidence suggest that alterations in the maternal microbiome may play a role in the pathogenesis of GDM and adverse pregnancy outcomes. This review describes changes in the maternal microbiome during the physiological adaptations of pregnancy, GDM and adverse maternal and neonatal outcomes. Findings from this review highlight the importance of understanding the link between the maternal microbiome and GDM. Furthermore, new therapeutic approaches to prevent or better manage GDM are discussed. Further research and clinical trials are necessary to fully realize the therapeutic potential of the maternal microbiome and translate these findings into clinical practice.
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Affiliation(s)
- Stephanie Dias
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (S.D.); (C.P.)
| | - Carmen Pheiffer
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (S.D.); (C.P.)
- Centre for Cardio-Metabolic Research in Africa (CARMA), Division of Medical Physiology, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town 7505, South Africa
- Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Sumaiya Adam
- Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
- Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
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9
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Shahi A, Khosravi S, Rezvan F, Salehi A, Mahmoudi MB, Amiri A. Evaluation of the periodontal disease on oral microorganisms during pregnancy: A systematic review and meta-analysis. J Clin Transl Res 2023; 9:144-152. [PMID: 37181818 PMCID: PMC10171318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/05/2023] [Accepted: 03/17/2023] [Indexed: 05/16/2023] Open
Abstract
Background and Aim In the present study, the potential changes of oral microbes during pregnancy were investigated by examining the findings of the previous studies and comprehensively examining their results. The relationship between oral microorganisms and birth outcomes and adverse labor outcomes was investigated; to provide sufficient evidence. The purpose of the present study was to evaluate periodontal disease in oral microorganisms during pregnancy. Materials and Methods All articles were published between January 2011 and January 2023 in international databases, including PubMed, Scopus, Science Direct, and Embase. To answer the research questions, the Google Scholar search engine employed the PECO strategy. STATA.V17 software was used to analyze the data. Results Two hundred and eighteen studies were found in the initial search; 63 full texts were reviewed; and finally, 14 articles were included in the analysis. The mean differences in salivary S. mutans carriage before and after prenatal dental treatment were 0.92 (MD; 95 CI [0.57, 1.27], P > 0.05). The odds ratio of association between perinatal mortality and periodontal treatment was -0.88 (OR; 95 CI [-2.53, 0.76], P > 0.05) and the odds ratio of association between pre-term birth and periodontal treatment was -0.31 (OR; 95 CI [-0.70, 0.09], P > 0.05). There was a statistically significant relationship between birth weight and periodontal treatment during pregnancy. Conclusion According to the present meta-analysis, periodontal treatment can reduce the odds ratio of perinatal mortality and pre-term birth by 88% and 31%, respectively. High association of microorganisms between pregnancy and postpartum requires further study. Relevance for Patients In the findings of the present study, it is observed that during pregnancy, there is a direct relationship between periodontal disease with low birth weight, perinatal mortality, and pre-term delivery; however, the high association of microorganisms between pregnancy and postpartum requires further study. Oral microforms are reported to be affected in pregnant women, and they should take extra care of their mouth and teeth. Sufficient and strong evidence can help to improve the health outcomes of mothers and children.
