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. 2022 Jul 25:12:943480.
doi: 10.3389/fcimb.2022.943480. eCollection 2022.

Candida species and selected behavioral factors co-associated with severe early childhood caries: Case-control study

Michaela Cvanova  1   2 , Filip Ruzicka  3 , Martina Kukletova  4 , Bretislav Lipovy  5 , Daniela Gachova  1 , Lydie Izakovicova Holla  4 , Zdenek Danek  1   6 , Veronika Hola  3 , Michaela Bartosova  4 , Jiri Jarkovsky  2 , Ladislav Dusek  2 , Petra Borilova Linhartova  1   4   6   7
Affiliations

Candida species and selected behavioral factors co-associated with severe early childhood caries: Case-control study

Michaela Cvanova et al. Front Cell Infect Microbiol. .

Abstract

Severe Early Childhood Caries (sECC) is a multifactorial disease associated with the occurrence of specific oral microorganisms and other environmental, behavioral, and genetic factors. This study aimed to construct a multivariable model including the occurrence of Candida spp. and selected behavioral factors (length of breastfeeding, serving sweet beverages and beginning of brushing child's teeth) to determine their relationships to the occurrence of sECC. In this case-control study 164 children with sECC and 147 children without dental caries were included. MALDI-TOF MS and multiplex qPCR were used to identify Candida spp. and selected bacteria in dental plaque samples, respectively. A questionnaire on oral hygiene, diet, and children's health was filled in by the parents. The constructed multivariable logistic regression model showed an independent influence of the microbial and behavioral factors in sECC etiopathogenesis. The occurrence of C. albicans and C. dubliniensis was associated with higher odds of sECC development (odds ratio, OR: 9.62 and 16.93, respectively), together with breastfeeding of 6 months or less (OR: 2.71), exposure to sweet beverages (OR: 3.77), and starting to brush child's teeth after the 12th month of age (OR: 4.10), all statistically significant (p < 0.01). Considering the high occurrence of C. albicans and C. dubliniensis in dental plaque in children with sECC, we propose them as "keystone pathogens" and risk factors for sECC. The models showed that presence of specific species of Candida in dental plaque may be a better descriptor of sECC than the mentioned behavioral factors.

Keywords: Candida dubliniensis; Candida sp.; Streptococcus mutans; breastfeeding; brushing of teeth; severe early childhood caries (sECC); sweet beverages.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Schema of primary teeth affected by dental caries in all 164 children with severe early childhood caries (sECC, with decay, missing, filled teeth for caries, dmft ≥ 6) included in this study. The percentage of affection of individual teeth by dental caries is expressed using the greyscale. For bacterial sampling, teeth affected by dental caries were selected – these teeth are marked by red lines.
Figure 2
Figure 2
Occurrence and diversity of the investigated oral microorganisms in the subgingival and supragingival dental plaque in the groups of children with sECC and controls. A. actinomycetemcomitans, Aggregatibacter actinomycetemcomitans; C., Candida; S. cerevisiae, Saccharomyces cerevisiae. */** p < 0.05/p < 0.001, statistically significant results between group of the children with sECC and controls, the difference is tested with Fisher’s exact test.
Figure 3
Figure 3
Microbial co-occurrence of Candida spp., selected cariogenic and periodontal bacteria in the groups of children with severe early childhood caries (sECC) and controls. Combinations for children with sECC are shown above the diagonal line, those for controls are below the line. A. actinomycetemcomitans, Aggregatibacter actinomycetemcomitans.
Figure 4
Figure 4
Significant relationships between behavioral risk factors for severe early childhood caries (sECC) development.
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