International Journal of Clinical Pediatric Dentistry

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VOLUME 17 , ISSUE 1 ( January, 2024 ) > List of Articles


Evaluation of Changes in Oral Microflora in Children with Early Childhood Caries after Full Mouth Rehabilitation

Mebin George Mathew, Neha N Rathod

Keywords : Early childhood caries, Full mouth rehabilitation, General anesthesia, Oral microflora

Citation Information : Mathew MG, Rathod NN. Evaluation of Changes in Oral Microflora in Children with Early Childhood Caries after Full Mouth Rehabilitation. Int J Clin Pediatr Dent 2024; 17 (1):21-25.

DOI: 10.5005/jp-journals-10005-2707

License: CC BY-NC 4.0

Published Online: 14-03-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aim: To evaluate the change in microflora in children suffering from severe early childhood caries (ECC) after full mouth rehabilitation. Materials and methods: A total of 60 children, aged 3–5 years suffering from severe ECC who fulfilled the inclusion and exclusion criteria were included in the study. Pooled plaque samples were taken and subjected to quantitative reverse transcriptase polymerase chain reaction (PCR) to obtain baseline mean values of Streptococcus mutans (S. mutans), Streptococcus sobrinus (S. sobrinus), Candida albicans (C. albicans), and Candida dubliniensis (C. dubliniensis) before full mouth rehabilitation was done under general anesthesia. Posttreatment samples were collected at 6, 12, and 18 months. Wilcoxon signed-rank test was used to compare the mean values of S. mutans, S. sobrinus, C. albicans, and C. dubliniensis before and after full mouth rehabilitation. Results: A total of 60 patients recruited for the study were present at the follow-up at 6 and 12 months. At 18 months, 55 patients returned, and five were lost due to follow-up. A statistically significant reduction was seen in all microorganisms at 6, 12, and 18 months compared to baseline values. At 18 months a slight increase in S. mutans, S. sobrinus, and C. albicans was seen. C. dubliniensis was not detected in any cases after full mouth rehabilitation. Caries recurrence was seen in four patients at 18 months. Conclusion: Significant reduction of S. mutans, S. sobrinus, C. albicans, and C. dubliniensis was seen at 6, 12, and 18 months. A complete reduction of only C. dubliniensis was seen. A significant but not permanent reduction of S. mutans, S. sobrinus, and C. albicans. Caries recurrence was seen in 7.27% of patients at 18 months.

