Dental plaque microbial profiles of children from Khartoum, Sudan, with congenital heart defects

Abstract

Few studies have focused on the bacterial species associated with the deterioration of the dental and gingival health of children with congenital heart defects (CHD). The aims of this study were (1) to examine the dental plaque of children with CHD in order to quantify bacterial load and altered bacterial composition compared with children without CHD; and (2) to investigate the correlation between the level of caries and gingivitis and dental biofilm bacteria among those children. In this cross-sectional study, participants were children (3–12 years) recruited in Khartoum State, Sudan. A total of 80 CHD cases from the Ahmed Gasim Cardiac Centre and 80 healthy controls from randomly selected schools and kindergartens were included. Participants underwent clinical oral examinations for caries (decayed, missing, and filled teeth indices [DMFT] for primary dentition, and DMFT for permanent dentition), and gingivitis (simplified gingival index [GI]). Pooled dental biofilm samples were obtained from four posterior teeth using paper points. Real-time quantitative polymerase chain reaction was used for the detection and quantification of Streptococcus mutans, Streptococcussanguinis, and Lactobacillus acidophilus. Checkerboard DNA–DNA hybridization was used for the detection of 40 additional bacterial species. CHD cases had a significantly higher caries experience (DMFT = 4.1 vs. 2.3, p < 0.05; DMFT = 1.4 vs. 0.7, p < 0.05) and a higher mean number of examined teeth with gingivitis (4.2 vs. 2.0; p < 0.05) compared with controls. S. mutans counts were significantly higher among the CHD cases (p < 0.05). Checkerboard results revealed that 18/40 bacterial species exhibited significantly higher mean counts among CHD cases (p < 0.01). Correlation analyses revealed that among CHD cases, the detection levels of Tannerella forsythia, Campylobacter rectus, Fusobacterium nucleatum subsp. vincentii, F. nucleatum subsp. nucleatum, and F. nucleatum subsp. polymorphum were highly positively correlated with GI. CHD cases harbor more cariogenic and periodontopathogenic bacterial species in their dental plaque, which correlated with higher levels of caries and gingivitis.

Inflammatory mediators in saliva and gingival fluid of children with congenital heart defect

“…With regard to the oral health of the children with CHD, studies have also shown that they are more prone to prevalent and long-lasting gingival inflammation compared to their healthy counterparts (Nosrati et al, 2013;Steelman et al, 2000) and that they harbour higher counts of several bacterial species that are known to be involved in initiation and progression of caries and gingival inflammation (Steelman et al, 2000;Steelman, Rosen, Nelson, & Kenamond, 2003). We recently demonstrated that a group of Sudanese children with CHD were found to harbour altered bacterial profiles which were correlated with higher cariogenicity and perio-pathogenicity (Ali et al, 2017). However, the mechanism behind the severe and prolonged gingivitis particularly among children with CHD is still unclear.…”

“…The amount of the bacterial members of the red complex (Tannerella forsythia (T. forsythia) , Porphyromonas gingivalis (P. gingivalis), Eubacterium nodatum (E. nodatum) and Terponema denticola (T. denticola) has previously been reported in pooled plaque samples taken from the four posterior teeth of each child in the two groups and described in detail (Ali et al, 2017). Briefly, the collected plaque samples were kept in sterile tubes and stored at −80°C.…”

Perioperative infections in congenital heart disease

“…Among 21 studies in low- and middle-income countries, four were conducted in China, 43 – 46 four in India, 47 – 50 three in Brazil, 51 – 53 two in Saudi Arabia 54 , 55 , and one each in Argentina, 56 Bosnia Herzegovina, 57 Iran, 58 Ethiopia, 59 Guatemala, 60 and Sudan 61 . One multicentre study involving 17 low- to middle-income countries included India, Pakistan, Colombia, Russia, China, Dominican Republic, Brazil, Argentina, El Salvador, Ukraine, Peru, Mexico, Belarus, Vietnam, Uganda, Guatemala, and Bangladesh 62 …”

“…There were five different study designs including one randomised controlled trial, 53 one non-randomised interventional before–after study, 62 16 cohort studies, 43 – 45 , 47 – 50 , 52 , 54 – 57 , 59 , 60 , 63 one case-control study, 51 and three cross-sectional studies 46 58 , 61 Most studies were conducted in children, with two in neonates 47 , 57 and two involving children and adult patients 43 50 …”

“…Among children and adults with culture-positive infective endocarditis, viridans group streptococci (56%), Staphylococcus spp (15%), Pseudomonas spp (7%), Corynebacterium diphtheriae (4%), Acinetobacter baumannii (4%), Salmonella enterica serovar Typhi (4%), and Granulicatella adiacens (4%) were isolated 50 . In Sudan, 160 children with CHD might develop rates of dental caries and gingivitis as high as 4 and 2%, respectively 61 …”