Archs
oral Biol. Vol. 22. pp. 193 to 199. Pergamon
Press
1977. Prmted
in Great
Britain
EFFECT
OF PROLONGED TOPICAL APPLICATION OF VANCOMYCIN ON HUMAN ORAL STREPTOCOCCUS MUTANS POPULATIONS H. V. JORDAN and P. F. DEPAOLA Forsyth Dental Center, Boston, Massachusetts 02115, U.S.A.
Summary--Changes in oral Streptococcus mutans populations were recorded in conjunction with a one-year clinical trial of the anticaries activity of topically applied vancomycin. At the outset, 268 children aged 9-l 1 years were randomly assigned to the experimental or control group. Subjects in the experimental group were treated with a 3 per cent vancomycin gel applied in pretrimmed plastic trays for 5 min on school days. Plaque samples were taken every 4-6 weeks over a 12-month period from one sound occlusal surface, two sound approxima1 surfaces and one sound smooth surface. The surfaces assayed were the same at each sampling. Strep. mutans populations were determined in these samples using a selective medium. Significant reductions in numbers were observed consistently in occlusal surfaces. Sporadic and less pronounced effects were detectable on approximal and smooth surfaces. The treatment effects disappeared when treatment was suspended during the summer and re-appearecl when treatment was resumed after the vacation.
INTRODL’CIYON Previous studies have shown that twice-daily applications for five con.secutive days of a 1 per cent vancomycin paste in young adults, and a 15 per cent vancomycin gel in children, significantly suppressed Streptococcus mutans in pooled plaque samples. The effect persisted one week for the less potent agent and nearly two months for the stronger one (DePaola, Jordan and Berg, !1974). Subsequently, a 3 per cent gel formulated specifically for dental usage was applied once a da.y for five days to the teeth of children and produced a one-week reduction in the level of Strep. mutans in fissures, but no effect on smooth or approximal surfaces (Jordan and DePaola, 1974). It was reasoned that the effect in fissures was due to the greater retentiveness of these surfaces which tended to keep the antibiotic in contact with the organism for some time after treatment. It was conjectured that an effect on all surfaces might be achieved if treatment were carried out over an extended period. Our present purpose was to monitor Strep. mutans populations on selected tooth surfaces in conjunction with a clinical trial of the anticaries activity of topicall:y applied vancomycin (DePaola, Jordan and Soparkar, 1977). MATERIALS AND
METHODS
The 268 subjects (DePaola et a!., 1977) were 9-11 years old and were randomly assigned to the treatment or control groups. The caries status of each subject was determinecl at baseline and 12 months later. Treated subjects received a S-min application every day in school of a 3 per cent vancomycin gel contained in fitted plastic trays (Kerr Flura-Tray, Kerr Co., Mich.). The average number of treatments given during the study was 150, with a range of 138-168. Each subject was assessed for the presence of Strep. mutans at the time of baseline caries examination,
which occurred in early December, approximately 11 weeks into the school year. Four sites in the dentition were selected for sampling-Site 1: The most cariessusceptible, sound occlusal surface; Sites 2 and 3: The two most caries-susceptible, sound approximal surfaces; Site 4: The most caries-susceptible, sound smooth surface. The relative susceptibility of the available sound surfaces in a dentition was determined by joint reference to the subject’s baseline examination record, and a table giving the rank order of susceptibility of tooth surfaces (Marthaler, 1966). The method for sampling each surface type has been described (Jordan and DePaola, 1974). The samples were delivered to the laboratory and plated on MSB agar, a medium selective for Strep. mutans (Gold, Jordan and van Houte, 1973). The plates were scored as follows: No. colonies on plate 0 1-9 l&99 It%999 1000 or more
Strep. mutans index 0 1 2 3 4
The assessment for Strep. mutans, as conducted at the baseline, was repeated approximately every 4 to 6 weeks until the end of the school year. An assay was performed at the start of the subsequent academic year prior to the resumption of treatments and a final evaluation was made at the time of the 12-month clinical follow-up. Altogether, eight Strep. mutans assays were conducted during the 12-month period. The community water supply was fluoridated four months after the study began. This occurred between the third and fourth Strep. mutans assays. The four surfaces (one occlusal, two approximal, one smooth) sampled in a given subject were always the same. During the investigation, however, about 4-S per cent 193
Smooth
OcClUSal
type
Surface
Control
Treated
Control
Treated
Group
1 13 9 41 23 35 13 17 33 32 30 5.46 13 23 51 12 16 18 21 44 16 26 5.12
0 1 2 3 4 0 1 2 3 4 X2 0 1 2 3 4 0 1 2 3 4 x2 13 23 65 10 6 9 18 52 18 22 14.17*
13 25 45 19 13 9 14 38 31 21 12.12*
2
9 2-l 53 22 1 8 16 56 26 15 15.22*
21 25 36 25 5 6 13 43 33 26 27.P
3
12 9 56 29 4 6 16 49 22 8 6.31
18 24 51 15 1 4 17 39 31 9 23.34* 7 13 51 31 4 9 20 41 22 14 8.82
12 26 44 20 4 7 17 42 28 16 11.70* 13 24 56 17 1 7 34 42 18 11 13.87*
27 40 33 8 2 11 22 41 29 9 29.16*
6
by group and by site
Sample number 5 4
of Strep. mutuns scores at each sampling,
Strep. mutans index
Table 1. The frequency
17 30 53 8 1 9 33 43 8 6 6.75
19 24 38 17 9 12 18 38 15 16 4.24
I
33 38 24 4 0 33 24 22 x2 = 120.50 10 p
oral Biol. Vol. 22. pp. 193 to 199. Pergamon
Press
1977. Prmted
in Great
Britain
EFFECT
OF PROLONGED TOPICAL APPLICATION OF VANCOMYCIN ON HUMAN ORAL STREPTOCOCCUS MUTANS POPULATIONS H. V. JORDAN and P. F. DEPAOLA Forsyth Dental Center, Boston, Massachusetts 02115, U.S.A.
