Transmission of Streptococcus mutans from Mother to Child

REVIEW ARTICLE

TRANSMISSION OF STREPTOCOCCUS MUTANS FROM MOTHER TO CHILD

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MARIYAH JAVED, M.Phil. Scholar 2 SAIMA CHAUDHRY, PhD 3 SIDRA BUTT, M.Phil. Scholar 4 SARA IJAZ, M.Phil. Scholar 5 RABIA ASAD M.Phil. Scholar 6 FAIZA AWAIS, M.Phil. Scholar 7 AYYAZ ALI KHAN, PhD

ABSTRACT Dental caries is the most infectious and communicable dental disease of all age groups, which effects overall health of an individual. Childhood caries is a multifactorial dental disease and if left untreated it leads to discomfort, pain and lack of interest in routine activities and ultimately destroys tooth structure and early loss of tooth. Steptococcus mutans (S.mutans) is the main cariogenic microorganism. S.mutans breaks down sugar for energy and produces acidic environment, which causes demineralization of superficial structures of tooth i.e. enamel and dentin resulting in dental caries. It can be transmitted horizontally and vertically. According to the recent studies vertical mode of transmission is more common in preschool children than horizontal. Mainly the transferred genotypes are responsible for the transmission of caries from mothers to their children. There is genotypic diversity in population to population. No such relevant study has been conducted on local population so there is a need to know the main cariogenic genotypes of S.mutans and its transmission from mothers to their children in local population. Key Words: Streptococcus mutans, mother to child transmission of caries

INTRODUCTION Dental caries remains a significant oral health problem worldwide for both children and adults.1 Dental caries is the result of interaction between microorganisms mainly Streptococcus mutans (S.mutans), teeth and fermentable carbohydrates.2 S.mutans is a facultative anaerobic Gram-positive cocci, sticks to the tooth surface, break down sugar for energy, lower the Ph and produce acidic environment, which causes demineralization of superficial structures of tooth as
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(enamel and dentine), and if not treated earlier the process continues and result in future dental caries.3 The common etiological factors in Childhood Caries (CC) are prolonged use of a bottle with high sugar containing milk, juice or liquid, intake of high caries risk diet, low socio-economical groups (with low level of maternal education) and pregnant mothers having carious teeth with high salivary S.mutans count.4 Changes in salivary composition are responsible for the beginning and development of dental caries in

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Department of Oral Health Sciences, Shaikh Zayed Medical Complex, Lahore. Mobile No: 03314090878, E-mail: mariyah.javed@hotmail.com For Correspondence: 51, Eden Avenue Extension, Defence Road, Lahore Cantt. Lecturer, Cell: 03334416740, E-mail: chaudhry_s@iadsr.edu.pk Mobile no: 03454653213, E-mail: sid_nmc@hotmail.com Mobile no: 03334583736, E-mail: saraijaz_10@yahoo.com Mobile no: 03214373153, E-mail: rabya02@gmail.com Mobile no: 03004688504, E-mail: faiza.awais@gmail.com Prof & Head of Department of Oral Health Sciences, Shaikh Zayed Medical Complex, Lahore. Mobile No: 03008454981, E-mail:

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Transmission of Streptococcus mutans from Mother to Child

pregnant mother.5 Microbiological studies have proved that children usually attain S.mutans from their mothers6 and both isolated strains have shown similar bacterial profiles7-8 with similar chromosomal or plasmid DNA patterns.9-10 This shows that mothers are the main source of transmission of dental caries to their children and the frequency of vertical transmission is more common in pregnant mothers.3 According to some studies those children whose mothers S.mutans salivary count is high they get bacteria at younger ages than whose mothers salivary count is low.11-12 Modes of S.mutans Transmission As the dental caries is a transmissible disease and S.mutans bacterium can be transmitted by both horizontally and vertically.4, 9 Horizontal transmission is more common in siblings, children in same classroom, nursery or day care centers. It usually spreads through contaminated saliva, sputum, blood from one person to another one. Children in the same nursery school have reported to carry similar bacterial strains of S.mutans in their saliva.13 On the other hand, vertical transmission is from parents to children. The term is restricted by some to genetic transmission and extended by others to include also transmission of infection from one generation to the next, by fluid as saliva, milk or through the placenta.14 In vertical transmission S.mutans spread mainly from mothers to their children.15 It is important to highlight that maternal transmission of S.mutans rate is different in those children who spent about 10 h per day in nursery schools in Chinese children (45%)16 and American children (71%)17 than those attending day care nurseries. This conflict shows there is possibility in variation of transmission source, depending on behavior, the frequency of salivary contact between mother and child and a mothers salivary S.mutans level18 and cultural and environmental conditions of the population studied.10,16,19 Exact method of vertical transmission is still debatable, but it is believed according to the literature that there may be close contact between mother and children by sharing of food and utensils.20 Pregnant Mothers as a Main Source of Vertical Transmission The tendency of dental caries transmission has been reported to be higher in those children whose

mothers are pregnant and have carious teeth with high S.mutans count in their saliva.15 Pregnancy leads to many temporary adaptive changes in the body, due to release of number of hormones as estrogen, progesterone, relaxin and gonadotropin.21 Pregnancy makes negative effects on oral health as nausea and vomiting because of neglect of tooth brushing22 so during this period the chances and risk of caries, gingival, periodontal and dental infections become higher than normal. The oral cavity is affected by such endocrine actions, and may present both transient and irreversible changes as well as modifications that are considered pathological.21 Window of Infectivity High salivary S.mutans level in pregnant mother might cause transmission through a number of daily saliva contacts between the child and the mother.23 The acquisition of S.mutans suggested to occur during a distinct age period: a window of infectivity between 19 and 31 months, in which the proportion of children with S.mutans increases from 25% to 75 %.23 Studies using genotypic and phenotypic methods strongly suggest that mother is the primary source of infection for children who carry S.mutans strains19,24,25-30 and saliva is the main tool for the transfer of strains.31 Colonization of S.mutans Once transmitted, S.muatns can colonize in the grooves of infants tongue.26 On the ages of one and two, bacteria start developing colonies on teeth that finally cause Childhood Caries (CC). Berkowitz et al (2003) reported in a study that mothers with high salivary S.mutans count, that is exceeded 105 colonyforming units (CFU) were about nine times more likely to pass the causative bacteria on to their children than mothers with low salivary S.mutans count.26 High caries prevalence has been shown in Pre-school children with high colonization of S.mutans than those children with low level of S.mutans.26 So at early age colonization with S.mutans is an important factor for the beginning of early caries.15,20 This time of colonization of microorganism is important to understand the caries risk factors as well as the correct time of preventive measures should be implemented. Klein et al. (2004) studied the pattern of vertical transmission of S.mutans from mother to child, genotypic diversity and stability, in this study16 motherchild pair monitored over a 20-months period. The children harbored one to four distinct genotypes of 494

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S.mutans, presence of matching genotypes of S.mutans was similar in 81.25 % of mother-child pairs, and 16 genotypes transmitted out of 52 genotypes.30 Genotypic diversity of S.mutans It has implicated as a virulent factor, more important than bacterial count in causing dental caries.32 14 distinct genotypes have identified from 88 isolates of S.mutans in saliva samples from young adults.32 Different genotypes of S.mutans have been detected at different age groups.24, 33-34 Emanuelsson et al. (2003) found a maximum of seven genotypes in the study with young adults who had experienced dental caries in the past.35 Napimoga et al. (2004) also detected eight genotypes in caries-active subjects by using Arbitrary Primer Polymerase Chain Reaction.36 Though, according to studies it has been observed that children harbor only one to five different genotypes of S.mutans.15,25,37-39 Napimoga et al. (2004) study found reporting correlation between genotypic diversity in caries active and caries free children and have shown conflicting results.36 The findings of Pieralisi, et al. (2010) study showed a favorable relationship between caries activity and the genotypic diversity of S.mutans.40 On the other hand, Kreulen et al. (1997) detected a negative correlation between caries activity and genotypic diversity.15 While study by Lembo et al. (2000) have found noteworthy differences in the number of genotypes identified in caries-free and caries-active children.41 Polymerase Chain Reaction Method versus Culture Method A review of literature Polymerase Chain Reaction and genotyping methods have been used for the detection of S.mutans genotypes. Bacterial culture is the gold standard for the detection of S.mutans in saliva samples. Selective media as mitis-salivaris (MS) or MS-Bacitracin (MSB) agar have been used to study colony morphology for the detection of S.mutans.42-43 Disadvantages of culture are, time consuming, difficult and not easy to differentiate the microorganisms among other species.44 For the detection of S.mutans in saliva, direct microscopy, enzyme test, species-specific DNA probes, PCR and Enzyme Linked Immunosorbent assay (ELISAs) cultivation. Polymerase Chain Reaction (PCR) methods have been reported to be more sensitive and specific for the detection of S.mutans than conventional cultural tech-

nique.45-46 By this method, low numbers of bacterial species with a detection limit of as few as 25-100 cells can be detected.46 CONCLUSION The aim of this study was to perform an evaluation of S.mutans in mother-childs oral cavities, which included the pattern of vertical transmission from mother to child and its genotypic diversity, in (PeriUrban area of Pakistani Population) up to 5 years old children saliva samples by PCR and genotype methods. Genotypes vary from population to population, and no related study has been done in Pakistan. In conclusion due to poor oral hygiene, low socio-economic status, low maternal education and hormonal changes, the chances of S.mutans genotypes transfer increases from pregnant mothers to their children rather than horizontal transmission. In short complete dental services and prevention of dental caries programs for pregnant women should be accessible so that, not only their own oral and general health is secured, but also their childrens caries risk is reduced. REFERENCES
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