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Pediatr Dent. 2014 Jul-Aug;36(4):348-54.

Role of microbiological factors in predicting early childhood caries.

Author information

Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong.
Oral Sciences, Faculty of Dentistry, at the National University of Singapore, Singapore.
Oral Sciences, Faculty of Dentistry, at the National University of Singapore, Singapore.
Department of Decision Sciences, School of Business, at the National University of Singapore, Singapore.
PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam; Saw Swee Hock School of Public Health, at the National University of Singapore, Singapore.



Microbiological methods that accurately identify caries-susceptible children may enhance caries control and assist treatment planning. This study's purpose was to evaluate the usefulness of two microbiological indicators (mutans streptococci [MS] and lactobacilli [LB] levels), singly and in combination, for predicting early childhood caries (ECC) and their contributions in multifactorial modeling.


A total of 1,782 randomly selected three- to five-year-olds were recruited and underwent oral examination and microbiological tests using commercially available diagnostic kits. A questionnaire was completed by their parents. After 12 months, the caries increment in 1,576 (∼88 percent) children was assessed.


Caries risk increased with the MS and LB levels but plateaued above the LB level of 10(5) CFU/ml saliva. MS, LB, and combined MS+LB models predicted one-year caries increment (Δdmft>0) with a sensitivity/specificity of 79 percent/67 percent, 51 percent/89 percent, and 66 percent/85 percent, respectively. Sensitivity/specificity reached 80 percent/80 percent when baseline caries experience ("past caries") was added to the MS+LB model and up to 85 percent/80 percent and 81 percent/85 percent when psychosociobehavioral factors and oral hygiene status were added to the MS+LB model, without and with "past caries," respectively.


The combined "mutans streptococci+lactobacilli+past caries" model is useful for identifying at-risk children. Incorporating MS and LB into a biopsychosociobehavioral model slightly improved the prediction, even without "past caries".

[Indexed for MEDLINE]

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