Summary--Changes in oral Streptococcus mutans populations were recorded in conjunction with a one-year clinical trial of the anticaries activity of topically applied vancomycin. At the outset, 268 children aged 9-l 1 years were randomly assigned to the experimental or control group. Subjects in the experimental group were treated with a 3 per cent vancomycin gel applied in pretrimmed plastic trays for 5 min on school days. Plaque samples were taken every 4-6 weeks over a 12-month period from one sound occlusal surface, two sound approxima1 surfaces and one sound smooth surface. The surfaces assayed were the same at each sampling. Strep. mutans populations were determined in these samples using a selective medium. Significant reductions in numbers were observed consistently in occlusal surfaces. Sporadic and less pronounced effects were detectable on approximal and smooth surfaces. The treatment effects disappeared when treatment was suspended during the summer and re-appearecl when treatment was resumed after the vacation.
INTRODL’CIYON Previous studies have shown that twice-daily applications for five con.secutive days of a 1 per cent vancomycin paste in young adults, and a 15 per cent vancomycin gel in children, significantly suppressed Streptococcus mutans in pooled plaque samples. The effect persisted one week for the less potent agent and nearly two months for the stronger one (DePaola, Jordan and Berg, !1974). Subsequently, a 3 per cent gel formulated specifically for dental usage was applied once a da.y for five days to the teeth of children and produced a one-week reduction in the level of Strep. mutans in fissures, but no effect on smooth or approximal surfaces (Jordan and DePaola, 1974). It was reasoned that the effect in fissures was due to the greater retentiveness of these surfaces which tended to keep the antibiotic in contact with the organism for some time after treatment. It was conjectured that an effect on all surfaces might be achieved if treatment were carried out over an extended period. Our present purpose was to monitor Strep. mutans populations on selected tooth surfaces in conjunction with a clinical trial of the anticaries activity of topicall:y applied vancomycin (DePaola, Jordan and Soparkar, 1977). MATERIALS AND
METHODS
The 268 subjects (DePaola et a!., 1977) were 9-11 years old and were randomly assigned to the treatment or control groups. The caries status of each subject was determinecl at baseline and 12 months later. Treated subjects received a S-min application every day in school of a 3 per cent vancomycin gel contained in fitted plastic trays (Kerr Flura-Tray, Kerr Co., Mich.). The average number of treatments given during the study was 150, with a range of 138-168. Each subject was assessed for the presence of Strep. mutans at the time of baseline caries examination,
which occurred in early December, approximately 11 weeks into the school year. Four sites in the dentition were selected for sampling-Site 1: The most cariessusceptible, sound occlusal surface; Sites 2 and 3: The two most caries-susceptible, sound approximal surfaces; Site 4: The most caries-susceptible, sound smooth surface. The relative susceptibility of the available sound surfaces in a dentition was determined by joint reference to the subject’s baseline examination record, and a table giving the rank order of susceptibility of tooth surfaces (Marthaler, 1966). The method for sampling each surface type has been described (Jordan and DePaola, 1974). The samples were delivered to the laboratory and plated on MSB agar, a medium selective for Strep. mutans (Gold, Jordan and van Houte, 1973). The plates were scored as follows: No. colonies on plate 0 1-9 l&99 It%999 1000 or more
Strep. mutans index 0 1 2 3 4
The assessment for Strep. mutans, as conducted at the baseline, was repeated approximately every 4 to 6 weeks until the end of the school year. An assay was performed at the start of the subsequent academic year prior to the resumption of treatments and a final evaluation was made at the time of the 12-month clinical follow-up. Altogether, eight Strep. mutans assays were conducted during the 12-month period. The community water supply was fluoridated four months after the study began. This occurred between the third and fourth Strep. mutans assays. The four surfaces (one occlusal, two approximal, one smooth) sampled in a given subject were always the same. During the investigation, however, about 4-S per cent 193
Smooth
OcClUSal
type
Surface
Control
Treated
Control
Treated
Group
1 13 9 41 23 35 13 17 33 32 30 5.46 13 23 51 12 16 18 21 44 16 26 5.12
0 1 2 3 4 0 1 2 3 4 X2 0 1 2 3 4 0 1 2 3 4 x2 13 23 65 10 6 9 18 52 18 22 14.17*
13 25 45 19 13 9 14 38 31 21 12.12*
2
9 2-l 53 22 1 8 16 56 26 15 15.22*
21 25 36 25 5 6 13 43 33 26 27.P
3
12 9 56 29 4 6 16 49 22 8 6.31
18 24 51 15 1 4 17 39 31 9 23.34* 7 13 51 31 4 9 20 41 22 14 8.82
12 26 44 20 4 7 17 42 28 16 11.70* 13 24 56 17 1 7 34 42 18 11 13.87*
27 40 33 8 2 11 22 41 29 9 29.16*
6
by group and by site
Sample number 5 4
of Strep. mutuns scores at each sampling,
Strep. mutans index
Table 1. The frequency
17 30 53 8 1 9 33 43 8 6 6.75
19 24 38 17 9 12 18 38 15 16 4.24
I
33 38 24 4 0 33 24 22 x2 = 120.50 10 p
