Are the mutans streptococci still considered relevant to understanding the microbial etiology of dental caries?

The mutans streptococci were once the primary focus of research dedicated to understanding the etiology of dental caries. That focus has now shifted to an emphasis on the ecological balances and complexities within the entirety of the plaque microbiome. Within that framework there are considerable differences of opinion regarding the importance and relative contributions of the mutans streptococci. This article explores the basis for the various viewpoints, the limitations of current knowledge, and the confounders that make it difficult to arrive at a consensus.

Protein Analysis of Sapienic Acid-Treated Porphyromonas gingivalis Suggests Differential Regulation of Multiple Metabolic Pathways.

UNLABELLED: Lipids endogenous to skin and mucosal surfaces exhibit potent antimicrobial activity against Porphyromonas gingivalis, an important colonizer of the oral cavity implicated in periodontitis. Our previous work demonstrated the antimicrobial activity of the fatty acid sapienic acid (C(16:1Δ6)) against P. gingivalis and found that sapienic acid treatment alters both protein and lipid composition from those in controls. In this study, we further examined whole-cell protein differences between sapienic acid-treated bacteria and untreated controls, and we utilized open-source functional association and annotation programs to explore potential mechanisms for the antimicrobial activity of sapienic acid. Our analyses indicated that sapienic acid treatment induces a unique stress response in P. gingivalis resulting in differential expression of proteins involved in a variety of metabolic pathways. This network of differentially regulated proteins was enriched in protein-protein interactions (P = 2.98 × 10(-8)), including six KEGG pathways (P value ranges, 2.30 × 10(-5) to 0.05) and four Gene Ontology (GO) molecular functions (P value ranges, 0.02 to 0.04), with multiple suggestive enriched relationships in KEGG pathways and GO molecular functions. Upregulated metabolic pathways suggest increases in energy production, lipid metabolism, iron acquisition and processing, and respiration. Combined with a suggested preferential metabolism of serine, which is necessary for fatty acid biosynthesis, these data support our previous findings that the site of sapienic acid antimicrobial activity is likely at the bacterial membrane. IMPORTANCE: P. gingivalis is an important opportunistic pathogen implicated in periodontitis. Affecting nearly 50% of the population, periodontitis is treatable, but the resulting damage is irreversible and eventually progresses to tooth loss. There is a great need for natural products that can be used to treat and/or prevent the overgrowth of periodontal pathogens and increase oral health. Sapienic acid is endogenous to the oral cavity and is a potent antimicrobial agent, suggesting a potential therapeutic or prophylactic use for this fatty acid. This study examines the effects of sapienic acid treatment on P. gingivalis and highlights the membrane as the likely site of antimicrobial activity.

The roles of cutaneous lipids in host defense.

Lauric acid (C12:0) and sapienic acid (C16:1Δ6) derived from human sebaceous triglycerides are potent antimicrobials found at the human skin surface. Long-chain bases (sphingosine, dihydrosphingosine and 6-hydroxysphingosine) are also potent and broad-acting antimicrobials normally present at the skin surface. These antimicrobials are generated through the action of ceramidases on ceramides from the stratum corneum. These natural antimicrobials are thought to be part of the innate immune system of the skin. Exogenously providing these lipids to the skin may provide a new therapeutic option, or could potentially provide prophylaxis in people at risk of infection. This article is part of a Special Issue entitled The Important Role of Lipids in the Epidermis and their Role in the Formation and Maintenance of the Cutaneous Barrier. Guest Editors: Kenneth R. Feingold and Peter Elias.

A Social Media Intervention for Promoting Oral Health Behaviors in Adolescents: A Non-Randomized Pilot Clinical Trial.

Poor oral hygiene and excessive consumption of soda are among the main drivers of systemic health issues in adolescents in the United States. This non-randomized pilot clinical trial focused on the effects of a health text message system and smartphone-based intervention on adolescent tooth-brushing behavior and dietary choices, with a convenience sample of 94 participants aged 12 to 14 years old. A group of 75 participants agreed to use a tooth-brushing app and received a health text message; the other group of 15 agreed to use the tooth-brushing app, but did not receive a health text message. Saliva specimens were collected directly before and at the end of each experiment; changes in the salivary presence of cariogenic bacteria over the duration of the study were evaluated and compared with the demographics and behavioral variables. Within the text message group, 5% of participants increased the frequency of daily tooth brushing. Within the non-intervention group, 29% of participants increased the frequency of their daily tooth brushing. There were reductions in the total salivary bacteria and total streptococci in both groups (p < 0.001), but no change in the presence of cariogenic Mutans streptococci. Raising adolescents' consciousness of oral health behavior resulted in marginal to moderate improvements to oral hygiene and dietary choices, as well as reductions in total salivary bacteria.

