ETIOLOGY/OTHER

ARTICLE ANALYSIS & EVALUATION ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Maternal oral bacterial levels predict early childhood caries development. Chaffee BW, Gansky SA, Weintraub JA, Featherstone JDB, Ramos-Gomez FJ. J Dent Res 2014;93(3):238-44.

Maternal Salivary Bacterial Challenge is Associated With Oral Infection Among Children and Predicts Early Childhood Caries (ECC) Incidence in a High-risk Cohort of 36-month-old Children SUMMARY

REVIEWER

Subjects

Dorota T. Kopycka-Kedzierawski, DDS, MPH

This study was conducted at San Ysidro Community Health Center near the US-Mexico border. Women who were eligible for the study were age 18–33 years, were in the second trimester of normal pregnancy with a single fetus, resided in the South San Diego Bay area, and provided evidence of geographic stability.1 A total of 361 mother-child dyads participated in the randomized clinical trial (RCT). Recruitment to the RCT occurred between 2003 and 2004; randomization occurred between 2004 and 2006. The 36-month outcome (child dental status) was assessed between 2006 and 2008.1 Following enrollment, mothers and their children returned to complete questionnaires, dental examinations, and saliva collections at visits corresponding to 4, 9, 12, 18, 24, 30, and 36 months postpartum. The cohort study nested in the RCT included 243 mother-child dyads for whom 36-month child dental assessments were available.

PURPOSE/QUESTION The authors measured the association of maternal salivary bacterial challenge (mutans streptococci [MS] and lactobacilli [LB]) from pregnancy through 24 months postpartum with ECC incidence at age 36 months.

SOURCE OF FUNDING Government, grant numbers: U54DE014251 and U54DE019385

Key Risk/Study Factor

TYPE OF STUDY/DESIGN

Main Outcome Measure

Prospective observational cohort nested in the randomized clinical trial

The primary outcome was the cumulative incidence (new caries lesions) of $1 decayed (cavitated) or restored primary teeth (d2ft > 0) at the child’s 36-month assessment visit.

LEVEL OF EVIDENCE Level 2: Limited-quality, patientoriented evidence

STRENGTH OF RECOMMENDATION GRADE Not applicable

J Evid Base Dent Pract 2014;14:147-148 1532-3382/$36.00 Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jebdp.2014.07.002

Maternal-child’s oral bacteria in saliva (mutans streptococci [MS] and lactobacilli [LB] levels) were identified as a risk factor for ECC.

Main Results After adjusting for sociodemographic status, feeding patterns, care practices, and maternal dental status, higher maternal salivary challenge of MS was associated significantly with greater ECC incidence at 36 months (cumulative incidence ratio: 2.4; 95% confidence interval [CI]: 1.3–4.9) if maternal LB salivary challenge was low. Higher maternal salivary challenge of MS and LB together was associated significantly with greater ECC incidence at 36 months (cumulative incidence ratio: 1.9; 95% CI: 1.1–3.8); the association with ECC and higher maternal salivary challenge of MS and LB together was weaker than the association with ECC incidence and higher bacterial salivary challenge of MS alone, suggesting no synergistic relationship. Children of mothers with higher maternal salivary MS levels averaged from baseline to 24 months were more likely to be MS positive at 36 months than children of mothers with lower salivary MS levels (63% vs 43%). Higher average maternal salivary LB levels were not statistically associated with child LB positivity (19% vs 13%).

JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE

Conclusions The authors concluded that maternal salivary bacterial challenge not only was associated with oral infection among children but also predicted increased ECC incidence in 36-month-old children.

