Efficacy of Probiotic, Chlorhexidine, and Sodium Fluoride Mouthrinses on Mutans Streptococci in 8- to 12-Year-Old Children: A Crossover Randomized Trial

<b><i>Introduction:</i></b> The oral cavity is home to a diverse and distinct microbiome. While the role of oral bacteria in cariogenic and other dental diseases is irrefutable, their beneficial effects in the form of probiotics (PB) has been less studied, especially pertaining to oral diseases in children. This study compares the efficacy of a PB mouthrinse with 0.12% chlorhexidine (CHX) and 0.05% sodium fluoride (NaF) mouthrinse on the colony counts of mutans streptococci (MS) in children. <b><i>Methods:</i></b> A triple-blind crossover randomized trial between interventional groups was planned. Fifty-one children between 8 to 12 years of age were divided into three groups (I, II, and III) and were exposed to all three mouthrinses (A, B, and C) by randomized allocation for a period of two weeks with an inter-phase washout period of four weeks. Pre- and post-interventional MS counts (CFU/mL) were assessed, and the mean change was analysed using the <i>t</i> test (intragroup) and ANOVA (intergroup and crossover). <b><i>Results:</i></b> The mean changes in the colony counts obtained with the use of PB, CHX, and NaF mouthrinses were −1.0223 (−1.2201 to −0.8246), −0.9564 (−1.1503 to −0.7626), and −0.9511 (−1.1554 to −0.7467), respectively, which were statistically significant (<i>p</i> &#x3c; 0.0001). However, the intergroup comparison for the mean change in colony counts revealed no statistically significant differences (<i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> The study concluded that the PB mouthrinse was equally efficacious as compared to CHX and NaF mouthrinses against MS in 8- to 12-year-old children. However, further studies are recommended to strengthen the evidence.

ANALYSIS OF BIOFILMS FOR STREPTOCOCCUS MUTANS FROM DENTAL ROOT SURFACES OF ADULT PATIENTS WITH ROOT CARIES

Background and objectives: Knowledge of the pathogenicity of the primary etiological factor of root caries, the microbial biofilm, might provide important information for the development of diagnosis and treatment strategies. This study assessed the numbers and revealed the proportion of Mutans streptococci , which is potential important cariogenic organisms, in biofilms collected from lesions at root surfaces with active caries lesions (ARC), inactive caries lesions, and sound root surfaces (SRS). Material and methods: Samples were cultured in MSB agar for Mutans streptococci counts, and brain-heart infusion agar for total viable anaerobic counts. After incubation, the number of colony-forming units (CFUs) was determined and compared between groups by the Mann-Whitney U test with a significance level set at 95%. The proportion of counts of Mutans streptococci in the total viable microorganisms was also analyzed by Chi-square test. 108 samples (36 from each surface) from 36 patients were cultured and analyzed. Results: The mean±SD for the counts of active root caries lesions was 7.47±9.89 10, significantly higher than that of inactive root caries lesions (2.5±0.97) and sound root surfaces (3.03±0.71). In conclusion, a trend towards higher counts was evident for ARC. In the ARC lesions among the dominant oral anaerobic bacteria, we could not identify streptococcal colonies (unspecified) in 11% while in IRC lesions it occurred in 47%, and SRS it occurred in 47%. In addition, in ARC the samples were ≥0.1-≥10 (CFU x10) ≥0.1-≥10 colonies of Streptococcus mutans. Conclusion: In conclusion, a trend towards higher counts was evident for ARC and for most samples, the proportion of Streptococcus mutans was low relative to the viable number of total viable anaerobic microorganisms. Peer Review History: Received: 5 September 2021; Revised: 10 October; Accepted: 24 October, Available online: 15 November 2021 Academic Editor: Ahmad Najib, Universitas Muslim Indonesia, Indones UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Rawaa Souhil Al-Kayali, Aleppo University, Syria, [email protected] Dr. Tamer Elhabibi, Suez Canal University, Egypt, [email protected] Similar Articles: ASSOCIATION BETWEEN THE STREPTOCOCCUS MUTANS BIOFILM FORMATION AND DENTAL CARIES EXPERIENCE AND ANTIBIOTICS RESISTANCE IN ADULT FEMALES CLINICAL FEATURES, AGE AND SEX DISTRIBUTIONS, RISK FACTORS AND THE TYPE OF BACTERIA ISOLATED IN PERIODONTITIS PATIENTS IN SANA'A, YEMEN

Susceptibility of Dental Caries Microcosm Biofilms to Photodynamic Therapy Mediated by Fotoenticine