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Affiliation(s)
- Anahita Shahi
- Department of Periodontics, School of Dentistry, Semnan University of Medical Sciences, Semnan, Iran
| | - Setareh Khosravi
- Department of Orthodontics, School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran
| | - Farnaz Rezvan
- Department of General Dentistry, Faculty of Dentistry, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ali Salehi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Islamic Azad University, Isfahan (Khorasgan) Branch, Isfahan, Iran
| | | | - Ali Amiri
- Department of Orthodontics, College of Stomatology, The First Affiliated Stomatological Hospital, Xi’an Jiaotong University, Xi’an, PR China
- Corresponding authors: Ali Amiri Department of Orthodontics, College of Stomatology, the First Affiliated Stomatological Hospital, Xi’an Jiaotong University, Xi’an, PR China. Tel: +86 298 265 5450 ;
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Zhang L, Manning S, Wu TT, Zeng Y, Lee A, Wu Y, Paster BJ, Chen G, Fiscella K, Xiao J. Impact of Nystatin Oral Rinse on Salivary and Supragingival Microbial Community among Adults with Oral Candidiasis. Microorganisms 2023; 11:1497. [PMID: 37374999 DOI: 10.3390/microorganisms11061497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/25/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
This study aimed to evaluate the impact of Nystatin oral rinse on salivary and supragingival microbiota in adults with oral candidiasis and identify predictive factors related to individuals' responses to Nystatin. The trial involved twenty participants who used 600,000 International Units/application of Nystatin oral rinse for seven days, four times a day, and were followed up at one week and three months after the rinse. The salivary and plaque microbiome of the participants were assessed via 16S rDNA amplicon sequencing. Overall, salivary and plaque microbiomes remained stable. However, among the participants (53 percent) who responded to Nystatin rinse (defined as free of oral Candida albicans post treatment), Veillonella emerged as a core genus alongside Streptococcus and Actinomyces in supragingival plaque at the 3-month follow-up. Furthermore, statistical models were fit to identify predictive factors of Nystatin rinse success (elimination of C. albicans) or failure (remaining C. albicans). The results revealed that an increased level of salivary Interferon (IFN)-γ-inducible protein (IP-10), also known as C-X-C motif chemokine ligand 10 (CXCL10), was an indicator of a failure of responding to Nystatin rinse. Future clinical trials are warranted to comprehensively assess the impact of antifungal treatment on the oral flora.
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Affiliation(s)
- Lanxin Zhang
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA 94720, USA
| | - Samantha Manning
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY 14627, USA
| | - Tong Tong Wu
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY 14627, USA
| | - Yan Zeng
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY 14627, USA
| | - Aaron Lee
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY 14627, USA
| | - Yan Wu
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY 14627, USA
| | - Bruce J Paster
- Department of Microbiology, Forsyth Institute, Cambridge, MA 02142, USA
| | - George Chen
- Department of Microbiology, Forsyth Institute, Cambridge, MA 02142, USA
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY 14627, USA
| | - Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY 14627, USA
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Alkhars N, Gaca A, Zeng Y, Al-Jallad N, Rustchenko E, Wu TT, Eliav E, Xiao J. Antifungal Susceptibility of Oral Candida Isolates from Mother-Infant Dyads to Nystatin, Fluconazole, and Caspofungin. J Fungi (Basel) 2023; 9:580. [PMID: 37233291 PMCID: PMC10219145 DOI: 10.3390/jof9050580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
The carriage of Candida albicans in children's oral cavities is associated with a higher risk for early childhood caries, so controlling this fungus in early life is essential for preventing caries. In a prospective cohort of 41 mothers and their children from 0 to 2 years of age, this study addressed four main objectives: (1) Evaluate in vitro the antifungal agent susceptibility of oral Candida isolates from the mother-child cohort; (2) compare Candida susceptibility between isolates from the mothers and children; (3) assess longitudinal changes in the susceptibility of the isolates collected between 0 and 2 years; and (4) detect mutations in C. albicans antifungal resistance genes. Susceptibility to antifungal medications was tested by in vitro broth microdilution and expressed as the minimal inhibitory concentration (MIC). C. albicans clinical isolates were sequenced by whole genome sequencing, and the genes related to antifungal resistance, ERG3, ERG11, CDR1, CDR2, MDR1, and FKS1, were assessed. Four Candida spp. (n = 126) were isolated: C. albicans, C. parapsilosis, C. dubliniensis, and C. lusitaniae. Caspofungin was the most active drug for oral Candida, followed by fluconazole and nystatin. Two missense mutations in the CDR2 gene were shared among C. albicans isolates resistant to nystatin. Most of the children's C. albicans isolates had MIC values similar to those from their mothers, and 70% remained stable on antifungal medications from 0 to 2 years. For caspofungin, 29% of the children's isolates showed an increase in MIC values from 0 to 2 years. Results of the longitudinal cohort indicated that clinically used oral nystatin was ineffective in reducing the carriage of C. albicans in children; novel antifungal regimens in infants are needed for better oral yeast control.