Antibacterial activity of sphingoid bases and fatty acids against Gram-positive and Gram-negative bacteria.

There is growing evidence that the role of lipids in innate immunity is more important than previously realized. How lipids interact with bacteria to achieve a level of protection, however, is still poorly understood. To begin to address the mechanisms of antibacterial activity, we determined MICs and minimum bactericidal concentrations (MBCs) of lipids common to the skin and oral cavity--the sphingoid bases D-sphingosine, phytosphingosine, and dihydrosphingosine and the fatty acids sapienic acid and lauric acid--against four Gram-negative bacteria and seven Gram-positive bacteria. Exact Kruskal-Wallis tests of these values showed differences among lipid treatments (P < 0.0001) for each bacterial species except Serratia marcescens and Pseudomonas aeruginosa. D-sphingosine (MBC range, 0.3 to 19.6 µg/ml), dihydrosphingosine (MBC range, 0.6 to 39.1 µg/ml), and phytosphingosine (MBC range, 3.3 to 62.5 µg/ml) were active against all bacteria except S. marcescens and P. aeruginosa (MBC > 500 µg/ml). Sapienic acid (MBC range, 31.3 to 375.0 µg/ml) was active against Streptococcus sanguinis, Streptococcus mitis, and Fusobacterium nucleatum but not active against Escherichia coli, Staphylococcus aureus, S. marcescens, P. aeruginosa, Corynebacterium bovis, Corynebacterium striatum, and Corynebacterium jeikeium (MBC > 500 µg/ml). Lauric acid (MBC range, 6.8 to 375.0 µg/ml) was active against all bacteria except E. coli, S. marcescens, and P. aeruginosa (MBC > 500 µg/ml). Complete killing was achieved as early as 0.5 h for some lipids but took as long as 24 h for others. Hence, sphingoid bases and fatty acids have different antibacterial activities and may have potential for prophylactic or therapeutic intervention in infection.

Evaluating the relationship between acidogenicity and acid tolerance for oral streptococci from children with or without a history of caries.

Background: Dental caries etiology is attributed to a dysbiotic imbalance within the plaque microbiome leading to a dominance of strong acidogens. Some studies that investigate the link between acidogens and caries quantify the recovery of acid tolerant strains on acid agar as a measure of acidogenic potential. This methodology assumes that acidogenic potential and acid tolerance are directly related. Aim: The validity of that assumption was investigated by statistically evaluating that relationship using streptococci recovered from children with or without a history of dental caries. Methods: Thirty streptococcal isolates were isolated from each of 13 subjects. Acidogenicity was quantified by measuring the terminal pH after overnight growth in Brain Heart Infusion (BHI) and Chemically Defined Medium (CDM). Acid tolerance was quantified by measuring the lowest pH acid agar displaying growth. Results: A significant difference in acidogenicity in CDM between levels of acid tolerance was found, but no significant difference in acidogenicity in BHI was noted. Moreover, there were no significant interactions between acid tolerance and caries history on acidogenicity measures in either medium. Conclusion: An ability to grow on acid agar below pH 5.0 is best aligned with strong acidogenicity and best able to distinguish between subjects with differing caries histories.

Vital signs of the emergency patient with pulpal necrosis and localized acute apical abscess.

Vital signs aid in assessing patient health and the disease severity. The objectives of this study were to determine changes in vital signs of patients with pulpal necrosis (PN) and acute apical abscess (AAA). The vital signs measured at the emergency visit were blood pressure, heart rate, temperature, and lymphadenopathy. Visual analogue scales (VASs) were used to assess (1) pain and (2) malaise. Emergency treatment was rendered. At a subsequent (baseline) visit and with clinical symptoms resolved, systemic vital sign measurements and VASs were repeated. The presence or absence of swelling with vital signs and VASs of pain and swelling were compared. Compared with baseline, data showed no marked elevation in temperature, blood pressure, or lymphadenopathy, regardless of presence or absence of swelling. VAS measurements of pain and malaise did show statistically significant higher numbers at the emergency appointment, indicating a difference from baseline. Swelling versus no swelling did not differ. Vital signs were not impacted by localized AAA, although pain and malaise were greater. Vital signs might not be useful determinants of treatment or pharmacotherapeutic measures with localized AAA.

