Association among early childhood caries, microbiological composition of dental biofilm, diet, oral hygiene and socioeconomic factors in preschoolers aging 36 to 48 months

Orientador: Marines Nobre dos Santos UchoaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: A prevalência da cárie precoce da infância (CPI) no Brasil é alta e sua severidade aumenta com a idade. Assim, métodos sensíveis para o diagnóstico precoce e a identificação de indicadores de risco são importantes para o controle desta doença. Essa dissertação, constituída por três artigos teve como objetivos: (1) revisar sistematicamente os trabalhos que evidenciaram associação entre os níveis de estreptococos do grupo mutans (SM) e a prevalência e progressão da CPI; (2) investigar a prevalência da CPI em pré-escolares após inclusão das lesões de mancha branca (LMB) no critério de diagnóstico e a influência destas lesões no perfil epidemiológico da população estudada; (3) identificar os principais indicadores de risco da CPI através da avaliação dos fatores microbiológicos, dietéticos, sociais e hábitos de higiene bucal, considerando os estágios de desenvolvimento da doença. No levantamento dos artigos da revisão (1951-2007) foram utilizadas as bases de dados: Pubmed, Scopus e Cochrane. Na realização dos estudos dois e três utilizou-se uma amostra constituída de 351 e 169 crianças, respectivamente. Estes pré-escolares, de 36-48 meses e ambos os gêneros, freqüentavam creches e pré-escolas municipais de Itatiba-SP. Os exames clínicos para determinação do índice de cárie foram realizados com auxílio de gaze, sonda e espelho sob luz artificial. No terceiro estudo as crianças foram divididas em 3 grupos experimentais (livres de cárie, LMB, lesões de cárie cavitadas). Para a avaliação da dieta foi empregado um diário, enquanto higiene bucal, renda familiar, etnia e escolaridade foram avaliados por questionário. A coleta do biofilme de todas as superfícies dentárias vestibulares e palatinas foi realizada com auxílio de alças esterilizadas (1 µl) para padronizar a quantidade removida. Técnicas quantitativas de cultura microbiológica foram empregadas para determinar o número de colônias de SM, microrganismos totais (MT) e lactobacilos (LB). Os dados da revisão foram avaliados qualitativamente, enquanto aqueles inerentes aos estudos dois e três foram analisados pelo teste t-pareado e pela regressão logística múltipla, respectivamente (_=0,05). Dos 119 artigos levantados na revisão, 16 foram avaliados e apenas 1 alcançou alto nível de evidência científica. No estudo dois, o índice de cárie aumentou significativamente (p<0,05) com a inclusão das LMB, que predominaram na maioria dos dentes, principalmente nas superfícies lisas livres. No terceiro estudo, dentre os indicadores de risco analisados, os mais significativos para o desenvolvimento de LMB foram: altos níveis de SM (OR=2,3, CI=1,01-5,14), alta freqüência diária de consumo de açúcar total (OR=5,4, CI=1,42-20,88) e presença de biofilme nos incisivos superiores (OR=2,3, CI=1,01-5,14). Os fatores significativos para a progressão da CPI foram: altos níveis de MT (OR=4,6, CI=1,56-13,74) e presença de LB (OR=20,3, CI=4,03-102,51). Através da revisão foi concluído que os níveis de SM são um forte indicador de risco para a CPI; entretanto, estudos longitudinais com maiores níveis de evidência científica são necessários para que os níveis de SM sejam apontados como fortes fatores de risco. As conclusões dos estudos dois e três revelaram que a inclusão das LMB no diagnóstico da