Non-intubated recovery from refractory cardiogenic shock on percutaneous VA-extracorporeal membrane oxygenation.

We report on the use of percutaneous femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in a fully awake, non-intubated and spontaneously breathing patient suffering from acute, severe and refractory cardiogenic shock due to a (sub)acute anterior myocardial infarction. Intensified heart failure therapy was closely monitored with a pulmonary artery catheter and allowed gradual weaning off the ECMO support without additional invasive measures, notably without mechanical ventilation. Neurological assessment was possible at all times and complete physical mobilisation was straightforward directly after weaning from ECMO. This limited invasive approach may encourage a more widespread use of percutaneous VA-ECMO.

Association of caries activity with the composition of dental plaque fluid.

This study tests the hypothesis that caries activity is associated with lower degrees of saturation with respect to enamel mineral in dental plaque fluid following sucrose exposure. Plaque fluids were obtained from caries-free, caries-positive, and caries-active subjects. Samples were collected before and at 3 and 7 min after a sucrose rinse on consecutive weeks and analyzed for organic acids, inorganic ions, pH, calcium activity, and, in selected samples, total protein. After sucrose, pH values were significantly lower in the caries-active group in comparison with the caries-free and caries-positive groups. Total and free calcium concentrations increased with decreasing pH, with free calcium being about one-third of total calcium. The caries-active group exhibited significantly lower degrees of saturation with respect to enamel mineral, after sucrose, and had significantly higher mutans streptococci levels in plaque than did the caries-free samples. Thus, saturation levels in post-sucrose plaque fluids reflect the cariogenic potential of dental plaque.

Food starches and dental caries.

Sucrose and starches are the predominant dietary carbohydrates in modern societies. While the causal relationship between sucrose and dental caries development is indisputable, the relationship between food starch and dental caries continues to be debated and is the topic of this review. The current view of dental caries etiology suggests that in-depth evaluation of the starch-caries relationship requires the consideration of several critical cariogenic determinants: (1) the intensity (i.e., the amount and frequency) of exposure of tooth surfaces to both sugars and starches, (2) the bioavailability of the starches, (3) the nature of the microbial flora of dental plaque, (4) the pH-lowering capacity of dental plaque, and (5) the flow rate of saliva. Studies of caries in animals, human plaque pH response, and enamel/dentin demineralization leave no doubt that processed food starches in modern human diets possess a significant cariogenic potential. However, the available studies with humans do not provide unequivocal data on their actual cariogenicity. In this regard, we found it helpful to distinguish between two types of situations. The first, exemplified by our forebears, people in developing countries, and special subject groups in more modern countries, is characterized by starch consumption in combination with a low sugar intake, an eating frequency which is essentially limited to two or three meals per day, and a low-to-negligible caries activity. The second, exemplified by people in the more modern societies, e.g., urban populations, is characterized by starch consumption in combination with significantly increased sugar consumption, an eating frequency of three or more times per day, and a significantly elevated caries activity. It is in the first situation that food starches do not appear to be particularly caries-inducive. However, their contribution to caries development in the second situation is uncertain and requires further clarification. Although food starches do not appear to be particularly caries inducive in the first situation, the possibility cannot be excluded that they contribute significantly to caries activity in modern human populations. The commonly used term "dietary starch content" is misleading, since it represents a large array of single manufactured and processed foods of widely varying composition and potential cariogenicity. Hence, increased focus on the cariogenicity of single starchy foods is warranted. Other aspects of starchy foods consumption, deserving greater attention, include the bioavailability of starches in processed foods, their retentive properties, also in relation to sugars present (starches as co-cariogens), their consumption frequency, the effect of hyposalivation on their cariogenicity, and their impact on root caries. The starch-caries issue is a very complex problem, and much remains uncertain. More focused studies are needed. At present, it appears premature to consider or promote food starches in modern diets as safe for teeth.

The pH of dental plaque in its relation to early enamel caries and dental plaque flora in humans.