Photodynamic therapy (PDT) mediated by Fotoenticine® (FTC), a new photosensitizer derived from chlorin e-6, has shown in vitro inhibitory activity against the cariogenic bacterium Streptococcus mutans. However, its antimicrobial effects must be investigated on biofilm models that represent the microbial complexity of caries. Thus, we evaluated the efficacy of FTC-mediated PDT on microcosm biofilms of dental caries. Decayed dentin samples were collected from different patients to form in vitro biofilms. Biofilms were treated with FTC associated with LED irradiation and analyzed by counting the colony forming units (log10 CFU) in selective and non-selective culture media. Furthermore, the biofilm structure and acid production by microorganisms were analyzed using microscopic and spectrophotometric analysis, respectively. The biofilms from different patients showed variations in microbial composition, being formed by streptococci, lactobacilli and yeasts. Altogether, PDT decreased up to 3.7 log10 CFU of total microorganisms, 2.8 log10 CFU of streptococci, 3.2 log10 CFU of lactobacilli and 3.2 log10 CFU of yeasts, and reached eradication of mutans streptococci. PDT was also capable of disaggregating the biofilms and reducing acid concentration in 1.1 to 1.9 mmol lactate/L. It was concluded that FTC was effective in PDT against the heterogeneous biofilms of dental caries.

The Role of Sugars in the Caries Process

The carious disease is a post-eruptive infectious pathology of the hard tissues of the tooth. It is the most common dental disease, with a prevalence of 60 to 90% in school children worldwide. It is a significant public health issue. The caries process involves cariogenic bacteria (mutans streptococci - lactobacilli), which, by metabolizing carbohydrates, produce acids that lower the pH of the oral cavity below a critical threshold and thus cause demineralization of the enamel.Indeed, the consumption of sugars and sweetened products is a known risk factor for caries induction. The most cariogenic sugars are the fast sugars, mainly sucrose, widely used in the food industry. In addition to the nature of the sugar, several other factors condition the appearance of caries disease, namely the quantity of sugar consumed, its consistency, the duration of its contact with the teeth, the time and frequency of its consumption.Among the pillars of caries prevention, the control of the frequency and timing of consumption is essential. If the eradication of free sugars remains challenging to apply, their consumption must be reduced. This article aims first to discuss the link between the different types of sugars and the caries process and then present the current recommendations for the consumption of sugars to prevent caries disease.

The Association of Early Childhood Caries with Salivary Antimicrobial Peptide LL37 and Mutans Streptococci

Purpose: This study aims to determine the relation of salivary LL37 level and mutans streptococci levels in early childhood caries (ECC). Study design: A case-control study was performed in children ≤71 months old. Unstimulated whole saliva was collected and the level of salivary LL37 was measured using an enzyme-linked immunosorbent assay kit. The mutans streptococci oral bacteria were isolated from saliva and identified using a modified SB-20 culture medium (SB-20M). Data were analyzed using descriptive statistics, bivariate, and Spearman’s rank correlation analysis. Results: The was a variability of salivary LL37 level among the children and the level was significantly associated with age and races. The median (IQR) value of salivary LL37 in caries-free (CF) children was significantly higher 393.50 (580.55) ng/mL compared to 172.50 (234.65) ng/mL in the ECC group. The ECC children exhibited a significantly higher count of S. mutans and S. sobrinus compared to the CF children. An inverse weak correlation between salivary LL37 and dmft was also observed. Conclusions: The low salivary LL37 level and higher S. mutans and S. sobrinus count in ECC supported the protective role of salivary LL37 against dental caries. Further studies are required to explore the definite relation between salivary LL37 levels and dental caries.

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.

Effect of Propolis Paste and Mouthwash Formulation on Healing after Teeth Extraction in Periodontal Disease

This study investigated the antimicrobial effects of a mouthwash containing propolis and the effect of a propolis paste formulation on dental healing after teeth extraction in patients with periodontal disease. In the mouthwash experience, the population comprised 40 patients, which were divided as follows: the control mouthwash, 0.2% chlorhexidine (v/v) mouthwash, 2% (w/v) propolis mouthwash, and propolis + chlorhexidine mouthwash. The study of the propolis paste comprised a population of 60 patients with periodontal disease, and a total of 120 symmetric tooth extractions were performed. Propolis showed antimicrobial activity by itself, and especially with the chlorhexidine association. Three days after surgery in the teeth treated with control paste, only 13.4% had completely healed; however, with propolis paste, in 90% of the periodontal sockets, healing was complete. In addition, a reduction in Mutans Streptococci and Lactobacilli cfu was observed with propolis, and especially with the association of chlorhexidine + propolis. Propolis mouthwash reduced bacterial proliferation, especially in association with chlorhexidine. Propolis paste is a viable alternative for socket healing after dental extraction. The knowledge gained from these findings will provide a foundation for similar propolis therapies in order to improve the healing process after dental surgery.