cárie possibilitou a identificação precoce de pré-escolares de risco à cárie e o direcionamento de medidas preventivasAbstract: The prevalence of early childhood caries (ECC) in Brazil is high and its severity increases with age. This way, sensitive methods for the early caries diagnosis and risk indicators identification are important for the disease control. This thesis, comprised by three manuscripts, aimed: (1) to undertake a systematic review of studies which have evidenced the association between mutans streptococci (MS) levels and the prevalence and progression of the ECC; (2) to investigate the increase of caries prevalence in young children after the inclusion of early caries lesions (ECL) to WHO thresholds caries detection and the influence of these lesions in the epidemiological profile of the studied population; (3) to identify the main risk indicators of the ECC, with regards to the microbiological, dietary and social factors, as well as oral hygiene habits, considering the development stages of dental caries. In the review, Pubmed, Scopus and Cochrane Library databases were searched for papers (1951-2007). In studies two and three the sample comprised 351 and 169 children, respectively. These preschoolers, aging 36 to 48 months, from both genders, attended public nurseries and preschools in the city of Itatiba-SP. The clinical examinations for caries index determination were performed using gauze, probe and mirror under artificial light. In the third study, the children were divided in three experimental groups (caries free, ECL and cavitated lesions). A chart was employed for the diet evaluation whereas oral hygiene, family income, ethnicity and education level were assessed by a questionnaire. Dental biofilm was collected from all buccal and lingual surfaces with a sterilized handle (1 µl) in order to standardize the amount removed. Quantitative microbiological culture techniques were performed to determine the number of mutans streptococci (MS) colonies and total microorganisms (TM) and lactobacilli (LB) counts. The review data were appraised trough qualitative analyses; the data from studies two and three were statistically analyzed by paired t-test and multiple logistic regression, respectively (_=0.05). Out of the 119 articles yielded in the review, 16 were appraised and only one article has achieved high value as evidence. In study two, the caries index has significantly increased (p<0.05) when the ECL were included; these ECL were the predominant caries lesion in the majority of the teeth, particularly on smooth surfaces. In the third study, among all risk indicators studied, the statistically significant indicators associated with ECL development were: high levels of MS (OR=2.3, CI=1.01-5.14), high daily frequency of total sugar consumption (OR=5.4, CI=1.42-20.88) and biofilm presence on maxillary incisors (OR=2.3, CI=1.01-5.14). The significant factors associated with ECC progression were: high levels of TM (OR=4.6, CI=1.56-13.74) and lactobacilli presence (OR=20.3, CI=4.03-102.51). From the review it was concluded that MS levels are a strong risk indicator for early childhood caries; however, longitudinal studies with high levels of scientific evidence are required to point out MS levels as a remarkable ECC risk factor. From studies two and three it was concluded that the inclusion of ECL in the caries diagnosis allowed the earlier identification of caries risk preschoolers and targeting of preventive measuresMestradoOdontopediatriaMestre em Odontologi