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Affiliation(s)
- Naemah Alkhars
- Department of General Dental Practice, College of Dentistry, Health Science Center, Kuwait University, Safat 13110, Kuwait;
- Translational Biomedical Science Program, Clinical and Translational Science Institute, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - Anthony Gaca
- Genomic Research Center, University of Rochester, Rochester, NY 14642, USA;
| | - Yan Zeng
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY 14620, USA (N.A.-J.)
| | - Nisreen Al-Jallad
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY 14620, USA (N.A.-J.)
| | - Elena Rustchenko
- Department of Biochemistry and Biophysics, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Tong Tong Wu
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Eli Eliav
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY 14620, USA (N.A.-J.)
| | - Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY 14620, USA (N.A.-J.)
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Aljaffary M, Jang H, Alomeir N, Zeng Y, Alkhars N, Vasani S, Almulhim A, Wu TT, Quataert S, Bruno J, Lee A, Xiao J. Effects of Nystatin oral rinse on oral Candida species and Streptococcus mutans among healthy adults. Clin Oral Investig 2023:10.1007/s00784-023-04969-5. [PMID: 36964224 DOI: 10.1007/s00784-023-04969-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 03/19/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVES To examine the effect of Nystatin oral rinse on oral Candida species and Streptococcus mutans carriage. MATERIALS AND METHODS Twenty healthy adults with oral candidiasis participated in the single-arm clinical trial and received Nystatin oral rinse for 7 days, 4 applications/day, and 600,000 International Units/application. Demographic-socioeconomic-oral-medical conditions were obtained. Salivary and plaque Candida species and Streptococcus mutans were assessed at baseline and 1-week and 3-month follow-ups. Twenty-four salivary cytokines were assessed. Candida albicans isolates underwent Nystatin susceptibility test. RESULTS Half of participants (10/20) were free of salivary C. albicans after using Nystatin rinse. Salivary S. mutans was significantly reduced at 3-month follow-up (p < 0.05). Periodontal status reflected by bleeding-on-probing was significantly improved at 1-week and 3-month follow-ups (p < 0.05). Plaque accumulation was significantly reduced at 1-week follow-up (p < 0.05). Interestingly, the responses to Nystatin oral rinse were not associated with race, gender, age, oral hygiene practice, adherence to Nystatin rinse, or sweet consumption (p > 0.05). No C. albicans isolates were resistant to Nystatin. Furthermore, salivary cytokine eotaxin and fractalkine were significantly reduced at 3-month follow-up among participants who responded to Nystatin rinse (p < 0.05). CONCLUSIONS The study results indicate that oral antifungal treatment had an effect on S. mutans salivary carriage. Future clinical trials are warranted to comprehensively assess the impact of antifungal treatment on the oral flora other than S. mutans and Candida. CLINICAL RELEVANCE Due to the potential cariogenic role of oral Candida species, antifungal approaches shed new light on the prevention and management of dental caries from a fungal perspective.
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Affiliation(s)
- Mohammed Aljaffary
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hoonji Jang
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
- Temple University, Philadelphia, PA, USA
| | - Nora Alomeir
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Yan Zeng
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Naemah Alkhars
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
- Faculty of Dentistry, Department of General Dental Practice, Kuwait University, Kuwait City, Kuwait
| | - Shruti Vasani
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Abdullah Almulhim
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Tong Tong Wu
- Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Sally Quataert
- Immunology and Microbiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jennifer Bruno
- Immunology and Microbiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Aaron Lee
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.
- Perinatal Oral Health, Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Ave, Rochester, 14620, USA.
