Salivary characteristics and dental caries experience in remote Indigenous children in Australia: a cross-sectional study

Lalloo, R., Tadakamadla, S.K., Kroon, J., Tut, O., Kularatna, S., Boase, R., Kapellas, K., Gilchrist, D., Cobbledick, E., Rogers, J., and Johnson, N.W. (2019) Salivary characteristics and dental caries experience in remote Indigenous children in Australia: a cross-sectional study. BMC Oral Health, 19. 21.

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Background: While associations between salivary characteristics and dental caries have been well studied, we are not aware of this being assessed in a remote Indigenous child population, where lifestyles may be different from urban children. Our aim was to assess associations between caries experience and putative biomarkers in saliva, accounting for oral hygiene and dietary habits.

Methods: Children attending schools in an Indigenous community in remote north Queensland, Australia were invited to an oral examination by qualified and calibrated examiners. Salivary flow rate, pH, buffering capacity and loads of mutans streptococci (MS), lactobacilli (LB) and yeasts were determined. Also, data on tooth brushing frequency and soft drinks consumption were obtained via a questionnaire. Caries experience was recorded by the International Caries Detection and Assessment System (ICDAS-II), and quantified as decayed, missing and filled surfaces. Relationships between the salivary variables and the cumulative caries experience (dmfs+DMFS) in the deciduous and permanent dentitions were examined by multivariate analyses to control the effect of confounders.

Results: The mean cumulative decayed (DS+ds), missing (MS+ms) and filled (FS+fs) surfaces were 3.64 (SD: 4.97), 1.08 (4.38) and 0.79 (1.84) respectively. Higher salivary MS and LB counts, low tooth brushing frequency and daily soft drink consumption were significantly related to greater caries experience. Caries experience was about twice in those with 10<^>5 CFU/ml saliva counts of MS (mean=6.33, SD: 8.40 vs 3.11, 5.77) and LB (7.03, 7.49 vs 4.41, 8.00). In the fully-adjusted multivariate model, caries experience in those with higher counts of MS and LB were 51 and 52% more than those with lower counts.

Conclusions: As with studies in other populations, childhood salivary counts of MS and LB were significantly associated with greater caries experience in this remote Indigenous community. To address the serious burden of oral disease, we are researching ways to promote a healthy oral environment by encouraging good dietary habits, and emphasising the importance of daily tooth brushing with a fluoridated toothpaste. Our ongoing longitudinal studies will indicate the success of measures employed to reduce the counts of bacteria closely associated with cariogenesis and their impact on caries increment.

Item ID: 57025
Item Type: Article (Research - C1)
ISSN: 1472-6831
Keywords: Dental caries, Saliva, Bacteria, Children, Fluoridation, Remote, Indigenous, Australia
Copyright Information: © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Funders: National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: NHMRC APP1081320
Date Deposited: 06 Feb 2019 07:39
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3203 Dentistry > 320307 Oral medicine and pathology @ 50%
45 INDIGENOUS STUDIES > 4504 Aboriginal and Torres Strait Islander health and wellbeing > 450417 Aboriginal and Torres Strait Islander public health and wellbeing @ 50%
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