Relationships between immunological factors, biochemical and microbiological composition of dental plaque, sugar exposure and early childhood caries incidence

Orientador: Marinês Nobre dos SantosTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: A cárie precoce da infância (CPI) é considerada um problema de saúde significativo no Brasil devido a sua alta prevalência. Como o perfil dessa doença na população infantil não é estático, estudos que avaliem o desenvolvimento da cárie, assim como sua etiologia são de grande importância para a prevenção e controle da CPI. Esta tese, constituída por 4 capítulos teve como objetivos: 1.avaliar o comportamento das lesões de manchas brancas ativas (LMB) na dentição decídua em um ano de acompanhamento; 2.explorar a associação entre desenvolvimento de cárie, colonização por bactérias cariogênicas e fatores imunológicos inerentes à saliva; 3.avaliar o poder de predição do fluoreto presente no biofilme dentário no desenvolvimento da CPI, considerando-se a exposição aos açúcares; 4.avaliar a associação entre os polissacarídeos extracelulares insolúveis (PECIs) do biofilme dentário, exposição aos açúcares, microrganismos cariogênicos e a CPI, assim como realizar um screening da habilidade das cepas de Streptococcus mutans (S.mutans) de produzir glucano in vitro. Para a realização desses estudos, pré-escolares (n=179, n=40, n=31, n=65, capítulos 1, 2, 3 e 4 respectivamente) de 3-4 anos, do município de Itatiba-SP foram acompanhados por um ano. Os exames clínicos para diagnóstico de cárie (critério OMS+LMB) foram realizados após verificação de presença/ausência de biofilme visível nos incisivos superiores. Depois disso, as crianças foram divididas nos grupos: livres de cárie e cárie ativos/inativos. O biofilme dentário foi coletado das superfícies lisas livres com auxílio de alças esterilizadas para contagem de microrganismos ou com palitos de madeira para dosagem de flúor e PECIs. A exposição aos açúcares foi avaliada por diário de dieta. As análises imunológicas e da capacidade das cepas de S.mutans de produzir glucano foram realizadas por meio ensaios no Luminex100 e zimografia, respectivamente. Após análise estatística (?=0,05) verificou-se que a maioria das LMB permaneceram ativas ou remineralizaram após um ano e que as crianças com atividade de cárie no baseline apresentaram maior risco de desenvolver novas superfícies cariadas que aquelas livres de cárie. Além disso, crianças com lactobacilos, menores níveis de IgA salivar anti-GbpB, presença de biofilme visível, maior exposição ao açúcar sólido, menor concentração de flúor e maior concentração de PECIs no biofilme mostraram maior chance de desenvolver CPI comparadas àquelas que não apresentavam essas condições. Não foi verificada correlação entre a habilidade das cepas de S.mutans de produzir glucanos e a concentração de PECIs no biofilme. Porém, as cepas que mais produziram glucano foram encontradas em crianças que desenvolveram cárie. Conclui-se que o monitoramento das LMB deve ser o tratamento de escolha no manejo da CPI, visto que a maioria remineralizou/permaneceu ativa, que o sistema imunológico sofreu maturação significativa no período do estudo e que a amplitude de resposta da IgA salivar contra os epítopos de S. mutans pode influenciar o grau com que esses microrganismos causam doença. Ainda, considerando-se a exposição à açúcares, a composição bioquímica e microbiológica do biofilme dentário influencia o desenvolvimento da CPI e a capacidade das cepas de S.mutans produzirem glucano in vitro não pôde refletir a concentração de PECIs no biofilme na população estudadaAbstract: Early childhood caries (ECC) is considered a significant oral health problem in Brazil due to its high prevalence. As caries profile in the pediatric population is not static, studies assessing the development of caries, as well as its etiology are of prime importance for ECC prevention and control. This thesis consists of 4 chapters aiming to: 1.evaluate the behaviour of early caries lesions (ECL) in early childhood; 2.explore the association between caries development, colonization with caries-associated microflora and immunity related to saliva; 3.assess the predictive power of dental plaque fluoride in early childhood caries development regarding sugar exposure conditions; 4.assess the associations between dental plaque extracellular insoluble polysaccharide (IP), sugar exposure, cariogenic microorganisms and ECC; and also to perform a screening of Streptococcus mutans (S.mutans) strains' ability to produce glucan in vitro. To perfom these studies, preschool children aging 3-4 years, from Itatiba-SP were followed for one year (n=179, n=40, n=31, n=65, chapters 1, 2, 3 and 4 respectively). Clinical examinations for caries diagnosis (WHO criteria+ECL) were performed after recording the presence/absence of visible dental plaque on maxillary incisors. After that, children were divided in groups: caries free and caries active/inactive. Dental plaque was collected from smooth surfaces using sterilized handles for microorganisms' enumeration or wooden sticks for fluoride and IP analyses. Immunological analysis and S.mutans ability to produce glucan were performed by Luminex100 assays and zimography, repectively. The frequency of sugar exposure was assessed by a diet chart. After statistical analysis (?=0.05) it was shown that most ECL remained active/remineralized after one year and that children with caries activity at baseline had higher risk for developing new carious surfaces than those caries free. In addition, children with lactobacilli, lower levels of salivary IgA anti-GbpB, presence of dental plaque, increased exposure to solid sugar, lower fluoride concentration and higher concentration of IP in dental plaque showed more chances for developing ECC than those who did not show these conditions. There was no correlation between the ability of S. mutans to produce glucan and IP concentration in the plaque. However, the strains with higher glucan production were found in children who developed caries. We conclude that the management of ECL should be conservative, as the majority remineralized/remained active, the secretory immune system is undergoing significant maturation during the period studied, and that the breadth of mucosal IgA response to epitopes of S.mutans virulence components may influence the degree to which these cariogenic microorganisms can cause disease. Still, considering sugar exposure, microbiological and biochemical composition of dental plaque influence the development of ECC, and the ability of S.mutans strains to produce glucan in vitro could not reflect IP concentration in dental plaque in the studied populationDoutoradoOdontopediatriaDoutor em Odontologi

