Berkowitz Rj

The early establishment of Streptococcus mutans in the mouths of infants

Abstract The colonization of Strep. mutans in infants was studied using a selective medium. The organism was not detected in 91 normal predentate infants, but was detected in two out of ten predentate cleft palate infants with acrylic obturators. In infants with only erupted primary incisors, the organism was detected in plaque samples from 9 of 40 subjects. Serological characterization of 66 Strep. mutans isolates from nine mother-child pairs revealed the c serotype to be the most common. In addition one b, two d, and one E serotype were isolated from the mothers. All isolates from infants were of the c serotype. Subsequent samples were obtained in the case where the b serotype was detected. Strains of this serotype were isolated from both mother and infant.

Mouth-to-mouth transmission of the bacterium Streptococcus mutans between mother and child

The production of bacteriocins by 314 Streptococcus mutans isolates from 20 mother-infant pairs was studied to test the likelihood of maternal transmission of this species. The patterns of inhibition were sufficiently different to allow differentiation of the 314 isolates into 41 bacteriocin types. The bacteriocin codes of isolates within one pair did not correspond to the codes of strains isolated from any other pair. The number of infant strains (per infant isolates) matching maternal strains within each mother-infant pair were 10/10, 10/10, 10/10, 12/12, 2/3, 10/10, 10/10, 10/10, 3/3, 5/10, 8/8, 3/3, 8/8, 3/3, 7/7, 4/4, 3/3, 8/8, 3/3 and 4/4 for pairs 1-20, respectively. Statistical analysis, utilizing a randomization test, generated a p value less than 0.0001, which is 12 standard errors above the level expected if the pairings were random.

Similarity of bacteriocins of Streptococcus mutans from mother and infant

Abstract Bacteriocin typing has been used as an epidemiological tool for tracing bacterial infections in man. The production of bacteriocins by 120 Streptococcus mutans isolates from 4 mother-infant pairs was studied to test the likelihood of maternal transmission of this species. The patterns of inhibition were sufficiently different to allow differentiation of the 120 isolates into 42 bacteriocin types. The bacteriocin codes of isolates within one pair did not correspond to the codes of strains isolated from any other pair examined. The number of infant strains (per 10 infant isolates) matching maternal strains within each mother-infant pair were 5 10 , 10 10 , 7 10 , and 9 10 for each of the pairs respectively. The results demonstrated significant intra-pair homogeneity of Strep. mutans strains based on bacteriocin production.

Maternal salivary levels of Streptococcus mutans and primary oral infection of infants

Streptococcus mutans was detected in 38 of 156 infants harbouring 6–8 primary incisor teeth. The salivary level of Strep. mutans was determined for each of the 156 mothers of the infant subjects. The difference in the distribution of the salivary levels of Strep. mutans within the maternal populations of infected versus non-infected infants was statistically significant (P < 0.0001). In addition, the frequency of infant infection (0.58) was approximately nine times greater when maternal salivary levels of the organism exceeded 105 colony-forming units (CFU) per ml relative to the frequency of infant infection (0.06) observed when maternal salivary reservoirs were less than or equal to 103 CFU/ml.

Primary oral infection of infants with Streptococcus mutans

Abstract Strep. mutans was not detected in 16 normal predentate infants, but was isolated from 3 43 infants with 1 to 5 primary incisor teeth and 12 42 infants with 6 to 8 incisors. The salivary level of Strep. mutans was determined for the 42 mothers of the infants with only 6 to 8 incisors. The difference in the distribution of the salivary levels of Strep. mutans within the maternal populations of infected versus non-infected infants was statistically significant (p = 0.03). Ten mothers harboured greater than 105 colony-forming units (CFUs) of Strep. mutans per ml. saliva. The organism was detected in 6 of their infants. Of 13 mothers with levels less than 103 CFUs per ml. saliva only 2 of their infants harboured the organism.

Chloral Hydrate Sedation: The Additive Sedative and Respiratory Depressant Effects of Nitrous Oxide

The combination of chloral hydrate and nitrous oxide (N2 O) is often used for sedation in pediatric dentistry.The purpose of this study was to determine the extent to which N2 O increases the level of sedation and respiratory depression in children sedated with chloral hydrate. Thirty-two children, 1-9 yr, received chloral hydrate, 70 mg/kg (maximum 1.5 g), and then received N2 O (30% and 50%). Hypoventilation (maximal PETCO2 > 45 mm Hg) occurred in 23 (77%) children during administration of chloral hydrate alone, in 29 (94%) breathing 30% N2 O (P = 0.08 versus control), and in 29 (97%) breathing 50% N2 O (P = 0.05 versus control). Mean PETCO2 was increased during 30% (P = 0.007) and 50% (P = 0.02) N2 O administration. Using chloral hydrate alone, 8 (25%) children were not sedated, 10 (31%) were consciously sedated, and 14 (44%) were deeply sedated. Using 30% N2 O, 2 children (6%) were not sedated, 0 were consciously sedated, and 29 (94%) were deeply sedated (P < 0.0001). Using 50% N2 O, 1 child (3%) was not sedated, 0 were consciously sedated, 27 (94%) were deeply sedated, and 1 (3%) had no response to a painful stimulus (P < 0.0001). We conclude that the addition of 30% or 50% N2 O to chloral hydrate often causes decreases in ventilation and usually results in deep, not conscious, sedation in children. Implications: Pediatric sedation in the dental office often consists of nitrous oxide (N2 O) after chloral hydrate premedication. We found that the addition of 30% or 50% N2 O to chloral hydrate often causes decreases in ventilation and usually results in deep, not conscious, sedation in children. (Anesth Analg 1998;86:724-8)

