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Biomedical subjects

J van Houte

Publications and source records attributed to J van Houte.

At least 19 recordsLinked to original sources

The pH of dental plaque in its relation to early enamel caries and dental plaque flora in humans.

Dental caries appears to result from the action of multiple, interrelated factors. A companion study dealt with the plaque-flora/caries relationship (van Ruyven et al., 2000). The plaque-pH/caries relationship is the subject of this study. Since both studies involve the same subjects, plaques, and tooth surfaces, data on the examined factors have also been integrated. In vivo plaque pH determinations (microelectrode) were done on buccal sound (s) and "white-spot" (ws) caries surfaces in a selected dentition area in a low-caries (no ws) and higher-caries subject group. The pH response to sugar was evaluated before and after a sugar rinse, a local sugar application, or sucking on a sugary lozenge. pH profiles with sugar rinsing and normal or limited salivary flow conditions, showed progressively decreasing plaque pH values at various time points in the order of: low-caries subjects (s sites), higher-caries subjects (s sites), higher-caries subjects (s + ws sites), and higher-caries subjects (ws sites). The minimum pH values showed the same trend. Analyses of all data indicated only a statistical difference for minimum values for s sites in low-caries subjects vs. ws sites in higher-caries subjects, and for s and ws sites in the latter. Local sugar application and sucking on a sugary lozenge induced smaller pH drops than sugar rinsing; such suboptimal sugar exposure caused a disappearance of the difference between the minimum pH values for s and ws sites observed with sugar rinsing in the higher-caries subjects. Initial plaque pH values were similar regardless of subject or tooth caries status. The values were also not correlated with the plaque levels of strongly iodophilic polysaccharide-storing bacteria. Collectively, both studies indicate that increasing subject caries status is characterized by increasing plaque levels of highly-acid-tolerant, acidogenic bacteria and an increasing plaque-pH-lowering potential and support the dynamic relationship between these parameters.

Administration, Topical↗

Relationship among mutans streptococci, "low-pH" bacteria, and lodophilic polysaccharide-producing bacteria in dental plaque and early enamel caries in humans.

Multiple interactions occur among major determinants of dental caries. We have studied the bacterial flora and pH-lowering capacity of the same dental plaques in relation to caries. The findings on the plaque flora are reported here. The buccal surfaces of upper teeth in each subject were selected for study. A low-caries group had no "white spot" caries (ws) in the selected dentition area; a higher-caries group averaged 4.1 ws in this area. The latter group was divided into subjects with 2, 3, or 4 ws and subjects with 5, 6, or 7 ws. Enumerated organisms in plaque samples (sound and ws sites) from all subjects were: (1) mutans streptococci (MS) on mitis-salivarius-bacitracin and mitis-salivarius agar; (2) non-mutans streptococci (non-MS) on mitis-salivarius agar; (3) organisms that were categorized according to their minimum pH in sugar broth, i.e., the predominant undifferentiated total flora on blood agar or the predominant non-MS flora on mitis-salivarius agar; and (4) iodophilic polysaccharide-storing organisms on trypticase-yeast extract-salts agar. Plaques covering ws lesions contained generally only low proportions (< 0.1%) of MS. The plaque proportions of all the above 4 bacterial groups were increased in the higher-caries group but were similar for s and ws sites in this group. Over half of the total plaque flora in subjects with 5, 6, or 7 ws consisted of "low-pH"-type organisms (minimum pH < 4.4). Many of these were neither MS nor "low-pH" non-MS. The numerical emergence of MS in plaque appeared to be preceded often by other types of "low-pH" bacteria, including the non-MS. Caries development in the absence or presence of MS as well as different bacterial successions in plaque can be explained readily by the dynamic and positive relationship among the factors carbohydrate consumption, plaque flora composition, plaque acidogenic potential, and caries activity.

Adolescent↗

Food starches and dental caries.

