Diet and caries-associated bacteria in severe early childhood caries

Abstract

Frequent consumption of cariogenic foods and bacterial infection are risk factors for early childhood caries (ECC). This study hypothesized that a short diet survey focused on frequency of foods, categorized by putative cariogenicity, would differentiate severe ECC (S-ECC) from caries-free children. Children's diets were obtained by survey and plaque bacteria detected by PCR from 72 S-ECC and 38 caries-free children. S-ECC children had higher scores for between-meal juice (p < 0.01), solid-retentive foods (p < 0.001), eating frequency (p < 0.005), and estimated food cariogenicity (p < 0.0001) than caries-free children. S-ECC children with lesion recurrence ate fewer putative caries-protective foods than children without new lesions. Streptococcus mutans (p < 0.005), Streptococcus sobrinus (p < 0.005), and Bifidobacteria (p < 0.0001) were associated with S-ECC, and S. mutans with S. sobrinus was associated with lesion recurrence (p < 0.05). S. mutans-positive children had higher food cariogenicity scores. Food frequency, putative cariogenicity, and S. mutans were associated with S-ECC individually and in combination.

Figure 1.

Daily frequencies of beverages and foods. (a) Daily beverage consumption in caries-free and S-ECC children. Percent of children who consumed each beverage type at mealtime and between meals. Significantly more severe-ECC children drank milk at mealtimes and also drank more juice, particularly between meals. More caries-free than S-ECC children drank water. (b) Food frequencies (number of food or beverage intakes a day) in S-ECC and caries-free children. A gap equal to or greater than 1 hr on the 24-hour diet survey defined distinct meal or snack periods. The proportions of S-ECC and caries-free children differed depending on the number of food intakes (frequency) a day. There was a significant trend with S-ECC children eating more frequently, with an opposite trend for the caries-free children (p = 0.002 Mantel-Haenszel chi-square).

Figure 2.

Mutans streptococci and Bifidobacteria in severe-ECC and caries-free children. (a) Detection of S. mutans, S. sobrinus, and Bifidobacteria by PCR in caries-free and severe-ECC children. All species, particularly Bifidobacteria, were associated with severe ECC compared with caries-free children. (b) Mutans streptococci in caries-free and S-ECC children. More children without mutans streptococci were caries-free than S-ECC children, whereas children with both species detected were predominantly S-ECC children, with intermediate values for detection of only one mutans streptococcus species. This was a significant trend of more disease when both mutans streptococci were detected (p < 0.0001, Mantel-Haenszel chi-square). (c) Food cariogenicity and detection of cariogenic pathogens. Children positive for test species showed higher mean food cariogenicity scores than children negative for the species, which was significant for S. mutans.