Breathing patterns and levels of consciousness in children during administration of nitrous oxide after oral midazolam premedication

PURPOSE The combination of midazolam and nitrous oxide is commonly used to achieve sedation and analgesia during pediatric oral procedures, yet there are few, if any, data that illustrate the ventilatory effects of N2O in children, especially when used in combination with additional central nervous system (CNS) depressants. It was hypothesized that the addition of N2O inhalation to oral midazolam premedication would enhance the sedative effects of the midazolam and add analgesia without causing significant respiratory depression. The purpose of this study was to test this hypothesis. MATERIALS AND METHODS Thirty-four healthy children about to undergo restorative dental treatment under general anesthesia were premedicated with oral midazolam, 0.7 mg/kg, and were then exposed to 40% N2O for 15 minutes after a 5-minute control period. The effect of adding N2O on SpO2, respiratory rate, PETCO2, VT, and VT/TI was examined and the levels of consciousness (conscious vs deep sedation) before and during N2O inhalation were determined. RESULTS During the course of the study, no child developed hypoxemia (SpO2 < 92%) nor clinically significant upper airway obstruction. Four children who did not develop hypoventilation (defined as PETCO2 > 45 mm Hg) during the control period did so after initiation of N2O. Overall, there were no significant differences in SpO2, PETCO2, VT, or VT/TI between the control and study periods. However, respiratory rates were significantly higher in the first 10 minutes of N2O inhalation when compared with the control period. Before starting N2O administration, 14 children were not clinically sedated, 19 children met the criteria for conscious sedation, and one child met the criteria for deep sedation. At the end of 15 minutes of N2O inhalation, 12 children were not clinically sedated, 17 children met the definition of conscious sedation, three were deeply sedated, and one child had no response to IV insertion, implying a state of general anesthesia. There were no differences in sedation scores between the control and study periods (P = .6). Overall, seven children had an increase in their sedation score while breathing N2O, four had a decrease in their sedation score, and 22 had no change. CONCLUSIONS The addition of 40% N2O to oral midazolam, 0.7 mg/kg, did not result in clinically meaningful respiratory depression nor upper airway obstruction, but did, in some children, cause an increase in the level of sedation beyond simple conscious sedation.

Reduced nicotine reward in obesity: cross-comparison in human and mouse.

RationaleTobacco use and obesity lead to significant morbidity and mortality.ObjectiveThis study was conducted to investigate the factors maintaining smoking behavior in lean and obese individuals by utilizing a mouse/human cross-validation model of nicotine reward.MethodsIn humans, a cigarette choice paradigm was used to examine the relative reinforcing value of nicotine in obese and non-obese smokers. Conditioned place preference (CPP) for nicotine was assessed in mice fed standard low fat rodent chow and mice rendered obese by a high fat diet.ResultsIn humans, obese smokers self-administered nicotine via cigarettes significantly less often than non-obese smokers and showed attenuated hedonic effects of nicotine-containing cigarettes compared to denicotinized cigarettes. Similarly, mice exposed to a high fat diet did not exhibit nicotine CPP, relative to control mice. mRNA levels for mu-opiate and leptin receptors were also downregulated in the ventral tegmental area of these mice.ConclusionsTogether, these studies provide the first evidence for reduced nicotine reward in obese subjects and suggest that this may be mediated by dietary influences on the endogenous opioid system.

Binge eating, mood, and quality of life in youth with type 2 diabetes: baseline data from the today study.

OBJECTIVE The current study examines the prevalence of binge eating and its association with adiposity and psychosocial functioning in a large, diverse sample of youth with type 2 diabetes. RESEARCH DESIGN AND METHODS In the TODAY study, 678 (mean age 14.0 years; 64.9% girls) of the 704 youth randomized to the study completed a self-report measure of eating disorder symptoms and were categorized as nonovereaters, overeaters, subclinical binge eaters, or clinical binge eaters. RESULTS Youth with clinical (6%) and subclinical (20%) levels of binge eating had significantly higher levels and rates of extreme obesity, global eating disorder and depressive symptoms, and impaired quality of life. CONCLUSIONS These findings highlight the importance of evaluating youth with type 2 diabetes for the presence of binge eating. Future research is needed to determine the cumulative effects of disordered eating, obesity, and psychosocial distress on adherence to lifestyle change recommendations and longitudinal response to treatment.

Microbial characteristics of the human dental caries associated with prolonged bottle-feeding

Plaque samples from caries lesions, white spot margins of these lesions, and caries-free smooth enamel surfaces, obtained from seven subjects with nursing bottle caries, all contained unusually high proportions of Streptococcus mutans. The proportion of lactobacilli present in plaque from caries lesions was statistically greater (p less than 0.01) than the proportion present in plaque obtained from white spot margins of these lesions or caries-free smooth enamel surfaces.