Raghad Final.doc J Bagh College Dentistry Vol. 26(2), June 2014 Dental caries among Orthodontics, Pedodontics and Preventive Dentistry 157 Dental caries among a group of boys with β-thalassemia major (10-12 years old) in relation to salivary Mutans streptococci Raghad R. Al-Zaidi, B.D.S. (1) Sulafa K. El- Samarrai, B.D.S., M.Sc., Ph.D. (2) ABSTRACT Background: Beta thalassemia major is an inherited disorder that may affect general and oral health.The purpose of this study was toassess the severity of dental caries in relation to oral cleanliness, mutans streptococciamong a group of boys with beta thalassemia majorin comparison with a control group. Materials and Methods: The study involved 30 boys with BTM aged 10-12 years compared to 30 healthy boys with the same age group. d1-4mfs and D1-4 MFS indices were applied (Muhlemann, 1976), the viable counts of mutans streptococci in stimulated saliva were also determined. Results: The entire thalassemic group was caries-active. For both dentitions, a higher dmfs/DMFS values were recorded for study compared to control group, difference was statistically not significantconcerning dmfs, while it was statistically significant concerning DMFS (P<0.05). Salivary bacterial counts of mutans streptococci were found to be higher in the study compared to control group and the difference was statistically highly significant (P<0.01).All correlations between bacterial counts and dmfs/DMFS indices in study group were statistically not significant. Conclusion: Patients with Beta thalasemic major had more caries severity compared to normal subjects. Key words: β-thalassemia, mutans streptococci. (J Bagh Coll Dentistry 2014; 26(2): 157-159). الخالصة . االضطرابات الوراثیة التي قد تؤدي الى انخفاض في انتاج كریات الدم الحمراء كما یعمل على زیادة تحطیمھا النوع الكبیر أحد أنواع یعتبرفقر دم البحر األبیض المتوسط :المقدمة .تصیب الفم واللعاب مما قد یزید من احتمالیة االصابة بتسّوس األسنان یعاني المصابون بھذا المرض من عدة تغیرات جرثومیة التي قد المكّورات المسبحیة عند مجموعة من األطفال الذكور المصابین بمرض فقر دم البحر األبیض المتوسط , نظافة الفم, تھدف ھذه الدراسة الى حساب حّدة تسّوس األسنان :أھداف الدراسة .جموعة ضابطةالنوع الكبیربالمقارنة مع م تم قیاس حّدة تسّوس األسنان . من األطفال األصّحاء ومن نفس الفئة العمریة 30سنة بالمقارنة مع ) 12- 10(مریض تتراوح أعمارھم مابین 30شملت الدراسة :المواد وطرق العمل ّینات الُلعاب المحّفز باالضافة احتساب االعداد الحّیة للمكّورات المسبحّیة في تم جمع ع). 1976(حسب طریقة موھلمان ) D1-4 MFSو d1-4 mfs) (حشوة, قلع, تسّوس(حسب مقیاس .اللعاب لدى ) dmfs) (حشوة, قلع, تسّوس(أظھرت النتائج وجود قیم عالیة للتسّوس حسب مقیاس , فیما یتعلق باألسنان اللبنیة. أظھرت النتائج اصابة جمیع االطفال بتسّوس األسنان :النتائج لدى المرضى ) DMFS) (حشوة, قلع, تسّوس(وجدت قیم عالیة للتسّوس حسب مقیاس , فیما یتعلق باألسنان الدائمیة. قارنة باألطفال األصّحاء مع عدم وجود فروقات معنویةالمرضى م ند األطفال المصابین بالمرض مقارنة مع المجموعة الضابطة مع النتائج بّینت أن أعداد المكّورات المسبحیة أعلى ع. )P<0.05(مقارنة باألطفال األصّحاء مع وجود فروقات معنویة .كل العالقات بین أعداد المكورات المسبحیة في اللعاب مع تسّوس األسنان لألطفال المصابین بالمرض كانت بدون فروقات معنویة.)P<0.01(وجود فرق معنوي عاٍل .مما یعني ضرورة توفیر برنامج وقائي فّعال لھؤالء األطفال المرضى, من أقرانھم من األطفال األصّحاء وجد أن تسّوس األسنان في األطفال المرضى أعلى :األستنتاج .المكّورات المسبحیة المیوتانز, فقر دم البحر المتوسط النوع الكبیر: كلمات مفتاحیة INTRODUCTION Beta thalassemias are a group of inherited blood disorders caused by reduced or absent synthesis of the beta chains of hemoglobin (1, 2). From the few studies regarding dental caries among patients with BTM it was concluded that the prevalence and severity of this disease were higher in those patient than in normal subjects (3, 4). There are a limited number of studies concerning counts of mutans streptococci in relation to dental caries in BTM (5). This study was designed to correlate dental caries severity to salivary mutans streptococci among of β- thalassemia major patients. (1)Master student. Department of Pedodontics and Preventive Dentistry, College of Dentistry, University of Baghdad (2)Professor. Department of Pedodontics and Preventive Dentistry, College of Dentistry, University of Baghdad MATERIALS AND METHODS The study group included 30 boys, with an age range of 10-12 years according to the last birth day (6); they were already diagnosed with β- thalassemia major, attending the thalassemic center in Ibn Al-Baladi Hospital for their regular checkup and blood transfusion. The control group included 30 boys matching in age and genders with the study group; they were examined in their primary school nearby the hospital. Prior to clinical examination, collection of stimulated salivary samples from both study and control groups was done (7). Each individual was asked to chew a piece of Arabic gum for one minute then to remove all saliva by expectoration, chewing was then continued for ten minutes with the same piece of gum and saliva collected in a sterile screw-capped bottles. After collection and disappearance of salivary foams, 0.1 ml of saliva wastransferred to 0.9 ml of sterile phosphate buffer saline (pH 7.0) for microbiological analysis. Dental caries was diagnosed by clinical examination; using dental mirror and sharp dental J Bagh College Dentistry Vol. 