Factors associated with dental caries experience in 1-year-old children.

OBJECTIVES: Dental caries in early childhood is an important public health problem. Previous studies have examined risk factors, but they have focused on children during the later stages of the disease process. The purpose of this study was to assess the factors associated with caries in children aged 6 to 24 months as part of a cross-sectional analysis. METHODS: Two hundred twelve mothers with children 6 to 24 months of age were recruited from Special Supplemental Nutrition Program for Women, Infants, and Children clinic sites in southeastern Iowa for participation in a longitudinal study of dental caries. Baseline assessments included detailed questions regarding the children's beverage consumption, oral hygiene, and family socioeconomic status. Dental caries examinations using the d(1)d(2-3)f criteria and semiquantitative assessments of salivary mutans streptococci (MS) levels of mother and child were also conducted. Counts of the number of teeth with visible plaque were recorded for maxillary and mandibular molars and incisors. RESULTS: Of the 212 child/mother pairs, 187 children had teeth. Among these children, the mean age was 14 months, and 23 of the children exhibited either d(1), d(2-3), or filled lesions. Presence of caries was significantly associated with older age, presence of MS in children, family income <$25,000 per year, and proportion of teeth with visible plaque. CONCLUSIONS: Results suggest that not only microbial measures, including MS and plaque levels, are closely associated with caries in very young children, but that other age-related factors may also be associated with caries. Continued study is necessary to more fully assess the risk factors for caries prevalence and incidence in preschool children.

Comparison of 5.25% sodium hypochlorite, MTAD, and 2% chlorhexidine in the rapid disinfection of polycaprolactone-based root canal filling material.

The purpose of this investigation was to compare the effectiveness of 5.25% sodium hypochlorite, MTAD, and 2% chlorhexidine in the rapid disinfection of Resilon pellets. Resilon pellets were randomly selected, contaminated with Enterococcus faecalis, and disinfected with 5.25% sodium hypochlorite, MTAD, or 2% chlorhexidine. Positive and negative controls were used. All samples were air dried, washed in sterile water, placed in centrifuge tubes containing BHI broth, and incubated at 37 degrees C for up to 7 days. Broths were visually checked for turbidity and scored for growth. Samples from each experimental and control group were randomly chosen, plated, incubated at 37 degrees C, and checked visually for growth. If growth occurred, a gram stain was performed to identify bacterial species. Results indicate that 5.25% sodium hypochlorite, MTAD, and 2% chlorhexidine were all effective in the rapid disinfection of Resilon and gutta-percha pellets, and a 1-minute immersion was sufficient to disinfect.

Improved method for rapid and accurate isolation and identification of Streptococcus mutans and Streptococcus sobrinus from human plaque samples.

Mutans streptococci (MS), specifically Streptococcus mutans (SM) and Streptococcus sobrinus (SS), are bacterial species frequently targeted for investigation due to their role in the etiology of dental caries. Differentiation of S. mutans and S. sobrinus is an essential part of exploring the role of these organisms in disease progression and the impact of the presence of either/both on a subject's caries experience. Of vital importance to the study of these organisms is an identification protocol that allows us to distinguish between the two species in an easy, accurate, and timely manner. While conducting a 5-year birth cohort study in a Northern Plains American Indian tribe, the need for a more rapid procedure for isolating and identifying high volumes of MS was recognized. We report here on the development of an accurate and rapid method for MS identification. Accuracy, ease of use, and material and time requirements for morphological differentiation on selective agar, biochemical tests, and various combinations of PCR primers were compared. The final protocol included preliminary identification based on colony morphology followed by PCR confirmation of species identification using primers targeting regions of the glucosyltransferase (gtf) genes of SM and SS. This method of isolation and identification was found to be highly accurate, more rapid than the previous methodology used, and easily learned. It resulted in more efficient use of both time and material resources.

Genotypic characterization and comparison of Streptococcus mutans in American Indian and Southeast Iowa children.

Early childhood caries is a complex health care issue that has a multifactorial etiology. One aspect of this etiology is the colonization and propagation of acidogenic bacteria at an early age. There have been several bacterial species associated with caries but 1 common species is Streptococcus mutans. Here, we describe genotypic diversity and commonality of Streptococcus mutans recovered from children representing 2 groups with similar socioeconomic demographics: a Northern Plains American Indian Tribe and a Southeast Iowa population. Forty 36-month-old American Indian children were selected from a cohort of 239 mothers and children, and forty 2- to 5-year-old children from Southeast Iowa were selected to compare the genotypic profiles of Streptococcus mutans recovered from each child's plaque. S. mutans isolates were selected from whole mouth plaque samples; DNA was extracted and amplified via AP-PCR to show specific genotype patterns. These patterns were compared with GelComparIIv6.5 gel analysis software. We found 18 distinct genotypes from 524 isolates; 13 of which were common between the 2 communities. Five genotypes were unique to only the American Indian children while the Southeast Iowa children harbored no unique genotypes. Although the American Indian children had some genotypes that were not present in the Southeast Iowa children, these were not widely distributed among the community. Furthermore, the levels of genotypic diversity and commonality were similar between the 2 populations. This study sets the groundwork for a comprehensive comparison of genotypes and caries among larger subsections of both populations.

Timing of primary tooth emergence among U.S. racial and ethnic groups.

OBJECTIVES: To compare timing of tooth emergence among groups of American Indian (AI), Black and White children in the United States at 12 months of age. METHODS: Data were from two sources - a longitudinal study of a Northern Plains tribal community and a study with sites in Indiana, Iowa and North Carolina. For the Northern Plains study, all children (n = 223) were American Indian, while for the multisite study, children (n = 320) were from diverse racial groups. Analyses were limited to data from examinations conducted within 30 days of the child's first birthday. RESULTS: AI children had significantly more teeth present (Mean: 7.8, Median: 8.0) than did Whites (4.4, 4.0, P < 0.001) or Blacks (4.5, 4.0, P < 0.001). No significant differences were detected between Black and White children (P = 0.58). There was no significant sex difference overall or within any of the racial groups. CONCLUSIONS: Tooth emergence occurs at a younger age for AI children than it does for contemporary White or Black children in the United States.

Factors associated with dental caries in a group of American Indian children at age 36 months.

OBJECTIVES: Early childhood caries (ECC) is rampant among American Indian children, but there has been relatively little study of this problem. This article reports on risk factors for caries for a group of American Indian children at age 36 months as part of a longitudinal study. METHODS: Pregnant women from a Northern Plains Tribal community were recruited to participate in a longitudinal study of caries and caries risk factors. Standardized dental examinations were completed on children, and questionnaires were completed by mothers at baseline and when children were 4, 8, 12, 16, 22, 28, and 36 months of age. Examinations were surface-specific for dental caries, and the questionnaires collected data on demographic, dietary, and behavioral factors. Nonparametric bivariate tests and logistic regression models were used to identify risk factors for caries at 36 months, and negative binomial regression was used to identify factors related to caries severity (dmf counts). RESULTS: Among the 232 children, and caries prevalence for cavitated lesions was 80%, with an additional 15% having only noncavitated lesions. The mean dmfs was 9.6, and of the total dmfs, nearly 62% of affected surfaces were decayed, 31% were missing, and 7% were filled. Logistic regression identified higher added-sugar beverage consumption, younger maternal age at baseline, higher maternal DMFS at baseline, and greater number of people in the household as significant (P < 0.05) risk factors. Negative binomial regression found that only maternal DMFS was associated with child dmf counts. CONCLUSIONS: By the age of 36 months, dental caries is nearly universal in this population of American Indian children. Caries risk factors included sugared beverage consumption, greater household size, and maternal factors, but further analyses are needed to better understand caries in this population.

Acidogenicity and acid tolerance of Streptococcus oralis and Streptococcus mitis isolated from plaque of healthy and incipient caries teeth.

BACKGROUND: Non-mutans low pH oral streptococci are postulated to contribute to caries etiology. OBJECTIVE: This study was undertaken to investigate whether the acidogenicity and acid tolerance of clinical strains of Streptococcus oralis and Streptococcus mitis correlate with health or early-stage enamel caries. DESIGN: S. oralis and S. mitis were isolated from plaque samples taken from the occlusal surfaces of second molars sampled at two different visits 4 years apart. All sites were sound at Visit 1; subjects were segregated into one of three groups based on the status of the site at Visit 2 and caries elsewhere in the dentition. Strains of S. oralis and S. mitis were evaluated for acidogenicity and acid tolerance, and the results correlated with the clinical status of the sites from which they were isolated. Mutans streptococci (MS) isolated from the plaque samples were also quantified, and the presence or absence of growth on pH 5.5 media or on media selective for bifidobacteria was recorded. RESULTS: No significant positive correlations were found between the acidogenicity properties of the S. oralis and S. mitis clones and caries at either visit. Similar results were obtained for acid tolerance of S. oralis clones but were inconclusive for S. mitis clones. A statistically significant positive correlation between MS levels and caries (or future caries) was evident at both visits, but there were no statistical correlations with the growth on pH 5.5 media or media selective for bifidobacteria. CONCLUSIONS: The low pH potential likely varies considerably among oral streptococcal species and is least likely to be found among strains of S. mitis. Accordingly, the concept and constitution of 'low pH streptococci' may need to be re-evaluated.