Dental caries appears to result from the action of multiple, interrelated factors. A companion study dealt with the plaque-flora/caries relationship (van Ruyven et al., 2000). The plaque-pH/caries relationship is the subject of this study. Since both studies involve the same subjects, plaques, and tooth surfaces, data on the examined factors have also been integrated. In vivo plaque pH determinations (microelectrode) were done on buccal sound (s) and "white-spot" (ws) caries surfaces in a selected dentition area in a low-caries (no ws) and higher-caries subject group. The pH response to sugar was evaluated before and after a sugar rinse, a local sugar application, or sucking on a sugary lozenge. pH profiles with sugar rinsing and normal or limited salivary flow conditions, showed progressively decreasing plaque pH values at various time points in the order of: low-caries subjects (s sites), higher-caries subjects (s sites), higher-caries subjects (s + ws sites), and higher-caries subjects (ws sites). The minimum pH values showed the same trend. Analyses of all data indicated only a statistical difference for minimum values for s sites in low-caries subjects vs. ws sites in higher-caries subjects, and for s and ws sites in the latter. Local sugar application and sucking on a sugary lozenge induced smaller pH drops than sugar rinsing; such suboptimal sugar exposure caused a disappearance of the difference between the minimum pH values for s and ws sites observed with sugar rinsing in the higher-caries subjects. Initial plaque pH values were similar regardless of subject or tooth caries status. The values were also not correlated with the plaque levels of strongly iodophilic polysaccharide-storing bacteria. Collectively, both studies indicate that increasing subject caries status is characterized by increasing plaque levels of highly-acid-tolerant, acidogenic bacteria and an increasing plaque-pH-lowering potential and support the dynamic relationship between these parameters.

Relationship among mutans streptococci, "low-pH" bacteria, and lodophilic polysaccharide-producing bacteria in dental plaque and early enamel caries in humans.

Multiple interactions occur among major determinants of dental caries. We have studied the bacterial flora and pH-lowering capacity of the same dental plaques in relation to caries. The findings on the plaque flora are reported here. The buccal surfaces of upper teeth in each subject were selected for study. A low-caries group had no "white spot" caries (ws) in the selected dentition area; a higher-caries group averaged 4.1 ws in this area. The latter group was divided into subjects with 2, 3, or 4 ws and subjects with 5, 6, or 7 ws. Enumerated organisms in plaque samples (sound and ws sites) from all subjects were: (1) mutans streptococci (MS) on mitis-salivarius-bacitracin and mitis-salivarius agar; (2) non-mutans streptococci (non-MS) on mitis-salivarius agar; (3) organisms that were categorized according to their minimum pH in sugar broth, i.e., the predominant undifferentiated total flora on blood agar or the predominant non-MS flora on mitis-salivarius agar; and (4) iodophilic polysaccharide-storing organisms on trypticase-yeast extract-salts agar. Plaques covering ws lesions contained generally only low proportions (< 0.1%) of MS. The plaque proportions of all the above 4 bacterial groups were increased in the higher-caries group but were similar for s and ws sites in this group. Over half of the total plaque flora in subjects with 5, 6, or 7 ws consisted of "low-pH"-type organisms (minimum pH < 4.4). Many of these were neither MS nor "low-pH" non-MS. The numerical emergence of MS in plaque appeared to be preceded often by other types of "low-pH" bacteria, including the non-MS. Caries development in the absence or presence of MS as well as different bacterial successions in plaque can be explained readily by the dynamic and positive relationship among the factors carbohydrate consumption, plaque flora composition, plaque acidogenic potential, and caries activity.

Accumulation of fermentable sugars and metabolic acids in food particles that become entrapped on the dentition.