COMMENTARY AND ANALYSIS The most recent data from the National Health and Nutritional Examination Survey (NHANES) of the Centers for Disease Control and Prevention (CDC) indicate that the prevalence of ECC in US 2- to 5-year-old children has increased significantly in the last decade to 28%.2 The prevalence of ECC is even greater for MexicanAmerican children when compared to US White nonHispanic children. It is also greater for US children who are in the lowest socioeconomic status (SES) bracket.2 ECC results from tooth-specific bacteria (mainly mutans streptococci [MS] and lactobacilli [LB]) that metabolize dietary sugars to produce acid. Over time and with increased acid exposure, the tooth structure demineralizes, resulting in cavities.3 A strong correlation between MS and LB counts and caries experience in young children has been reported in numerous studies.3–5 The authors of this study hypothesized that higher maternal salivary challenge of MS and LB averaged over the study period will be associated with greater ECC incidence among children. The authors concluded that higher maternal salivary bacterial challenge was associated with greater ECC incidence in children age 36 months for MS alone; it was also greater for LB, but did not reach statistically significant levels. At least two important limitations of this study should be mentioned. First, the authors did not isolate bacterial strains for genetic analysis and for that reason they could not confirm maternal to child bacterial transfer. The mouth of the newborn baby is usually sterile. Acquisition of the resident oral microflora depends on the successive transmission of microbes to the site of potential colonization. Although oral organisms can be derived from water, food, and other nutritious fluids, the main route of transmission in the oral cavity is via saliva.6 Children’s salivary MS and LB can be of maternal and non-maternal origin. Other family members who serve as caregivers, childcare staff, and siblings can be the non-maternal sources of oral bacteria in children. This scenario could be possible for the children who participated in the study.

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Second, the study population comprised mothers and children who were at high risk for caries onset and progression. The mothers were mostly poor MexicanAmerican women (90.1% of the mothers self-reported an annual income of $35,000 or less) with a low education attainment (42.3% of the mothers reported less than a high school degree). These sociodemographic factors alone are important risk factors for ECC onset. Additionally, the authors presented limited data on the diet and dietary behavior of the children who participated in the study. Frequent consumption of fermentable carbohydrates, night-time bottle feeding with juice or other sweetened beverages, repeated use of a sippy cup, and frequent between-meal consumption of sugar-containing snacks or drinks may increase the risk of ECC. Considering a homogenous sample of subjects who participated in the aforementioned study, the study results should be interpreted with caution because it is not clear if they can be generalizable to the US population per se. Further studies are essential to determine the precise process of the maternal oral bacteria transmission leading to increased ECC incidence in young children.

REFERENCES 1. Ramos-Gomez FJ, Gansky SA, Featherstone JD, et al. Mother and Youth Access (MAYA) maternal Chlorhexidine Counseling and Pediatric Fluoride Varnish randomized clinical trial to Prevent early childhood caries. Int J Paediatr Dent 2012;22(3):169-79. 2. Dye BA, Tan S, Smith V, et al. Trends in oral health status: United States, 1988–1994 and 1999–2004. Vital Health Stat 2007;11(248):5-20. National Center for Health Statistics. 3. Loesche WJ. Role of Streptococcus mutans in human dental decay. Microbiol Rev 1986;50(4):353-80. 4. Plonka KA, Pukallus ML, Barnett AG, et al. A longitudinal study comparing mutans streptococci and lactobacilli colonisation in dentate children aged 6 to 24 months. Caries Res 2012;46(4):385-93. 5. Teanpaisan R, Thitasomakul S, Piwat S, et al. Longitudinal study of the presence of mutans streptococci and lactobacilli in relation to dental caries development in 3-24 month old Thai children. Int Dent J 2007;57(6):445-51. 6. Fejeskov O, Kidd Edwina AM, editors. Dental Caries. The Disease and Its Management. Blackwell Munksgaard; 2003. p. 29.

REVIEWER Dorota T. Kopycka-Kedzierawski, DDS, MPH University of Rochester, Eastman Institute for Oral Health, 625 Elmwood Avenue, Box 683, Rochester, NY 14620, USA [email protected]

September 2014

Maternal salivary bacterial challenge is associated with oral infection among children and predicts early childhood caries (ECC) incidence in a high-risk cohort of 36-month-old children.

Maternal salivary bacterial challenge is associated with oral infection among children and predicts early childhood caries (ECC) incidence in a high-risk cohort of 36-month-old children. - PDF Download Free
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