Is Mutans Streptococci count a risk predictor of Early Childhood Caries? A systematic review and meta-analysis

Abstract

Background: The review aims to determine the risk predictability of mutans streptococci in the development of carious lesions in children with primary dentition.

Methods: Longitudinal observational studies with at least 6 months follow-up and evaluating mutans streptococci presence in caries-free children under 6 years of age for the development of any cavitated or non-cavitated carious lesion. Six databases and grey literature were searched without any restrictions. Risk of bias was evaluated using the New Castle Ottawa scale for longitudinal studies, and the certainty of the evidence was evaluated by Grading of Recommendations Assessment, Development and Evaluation using GRADEpro software. Meta-analysis was performed using a random effect (DerSimonian and Laird, DL) model, and heterogeneity was evaluated using tau-squared, I² statistics and prediction interval. Sensitivity analysis was performed to assess the relationship between the mutans streptococci presence at baseline and the caries development, according to the sample and methods used for the microbiological assessment and the length of follow-up of the studies. Publication bias was checked by funnel plot using a random effect (DerSimonian and Laird, DL) model.

Results: Twelve studies met the inclusion criteria and were included in the review. Four studies received a maximum of 9 stars, and among the remaining eight studies, six received 8 stars and the rest two studies were assigned 7 stars in the risk of bias scale. After pooling the results quantitatively, odds ratio (OR) was found to be 4.13 (95% CI: 3.33, 5.12), suggesting that children with mutans streptococci had 4 times higher odds of developing caries later (p < 0.001). Four studies were pooled to compare future caries experience among children with and without mutans streptococci at baseline, obtaining standardized mean difference (SMD) of 0.85 (95% CI: 0.33, 1.37), indicating a large effect (p < 0.001). Certainty of evidence was found to be moderate, and no publication bias was reported by the funnel plot criteria of symmetry.

Conclusions: Presence of mutans streptococci in a preschool child is a risk predictor for future caries experience. Early identification of children with increased caries-risk may facilitate in implementation of appropriate preventive strategies.

Keywords: Child; Dental caries; Preschool; Risk; Streptococcus mutans.

Fig. 1

PRISMA flow diagram for the study selection

Fig. 2

Forest plot of the pooled Odds Ratio (OR) of the development of caries in children with and without mutans streptococci

Fig. 3

Forest plot of Standardized mean difference (SMD) of future caries experience in children with and without mutans streptococci

Fig. 4

Forest plot of pooled Odds ratio (OR) of development of caries in children with and without mutans streptococci according to method of assessment of mutans streptococci

Fig. 5

Forest plot of pooled Odds ratio (OR) of development of caries in children with and without mutans streptococci according to the sample used for its detection

Fig. 6

Forest plot of pooled Odds ratio (OR) of development of caries in children with and without mutans streptococci according to the length of follow-ups of the studies

Fig. 7

Funnel plot for the publication bias among the included studies