Earlier studies (Kashket et al., 1991) showed that particles of high-starch snack foods remained longer on the teeth than those of high-sucrose, low-starch foods. The question arose whether the prolonged presence of food particles enhances cariogenicity. A study was undertaken to measure sugars, starches, and metabolic acids in retained food particles. Subjects consumed portions of different foods, and particles were removed from all bicuspids and first molars at defined times after swallowing. Dry weights, sugars, and short-chain carboxylic acids were determined. High-sucrose foods were cleared rapidly from the teeth, while high-starch foods were retained for up to 20 min. Sucrose, glucose, and fructose persisted in the retained particles. Particles of high-starch foods accumulated maltose and maltotriose, presumably from the breakdown of starch by salivary amylase. At maximum, maltose plus maltotriose constituted 94% of total sugars in particles of potato chips; corresponding values in doughnuts, peanut butter cookies, and salted crackers were 43, 51, and 61%, respectively. Total fermentable sugars in the particles of high-starch foods were similar to those for the high-sucrose confectionery products. Carboxylic acids accumulated within the particles, presumably due to the fermentation of the sugars by entrapped salivary micro-organisms. At maximum (5 to 7 min), acetic, formic, lactic, and propionic acids rose 17-, 30-, 15-, and 1.3-fold, respectively, in doughnuts, and to smaller degrees in potato chips, salted crackers, and chocolate-caramel-peanut bars. In summary, the study demonstrated the persistence of sugars, the progressive accumulation of starch breakdown products, and the fermentation of the accumulated sugars in retained food particles. The findings support the view that high-starch foods contribute to the development of caries lesions.

The final pH of bacteria comprising the predominant flora on sound and carious human root and enamel surfaces.

Acidogenesis at low pH appears to be an important bacterial cariogenic trait. However, most information in this regard pertains to only a few of the acidogenic dental plaque bacteria. Therefore, the 'final' pH in sugar broth was determined for a wide variety of oral bacteria. Their source was: (1) carious material from advanced root lesions (ARL), (2) plaque from sound root surfaces of root-caries-free subjects (SRS), (3) plaque from "white spot" coronal lesions and sound coronal surfaces of caries-active subjects, and (4) plaque from sound coronal surfaces of caries-free subjects. Strains from groups 1 and 2 (ARL, 389 strains; SRS, 358 strains) were previously identified (van Houte et al., 1994) to the genus/species level and belonged to the predominant cultivable flora (PCF). Strains from groups 3 and 4 also belonged to the PCF but were not identified. All strains were placed in one of 4 final pH categories: < 4.2, 4.2-4.4, 4.4-4.6, and > or = 4.6. The main findings were: (1) ARL samples contained many strains with a final pH < 4.2 (mean percentage of 25.7). They included all strains of Lactobacillus and mutans streptococci (MS), most Bifidobacterium strains and non-mutans streptococci (non-MS), and about 20% of the Actinomyces strains. By contrast, SRS samples contained far fewer strains with a final pH < 4.2 (mean percentage of 8.4) which were nearly all non-MS. (2) Organisms with a final pH < 4.4 constituted mean percentages of 41.5 and 32.1 for the ARL and SRS samples, respectively. (3) The final pH distribution of strains in samples from coronal surfaces showed a tendency relative to caries activity (group 3 vs. group 4) similar to that for groups 1 and 2. Our findings further support the concept that increased cariogenic conditions are associated with increased proportions of organisms capable of acidogenesis at a low pH and that this shift involves organisms other than the MS and lactobacilli.

The predominant cultivable flora of sound and carious human root surfaces.

Little detailed knowledge exists about the composition of the human root flora. Therefore, the predominant cultivable flora (PCF) was determined for samples of: (1) plaque from sound root surfaces (SRS) in eight subjects without root caries, (2) plaque from incipient root lesions (IRL) in eight subjects with root caries, and (3) carious material from advanced root lesions (ARL) in nine other subjects with root caries. Generally, one root surface was sampled per subject, and organisms-358, 512, and 389 for SRS, IRL, and ARL, respectively-were identified by standard methods. It was found that: (1) streptococci, actinomyces, and veillonellae constituted 84.2, 57.8, and 65.7% of the PCF of SRS, IRL, and ARL samples, respectively; (2) a wide variety of other Gram-positive cocci and Gram-positive and -negative rods was also present; (3) the PCF of many samples was often dominated by few organisms, the identity of which differed from sample to sample; (4) a negative and no association with root caries existed for the PCF levels of the non-mutans streptococci (non-MS) and the actinomyces; and (5) mutans streptococci (MS) and lactobacilli (L) were not always present among the PCF of IRL and ARL, respectively, and non-MS were isolated from the PCF of most lesions and actinomyces from all lesions. Our findings illustrate the complexity of the root surface flora and suggest that root caries development involves organisms other than MS and L.