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Azevedo MJ, Araujo R, Campos J, Campos C, Ferreira AF, Falcão-Pires I, Ramalho C, Zaura E, Pinto E, Sampaio-Maia B. Vertical Transmission and Antifungal Susceptibility Profile of Yeast Isolates from the Oral Cavity, Gut, and Breastmilk of Mother-Child Pairs in Early Life. Int J Mol Sci 2023; 24:ijms24021449. [PMID: 36674962 PMCID: PMC9867488 DOI: 10.3390/ijms24021449] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 01/13/2023] Open
Abstract
Yeast acquisition begins at birth; however, the contribution of the mother on yeast transmission to the offspring and associated resistance is yet to be clarified. The aim of this study was to explore the vertical transmission of yeasts and their antifungal susceptibility profile in early life. Oral, fecal, and breastmilk samples were collected from 73 mother-child pairs four to twelve weeks after delivery and cultured on Sabouraud dextrose agar with chloramphenicol. The isolates were identified by MALDI-TOF MS. The vertical transmission was studied by microsatellite genotyping. Antifungal susceptibility was determined for fluconazole, voriconazole, miconazole, anidulafungin, and nystatin by broth microdilution assay, following CLSI-M60 guidelines. A total of 129 isolates were identified from 53% mother-child pairs. We verified the vertical transmission of Candida albicans (n = three mother-child pairs) and Candida parapsilosis (n = one mother-child pair) strains, including an antifungal resistant strain transmitted from breastmilk to the gut of a child. Most isolates were susceptible to the tested antifungals, with the exception of four C. albicans isolates and one R. mucilaginosa isolate. The vertical transmission of yeasts happens in early life. This is the first work that demonstrated the role of the mother as a source of transmission of antifungal-resistant yeasts to the child.
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Affiliation(s)
- Maria João Azevedo
- INEB—Instituto Nacional de Engenharia Biomédica, 4150-177 Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Department of Preventive Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Ricardo Araujo
- INEB—Instituto Nacional de Engenharia Biomédica, 4150-177 Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
| | - Joana Campos
- INEB—Instituto Nacional de Engenharia Biomédica, 4150-177 Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
| | - Carla Campos
- Serviço de Patologia Clínica, Departamento de Patologia e Medicina Laboratorial, Instituto Português de Oncologia do Porto Francisco Gentil, 4200-072 Porto, Portugal
- Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal
| | | | - Inês Falcão-Pires
- Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Carla Ramalho
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
- Department of Gynecology and Obstetrics, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
| | - Egija Zaura
- Department of Preventive Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Eugénia Pinto
- Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal
- Centro Interdisciplinar de Investigação Marinha e Ambiental (CIIMAR), Universidade do Porto, 4450-208 Matosinhos, Portugal
| | - Benedita Sampaio-Maia
- INEB—Instituto Nacional de Engenharia Biomédica, 4150-177 Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Faculdade de Medicina Dentária, Universidade do Porto, 4200-393 Porto, Portugal
- Correspondence:
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Karajacob AS, Azizan NB, Al-Maleki ARM, Goh JPE, Loke MF, Khor HM, Ho GF, Ponnampalavanar S, Tay ST. Candida species and oral mycobiota of patients clinically diagnosed with oral thrush. PLoS One 2023; 18:e0284043. [PMID: 37068057 PMCID: PMC10109505 DOI: 10.1371/journal.pone.0284043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/22/2023] [Indexed: 04/18/2023] Open
Abstract
Overgrowth of Candida yeasts in the oral cavity may result in the development of oral thrush in immunocompromised individuals. This study analyzed the diversity and richness of the oral mycobiota of patients clinically diagnosed with oral thrush (OT), follow-up of oral thrush patients after antifungal therapy (AT), and healthy controls (HC). Oral rinse and oral swab samples were collected from 38 OT patients, 21 AT patients, and 41 healthy individuals (HC). Pellet from the oral rinse and oral swab were used for the isolation of oral Candida yeasts on Brilliance Candida Agar followed by molecular speciation. ITS1 amplicon sequencing using Illumina MiSeq was performed on DNA extracted from the oral rinse pellet of 16 OT, 7 AT, and 7 HC oral rinse samples. Trimmed sequence data were taxonomically grouped and analyzed using the CLC Microbial Genomics Module workflow. Candida yeasts were isolated at significantly higher rates from oral rinse and swab samples of OT (68.4%, p < 0.001) and AT (61.9%, p = 0.012) patients, as compared to HC (26.8%). Predominance of Candida albicans specifically, was noted in OT (60.5%, p < 0.001) and AT (42.9%, p = 0.006) vs. HC (9.8%), while non-albicans Candida species was dominant in HC. Analysis of oral mycobiota from OT patients showed the presence of 8 phyla, 222 genera, and 309 fungal species. Low alpha diversity (Shannon index, p = 0.006; Chao-1 biased corrected index, p = 0.01), varied beta diversity (Bray-Curtis, p = 0.01986; Jaccard, p = 0.02766; Weighted UniFrac, p = 0.00528), and increased relative abundance of C. albicans (p = 3.18E-02) was significantly associated with the oral mycobiota of OT vs. HC. This study supported that C. albicans is the main etiological agent in oral thrush and highlights the association of fungal biodiversity with the pathophysiology of oral thrush.