Sucrose and starches are the predominant dietary carbohydrates in modern societies. While the causal relationship between sucrose and dental caries development is indisputable, the relationship between food starch and dental caries continues to be debated and is the topic of this review. The current view of dental caries etiology suggests that in-depth evaluation of the starch-caries relationship requires the consideration of several critical cariogenic determinants: (1) the intensity (i.e., the amount and frequency) of exposure of tooth surfaces to both sugars and starches, (2) the bioavailability of the starches, (3) the nature of the microbial flora of dental plaque, (4) the pH-lowering capacity of dental plaque, and (5) the flow rate of saliva. Studies of caries in animals, human plaque pH response, and enamel/dentin demineralization leave no doubt that processed food starches in modern human diets possess a significant cariogenic potential. However, the available studies with humans do not provide unequivocal data on their actual cariogenicity. In this regard, we found it helpful to distinguish between two types of situations. The first, exemplified by our forebears, people in developing countries, and special subject groups in more modern countries, is characterized by starch consumption in combination with a low sugar intake, an eating frequency which is essentially limited to two or three meals per day, and a low-to-negligible caries activity. The second, exemplified by people in the more modern societies, e.g., urban populations, is characterized by starch consumption in combination with significantly increased sugar consumption, an eating frequency of three or more times per day, and a significantly elevated caries activity. It is in the first situation that food starches do not appear to be particularly caries-inducive. However, their contribution to caries development in the second situation is uncertain and requires further clarification. Although food starches do not appear to be particularly caries inducive in the first situation, the possibility cannot be excluded that they contribute significantly to caries activity in modern human populations. The commonly used term "dietary starch content" is misleading, since it represents a large array of single manufactured and processed foods of widely varying composition and potential cariogenicity. Hence, increased focus on the cariogenicity of single starchy foods is warranted. Other aspects of starchy foods consumption, deserving greater attention, include the bioavailability of starches in processed foods, their retentive properties, also in relation to sugars present (starches as co-cariogens), their consumption frequency, the effect of hyposalivation on their cariogenicity, and their impact on root caries. The starch-caries issue is a very complex problem, and much remains uncertain. More focused studies are needed. At present, it appears premature to consider or promote food starches in modern diets as safe for teeth.

Animals↗

The final pH of bacteria comprising the predominant flora on sound and carious human root and enamel surfaces.

Acidogenesis at low pH appears to be an important bacterial cariogenic trait. However, most information in this regard pertains to only a few of the acidogenic dental plaque bacteria. Therefore, the 'final' pH in sugar broth was determined for a wide variety of oral bacteria. Their source was: (1) carious material from advanced root lesions (ARL), (2) plaque from sound root surfaces of root-caries-free subjects (SRS), (3) plaque from "white spot" coronal lesions and sound coronal surfaces of caries-active subjects, and (4) plaque from sound coronal surfaces of caries-free subjects. Strains from groups 1 and 2 (ARL, 389 strains; SRS, 358 strains) were previously identified (van Houte et al., 1994) to the genus/species level and belonged to the predominant cultivable flora (PCF). Strains from groups 3 and 4 also belonged to the PCF but were not identified. All strains were placed in one of 4 final pH categories: < 4.2, 4.2-4.4, 4.4-4.6, and > or = 4.6. The main findings were: (1) ARL samples contained many strains with a final pH < 4.2 (mean percentage of 25.7). They included all strains of Lactobacillus and mutans streptococci (MS), most Bifidobacterium strains and non-mutans streptococci (non-MS), and about 20% of the Actinomyces strains. By contrast, SRS samples contained far fewer strains with a final pH < 4.2 (mean percentage of 8.4) which were nearly all non-MS. (2) Organisms with a final pH < 4.4 constituted mean percentages of 41.5 and 32.1 for the ARL and SRS samples, respectively. (3) The final pH distribution of strains in samples from coronal surfaces showed a tendency relative to caries activity (group 3 vs. group 4) similar to that for groups 1 and 2. Our findings further support the concept that increased cariogenic conditions are associated with increased proportions of organisms capable of acidogenesis at a low pH and that this shift involves organisms other than the MS and lactobacilli.

Bacteria↗

Effect of antibody in gingival crevicular fluid on early colonization of exposed root surfaces by mutans streptococci.

The effect of antibody to Streptococcus mutans in gingival crevicular fluid (GCF) on the recolonization of cleaned buccal root surface sites by indigenous mutans streptococci was studied. Seven subjects (mean age = 64 years) were selected from a population of 28 on the basis of the presence of appropriate sites with and without detectable immunoglobulin G (IgG) antibody in GCF to formalin-killed S. mutans and adequate levels of mutans streptococci in saliva available for root surface recolonization. Root surfaces exposed to GCF that did or did not contain antibody were then cleaned and sampled for residual plaque organisms (total cultivable flora and mutans streptococci) directly after cleaning (time 0) as well as 24 h later. One subject failed to recolonize at 24 h at any (antibody-positive or antibody-negative) experimental site. For each of the remaining 6 subjects, the mean levels of mutans streptococci (mean percentage of total flora) were lower at sites with IgG antibody to S. mutans in GCF than at antibody-negative sites in the same subject. In each of the 6 subjects, the site with the highest recolonization level was antibody-negative. Comparison based on intrasubject randomization of sites suggested diminished recolonization of mutans streptococci at sites with antibody 24 h after cleaning. The results support the idea that antibody in GCF can modify the early colonization of gingival root surface areas by potentially cariogenic plaque bacteria such as mutans streptococci.

Aged↗

Role of micro-organisms in caries etiology.

The microbial etiology of dental caries is discussed in terms of the dynamic relationship among the dental plaque microbiota, dietary carbohydrate, saliva, and the pH-lowering and cariogenic potential of dental plaque. The evidence supports a concept of caries as a dietary carbohydrate-modified bacterial infectious disease. Its key feature is a dietary carbohydrate-induced enrichment of the plaque microbiota with organisms such as the mutans streptococci and lactobacilli which causes an increase of plaque's pH-lowering and cariogenic potential. The shift in the plaque proportions of these organisms appears to be related to their relatively high acid tolerance. A large body of evidence also supports a major effect of saliva on caries development. Integration of salivary effects with the concept of caries as a dietary carbohydrate-modified bacterial infectious disease suggests a broader concept which includes a major role of saliva in the regulation of the exposure of tooth surfaces to carbohydrate and of plaque acidity and, hence, the microbial composition and the pH-lowering and cariogenic potential of dental plaque. It is proposed that caries occurs preferentially in dentition sites characterized by a relatively high exposure to carbohydrate and diminished salivary effects. Some implications of this concept are discussed.

Dental Caries↗

The predominant cultivable flora of sound and carious human root surfaces.

Little detailed knowledge exists about the composition of the human root flora. Therefore, the predominant cultivable flora (PCF) was determined for samples of: (1) plaque from sound root surfaces (SRS) in eight subjects without root caries, (2) plaque from incipient root lesions (IRL) in eight subjects with root caries, and (3) carious material from advanced root lesions (ARL) in nine other subjects with root caries. Generally, one root surface was sampled per subject, and organisms-358, 512, and 389 for SRS, IRL, and ARL, respectively-were identified by standard methods. It was found that: (1) streptococci, actinomyces, and veillonellae constituted 84.2, 57.8, and 65.7% of the PCF of SRS, IRL, and ARL samples, respectively; (2) a wide variety of other Gram-positive cocci and Gram-positive and -negative rods was also present; (3) the PCF of many samples was often dominated by few organisms, the identity of which differed from sample to sample; (4) a negative and no association with root caries existed for the PCF levels of the non-mutans streptococci (non-MS) and the actinomyces; and (5) mutans streptococci (MS) and lactobacilli (L) were not always present among the PCF of IRL and ARL, respectively, and non-MS were isolated from the PCF of most lesions and actinomyces from all lesions. Our findings illustrate the complexity of the root surface flora and suggest that root caries development involves organisms other than MS and L.

Actinomyces↗

Oral streptococcal colonization of infants.

The objective of this study was to determine the prevalence and proportions of different streptococcal species among the streptococcal flora during infancy. A total of 60 oral samples were collected by oral swabbing of the buccal mucosa and alveolar ridges of 18 infants before tooth eruption and from buccal and lingual surfaces of teeth after tooth eruption. A total of 549 isolates on mitis salivarius agar were speciated, principally by recently revised biochemical criteria of Kilian et al. Streptococcus mitis biovar 1 predominated, both in prevalence (89%) and proportion of oral streptococci recovered in each sample (median = 87% of streptococcal flora). Streptococcus salivarius was also prevalent (94%) but generally represented a small percentage of the total streptococcal flora (median = 3%). Streptococcus oralis and Streptococcus anginosus strains were detected in approximately one third of predentate and dentate infants in the first year of life. Streptococcus sanguis strains were not detected before tooth eruption, but could be detected in 7/14 of the infants with teeth. Thus, S. mitis constitutes the major component of the initially colonizing streptococcal microbiota of the young infant.

Alveolar Process↗

Effect of sucrose concentration on the cariogenic potential of pooled plaque fluid from caries-free and caries-positive individuals.

Pooled plaque samples were obtained from (1) coronal surfaces of two groups of caries-free (CF) subjects, (2) coronal 'white-spot' surface areas of a group of caries-positive (CP) subjects, and (3) exposed, sound root surfaces of root caries-free (RCF) and root caries-positive (RCP) subjects. The plaque samples were obtained before and 3 min after a 1 min rinse with a 0.5, 1, 2, 5 and 10% sucrose solution. Plaque fluid was then isolated from each plaque sample by centrifugation and analyzed for inorganic ions, organic acids, and pH values. With increasing sucrose concentration: (1) plaque fluid pH and the degree of saturation (DS) with respect to tooth mineral decreased; (2) the pH and DS values of CP and RCP samples were consistently lower than those of CF and RCF samples, respectively; (3) plaque fluid lactic acid concentrations increased and were consistently higher in the CP and RCP samples than in the CF and RCF samples, respectively, and (4) plaque fluid lactic acid concentrations leveled off between 1 and 5% sucrose; this occurred at lower sucrose concentrations with CP and RCP samples than with CF and RCF samples, respectively. RCP samples contained consistently higher levels of mutants streptococci than RCF samples. The chemical composition of plaque fluids, following sucrose exposure, were found to correlate well with caries history. The observed differences in lactic acid concentrations in samples from CF and CP subjects are discussed with regard to differences in microbiological composition and possible differences in plaque permeability to sucrose.

Adolescent↗

Microbiological predictors of caries risk.

The prediction of caries risk has been of long-standing interest. Generally, few of the tests involving oral bacteria or their products have become accepted. Presently, the main focus is on counts of lactobacilli (L) and mutans streptococci (MS). Due to their positive numerical association with human caries and the linkage of this association to carbohydrate consumption, counts of L and MS may, potentially, serve not only as a caries risk predictor but also as an indicator of carbohydrate consumption, another caries-risk factor. The value of counts of L and MS as caries-risk predictors has been evaluated by means of studies providing data on test sensitivity, specificity, and predictive values. These and other studies indicate that their use for the prediction of caries risk of individuals is not possible but is more promising for that of the caries risk of groups (e.g., identification of high-caries-risk subjects); further, the prediction of low caries risk may be more reliable than that of high caries risk. The influence of test variables on the test results has been discussed. These include the level of caries increment, subject age, methods of caries evaluation, use of saliva or dental plaque as test sample, sampling frequency, type of bacterial growth medium, and the use of simplified methods rather than conventional laboratory procedures for microbial enumeration. An approach to optimize the use of microbiological caries-risk predictors in different populations as well as their use in conjunction with other caries-risk predictors has been discussed. The latter include the incipient caries lesion or past caries experience and salivary buffering capacity and flow rate. Due to the multifactorial nature of caries etiology, it is expected that multivariate approaches rather than the use of single parameters may improve caries risk prediction for individuals as well as groups of subjects.

Colony Count, Microbial↗

Enamel demineralization by acid produced from endogenous substrate in oral streptococci.

Bovine enamel blocks were covered by a bacterial cell mass and held in the mouths of human volunteers by a palatal appliance, to study the effects of acid production from endogenous bacterial substrate on the pH of the mass and on enamel demineralization. Variables were cells with and without endogenous substrate, rinsing with 10 per cent glucose or sucrose solution, or no rinsing and the type of organism. Acid production from endogenous substrate by Streptococcus mutans strain IB-1600, due, at least in part, to intracellular glycogen degradation, caused a marked and prolonged pH drop and significant enamel demineralization. A similar but less marked effect was obtained with a strain of Streptococcus mitis, Streptococcus sanguis and Actinomyces viscosus. Thus acid production from endogenous sources by plaque bacteria may be of importance in the aetiology of dental caries.

Acids↗

Variable colonization by oral streptococci in molar fissures of monoinfected gnotobiotic rats.

Germfree Sprague-Dawley rats, fed a high-sucrose diet, were monoinfected with strains of Streptococcus mitis, Streptococcus sanguis, and Streptococcus mutans. Viable cell recoveries from six molar teeth, considered to reflect mainly bacterial colonization of intact fissures, were in the order of 10(6), 10(7), and 10(8) CFU, respectively. Some of the implications of the variation of bacterial plaque-forming ability in the rat model are discussed.

Animals↗

The intra-oral effect on enamel demineralization of extracellular matrix material synthesized from sucrose by Streptococcus mutans.

The role of extracellular matrix material (EMM) synthesized from sucrose (S) by Streptococcus mutans IB-1600 in altering the demineralizing potential of artificial plaque was evaluated with an intraoral enamel demineralization test (IEDT). The artificial plaque samples were prepared from cells cultivated in Todd-Hewitt broth (THB) supplemented with various S concentrations and by mixing THB-grown cells with increasing proportions of EMM (heat-killed THB + 2% S-cultivated cells). The samples were also evaluated for cell density (DNA content) and acidogenicity in vitro (pH-stat), as well as for in situ pH changes during a 45-minute intra-oral test following a 10% glucose rinse. An increase in the proportion of EMM relative to cell density was associated with an increase in enamel demineralization. This trend reversed when the ratio of cells to EMM was less than 1:19. Experiments involving strains of S. mitis, S. sanguis, and S. salivarius suggested a similar effect of EMM. The intra-oral pH data suggest that the presence of EMM may enhance demineralization by altering diffusion properties of plaque.

Acids↗

Infectivity and natural transmission of the bacterium Streptococcus mutans in monkeys (Macaca fascicularis) at different ages.

Oral inoculation of adolescent monkeys with laboratory strains of Streptococcus mutans resulted in only sporadic implantation. Oral colonization of all strains, except possibly one, was not enhanced by dietary sucrose compared with glucose nor by precleaning of accessible tooth surfaces. Infant animals were more susceptible to implantation by laboratory-maintained strains of Strep. mutans than adolescent or adult animals. This difference was magnified when in-vivo maintained Strep. mutans strains were used. Strep. mutans was readily acquired by uninfected adolescent animals from infected cage mates. Strep. mutans-free adolescent monkeys exhibited significant-salivary IgA and serum-IgG response to Strep. mutans antigen, possibly representing a cross-reaction to indigenous Streptococcus sanguis. Uninfected infant animals showed no salivary or serum response to Strep. mutans. There was no change in salivary IgA antibody to Strep. mutans in adolescent animals after implantation or in recipient animals after acquisition of Strep. mutans.

Age Factors↗

In-vitro inhibition of glucosyltransferase from the dental plaque bacterium Streptococcus mutans by common beverages and food extracts.

Some fruit juices and beverages inhibit the glucosyltransferases of Streptococcus mutans. Inhibition by cocoa, coffee and tea was due partly to gelatin-precipitable tannins and partly to components that exhibited properties of monomeric polyphenols. Charcoal treatment removed all inhibitory activity. Catechin, a known constituent of these beverages, was an effective inhibitor of the enzymes. The effects of the fruit juices were attributable mainly to the inhibition of the glucosyltransferases by the endogenous fructose and glucose. The findings show that naturally-occurring constituents of foods can inhibit extracellular polysaccharide formation from sucrose. Such constituents may play a role in regulating dental plaque formation in vivo and, thereby, may have long-term effects on the development of dental caries.

Beverages↗

Transmission of the oral bacterium Streptococcus mutans to young Macaca fascicularis monkeys from human nursery attendants.

Streptococcus mutans was detected in the mouths of 2 out of 7 infant monkeys that had been delivered by caesarian section and nursery-reared without contact with their mothers or other monkeys. Their human nursery attendants all harboured Strep. mutans biotype c (c serotype) as found in the monkeys. Bacteriocin studies also indicated similarity between the animal and human isolates. These findings suggest that the infant monkeys acquired Strep. mutans from the nursery personnel. Evidence for the reverse transmission of enterococci, from monkeys to man was also obtained.

Animals↗

Effect of some salts of calcium, sodium, potassium, and strontium on intra-oral enamel demineralization.

A newly-developed intra-oral enamel demineralization test was used to evaluate the effect of supplementation of a 10% sucrose solution with various components on enamel demineralization induced by the sucrose. Five human subjects wore a palatal prosthesis holding eight blocks of subsurface bovine enamel covered with a layer of S. mutans cells. The test involved rinsing with sucrose solution or with sucrose solution supplemented with 0.162 mol/l of different calcium salts or equivalent concentrations of Na-, K-, and Sr salts; rinsing was for one min at times zero and 45 min of the 90-minute test period. Ca-propionate, Ca-acetate, and Ca-levulinate completely inhibited sucrose-induced enamel demineralization; Ca-chloride, Ca-lactate, and Ca-ascorbate gave from 65-75%, and K-acetate, Na-lactate, and Sr-lactate 39, 25, and 18% inhibition, respectively. Consideration of the anion dissociation constants and the Ca-anion association constants of the salts suggests that the observed inhibition is caused mainly by common ion effects and, to a lesser extent, by buffer effects.

Adult↗