Association of Streptococcus Mutans and Candida Albicans in Early Childhood Caries Relapse

Purpose: Candida albicans has also been associated with Early Childhood Caries (ECC). In addition, previous studies have shown the collagen binding adhesins of Streptococcus mutans, 22 Cnm and Cbm, are implicated in the severity of caries. This cross-sectional clinical study 23 explored the relationship between the presence of C. albicans and S. mutans in saliva and 24 dental plaque, and the caries status of infants ages 6 to 60 months. We hypothesized children 25 infected with cnm+ S. mutans and C. albicans have poorer caries outcomes which is associated 26 with high caries recurrence rates. 27

Methods: Saliva and plaque samples were taken from participants who: i) were caries-free (CF), 28 ii) received dental care for ECC and showed no signs of relapse within 6 months (CE-NR), and 29 iii) received dental care for ECC and relapsed within 6 months (CR). Samples were then plated 30 onto media for quantification of total bacteria, S. mutans and Candida sp. S. mutans-like 31 colonies were then screened by PCR to determine serotype and presence of the cnm and cbm 32 genes. 33

Results: Cnm+ S. mutans strains were detected only in samples from CR subjects. Of the 12 CR 34 cases, 5 were colonized by cnm+ strains and had both higher S. mutans and yeasts salivary 35 counts compared to the cnm- S. mutans CR patients. C. albicans was detected in 69% of CR 36 subjects, whereas it was detected in only 29% and 33% in CF and CE-NR subjects, 37 respectively. 38

Conclusion: The data suggests that cnm+ S. mutans is intimately associated with C. albicans 39 creating a hypervirulent biofilm.