**3.3.1 Streptococus mutans**

Streptococcus mutans are bacterias that grow in chains or in pairs, no movement, non-spore forming and usually react positively to Gram test. The name given by the tendency to change shape, can be found as spheres or more elongated, like bacillus.

There are numerous reports of a positive correlation between the presence of mutans streptococci and caries increase (Ansai et al., 1994; Heintze et al., 1999; Larmas, 1992; Niwa & Fukuda, 1989; Tanzer et al., 2001).

Streptococcus mutans are the most important bacterias at the beginning of the caries, colonize the host only after the first tooth erupts, are acquired primarily by direct transmission from mothers, have a preference for the occlusal surfaces of molars and interproximal areas of teeth and lack of ability to adhere to the oral soft tissues (National Institutes of Health Consensus, 2001).

The action of Streptococcus mutans, occurs in three phases: 1) initial interaction with the tooth surface via adhesins, 2) the colonization and growth of cariogenic bacteria in the film and 3) the production of glucose and glucans by the bacterial enzyme glucosyltransferase, which is involved into formation of lactic acid and initiates the process of demineralization of the tooth (Anusavice, 2005).

Microorganisms are more involved in the formation of cavities by their own virulence factors: acidogenicity, aciduric (acid produced in a medium with low pH) and acidophilus (resists the acidity of the medium).

Diverse tests based predominantly on quantitative estimation of Streptococcus mutans per milliliter of saliva (colony-forming unit [CFU]/mL): MSBB method (Matsukubo et al.), Caries Screen SM (Jordan et al.) and Dentocult® SM (Orion Diagnostica, Espoo, Finland) according to Jensen and Bratthall (1989).

These three are based on the fact that bacitracin inhibits the growth of other oral streptococci except mutans on mitis salivarius medium (Fig. 7).

A recently developed Streptococcus mutans detection system, Saliva-Check SM® (GC America, USA), eliminates the need for an incubation period. It can detect salivary S. mutans levels in 30 minutes.

Fig. 7. Dentocult SM® strip mutans.

164 Contemporary Approach to Dental Caries

The acids produced by bacterial fermentation in plaque dissolve the mineral matrix of the tooth. A reversible chalk-white spot is the first manifestation of the carious lesion, which can lead to cavitation if the mineral continues to be exposed to acid. Early detection of carious lesions provides a great opportunity to limit enamel demineralization associated with this

Streptococcus mutans are bacterias that grow in chains or in pairs, no movement, non-spore forming and usually react positively to Gram test. The name given by the tendency to

There are numerous reports of a positive correlation between the presence of mutans streptococci and caries increase (Ansai et al., 1994; Heintze et al., 1999; Larmas, 1992; Niwa

Streptococcus mutans are the most important bacterias at the beginning of the caries, colonize the host only after the first tooth erupts, are acquired primarily by direct transmission from mothers, have a preference for the occlusal surfaces of molars and interproximal areas of teeth and lack of ability to adhere to the oral soft tissues (National

The action of Streptococcus mutans, occurs in three phases: 1) initial interaction with the tooth surface via adhesins, 2) the colonization and growth of cariogenic bacteria in the film and 3) the production of glucose and glucans by the bacterial enzyme glucosyltransferase, which is involved into formation of lactic acid and initiates the process of demineralization

Microorganisms are more involved in the formation of cavities by their own virulence factors: acidogenicity, aciduric (acid produced in a medium with low pH) and acidophilus

Diverse tests based predominantly on quantitative estimation of Streptococcus mutans per milliliter of saliva (colony-forming unit [CFU]/mL): MSBB method (Matsukubo et al.), Caries Screen SM (Jordan et al.) and Dentocult® SM (Orion Diagnostica, Espoo, Finland)

These three are based on the fact that bacitracin inhibits the growth of other oral streptococci

A recently developed Streptococcus mutans detection system, Saliva-Check SM® (GC America, USA), eliminates the need for an incubation period. It can detect salivary S.

change shape, can be found as spheres or more elongated, like bacillus.

Interpreting the result:

**3.3 Bacterial markers** 

**3.3.1 Streptococus mutans** 

& Fukuda, 1989; Tanzer et al., 2001).

Institutes of Health Consensus, 2001).

of the tooth (Anusavice, 2005).

mutans levels in 30 minutes.

(resists the acidity of the medium).

according to Jensen and Bratthall (1989).

except mutans on mitis salivarius medium (Fig. 7).

process.

Very low 0 to 5 points Low 6 to 9 points Normal/High 10 to 12 points

> The average value for any possibility of decay should be more than 250,000 colony-forming unit (CFU) per milliliter of saliva, the higher values of 1'000, 000 CFU / mL indicate a high risk of caries (Heintze et al., 1999).

> The bacitracin disc may be placed in the selective culture Dentocult® SM2; 15 minutes before sampling. Let the patient chew a paraffin pellet for 1 minute. This stimulates the secretion of saliva and transfers mutans streptococci from toothsurfaces into the saliva. Press the rough surface of the strip against the saliva remaining on the patient´s tongue (Fig. 8).

Fig. 8. Specimen collection, and model chart.

<sup>2</sup> Dentocult® SM Strip Mutans (Orion Diagnostica, Helsinki, Finland)

Clinical, Salivary and Bacterial Markers on the Orthodontic Treatment 167

the tube in an incubator for 72 hours at 37° C. To obtain a colony count remove the slide from the tube and compare the colony density with the model chart provided in the kit:

Actually exists the CRT bacteria test (Ivoclar Vivadent AG, Schaan, Liechtenstein) which

Prognosis of caries becomes more effective when the lactobacilli and streptococci tests are

Acidogenic bacteria in dental plaque metabolize carbohydrates rapidly getting acid as final product. The result is a change in pH of the plaque, as it relates to the time called the Stephan curve as a scheme to bring it takes a curve. The pH decreases rapidly in the first few minutes to gradually increase; it suggests that in 30 minutes should return to normal levels. The caries activity test Cariostat®**4**, developed by Shimono, is used to measure the decrease of pH caused by bacterial action in the plaque. It has been reported positive correlations

Not only can determine whether establishing new carious lesions, but also diagnose active

allows clearly identify and semi-quantitatively determine both cariogenic bacterias.

Fig. 10. Collect the lactobacillus sample, manufactured chart.

between caries activity test score and the counts of *SM* and *LB*.

4 Cariostat® (Dentsply-Sankin KK, Tokyo, Japan)

or chronic lesions present (Nishimura et al., 1988; Lara-Carrillo et al., 2010b).

NC Non count or few colonies 0 1 000 UFC/ml (low) 1 10 000 UFC/ml (medium) 2 100 000 UFC/ml (high) 3 1 000 000 UFC/ml (higher)

combined.

**3.4 Plaque pH** 

Incubate the vial at 37° C for 48 hours with the cap one quarter of a turn open. Interpretation of results according following score:

