Abstract
ABSTRACT The protected niche of deep-caries lesions is a distinctive ecosystem. We assessed the Candida biome and its cariogenic traits from dentin samples of 50 children with severe-early childhood caries (S-ECC). Asymptomatic, primary molars belonging to International Caries Detection and Assessment-ICDAS caries-code 5 and 6 were analyzed, and C. albicans (10-isolates), C. tropicalis (10), C. krusei (10), and C. glabrata (5) isolated from the lesions were then evaluated for their biofilm formation, acidogenicity, and the production of secreted hydrolases: hemolysins, phospholipase, proteinase and DNase. Candida were isolated from 14/43 ICDAS-5 lesions (32.5%) and 44/57 ICDAS-6 lesions (77.2%). Compared to, ICDAS-5, a significantly higher frequency of multi-species infestation was observed in ICDAS-6 lesions (p=0.001). All four candidal species (above) showed prolific biofilm growth, and an equal potency for tooth demineralization. A significant interspecies difference in the mean phospholipase, as well as proteinase activity was noted (p < 0.05), with C. albicans being the predominant hydrolase producer. Further, a positive correlation between phospholipase and proteinase activity of Candida-isolates was noted (r = 0.818, p < 0.001). Our data suggest that candidal mycobiota with their potent cariogenic traits may significantly contribute to the development and progression of S-ECC.
Highlights
Childhood caries (ECC) is the most ubiquitous, plaque biofilm-mediated, aggressive form of dental caries affecting children the world over [1,2]
The aim of this study was first, to characterize the prevalence of Candida species in severe-early childhood caries (S-Early childhood caries (ECC)) in a Middle East child cohort, with International Caries Detection and Assessment System (ICDAS) caries code 5 and 6, and to evaluate the biofilm formation, acidogenicity, and the production of four secreted hydrolases: hemolysin, phospholipases, proteinase, and DNase in a select group of 35 wild-type C. albicans (10 strains), C tropicalis [10], C. krusei [10] and C. glabrata [5] isolated from such lesions
The severity of cavitated lesions was determined by the examiner according to ICDAS classification; viz. code 5 being a distinct cavity with visible dentine involving less than half the tooth surface, and code 6, an extensive and distinct cavity with visible dentine affecting more than half of the surface
Summary
Childhood caries (ECC) is the most ubiquitous, plaque biofilm-mediated, aggressive form of dental caries affecting children the world over [1,2]. A hypervirulent variant of this intractable disease is called severe-early childhood caries (S-ECC) [3]. According to International Caries Detection and Assessment System (ICDAS), S-ECC could subcategorized as caries code-5, a distinct cavity with visible dentin, and caries code 6, an extensive caries lesion involving half/more than half of tooth. S-ECC is rampant in the developing world due to the relatively wide and cheap availability and accessibility of sucrose substrates, and inadequate dental health care delivery systems [6]. S-ECC lesions may further progress, leading to extensive cavitation, reaching the pulp chamber, and compromising the longevity of the tooth, while simultaneously serving as a potent reservoir for systemically seeded infections [3,7,8]
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