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International Poster Journal of Dentistry and Oral Medicine



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Int Poster J Dent Oral Med 13 (2011), No. 2     15. June 2011

Int Poster J Dent Oral Med 2011, Vol 13 No 2, Poster 535

The mode of delivery and presence of Streptococcus mutans in the saliva of newborns – preliminary results

Language: English

Vlasta Merglová,
Charles University, Faculty of Medicine, Department of Dentistry, Pilsen, Czech republic
Petra Stunová, Jiří Dort,
Charles University, Department of Neonatology, Faculty Hospital, Pilsen, Czech republic

June 4.-6., 2010
10th EAPD congress
Harrogate, UK


Dental caries is considered to be an infectious and transmissible disease. Dental caries can occur very shortly after tooth eruption in infants and toddlers – early childhood caries (Fig. 1). Streptococcus mutans (SM) plays a major role in the etiology of dental caries in humans therefore an acquisition and transmission of SM have received an extensive attention.
Within 24 hours after birth the oropharynx of the newborns becomes rapidly colonized with bacteria. An early flora is composed of Staphylococcus epidermidis, Streptococcus viridans, gram negative bacilli and a small group of variable transient microbes.
SM is transmitted to the oral cavity of the children more frequently from the saliva of the mother who infects the child during her care, especially if herself does not keep an adequate oral hygiene, caries in her oral cavity are not treated, suffers from present periodontal diseases and neglects the basic hygiene rules. SM requires a non – shedding surface for colonization but recent studies confirmed its presence in the mouth of pre – dentate infants. In these infants SM can create colonies which adhere to the tongue mucosa, or can occure freely in the saliva.

Factors affecting an initial aquisition of SM in infants are:
- high maternal SM levels
- active caries in mother
- low birthweight infant
- pathologic conditions in oral cavity of infants (clefts, cysts)
- early tooth eruption
- low salivary IgA
- enamel defects
- mode of delivery


The aim of our study was to find correlation between mode of delivery and amount of SM in newborns' oral cavity.

Material and Methods

A total number of 49 newborns (26 boys and 23 girls) was randomly enrolled in this study. 29 newborns were delivered vaginally – group A and 20 by Caesarean section – group B (Graph 1).

Complications of pregnancy, mode of delivery, gestational age, birthweight, health status and amount of SM in saliva were registered in newborns. Dentocult SM Strip Mutans test, Orion Diagnostica™ (Fig. 2) was used to detect SM in saliva. The method is based on the use of a selective culture broth and the adherence and growth of SM on the test strip. Samples of saliva were collected from tongue with the test strip (Fig. 3) and upper and lower alveolar mucosa with microbrushes (Fig. 4). The samples were incubated 48 hours in temperature 37° C. For evaluation of SM amounts in incubated samples we used own scale developed for predentate children (Fig. 5a, b, c, d ). We confirmed questionable findings with conventional techniques used in microbiological laboratory. Findings in group A and B were compared using Student's t-test and chi-square test for statistical analysis.

Fig. 1: Early childhood caries Fig. 2: Dentocult SM Strip mutans test (Orion Diagnostica)
Fig. 3: Collection of saliva with test strip from tongue Fig. 4: Collection of saliva with microbrush from alveolar mucosa
Fig. 5a: Own scale of SM colonization of newborns (degree 0) Fig. 5b: Own scale of SM colonization in saliva of newborns (degree 1)
Fig. 5c: Own scale of SM colonization in saliva of newborns (degree 2) Fig. 5d: Own scale of SM colonization in saliva of newborns (degree 3)


All 49 newborns have had physiologic conditions in their oral cavity. SM was detected in saliva obtained from tongue mucosa in 35 newborns (71 %) and from maxillary and mandibular alveolar mucosa in 39 newborns (79 %). Significant statistical differences were not observed between group A and B including birthweight and amount of SM from tongue and alveolar mucosa (Graf 2 and Graf 3a, b).

Graph 1: Number of newborns delivered with Caesarean section and vaginally Graph 2: Birth - weight of newborns delivered with Caesarean section and vaginally
Graph 3a: Grade of SM colonization in newborns Graph 3b: Grade of SM colonization in newborns


Recent studies have shown that SM can colonize the mouth of predentate infants. In our study we found SM in saliva obtained from tongue and lower and upper alveolar mucosa of 2 days old newborns. We supposed vertical transmission of microbes from mother's saliva very shortly after birth.


  1. Berkovitz R. J. Causes, Treatment and Prevention of Early Childhood Caries: A Microbiologic Perspective. J Can Dent Assoc 2003; 69 ( 5 ): 304-307.
  2. Li Y. et al. Mode of Delivery and other maternal Factors Influence the Acquisition of Streptococcus mutans in Infants. J Dent Res 2005; 84 ( 9 ): 806-811.
  3. Ramalingam L. Messer L. B. Early Childhood Caries: An Update. Singapore Dent J 2004; 26 ( 1 ): 21 - 29.
  4. Tanaba Y. et al. Screening Method for Cariogenic Bacteria in Infants and Toddlers. IADR/AADR/CADR 82 nd General Session, March 10.-13. 2004, Honolulu.
  5. Wan A.K.L. et al. Oral colonization of Streptococcus mutans in six - month - old predentate infants. J Dent Res 2001; 80 ( 12 ): 2060-2065.

Supported by grant from IGA Health Ministry of Czech Republic NS 9732 - 4.

This Poster was submitted by Vlasta Merglová.

Correspondence address:
Vlasta Merglová
Charles University
Faculty of Medicine, Department of Dentistry, Faculty Hospital
Alej Svobody 80
304 60 Pilsen
Czech republic