Effect of root canal filling/sealer systems on apical endotoxin penetration: a coronal leakage evaluation.

Endotoxin, elaborated by gram-negative organisms, is an important factor in apical periodontitis. The objective of this study was to evaluate the magnitude of endotoxin penetration through root canal treated teeth using a dual chamber model system. Forty-four maxillary anterior teeth were prepared endodontically and canals filled either by lateral condensation or a warm thermoplasticized technique in combination with either Roth's 801 or AH 26 sealer. Teeth were suspended in the model system with a mixed anaerobic bacterial suspension in the upper chamber and HBSS in the lower chamber. The QCL-1000 LAL assay was used to measure endotoxin at 0, 1, 7, 14, and 21 days. Response feature analysis using trapezoidal area under the curve was performed; the four treatment groups were compared using nonparametric methods. Groups differed (p = 0.028), with thermoplasticized root canal filling/Roth's 801 sealer permitting the least apical endotoxin penetration. Results suggest that Roth's 801 sealer may have a role in inhibiting endotoxin penetration.

Genotypic characterization of initial acquisition of Streptococcus mutans in American Indian children.

BACKGROUND: Severe-early childhood caries (S-ECC) is one of the most common infectious diseases in children and is prevalent in lower socio-economic populations. American Indian children suffer from the highest levels of S-ECC in the United States. Members of the mutans streptococci, Streptococcus mutans, in particular, are key etiologic agents in the development of caries. Children typically acquire S. mutans from their mothers and early acquisition is often associated with higher levels of tooth decay. METHODS: We have conducted a 5-year birth cohort study with a Northern Plains Tribe to determine the temporality and fidelity of S. mutans transmission from mother to child in addition to the genotypic diversity of S. mutans in this community. Plaque samples were collected from 239 mother/child dyads at regular intervals from birth to 36 months and S. mutans were isolated and genotyped by arbitrarily primed-polymerase chain reaction (AP-PCR). RESULTS: Here we present preliminary findings from a subset of the cohort. The focus for this paper is on initial acquisition events in the children. We identified 17 unique genotypes in 711 S. mutans isolates in our subset of 40 children, 40 mothers and 14 primary caregivers. Twelve of these genotypes were identified in more than one individual. S. mutans colonization occurred by 16 months in 57.5% of the children and early colonization was associated with higher decayed, missing and filled surface (DMFS) scores (p=0.0007). Children colonized by S. mutans shared a common genotype with their mothers 47.8% of the time. While multiple genotypes were common in adults, only 10% of children harbored multiple genotypes. CONCLUSION: These children acquire S. mutans at an earlier age than the originally described 'window of infectivity' and often, but not exclusively, from their mothers. Early acquisition is associated with both the caries status of the children and the mothers.

An effective psychoeducational intervention for early childhood caries prevention: part I.

PURPOSE: The purpose was to compare whether mothers exposed to an autonomy-supportive psychoeducational videotaped message, informed by the self-determination theory (SDT), demonstrated greater changes in oral health knowledge and behavioral intentions as a preventive means for early childhood caries (ECC) than mothers exposed to a neutral message delivered by brochure. METHODS: Data were collected at baseline, one-, and six-month follow-ups from 415 12- to 49-month-old WIC-enrolled children and their mothers: 283 in the video intervention group and 132 in the brochure control group. Mothers completed questionnaires on maternal knowledge and behavioral intentions for oral health care. Chi-square, Wilcoxon rank-sum, and Mann-Whitney tests were used to analyze data (P<.05). RESULTS: Relative to their baseline scores, the intervention group showed a greater increase in knowledge than the control group, both at one-month (P=.002) and six-month follow-ups (P<.001). The video group also demonstrated a greater increase in behavioral intentions than controls, both at one-month (P<.05) and six-month follow-ups (P<.001). Knowledge and behavioral intention levels at six-month follow-up did not differ significantly from those at one-month follow-up, indicating that intervention-based increases in these measures were maintained over time. CONCLUSIONS: Data provided evidence of the effectiveness of the autonomy-supportive psychoeducational intervention for ECC prevention relative to a neutral brochure.