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Affiliation(s)
| | - Nuramirah Binti Azizan
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Joanne Pei En Goh
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mun Fai Loke
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Hui Min Khor
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Gwo Fuang Ho
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Sasheela Ponnampalavanar
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Sun Tee Tay
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Alkhars N, Zeng Y, Alomeir N, Al Jallad N, Wu T, Aboelmagd S, Youssef M, Jang H, Fogarty C, Xiao J. Oral Candida Predicts Streptococcus mutans Emergence in Underserved US Infants. J Dent Res 2022; 101:54-62. [PMID: 34018817 PMCID: PMC8721728 DOI: 10.1177/00220345211012385] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Despite the cariogenic role of Candida suggested from recent studies, oral Candida acquisition in children at high risk for early childhood caries (ECC) and its association with cariogenic bacteria Streptococcus mutans remain unclear. Although ECC disproportionately afflicts socioeconomically disadvantaged and racial-minority children, microbiological studies focusing on the underserved group are scarce. Our prospective cohort study examined the oral colonization of Candida and S. mutans among 101 infants exclusively from a low-income and racial-minority background in the first year of life. The Cox hazard proportional model was fitted to assess factors associated with the time to event of the emergence of oral Candida and S. mutans. Oral Candida colonization started as early as 1 wk among 13% of infants, increased to 40% by 2 mo, escalated to 48% by 6 mo, and remained the same level until 12 mo. S. mutans in saliva was detected among 20% infants by 12 mo. The emergence of S. mutans by year 1 was 3.5 times higher (hazard ratio [HR], 3.5; confidence interval [CI], 1.1-11.3) in infants who had early colonization of oral Candida compared to those who were free of oral Candida (P = 0.04) and 3 times higher (HR, 3.0; CI, 1.3-6.9) among infants whose mother had more than 3 decayed teeth (P = 0.01), even after adjusting demographics, feeding, mother's education, and employment status. Infants' salivary S. mutans abundance was positively correlated with infants' Candida albicans (P < 0.01) and Candida krusei levels (P < 0.05). Infants' oral colonization of C. albicans was positively associated with mother's oral C. albicans carriage and education (P < 0.01) but negatively associated with mother's employment status (P = 0.01). Future studies are warranted to examine whether oral Candida modulates the oral bacterial community as a whole to become cariogenic during the onset and progression of ECC, which could lead to developing novel ECC predictive and preventive strategies from a fungal perspective.
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Affiliation(s)
- N. Alkhars
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Y. Zeng
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA,Department of Forensic Medicine, North Sichuan Medical College, Nanchong, Sichuan, China
| | - N. Alomeir
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - N. Al Jallad
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - T.T. Wu
- Department of Biostatistics and computational biology, University of Rochester Medical Center, Rochester, NY, USA
| | - S. Aboelmagd
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - M. Youssef
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - H. Jang
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - C. Fogarty
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - J. Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA,J. Xiao, Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Ave, Rochester, NY 14620, USA.