Effect of antibody in gingival crevicular fluid on early colonization of exposed root surfaces by mutans streptococci.

The effect of antibody to Streptococcus mutans in gingival crevicular fluid (GCF) on the recolonization of cleaned buccal root surface sites by indigenous mutans streptococci was studied. Seven subjects (mean age = 64 years) were selected from a population of 28 on the basis of the presence of appropriate sites with and without detectable immunoglobulin G (IgG) antibody in GCF to formalin-killed S. mutans and adequate levels of mutans streptococci in saliva available for root surface recolonization. Root surfaces exposed to GCF that did or did not contain antibody were then cleaned and sampled for residual plaque organisms (total cultivable flora and mutans streptococci) directly after cleaning (time 0) as well as 24 h later. One subject failed to recolonize at 24 h at any (antibody-positive or antibody-negative) experimental site. For each of the remaining 6 subjects, the mean levels of mutans streptococci (mean percentage of total flora) were lower at sites with IgG antibody to S. mutans in GCF than at antibody-negative sites in the same subject. In each of the 6 subjects, the site with the highest recolonization level was antibody-negative. Comparison based on intrasubject randomization of sites suggested diminished recolonization of mutans streptococci at sites with antibody 24 h after cleaning. The results support the idea that antibody in GCF can modify the early colonization of gingival root surface areas by potentially cariogenic plaque bacteria such as mutans streptococci.

Role of micro-organisms in caries etiology.

The microbial etiology of dental caries is discussed in terms of the dynamic relationship among the dental plaque microbiota, dietary carbohydrate, saliva, and the pH-lowering and cariogenic potential of dental plaque. The evidence supports a concept of caries as a dietary carbohydrate-modified bacterial infectious disease. Its key feature is a dietary carbohydrate-induced enrichment of the plaque microbiota with organisms such as the mutans streptococci and lactobacilli which causes an increase of plaque's pH-lowering and cariogenic potential. The shift in the plaque proportions of these organisms appears to be related to their relatively high acid tolerance. A large body of evidence also supports a major effect of saliva on caries development. Integration of salivary effects with the concept of caries as a dietary carbohydrate-modified bacterial infectious disease suggests a broader concept which includes a major role of saliva in the regulation of the exposure of tooth surfaces to carbohydrate and of plaque acidity and, hence, the microbial composition and the pH-lowering and cariogenic potential of dental plaque. It is proposed that caries occurs preferentially in dentition sites characterized by a relatively high exposure to carbohydrate and diminished salivary effects. Some implications of this concept are discussed.

Microbiological predictors of caries risk.

The prediction of caries risk has been of long-standing interest. Generally, few of the tests involving oral bacteria or their products have become accepted. Presently, the main focus is on counts of lactobacilli (L) and mutans streptococci (MS). Due to their positive numerical association with human caries and the linkage of this association to carbohydrate consumption, counts of L and MS may, potentially, serve not only as a caries risk predictor but also as an indicator of carbohydrate consumption, another caries-risk factor. The value of counts of L and MS as caries-risk predictors has been evaluated by means of studies providing data on test sensitivity, specificity, and predictive values. These and other studies indicate that their use for the prediction of caries risk of individuals is not possible but is more promising for that of the caries risk of groups (e.g., identification of high-caries-risk subjects); further, the prediction of low caries risk may be more reliable than that of high caries risk. The influence of test variables on the test results has been discussed. These include the level of caries increment, subject age, methods of caries evaluation, use of saliva or dental plaque as test sample, sampling frequency, type of bacterial growth medium, and the use of simplified methods rather than conventional laboratory procedures for microbial enumeration. An approach to optimize the use of microbiological caries-risk predictors in different populations as well as their use in conjunction with other caries-risk predictors has been discussed. The latter include the incipient caries lesion or past caries experience and salivary buffering capacity and flow rate. Due to the multifactorial nature of caries etiology, it is expected that multivariate approaches rather than the use of single parameters may improve caries risk prediction for individuals as well as groups of subjects.

