Profuse diversity and acidogenicity of the candida-biome of deep carious lesions of Severe Early Childhood Caries (S-ECC)

Abstract

Introduction: The retentive niches of deep caries lesions have a distinct biome. Methods: We evaluated the site-specific (occlusal and proximal) Candida -biome of Severe-Early Childhood Caries (S-ECC) in 66- children (132 lesions). Asymptomatic primary molars fitting the definition of the International Caries Detection and Assessment-(ICDAS)-caries-code 5/6 were analyzed. Deep-dentinal sampling and simultaneous assessment of pH were performed. Clinical isolates were speciated using multiplex-PCR and evaluated for their acidogenic and aciduric potential. Results: Surprisingly, a high prevalence of Candida species (72.7%), either singly or in combination, was noted from both the proximal and occlusal cavities. C. tropicalis was the most prevalent species (47%; 34/72), followed by C. krusei (43.1%; 31/72) and C. albicans (40.3%; 29/72), with C. glabrata being the least (9.7%; 7/72). Over 45% low-pH niches (pH <7) of both sites yielded either dual or triple species of Candida . Genotyping revealed three distinct C. albicans genotypes (A, B, and C) with (14/29; 48.3%) of strains belonging to Genotype A. All four evaluated Candida species exhibited acidogenic and aciduric potential, C. tropicalis being the most potent. Conclusion: This, the first report of the high-density, multispecies, yeast colonization of deep-dentinal lesions in S-ECC, suggests that the Candida -biome plays a significant etiologic role in the condition, possibly due to their profound acidogenicity in milieus rich in dietary carbohydrates.

Diversity of site-specific microbes of occlusal and proximal lesions in severe- early childhood caries (S-ECC)

“…In terms of the predominant microbiota of dental caries, both streptococcal and lactobacillus genera have long been recognized to play a critical role, although recent work indicates clearly that fungi, predominantly Candida species, are prevalent in deep cavitated lesions [ 18 , 19 ]. Indeed, in a recent study, we have unequivocally demonstrated the profusion of candidal species in S-ECC [ 20 ]. Furthermore, the current consensus is that caries, in general, is not caused by specific organisms, such as Streptococcus mutans and lactobacilli, but by a polymicrobial consortium of cariogenic species.…”

Diversity of Site-Specific Microbes of Occlusal and Proximal Lesions in Severe- Early Childhood Caries (S-ECC)

“…Both streptococci and lactobacilli have long been recognized to play a critical role in dental caries, although recent work indicates clearly that fungi, predominantly Candida species, play a critical role, particularly in the deep cavitated caries lesions [18]. Indeed, in a recent study, we have unequivocally demonstrated the profusion of candidal species in S-ECC [19]. Furthermore, the current consensus is that caries, in general, is not caused by speci c organisms, such as Streptococcus mutans and lactobacilli, but by a polymicrobial consortium of cariogenic species.…”

Candida albicans and Early Childhood Caries

“…Although some pilot clinical studies with limited subjects did not observe significant differences in the prevalence of oral C. albicans between children with or without dental caries (9,10), multiple lines of evidence have shown that the presence of C. albicans in saliva and dental plaque is strongly associated with dental caries, especially ECC. In this regard, a number of cross-sectional studies have revealed that the prevalence of oral C. albicans in ECC children is significantly higher than that in caries-free children (4,(11)(12)(13)(14). In addition, several studies indicate that both the prevalence and carriage of oral C. albicans is positively correlated with the severity of ECC (12,(15)(16)(17).…”

“…It was found that genotypes A, B, and C are typically detected in the dental plaque of children, genotype D is found in the periodontal pocket of patients with periodontitis, while genotype E is rarely present in the oral cavity (13). Others found that genotype A is mostly predominant in plaque biofilms of children with S-ECC, followed by genotypes C and B (11). In addition, genotype A was predominantly associated with proximal lesions, whereas genotypes B and C were mainly isolated from occlusal cavities.…”

“…Although analysis of the number and biomass of microorganisms associated with dental caries revealed that S. mutans dominates in number followed by Lactobacilli and C. albicans, the biomass of C. albicans is much larger than that of Lactobacilli and S. mutans (25)(26)(27). Clinical studies have shown that the presence of C. albicans in the oral cavity is associated with a highly acidogenic and aciduric bacterial community in S-ECC (11,20). Despite being lower in abundance, C. albicans dissolved hydroxyapatite crystals at a 20-fold faster rate than S. mutans (26).…”