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16
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Jang H, Al Jallad N, Wu TT, Zeng Y, Fadaak A, Malmstrom H, Fiscella K, Xiao J. Changes in Candida albicans, Streptococcus mutans and oral health conditions following Prenatal Total Oral Rehabilitation among underserved pregnant women. Heliyon 2021; 7:e07871. [PMID: 34485745 PMCID: PMC8405901 DOI: 10.1016/j.heliyon.2021.e07871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/07/2021] [Accepted: 08/23/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives To assess the oral health condition and oral microbial outcomes from receiving an innovative treatment regimen - Prenatal Total Oral Rehabilitation (PTOR). Methods This prospective cohort study included 15 pregnant women in the PTOR group who had a baseline visit before PTOR and three follow-up visits (immediate after, 2 weeks and 2 months) after receiving PTOR. A historical control group of additional 15 pregnant women was matched from a separate study based on a propensity score. Along with demographic and medical background, oral health conditions and perinatal oral health literacy were assessed. Oral samples (saliva and plaque) were analyzed to identify and quantify Streptococcus mutans and Candida species by culturing-dependent and -independent methods. Results Significant reductions of salivary S. mutans were observed following PTOR, the effect remained until 2-month follow-up (p < 0.05). The carriage of salivary and plaque S. mutans at the 2-month visit of the PTOR group was significantly lower than that of the control group (p < 0.05). Oral health conditions reflected by BOP and PI were significantly improved upon receiving PTOR (p < 0.05). Receiving PTOR significantly improved the perinatal oral health literacy score, and the knowledge retained until 2-month follow-up (p < 0.05). Conclusions PTOR is associated with an improvement in oral health conditions and perinatal oral health literacy, and a reduction in S. mutans carriage, within a 2-month follow-up period. Future clinical trials are warranted to comprehensively assess the impact of PTOR on the maternal oral flora other than S. mutans and Candida, birth outcomes, and their offspring's oral health.
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Affiliation(s)
- Hoonji Jang
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Nisreen Al Jallad
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Tong Tong Wu
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Yan Zeng
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Ahmed Fadaak
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Hans Malmstrom
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
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17
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Oral microflora and pregnancy: a systematic review and meta-analysis. Sci Rep 2021; 11:16870. [PMID: 34413437 PMCID: PMC8377136 DOI: 10.1038/s41598-021-96495-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 08/02/2021] [Indexed: 02/07/2023] Open
Abstract
Understanding changes in oral flora during pregnancy, its association to maternal health, and its implications to birth outcomes is essential. We searched PubMed, Embase, Web of Science, and Cochrane Library in May 2020 (updated search in April and June 2021), and conducted a systematic review and meta-analyses to assess the followings: (1) oral microflora changes throughout pregnancy, (2) association between oral microorganisms during pregnancy and maternal oral/systemic conditions, and (3) implications of oral microorganisms during pregnancy on birth outcomes. From 3983 records, 78 studies were included for qualitative assessment, and 13 studies were included in meta-analysis. The oral microflora remains relatively stable during pregnancy; however, pregnancy was associated with distinct composition/abundance of oral microorganisms when compared to postpartum/non-pregnant status. Oral microflora during pregnancy appears to be influenced by oral and systemic conditions (e.g. gestational diabetes mellitus, pre-eclampsia, etc.). Prenatal dental care reduced the carriage of oral pathogens (e.g. Streptococcus mutans). The Porphyromonas gingivalis in subgingival plaque was more abundant in women with preterm birth. Given the results from meta-analyses were inconclusive since limited studies reported outcomes on the same measuring scale, more future studies are needed to elucidate the association between pregnancy oral microbiota and maternal oral/systemic health and birth outcomes.