Predicting dental caries increment using salivary biomarkers in a remote Indigenous Australian child population

Background The burden of childhood dental caries amongst Indigenous Australians is higher than in other Australians. Because of differences in lifestyle and the evolutionary history of the oral microbiota, associated risk indicators may differ. Here, we evaluate associations between caries increment, salivary biomarkers and baseline caries among children aged 5–17 years residing in a remote rural Indigenous community. Methods This study was part of a trial assessing cost-effectiveness of an intervention to prevent dental caries among children. Baseline epidemiology and application of topical caries-preventive measures was conducted in 2015, followed-up in 2016 and 2017. Children who did not consent or failed to attend the prevention visits but did attend for follow-up epidemiology constituted a natural comparison group for evaluating the intervention. Saliva flow, pH, buffering and bacterial loads were measured at all visits. Caries was scored by the International Caries Detection and Assessment system. Outcome was caries increment. Explanatory variables were sex, being in experimental or comparison group, baseline caries, saliva flowrate and buffering, pH, and salivary loads of mutans streptococci (MS), Lactobacilli (LB), and yeast. Chi Square tests compared caries incidence in relation to explanatory variables and Generalised Linear Models explored associations between explanatory and outcome variables. Results Of 408 participants at baseline, only 208 presented at 2-year follow-up. Of caries-free children at baseline, significantly fewer had incipient (p = 0.01) and advanced (p = 0.04) caries after two years. Children in the experimental group experienced fewer tooth surfaces with advanced caries (p = 0.02) than comparison children. Having caries at baseline (p = 0.02) and low salivary flow-rates (p < 0.001) saw a significant increase in advanced caries after two years. Children with high salivary loads of MS (p = 0.03) and LB (p = 0.004) experienced more advanced carious surfaces. Multivariable analysis revealed 58% reduction (p = 0.001) in advanced caries among children with high salivary flow rates. Caries increment was 61% (p = 0.03) more for incipient and 121% (p = 0.007) more for advanced caries among children who harboured higher loads of MS. Conclusion As with other ethnicities, children with low salivary flow and those with high MS had higher incipient and advanced caries increments after two years. Such risk assessments facilitate targeted preventive interventions for such communities. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), No: ACTRN12615000693527: 3 July 2015.

Streptococcus salivarius Isolates of Varying Acid Tolerance Exhibit F1F0-ATPase Conservation

Genes encoding the subunits of the membrane-bound F₁F₀-ATPase (responsible for exporting protons from the cytoplasm and contributing to acid tolerance) were sequenced for 24 non-mutans streptococci isolated from carious lesions. Isolates, mostly <i>Streptococcus salivarius</i>, displayed a continuum of acid tolerance thresholds ranging from pH 4.55 to 3.39, but amino acid alignments of F₁F₀-ATPase subunits revealed few non-synonymous substitutions and these were unrelated to acid tolerance. Thus, the F₁F₀-ATPase is highly-conserved among <i>S. salivarius</i> isolates despite varying acid tolerance thresholds, supporting the contention that acid tolerance is determined by the level of gene/protein expression rather than variation in molecular structure.

Association of Candida albicans and Cbp+ Streptococcus mutans with early childhood caries recurrence

Early childhood caries (ECC) recurrence occurs in approximately 40% of treated cases within one year. The association of Streptococcus mutans and Candida albicans with the onset of ECC is well known. Also, S. mutans strains harboring collagen-binding proteins (Cbps) avidly bind to collagen-rich dentin and are linked to increased caries risk. Here, we investigated the presence of Cbp+S. mutans and C. albicans in saliva and dental plaque of children with varying caries statuses, and their salivary microbiome. In this cross-sectional study, 143 children who were caries-free (n = 73), treated for ECC with no signs of recurrence after 6 months (n = 45), or treated for ECC and experiencing recurrence within 6 months following treatment (n = 25) were enrolled. Co-infection with C. albicans and S. mutans, especially Cbp+S. mutans, was strongly associated with caries recurrence. Subjects of the recurrence group infected with Cbp+S. mutans showed a greater burden of Candida spp. and of Mutans streptococci in dentin than those infected with Cbp- strains. Salivary microbiome analysis revealed that Streptococcus parasanguinis was overrepresented in the caries recurrence group. Our findings indicate that Cbp+S. mutans and C. albicans are intimately associated with caries recurrence, contributing to the establishment of recalcitrant biofilms.