Oral streptococcal colonization of infants.

The objective of this study was to determine the prevalence and proportions of different streptococcal species among the streptococcal flora during infancy. A total of 60 oral samples were collected by oral swabbing of the buccal mucosa and alveolar ridges of 18 infants before tooth eruption and from buccal and lingual surfaces of teeth after tooth eruption. A total of 549 isolates on mitis salivarius agar were speciated, principally by recently revised biochemical criteria of Kilian et al. Streptococcus mitis biovar 1 predominated, both in prevalence (89%) and proportion of oral streptococci recovered in each sample (median = 87% of streptococcal flora). Streptococcus salivarius was also prevalent (94%) but generally represented a small percentage of the total streptococcal flora (median = 3%). Streptococcus oralis and Streptococcus anginosus strains were detected in approximately one third of predentate and dentate infants in the first year of life. Streptococcus sanguis strains were not detected before tooth eruption, but could be detected in 7/14 of the infants with teeth. Thus, S. mitis constitutes the major component of the initially colonizing streptococcal microbiota of the young infant.

The association of mutans streptococci and non-mutans streptococci capable of acidogenesis at a low pH with dental caries on enamel and root surfaces.

Coronal dental plaque from each of 12 caries-positive subjects (Group I) was pooled from "white spot" tooth surface areas and, separately, from sound surface areas; sound surface areas in each of 18 caries-free subjects (Group II) were sampled similarly. Two samples, one consisting of material from a root-surface lesion and another of plaque from a sound root-surface area, were obtained from each of another 10 subjects (Group III). The samples from Groups I and II were evaluated for: (1) pH-lowering potential in vitro with dispersed plaque suspensions, excess glucose supply, and a 60-minute test; (2) the levels of mutans streptococci (MS) and lactobacilli; and (3) the distribution of the predominant non-mutans streptococci (non-MS) according to their final pH in glucose broth; only microbial analysis was done for the Group III samples. The levels of the MS were generally positively associated with caries. A weaker positive association was found for the levels of those non-MS capable of acidogenesis at low pH (final pH < 4.4). The latter generally far outnumbered the MS in all types of samples. The levels of lactobacilli were nearly always very low. The pH-lowering potential (final pH and pH drop rate) was higher for plaque from "white spot" areas than for plaque from sound surface areas (Group I). The samples from caries-free subjects (Group II), however, exhibited a pH-lowering potential which was not significantly different from that of both types of samples from the caries-active subjects (Group I).(ABSTRACT TRUNCATED AT 250 WORDS)

Cariogenic potential of pooled plaque fluid from exposed root surfaces in humans.

The composition of pooled plaque fluid from exposed root surfaces of five population samples was determined before and at selected times (3, 7 and 15 min) after a 5 and 10% sucrose rinse. Subjects were 45-65 yr old, had exposed, sound root surfaces, and were grouped according to root caries status [caries-free (CF), no root caries history; caries-positive (CP), recorded root caries experience]. Samples were obtained only from the sound surfaces of the CF and CP subjects after overnight fasting. Plaque samples from each subgroup were pooled under mineral oil and maintained on ice. Plaque fluid was then isolated by centrifugation and analysed for organic acids and inorganic ions (ion chromatography), and pH (microelectrodes). From these data, the degree of saturation [DS(TM)] in plaque fluid with respect to tooth mineral (TM) was calculated. Before exposure to sucrose, plaque fluids from the CF and the CP subgroups had similar ionic compositions. These fluids were also found to be supersaturated with respect to tooth mineral. After exposure to sucrose, a rapid decrease in plaque fluid pH was observed, which corresponded primarily to lactic acid production. For all times examined, mean pH and DS(TM) values were lower and lactic acid concentrations were higher in the CP than the CF samples. Lower values of DS(TM) suggest that plaque fluid from CP subjects had a measurably greater cariogenic potential. Calcium concentrations also increased significantly and to comparable levels in all plaque fluid samples after sucrose exposure, despite lower acid production in CF samples.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of sucrose concentration on the cariogenic potential of pooled plaque fluid from caries-free and caries-positive individuals.