An effective psychoeducational intervention for early childhood caries prevention: part II.

PURPOSE: The purpose was to compare whether mothers exposed to an autonomy-supportive psychoeducational videotaped message, informed by self-determination theory (SDT), demonstrated greater changes in behavior concerning their children's oral health than mothers exposed to a neutral message delivered by brochure. METHODS: Data were collected at baseline, one- and six-month follow-ups from 415 12- to 49-month-old WIC-enrolled children and their mothers: 283 in the video intervention group and 132 in the brochure control group. Mothers completed questionnaires regarding their child's dietary/oral hygiene habits. Chi-square, Wilcoxon Signed Rank, Mann-Whitney, and McNemar tests were used to analyze data (P<0.05). RESULTS: Significantly more positive changes were observed for dietary/oral hygiene behaviors among the intervention group mothers at one- and six-month follow-ups than for the controls. Significantly fewer mothers in the intervention group shared dining ware with their child at both one- (P=0.0046) and six-month follow-ups (P<0.0001); this practice was decreased only at six-months for the control group mothers (P=0.05). Restricting consideration only to mothers who were not checking for white spot lesions at baseline, a significantly greater proportion of mothers in the intervention group performed this behavior at six-months (P=0.0044). CONCLUSIONS: Data provided evidence of the effectiveness of the SDT videotaped oral health message relative to a neutral brochure.

Oral mucosal lipids are antibacterial against Porphyromonas gingivalis, induce ultrastructural damage, and alter bacterial lipid and protein compositions.

Oral mucosal and salivary lipids exhibit potent antimicrobial activity for a variety of Gram-positive and Gram-negative bacteria; however, little is known about their spectrum of antimicrobial activity or mechanisms of action against oral bacteria. In this study, we examine the activity of two fatty acids and three sphingoid bases against Porphyromonas gingivalis, an important colonizer of the oral cavity implicated in periodontitis. Minimal inhibitory concentrations, minimal bactericidal concentrations, and kill kinetics revealed variable, but potent, activity of oral mucosal and salivary lipids against P. gingivalis, indicating that lipid structure may be an important determinant in lipid mechanisms of activity against bacteria, although specific components of bacterial membranes are also likely important. Electron micrographs showed ultrastructural damage induced by sapienic acid and phytosphingosine and confirmed disruption of the bacterial plasma membrane. This information, coupled with the association of treatment lipids with P. gingivalis lipids revealed via thin layer chromatography, suggests that the plasma membrane is a likely target of lipid antibacterial activity. Utilizing a combination of two-dimensional in-gel electrophoresis and Western blot followed by mass spectroscopy and N-terminus degradation sequencing we also show that treatment with sapienic acid induces upregulation of a set of proteins comprising a unique P. gingivalis stress response, including proteins important in fatty acid biosynthesis, metabolism and energy production, protein processing, cell adhesion and virulence. Prophylactic or therapeutic lipid treatments may be beneficial for intervention of infection by supplementing the natural immune function of endogenous lipids on mucosal surfaces.

Factors associated with mutans streptococci among young WIC-enrolled children.

OBJECTIVES: The objective of this study is to assess relationships between the presence or absence of mutans streptococci (MS) and other covariates in children aged 12-49 months. METHODS: Data were analyzed using baseline information from 411 children enrolled in the Special Supplemental Food Program for Women, Infants and Children (WIC) who participated in a psychoeducational study in Iowa. Children were assessed for MS using a semiquantitative method (RODAC plates). Dental examinations using d(1) d(2) .(3) criteria and presence of visible plaque on incisors and molars were completed. Mothers completed a series of detailed questionnaires regarding their child's oral health, their socioeconomic status, their child's dietary/oral hygiene habits, and beverage consumption, among other behaviors. Bivariate relationships with the presence of MS were assessed and followed by multivariable modeling using logistic regression (alpha = 0.05). RESULTS: MS was present in 144 children (35 percent). Bivariate relationships with MS presence were identified for multiple covariates that included demographic characteristics, type of beverage consumption, dental caries, and plaque measures. Multivariate logistic regression modeling suggested that MS presence in children was positively associated with nonwhite race of the child, number of teeth present, presence of cavitated lesions, proportion of teeth with plaque, and lower levels of maternal education. CONCLUSIONS: The presence of MS was associated with greater caries and plaque scores and with low maternal education and nonwhite racial background.