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  1. Early childhood caries: IAPD Bangkok declaration. Int J Paediatr Dent 2019;29(3):384–386.
  2. Hemadi AS, Huang R, Zhou Y, et al. Salivary proteins and microbiota as biomarkers for early childhood caries risk assessment. Int J Oral Sci 2017;9(11):e1. DOI: 10.1038/ijos.2017.35
  3. Berkowitz RJ. Causes, treatment and prevention of early childhood caries: a microbiologic perspective. J Can Dent Assoc 2003;69(5):304–307.
  4. Vishwanathan S, Chikkanarasaiah N, Bilichodmath S. Effect of full-mouth rehabilitation on Streptococcus mutans and Streptococcus sobrinus levels in children with severe early childhood caries. J Dent Child (Chic) 2020;87(2):77–82.
  5. Kim D, Sengupta A, Niepa TH, et al. Candida albicans stimulates Streptococcus mutans microcolony development via cross-kingdom biofilm-derived metabolites. Sci Rep 2017;7:41332. DOI: 10.1038/srep41332
  6. Xiao J, Huang X, Alkhers N, et al. Candida albicans and early childhood caries: a systematic review and meta-analysis. Caries Res 2018;52(1-2):102–112. DOI: 10.1159/000481833
  7. Al-Ahmad A, Auschill TM, Dakhel R, et al. Prevalence of Candida albicans and Candida dubliniensis in caries-free and caries-active children in relation to the oral microbiota-a clinical study. Clin Oral Investig 2016;20(8):1963–1971. DOI: 10.1007/s00784-015-1696-9
  8. Schroth RJ, Quiñonez C, Shwart L, et al. Treating early childhood caries under general anesthesia: a national review of Canadian data. J Can Dent Assoc 2016;82:g20.
  9. Mathew MG, Jeevanandan G, Vishwanathaiah S, et al. Evaluation of change in quality of life, dental fear and dental anxiety in young children following full-mouth dental rehabilitation under general anesthesia for early childhood caries. J Contemp Dent Pract 2023;24(4):250–256. DOI: 10.5005/jp-journals-10024-350
  10. Mathew MG, Jeevanandan G, Vishwanathaiah S, et al. Parental and child outlook on the impact of ECC on Oral health-related quality of life: a prospective interventional study. J Contemp Dent Pract 2022;23(9):877–882. DOI: 10.5005/jp-journals-10024-3397
  11. Schroth RJ, Morey B. Providing timely dental treatment for young children under general anesthesia is a government priority. J Can Dent Assoc 2007;73(3):241–243.
  12. Pierce A, Singh S, Lee J, et al. The burden of early childhood caries in Canadian Children and associated risk factors. Front Public Health 2019;7:328. DOI: 10.3389/fpubh.2019.00328
  13. Nadkarni MA, Martin FE, Jacques NA, et al. Determination of bacterial load by real-time PCR using a broad-range (universal) probe and primers set. Microbiology (Reading) 2002;148(Pt. 1):257–266. DOI: 10.1099/00221287-148-1-257
  14. Alanazi GS, Pani SC, AlKabbaz HJ. Salivary antioxidant capacity of children with severe early childhood caries before and after complete dental rehabilitation. Arch Oral Biol 2018;95:165–169. DOI: 10.1016/j.archoralbio.2018.08.002
  15. Igarashi T, Yamamoto A, Goto N. PCR for detection and identification of Streptococcus sobrinus. J Med Microbiol 2000;49(12):1069–1074. DOI: 10.1099/0022-1317-49-12-1069
  16. Hughes CV, Dahlan M, Papadopolou E, et al. Aciduric microbiota and mutans streptococci in severe and recurrent severe early childhood caries. Pediatr Dent 2012;34(2):e16–e23.
  17. Xiao J, Moon Y, Li L, et al. Candida albicans carriage in children with severe early childhood caries (S-ECC) and maternal relatedness. PLoS One 2016;11(10):e0164242. DOI: 10.1371/journal.pone.0164242
  18. Bachtiar EW, Bachtiar BM. Relationship between Candida albicans and Streptococcus mutans in early childhood caries, evaluated by quantitative PCR. F1000Res 2018;7:1645. DOI: 10.12688/f1000research.16275.2
  19. Gregoire S, Xiao J, Silva BB, et al. Role of glucosyltransferase B in interactions of Candida albicans with Streptococcus mutans and with an experimental pellicle on hydroxyapatite surfaces. Appl Environ Microbiol 2011;77(18):6357–6367. DOI: 10.1128/AEM.05203-11
  20. Childers NK, Osgood RC, Hsu KL, et al. Real-time quantitative polymerase chain reaction for enumeration of Streptococcus mutans from oral samples. Eur J Oral Sci 2011;119(6):447–454. DOI: 10.1111/j.1600-0722.2011.00888.x
  21. Twetman S, Fritzon B, Jensen B, et al. Pre- and posttreatment levels of salivary mutans streptococci and lactobacilli in pre-school children. Int J Paediatr Dent 1999;9(2):93–98. DOI: 10.1046/j.1365-263x.1999.00108.x
  22. Chen Z, Saxena D, Caufield PW, et al. Development of species-specific primers for detection of Streptococcus mutans in mixed bacterial samples. FEMS Microbiol Lett 2007;272(2):154–162. DOI: 10.1111/j.1574-6968.2007.00756.x
  23. Loyola-Rodriguez JP, Martinez-Martinez RE, Flores-Ferreyra BI, et al. Distribution of Streptococcus mutans and Streptococcus sobrinus in saliva of Mexican preschool caries-free and caries-active children by microbial and molecular (PCR) assays. J Clin Pediatr Dent 2008;32(2):121–126.
  24. Klinke T, Urban M, Lück C, et al. Changes in Candida spp., mutans streptococci and lactobacilli following treatment of early childhood caries: a 1-year follow-up. Caries Res 2014;48(1):24–31. DOI: 10.1159/000351673
  25. Rajkumaar J, Mathew MG. Association of severe early childhood caries with salivary ferritin. J Family Med Prim Care 2020;9(8):3991–3993. DOI: 10.4103/jfmpc.jfmpc_9_20
  26. Foster T, Perinpanayagam H, Pfaffenbach A, Certo M: recurrence of early childhood caries after comprehensive treatment with general anesthesia and follow-up. J Dent Child (Chic) 2006;73(1):25–30.
  27. Mathew MG, Samuel SR, Soni AJ, et al. Evaluation of adhesion of Streptococcus mutans, plaque accumulation on zirconia and stainless steel crowns, and surrounding gingival inflammation in primary molars: randomized controlled trial. Clin Oral Investig 2020;24(9):3275–3280. DOI: 10.1007/s00784-020-03204-9
  28. Mathew MG, Roopa KB, Soni AJ, et al. Evaluation of clinical success, parental and child satisfaction of stainless steel crowns and zirconia crowns in primary molars. J Family Med Prim Care 2020;9(3):1418–1423. DOI: 10.4103/jfmpc.jfmpc_1006_19
  29. Wang Z, Shen Y, Haapasalo M. Dental materials with antibiofilm properties. Dent Mater 2014;30(2):1–16. DOI: 10.1016/
  30. Steinberg D, Eyal S. Early formation of Streptococcus sobrinus biofilm on various dental restorative materials. J Dent 2002;30(1):47–51. DOI: 10.1016/s0300-5712(01)00058-6
  31. Schmoeckel J, Gorseta K, Splieth CH, et al. How to intervene in the caries process: early childhood caries - a systematic review. Caries Res 2020;54(2):102–112. DOI: 10.1159/000504335
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