26(2), June 2014 Dental caries among Orthodontics, Pedodontics and Preventive Dentistry 158 explorer. Assessment and recording of caries experience was by the application of (d1-4 mfs/D1-4 MFS). The selective media for the cultivation of mutans streptococci was Mitis Salivarius Bacitracin Agar. Isolation and identification of bacteria were done according to Holbrook and Beighton(8). Statistical Analyses were achievedby using SPSS version 20 (Statistical Package for Social Sciences). Descriptive measurement (mean and standard deviation) and interferential statistic involved (Student's t-test, Paired t-test, Person's correlation coefficient, and multiple liner regression) were applied. The level of confidence was 95%. RESULTS Clinical examination showed that all subjects were affected by dental caries. Decayed, missed and filled teeth surfaces of boys by fractions of d1- 4mfs/D1-4 MFS index are represented by their means and standard deviations (SD) in Tables (1) and (2). Salivary bacterial counts of mutans streptococci were found to be higher in study group (3.63±1.650)CFU/ml×104 compared to control group (1.93±0.907)CFU/ml×104 and the difference was statistically highly significant (P<0.01). All correlations between bacterial counts and dmfs/DMFS were statistically not significant Table (3). Tables (4) and (5) illustrate results of single linear regressions of dmfs and DMFS indices as a (dependent variable) in both study and control groups explained by mutans streptococci count (independent variables). The recorded correlation coefficient (r) between dmfs and bacterial count was 0.242 in study group and 0.320 in control group, the R2 value was lower in the study compared to the control group. For DMFS, the correlation coefficient (r) with bacterial count was 0.041 in study group and 0.252 in control group; the R2 value was also lower in the study compared to the control group. Table 1: Caries-experience of primary teeth (dmfs) among study and control groups Parameters No. Study Control Mean ±SD Mean ±SD ds 30 6.100 5.797 4.400 4.966 ms 30 0.330 1.269 0.630 2.684 fs 30 - - - - dmfs 30 6.430 6.185 5.030 5.468 Table 2: Caries-experience of permanent teeth (DMFS) in study and control groups Parameters No. Study Control t-value P-value Mean ±SD Mean ±SD DS 30 6.500 4.297 4.230 2.029 2.613* 0.011 MS 30 - - - - - - FS 30 - - - - - - DMFS 30 6.500 4.297 4.230 2.029 2.613* 0.011 *significant at the level P<0.05,df=29 Table 3: Correlation coefficients between mutans streptococci counts in saliva and caries- experience (primary and permanent teeth) in study and control groups Caries-Experience Study Control r P r P dmfs 0.242 0.198 0.320 0.084 DMFS -0.041 0.831 0.252 0.179 Table 4: Single linear regression of caries-experience (dmfs) with mutans streptococci counts in study and control groups Group Coefficients t-value P-value B S.E Study R2=5.8% 1.168 0.886 1.318 0.198 Control R2=10.3% 1.930 1.079 1.789 0.084 J Bagh College Dentistry Vol. 26(2), June 2014 Dental caries among Orthodontics, Pedodontics and Preventive Dentistry 159 Table 5: Single linear regression of caries-experience (DMFS) with mutans streptococci counts in study and control Groups Group Coefficients t-value P-value B S.E Study R2=0.2% -0.137 0.634 -0.216 0.831 Control R2=6.4% 0.564 0.409 1.380 0.179 DISCUSSION Data of the present study showed that all children in both study and control groups had dental caries, i.e. a 100% of occurrence of the disease; this may indicate that both groups may have the same susceptibility to dental caries. However, data revealed that there is a variation in the severity of caries-experience between the groups; this was true for primary and permanent teeth. For both dentitions, caries-experience as measured by dmfs/DMFS index was higher in the study group compared to the control and differences were statistically significant for DMFS and not significant for dmfs. This may indicate a higher severity of dental caries among study group compared to control; the same results were recorded by others (9, 10). In thalassemic patient, the DMFS index was composed of decay surface only, as no case was seen with either missing or filling surfaces. This is an indication of the increased need for dental treatment. The increased severity of dental caries among thalassemic children may be attributed to poor oral cleanliness, related to certain oral structural changes that take place in thalassemic patient due to maxillary enlargement result in protrusion of anterior teeth, increase space between teeth, over-bite or open-bite and varying degrees of malocclusion, aid in more plaque accumulation (11). Another explanation for the increase severity of dental caries in the study group is the higher counts of mutans streptococci in the thalassemic group; as found by this study with a statistically high significant difference, the same result was reported by other (5).The higher counts of salivary mutans streptococci may be related to the lower IgA level in saliva of thalassemic patients that may lead to increased microbial proliferation (12). Results of multiple linear regressions revealed a more impact of mutans streptococci on dental caries of the control group compared to study group. 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