Supplementary Material for: Changes in Candida spp., Mutans Streptococci and Lactobacilli following Treatment of Early Childhood Caries: A 1-Year Follow-Up

Early childhood caries (ECC) is closely related to high numbers of mutans streptococci, lactobacilli and Candida albicans. Oral colonization of these microorganisms was monitored in a prospective clinical study in order to investigate the effect of comprehensive treatment under general anesthesia and the sustainability of microbial changes. Saliva samples were collected from 50 healthy infants with ECC before and in regular intervals up to 12 months after treatment. Microorganisms were detected by cultivation on selective agars (CRT® bacteria and Sabouraud/CandiSelect™) and scored. Additionally, plaque on upper front teeth and the dmft were recorded. Parents were repeatedly interviewed regarding the children's diet and oral hygiene, accompanied by corresponding advice. Plaque frequency and the numbers of mutans streptococci, lactobacilli and yeasts were significantly reduced as a result of treatment (p < 0.0001, Wilcoxon test). Nevertheless, this effect was not permanent. An ordinal regression model on the follow-up period revealed that the odds for bacteria and yeasts to reach a higher score increased linearly over time (p < 0.01) with an odds ratio of 2.244 per year. One third (34%) of the children developed new dentinal lesions within 1 year postoperatively. High scores of lactobacilli before treatment predicted caries relapse (p < 0.05). Nutritional and oral hygiene habits changed only slightly despite advising. Elimination and restoration of ECC lesions under general anesthesia proved to be an effective procedure in reducing cariogenic bacteria and yeasts. A satisfactory and sustainable success, however, could be achieved neither regarding microbiologic parameters nor with respect to the relapse rate. More suitable strategies are needed.

儿童早期龋病（Early childhood caries, ECC）与高载量的变形链球菌（mutans streptococci）、乳酸杆菌（lactobacilli）及白色念珠菌（Candida albicans）密切相关。本前瞻性临床研究对上述微生物的口腔定植情况进行监测，以探究全身麻醉下综合治疗的效果及微生物学变化的可持续性。研究人员从50例罹患ECC的健康婴幼儿体内采集唾液样本，采集时间涵盖治疗前及治疗后12个月内的各定期随访时间点。通过选择性琼脂培养基（CRT®细菌培养基与Sabouraud/CandiSelect™培养基）培养检测微生物并完成评分。此外，记录上颌前牙菌斑情况及龋失补指数（decayed, missing, filled teeth, dmft）。研究人员反复对患儿家长开展儿童饮食与口腔卫生相关访谈，并同步提供针对性健康指导。治疗后，菌斑检出率、变形链球菌、乳酸杆菌及酵母菌的数量均显著降低（p < 0.0001，威尔科克森检验（Wilcoxon test））。但该治疗效果并非持久。针对随访周期的有序回归模型分析显示，微生物及酵母菌评分升高的比值比（odds ratio）随时间呈线性增长（p < 0.01），年均比值比为2.244。术后1年内，三分之一（34%）的患儿出现了新的牙本质龋损。治疗前乳酸杆菌高评分可预测龋病复发（p < 0.05）。尽管给予了相应指导，患儿的营养与口腔卫生习惯仅发生轻微改变。全身麻醉下清除并修复ECC病变被证实是降低致龋菌及酵母菌数量的有效手段。但无论是微生物学指标还是龋病复发率层面，均无法获得令人满意且持久的治疗效果。亟需探索更为适宜的干预策略。