Cárie dentária e fatores relacionados em crianças Brasileiras de região com água fluoretada e não fluoretada

PURPOSE: To compare the caries prevalence, saliva buffering capacity (SBC), oral hygiene (OH), dietary habits, family income (FI) and frequency of visits to a dental office (Do) between Brazilian children living in areas with and without fluoridated public water supply. METHODS: Forty-six 5-7-year-old preschoolers were selected in Itatiba, SP, Brazil; 19 were from a fluoridated area, and 27 were from a non-fluoridated area. The caries index was determined according to the World Health Organization criteria, and the SBC was assessed by titration with hydrochloric acid. The FI, frequency of OH and visits to Do were estimated by questionnaire. The dietary habits were assessed with a diet chart. The differences between the groups were analyzed with Mann-Whitney-U tests (&#945;=0.05). RESULTS: Children from the non-fluoridated area showed significantly higher dmft/DMFT than those from the fluoridated area, but they showed significantly lower SBC, OH frequency and FI. No significant differences were observed between the areas for dietary habits and visits to Do. CONCLUSION: Children from fluoridated areas showed higher salivary buffering capacity, family income and oral hygiene frequency as well as lower caries prevalence, supporting the beneficial effect of fluoride in the tap water for caries prevention.OBJETIVO: Comparar prevalência de cárie, capacidade tamponante da saliva (CTS), higiene bucal (HB), hábitos dietéticos, renda familiar (RF) e frequência de visita a consultórios odontológicos (Co) entre crianças brasileiras residentes em áreas de água de abastecimento público fluoretadas e não fluoretadas. METODOLOGIA: Quarenta e seis crianças entre 5-7 anos foram selecionadas em Itatiba-SP-Brasil, sendo 19 pertencentes à área fluoretada e 27 à área não fluoretada. O índice de cárie foi determinado de acordo com o critério da Organização Mundial de Saúde e a CTS foi medida por titulação com ácido clorídrico. A RF, frequência de HB e visita ao Co foram estimadas por questionário. Os hábitos dietéticos foram avaliados com diário de dieta. As diferenças entre as variáveis foram analisadas pelo teste de Mann Whitney (&#945;=0,05). RESULTADOS: As crianças da área não fluoretada apresentaram significativamente maior ceod/CPOD que àquelas da área fluoretada, porém significativamente menor CTS, HB e RF. Com relação a hábitos dietéticos e visitas ao Co, não foi observada diferença significativa entre as áreas. CONCLUSÃO: As crianças da área fluoretada apresentaram maior capacidade tamponante da saliva, renda familiar e frequência de higiene bucal, assim como menor prevalência de cárie, reforçando o efeito benéfico do flúor nas águas de abastecimento para prevenir a cárie

Exploring the Relationship between Salivary Levels of TNF-α, <i>Lactobacillus acidophilus, </i><i>Lactobacillus gasseri,</i> Obesity, and Caries in Early Childhood

This research aimed to explore the relationship between tumor necrosis factor-α (TNF-α), Lactobacillus acidophilus (L. acidophilus), Lactobacillus gasseri (L. gasseri), obesity, and early childhood caries. After caries and obesity diagnosis based on the WHO criteria, 94 preschoolers were assessed. Unstimulated saliva was collected for analysis of TNF-α by the Milliplex system and for L. acidophilus and L. gasseri using real-time polymerase chain reaction (RT-PCR). In obese children, each unit increase in the body mass index (BMI), and the TNF-α levels was associated with a one-time increase in the number of decayed surfaces (p 0.05). Meanwhile, in eutrophic preschoolers, the presence of L. gasseri and L. acidophilus was linked, respectively, to an increase of 3.04 and 1.59 times in the number of decayed surfaces (p 0.05); in obese children, the presence of L. acidophilus was not significant (p > 0.05) and L. gasseri was shown as a possible protective indicator (RR:0.49–p L. gasseri was significant, and in an opposite way, reinforcing that obesity can modulate oral bacteria

