A Social Media Intervention for Promoting Oral Health Behaviors in Adolescents: A Non-Randomized Pilot Clinical Trial

Poor oral hygiene and excessive consumption of soda are among the main drivers of systemic health issues in adolescents in the United States. This non-randomized pilot clinical trial focused on the effects of a health text message system and smartphone-based intervention on adolescent tooth-brushing behavior and dietary choices, with a convenience sample of 94 participants aged 12 to 14 years old. A group of 75 participants agreed to use a tooth-brushing app and received a health text message; the other group of 15 agreed to use the tooth-brushing app, but did not receive a health text message. Saliva specimens were collected directly before and at the end of each experiment; changes in the salivary presence of cariogenic bacteria over the duration of the study were evaluated and compared with the demographics and behavioral variables. Within the text message group, 5% of participants increased the frequency of daily tooth brushing. Within the non-intervention group, 29% of participants increased the frequency of their daily tooth brushing. There were reductions in the total salivary bacteria and total streptococci in both groups (p < 0.001), but no change in the presence of cariogenic Mutans streptococci. Raising adolescents' consciousness of oral health behavior resulted in marginal to moderate improvements to oral hygiene and dietary choices, as well as reductions in total salivary bacteria.

Role of mutans streptococci, acid tolerant bacteria and oral Candida species in predicting the onset of early childhood caries

Aim

Early childhood caries is the most common chronic infectious disease in children in the United States. This study, which is part of a larger, longitudinal study exploring oral microbiological components of caries development in children, reports on the impact of total mutans streptococci (MS), total acid tolerant bacteria and Candida species on the development of dental caries in a subset of these children. Of particular interest was the relationship between caries development and co-colonization of mutans streptococci and Candida species.

Methods

Children between the ages of 12 and 47 months displaying no evidence of dental caries were recruited for a longitudinal study (n = 130). Twelve age- and gender-matched pairs were selected. In each pair, one child developed caries during the study, and one did not. Whole mouth plaque samples were collected by swab at baseline and every 6 months thereafter for a duration of 18 months and spiral plated for microbial counts (CFU/ml). Cut-offs based on percent of total cultivable flora were designated for all microbial measures. A scoring system designated the Plaque Microbial Index (PMI) was developed for use in statistical analyses to assess potential predictive factors for caries risk assessment.

Results

Children who developed caries were significantly more likely to harbor higher percentages of acid tolerant bacteria (p = 0.003), MS (p < 0.001) and have Candida species present (p < 0.001) at ≥1 visit leading up to caries onset. Mean PMI scores derived from the aforementioned microbial measures, were higher for caries active children than caries free children (p = 0.000147). Co-colonization of MS and Candida species was significantly associated with caries development (p < 0.001) and detection of both at the same visit had a 100% positive predictive value and 60% negative predictive value for caries development.

Conclusion

In children who developed caries, there was a statistically significant association with the percent of total flora that was acid tolerant, the percent of MS, the presence of Candida and co-colonization of MS and Candida species. Combining these microbial measures into PMI scores further delineated children who developed caries from those who remained caries-free. These microbiological measures show potential as predictive factors and risk assessment tools for caries development.

Assessment of Diversity and Fidelity of Transmission of Streptococcus mutans Genotypes in American Indian and Southeast Iowa Mother-Child Dyads

Early childhood caries (ECC) is a common chronic infectious disease of childhood with a complex etiology and many contributing risk factors. Its prevalence is greater in certain racial and ethnic minority groups and populations with low socioeconomic status. Among the species of bacteria that contribute to the progression of dental caries, Streptococcus mutans (SM) has long been considered a primary etiological agent of the disease. We report here on the genotypic diversity, commonality, and fidelity of mother-child transmission of S. mutans in mother-child dyads in two high-risk populations.

Methods

Thirty-eight mother-child dyads from a Southeast Iowa population and 40 dyads from a Northern Plains American Indian Tribe were selected for a comparison of S. mutans genotype profiles within and between populations. S. mutans was isolated from whole mouth plaque samples collected from each subject. DNA was extracted and AP-PCR using OPA2 primer was performed. Amplified DNA was electrophoresed and images of the resulting patterns were compared via GelCompar®IIv6.5 software.

