Abstract
BackgroundDespite the well-documented associations between poor maternal oral health and increased risk for adverse birth outcomes and dental caries in children after birth, prenatal oral health care is under-utilized, especially among the underserved population. In addition, oral Candida has recently been suggested as a potential culprit for children’s dental caries, with evident maternal contributions. Therefore, this study aimed to obtain epidemiological data on the oral health and oral Candida carriage in a cohort of underserved US pregnant women, and reveal factors associated with their oral Candida carriage.MethodsDemographic-medical-oral hygiene practice data were collected. Comprehensive oral examination was conducted. Caries status and plaque index were recorded. Oral samples (saliva, plaque and swab) were processed to identify Candida species and Streptococcus mutans by culturing-dependent and -independent methods. Multiple logistic regression analyses were used to identify factors associated with oral Candida carriage and caries severity.ResultsEighty-two socioeconomically disadvantaged women (48 pregnant and 34 non-pregnant) were enrolled. More pregnant women (79.1%) had > = 1 untreated decayed tooth when compared to their non-pregnant counterparts (47.1%) (p = 0.01). The average number of decayed teeth in pregnant and non-pregnant women was 3.9 and 3.1 (p > 0.05). Caries severity was positively associated with race (African American vs. white), plaque index and salivary Candida albicans level. C. albicans was the most predominant/abundant Candida strain, with cheek and tonsil as the most common colonized sites. The detection of C. albicans was 56%/56% in saliva and 40%/47% in plaque of the pregnant and non-pregnant groups, respectively. Study women’s oral Candida carriage is positively associated with hypertension [p = 0.03, odds ratio = 14.47(1.28, 163.51)], decayed teeth number [p = 0.04, odds ratio = 1.31 (1.01,1.69)] and salivary S. mutans level [p = 0.03, odds ratio = 4.80 (1.18–19.43)].ConclusionsSocioeconomically disadvantaged US women are in need of improved prenatal oral health, a large proportion of them have untreated decayed teeth and high carriage of oral Candida. Due to the observed significant association between the decayed teeth number and oral Candida carriage, providing oral health care during pregnancy (including limiting decayed teeth) will not only improve women’s oral health, but also present as a promising approach to reduce oral Candida carriage in women.
Highlights
Despite the well-documented associations between poor maternal oral health and increased risk for adverse birth outcomes and dental caries in children after birth, prenatal oral health care is under-utilized, especially among the underserved population
We showed that children with oral C. albicans presented with > 5 times greater odds of experiencing early childhood caries (ECC) than children without this yeast strain [29]
None of the study subjects were diagnosed as oral candidiasis upon clinical examination based on clinical diagnostic criteria, when we plot the amount of salivary C. albicans carried in pregnant women group (Fig. 1c), we found more than 50% of the pregnant women could be diagnosed as oral candidiasis based on the salivary Candida colony forming unit (CFU) established by Epstein et al [46]
Summary
Despite the well-documented associations between poor maternal oral health and increased risk for adverse birth outcomes and dental caries in children after birth, prenatal oral health care is under-utilized, especially among the underserved population. Poor maternal oral health is known to be associated with increased adverse birth outcomes, preterm and low birth weight deliveries [1, 2]. A recent study reanalyzed the data from a previous birth cohort, and suggested that periodontal treatment provided to mothers with mild to moderate periodontal disease before 21 weeks of gestation may prevent preterm births [4]. Besides the association between maternal periodontal diseases and adverse birth outcomes, a strong correlation was found between maternal carriage of dental caries related microorganisms and an increased risk for dental caries in children [5]. Understanding the acquisition of cariogenic microbes are vital to the development of improved preventive strategies
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