Pooled plaque samples were obtained from (1) coronal surfaces of two groups of caries-free (CF) subjects, (2) coronal 'white-spot' surface areas of a group of caries-positive (CP) subjects, and (3) exposed, sound root surfaces of root caries-free (RCF) and root caries-positive (RCP) subjects. The plaque samples were obtained before and 3 min after a 1 min rinse with a 0.5, 1, 2, 5 and 10% sucrose solution. Plaque fluid was then isolated from each plaque sample by centrifugation and analyzed for inorganic ions, organic acids, and pH values. With increasing sucrose concentration: (1) plaque fluid pH and the degree of saturation (DS) with respect to tooth mineral decreased; (2) the pH and DS values of CP and RCP samples were consistently lower than those of CF and RCF samples, respectively; (3) plaque fluid lactic acid concentrations increased and were consistently higher in the CP and RCP samples than in the CF and RCF samples, respectively, and (4) plaque fluid lactic acid concentrations leveled off between 1 and 5% sucrose; this occurred at lower sucrose concentrations with CP and RCP samples than with CF and RCF samples, respectively. RCP samples contained consistently higher levels of mutants streptococci than RCF samples. The chemical composition of plaque fluids, following sucrose exposure, were found to correlate well with caries history. The observed differences in lactic acid concentrations in samples from CF and CP subjects are discussed with regard to differences in microbiological composition and possible differences in plaque permeability to sucrose.

In vitro acidogenic potential and mutans streptococci of human smooth-surface plaque associated with initial caries lesions and sound enamel.

Samples of human dental plaque were pooled from several "white spot" smooth tooth surface areas as well as from several clinically-sound tooth surface areas in each of 12 caries-positive college students. Each of the two samples from each subject was used for the determination of: (1) pH-lowering potential in vitro involving dispersed plaque suspensions, excess glucose supply, and a 60-minute test, and (2) the proportions of mutans streptococci and lactobacilli. When all subjects were considered, plaques from "white spot" areas, as compared with samples from sound surface areas, were characterized by significantly higher proportions of mutans streptococci, a lower starting ("resting") pH, a faster rate of pH drop between pH 6.0 and 5.0, and a lower minimum pH of the suspension; the lactobacillus proportions were generally very low in both types of plaques. For individual subjects, however, the proportions of mutans streptococci in plaque associated with "white spot" areas showed a wide range (0.001-10.0%), and samples with high as well as low levels of these micro-organisms could exhibit a high rate of pH drop and a low pH minimum. This suggests that, besides mutans streptococci and lactobacilli, other bacteria capable of acidogenesis at a low pH may contribute to the high pH-lowering potential exhibited by many plaques.

Mutans streptococci and non-mutans streptococci acidogenic at low pH, and in vitro acidogenic potential of dental plaque in two different areas of the human dentition.

Samples of human dental plaque were obtained from sound tooth surfaces in the lower anterior and upper posterior areas of each of 11 subjects with various degrees of caries experience. Both types of plaque were compared for: (1) their pH-lowering potential [pH at 10 and 60 min after sugar addition and the pH drop between 0 and 10 min (delta pH)] with an in vitro method involving dispersed plaque suspensions and excess glucose supply; (2) the proportions of mutans streptococci; and (3) the distribution of the predominant non-mutans streptococci according to their final pH in glucose broth. Compared with plaque from the lower anterior area, plaque from the upper posterior area exhibited a significantly higher pH-lowering potential, i.e., a lower pH at 10 and 60 min and a greater delta pH and significantly higher levels of mutans streptococci. The final pH values for the non-mutans streptococci exhibited a wide range from about 4.4 to over 5.0. The proportions of such organisms designated as capable of acidogenesis at low pH (final pH less than 4.6), whether expressed as a percentage of the total non-mutans streptococci or of the total plaque flora, were significantly increased in plaque from the upper posterior area. The proportions of non-mutans streptococci capable of acidogenesis at low pH in plaque from the upper posterior area were also significantly increased, with decreasing pH values at 10 and 60 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Lack of correlation between food retention on the human dentition and consumer perception of food stickiness.