Results

Thirty unique S. mutans genotypes were identified from the 1,638 S. mutans isolates analyzed. Fifteen genotypes (50%) were seen in both cohorts, while 11 were unique to the American Indian (AI) cohort and 4 were unique to the Southeast Iowa (SEI) population. Within the AI cohort, 61.5% (16/26) of the S. mutans genotypes identified were seen in ≥2 individuals and 14 of the 26 (53.8%) were seen in ≥2 dyads. In the SEI cohort, 78.9% (15/19) of the S. mutans genotypes identified were seen in ≥2 individuals and 13 of the 19 (68.4%) were present in ≥2 dyads. Fifty-seven percent of AI children and 23% of SEI children displayed fidelity of mother-child transmission of ≥1 S. mutans genotype.

Conclusion

In comparing the populations, we observed large variation in genotypic diversity and fidelity of mother-child transmission, while the amount of commonality seen in both cohorts was similarly high in both groups. This study furthers our understanding of the genotypic diversity of S. mutans in both of these populations and provides a basis for further comparison to other populations at greater risk for developing ECC.

Mutans Streptococci and Lactobacilli: Colonization Patterns and Genotypic Characterization of Cariogenic Bacterial Species in American Indian Children

Aim: The purpose of this study was to investigate the presence of Streptococcus mutans, Streptococcus sobrinus, and Lactobacillus species in an American Indian population displaying a high incidence of severe early childhood caries (S-ECC) and to explore the genotypic diversity and fidelity of transmission of S. sobrinus in this population.

Methods: We report here on the microbial profiles of 71 children compiled from birth to 36 months of age and initial exploration of genotypic diversity in a subset of 40 mother/child dyads. Whole mouth plaque samples were collected from mother/child dyads in a Northern Plains American Indian cohort. Mutans streptococci (MS) and Lactobacillus counts were recorded and presence/absence of S. mutans, S. sobrinus, and Lactobacillus was noted for each child. S. sobrinus was isolated and genotyped via arbitrarily primed-polymerase chain reaction (AP-PCR).

Results: The children in this study were divided into caries active (CA) and caries free (CF) groups. S. mutans, S. sobrinus, and Lactobacillus species were detected more frequently in CA groups. Distribution of MS and Lactobacillus counts was significantly different between the two groups, as was the distribution of three species colonization profiles. Twelve S. sobrinus genotypes were detected in the subset of mother/child dyads. Individual participants displayed a range of 0–3 distinct genotypes while mother/child pairs displayed a range of 1–5 genotypes. Eighty-three percent of children shared at least one genotype with his/her mother.

Conclusion: Caries active children in this population display different microbial profiles than the caries free children in this cohort. A small number of S. sobrinus genotypes appear to be very common in this population. A high rate of vertical transmission of S. sobrinus from mother to child is seen in these mother/child dyads.

Evaluating the relationship between acidogenicity and acid tolerance for oral streptococci from children with or without a history of caries

Background: Dental caries etiology is attributed to a dysbiotic imbalance within the plaque microbiome leading to a dominance of strong acidogens. Some studies that investigate the link between acidogens and caries quantify the recovery of acid tolerant strains on acid agar as a measure of acidogenic potential. This methodology assumes that acidogenic potential and acid tolerance are directly related. Aim: The validity of that assumption was investigated by statistically evaluating that relationship using streptococci recovered from children with or without a history of dental caries. Methods: Thirty streptococcal isolates were isolated from each of 13 subjects. Acidogenicity was quantified by measuring the terminal pH after overnight growth in Brain Heart Infusion (BHI) and Chemically Defined Medium (CDM). Acid tolerance was quantified by measuring the lowest pH acid agar displaying growth. Results: A significant difference in acidogenicity in CDM between levels of acid tolerance was found, but no significant difference in acidogenicity in BHI was noted. Moreover, there were no significant interactions between acid tolerance and caries history on acidogenicity measures in either medium. Conclusion: An ability to grow on acid agar below pH 5.0 is best aligned with strong acidogenicity and best able to distinguish between subjects with differing caries histories.