Presence of Candida spp. in infants oral cavity and its association with early childhood caries

spp., mainly C. albicans, colonizes oral cavity of infants. Transmission by mother to childbirth, pacifier use, feeding habits and caries are factors related to Candida oral colonization. Some researches related that early childhood caries favor the oral colonization of C. albicans. The present literature review described the presence of Candida spp. in oral cavity of infants and its association with early childhood caries (ECC). The literature was searched for original papers relating Candida, pacifier and baby bottle usage and ECC. The articles were selected using Bireme and Medline databases. Manual tracing of references cited in key papers was also elicited. It can be concluded that Candida spp. colonization in the infants oral cavity, especially C. albicans, can be related to the pacifier usage, feeding habits and caries lesions. The early childhood caries favor the C. albicans colonization, although its role in the carious process need further studies to be elucidate scientifically

Presence of Candida spp. in infants oral cavity and its association with early childhood caries

Candida spp., mainly C. albicans , colonizes oral cavity of infants. Transmission by mother to childbirth, pacifier use, feeding habits and caries are factors related to Candida oral colonization. Some researches related that early childhood caries favor the oral colonization of C. albicans. The present literature review described the presence of Candida spp. in oral cavity of infants and its association with early childhood caries (ECC). The literature was searched for original papers relating Candida, pacifier and baby bottle usage and ECC. The articles were selected using Bireme and Medline databases. Manual tracing of references cited in key papers was also elicited. It can be concluded that Candida spp. colonization in the infants&apos; oral cavity, especially C. albicans, can be related to the pacifier usage, feeding habits and caries lesions. The early childhood caries favor the C. albicans colonization, although it&apos;s role in the carious process need further studies to be elucidate scientificall

Early Childhood Caries And Mutans Streptococci: A Systematic Review.

The aim of the present study was to undertake a systematic review to investigate whether mutans streptococci levels are a strong risk indicator/factor for ECC, based on the current quality of the literature regarding the relationship between early childhood caries (ECC) and these microorganisms. The authors searched PubMed, Scopus and Cochrane Library databases for papers from 1951 to 2007. The minimal inclusion requirements were assessment of preschool children reporting mutans streptococci counts, mainly in saliva and biofilm samples, and caries assessment. Since the heterogeneity of the studies did not allow a meta-analysis (chi(2) test), a qualitative analysis was conducted. The electronic search yielded 120 articles, but only 16 scientific papers were critically appraised. Of the 16 scientific papers included in the review, only one cross-sectional study achieved a high value of evidence. It was concluded that mutans streptococci levels are a strong risk indicator for ECC. However, further well designed longitudinal studies with high evidence values are required to confirm mutans streptococci levels as a significant ECC risk factor.859-7

Oral Rehabilitation Of Primary Dentition Affected By Amelogenesis Imperfecta: A Case Report.

The purpose of the case report was to describe the treatment of a 4(1/2)-year-old boy with amelogenesis imperfect (AI) in the primary dentition. AI is a hereditary condition that affects the development of enamel, causing quantity, structural, and compositional anomalies involving all dentitions. Consequently, the effects can extend to both the primary and secondary dentitions. A 4(1/2)-year-old boy was brought to the dental clinic complaining of tooth hypersensitivity during meals. The medical history and clinical examination were used to arrive at the diagnosis of amelogenesis imperfecta. The treatment was oral rehabilitation of the primary molars with stainless steel crowns and resin-filled celluloid forms of both maxillary and mandibular primary incisors and canines. Improvements in the patient's psychological behavior and the elimination of tooth sensitiveness were observed, and the reestablishment of a normal occlusion resulted in improved eating habits. The child was monitored in the Pediatric Dentistry Clinic at four-month intervals until the mixed dentition stage. The oral rehabilitation of young children with AI is necessary to reestablish the stomatognathic system function, so important for a child's systemic health. An adequate medical history and a careful clinical examination were essential for a correct diagnosis. Treatment was rendered that was appropriate for the child's age and clinical/psychological characteristics. Cost-effective restorative techniques involving stainless steel and composite-resin crowns are shown for the restoration of a young patient with amelogensis imperfecta.11071-