When dental health professionals advise that sticky foods be avoided, it is left to the consumer to choose correctly among different foods. In this study, comparisons were made among consumer ratings of stickiness of 21 commercially available foods and objective measurements of tooth retention of each of the foods. No correlation was found between the two, and neither the rates of clearance of food particles from the teeth nor the rates of clearance of food-derived sugars from the saliva correlated with ratings of food stickiness. Cookies, crackers, and potato chips were most retentive, whereas caramels, jelly beans, raisins, and milk chocolate bars were among those poorly retained. Clearance rates appeared to vary inversely with initial retention. However, chocolate-caramel bars exhibited high initial retention and a very rapid rate of clearance from the teeth. The findings show that consumers cannot accurately assess the retentiveness of foods and, thus, the advise simply to avoid sticky ones is inadequate.

Association of the microbial flora of dental plaque and saliva with human root-surface caries.

Dental plaque was obtained from one or two sound root surfaces of subjects with different degrees of root-surface caries experience. From subjects with root-surface caries, plaque samples were also obtained from either one incipient or one more advanced lesion. Proportions of the total flora were determined for total streptococci and different streptococcal species, total and different Actinomyces species, and lactobacilli. A sample of saliva was obtained from about one-third of the subjects for determination of the concentrations of mutans streptococci and lactobacilli. The main observations were: (1) Subjects without root-surface caries or restorations (group I), as compared with subjects with root-surface caries with or without restorations (group II), were characterized by having a lower prevalence and proportion of mutans streptococci and a higher prevalence and proportion of A. naeslundii in plaque on sound root surfaces; (2) subjects in group I also tended to have a lower salivary concentration of mutans streptococci and lactobacilli than subjects in group II; (3) dental plaque on sound surfaces in group II subjects contained a lower proportion of mutans streptococci than plaque associated with incipient or advanced lesions; and (4) the prevalence and proportion of lactobacilli in plaque associated with sound as well as carious root surfaces were very low. The data reinforce findings from other studies and indicate that, as for coronal caries, the plaque and saliva populations of mutans streptococci specifically are correlated positively with the presence of root-surface caries.

Increased pH-lowering ability of Streptococcus mutans cell masses associated with extracellular glucan-rich matrix material and the mechanisms involved.

Streptococcus mutans strain IB-1600 was cultivated in Todd-Hewitt broth (THB) or THB supplemented with sucrose (S). Cell mass obtained from THB exhibited a high cell density and negligible glucan-rich extracellular matrix material (EMM), whereas cell mass from 2% S-supplemented THB exhibited widely-spaced cells separated by EMM. The pH-lowering potential of the different cell masses was studied in vivo with an intra-oral enamel demineralization test and rinsing with glucose solution, and in vitro with a model which permits vertical penetration of glucose through the cell mass and pH evaluation at different depths within the cell mass. In vivo, the pH profile of EMM-rich cell mass derived from 2% S-supplemented THB was characterized by a lower pH minimum and a slower return of the pH as compared with THB-derived cell mass. In vitro, an increase in cell mass EMM content was associated with a more rapid initiation and an increase in the rate of pH drop in the depth of the cell masses. Evaluation of the acidogenic potential of the cells in cell masses derived from THB and 2% S-supplemented THB with suspensions of dispersed cell mass and added glucose indicated no difference. The buffering capacity of cell mass derived from 2% S-supplemented THB within the pH range of 6.5-4.0 was greatly reduced as compared with that of THB-derived cell mass, due to the relatively low buffering capacity of EMM. The presence of EMM also appeared to enhance the porosity of the cell mass.(ABSTRACT TRUNCATED AT 250 WORDS)