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18
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Joao I, Bujdáková H, Jordao L. Opportunist Coinfections by Nontuberculous Mycobacteria and Fungi in Immunocompromised Patients. Antibiotics (Basel) 2020; 9:antibiotics9110771. [PMID: 33147819 PMCID: PMC7693372 DOI: 10.3390/antibiotics9110771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022] Open
Abstract
Nontuberculous mycobacteria (NTM) and many fungal species (spp.) are commonly associated with opportunistic infections (OPIs) in immunocompromised individuals. Moreover, occurrence of concomitant infection by NTM (mainly spp. of Mycobacterium avium complex and Mycobacterium abscessus complex) and fungal spp. (mainly, Aspergillus fumigatus, Histoplasma capsulatum and Cryptococcus neoformans) is very challenging and is associated with poor patient prognosis. The most frequent clinical symptoms for coinfection and infection by single agents (fungi or NTM) are similar. For this reason, the accurate identification of the aetiological agent(s) is crucial to select the best treatment approach. Despite the significance of this topic it has not been sufficiently addressed in the literature. This review aims at summarizing case reports and studies on NTM and fungi coinfection during the last 20 years. In addition, it briefly characterizes OPIs and coinfection, describes key features of opportunistic pathogens (e.g., NTM and fungi) and human host predisposing conditions to OPIs onset and outcome. The review could interest a wide spectrum of audiences, including medical doctors and scientists, to improve awareness of these infections, leading to early identification in clinical settings and increasing research in the field. Improved diagnosis and availability of therapeutic options might contribute to improve the prognosis of patients’ survival.
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Affiliation(s)
- Ines Joao
- National Institute of Health Doutor Ricardo Jorge, 1649-016 Lisboa, Portugal;
| | - Helena Bujdáková
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 842 15 Bratislava, Slovakia
- Correspondence: (H.B.); (L.J.)
| | - Luisa Jordao
- National Institute of Health Doutor Ricardo Jorge, 1649-016 Lisboa, Portugal;
- Correspondence: (H.B.); (L.J.)
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Eidt G, Waltermann EDM, Hilgert JB, Arthur RA. Candida and dental caries in children, adolescents and adults: A systematic review and meta-analysis. Arch Oral Biol 2020; 119:104876. [PMID: 32905885 DOI: 10.1016/j.archoralbio.2020.104876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/10/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to investigate whether the presence of fungi of the genus Candida in oral cavity is associated with dental caries in children and adolescents (from 6 to 18 years) or in adults (older than 18 years). DESIGN Electronic search was carried out in MEDLINE, EMBASE and LILACS databases. Studies that evaluated the presence of Candida spp. and dental caries on those individuals were included. Data extraction and evidence quality assessment were performed by two independent investigators. Prevalence ratio (PR) was calculated considering 95 % confidence interval (CI). Meta-analysis was performed using random effect Mantel-Haenszel model. RESULTS Thirty out of 123 publications selected for full-reading were included in the systematic review. Prevalence of Candida spp. in the oral cavity ranged from 7.7 % to 78 %. Prevalence of dental caries in individuals harbouring Candida spp. ranged from 27.2%-100% and was higher than in individuals not harbouring Candida spp. (PR = 1.72 [1.46-2.02]). Prevalence of dental caries was 2.3 times higher in individuals harbouring Candida spp. in mucosa. Moreover, dental caries prevalence was 80 % and 48 % higher in children/adolescents and adults harbouring Candida spp., respectively (95 % CI [1.44-2.25] and [1.20-1.83]). The quality of evidence of most studies (n = 21) was graded as fair. CONCLUSIONS These results suggest that, regardless of age or sample site, individuals with the presence of Candida spp. have a higher prevalence of dental caries when compared to individuals without these microorganisms in the oral cavity.
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Affiliation(s)
- Gustavo Eidt
- Preventive and Community Dentistry Department, Dental School, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2492, Porto Alegre, 90035-003, Brazil.
| | - Elen Darlise Marques Waltermann
- Preventive and Community Dentistry Department, Dental School, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2492, Porto Alegre, 90035-003, Brazil.
| | - Juliana Balbinot Hilgert
- Preventive and Community Dentistry Department, Dental School, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2492, Porto Alegre, 90035-003, Brazil.
| | - Rodrigo Alex Arthur
- Preventive and Community Dentistry Department, Dental School, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2492, Porto Alegre, 90035-003, Brazil.
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