Hindawi Publishing Corporation

International Journal of Dentistry

Volume 2017, Article ID 452108, 4
pages doi:10.1155/2014/452108

Clinical Study

Relationship between Cariogenic Bacteria and pH of Dental

Plaque at Margin of Fixed Prostheses

Junko Tanaka, Norio Mukai, Muto Tanaka, and Masahiro Tanaka

Department of Fixed Prosthodontics and Occlusion, Osaka Dental University, 1-5-17, Otemae, Chuo-ku, Osaka 540-0008,
Japan

Correspondence should be addressed to Junko Tanaka, [email protected]

Received 30 June 2017; Revised 13 September 2017; Accepted 1 October 2017

Academic Editor: Alexandre Rezende Vieira Copyright © 2014 Junko Tanaka et al. This is an open access article distributed
under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.

Objective. The purpose of this study was to investigate whether teeth that have undergone prosthetic restoration are under
conditions that promote caries recurrence. Methods. The subjects were 20 dentate adults with both a healthy tooth and an affected
tooth entirely covered with a complete cast crown in the molar regions of the same arch. The pH was measured in plaque adhering
to the margin of the tooth covered with a complete cast crown and adhering to the cervicobuccal area of the natural tooth. In
addition, the numbers of cariogenic bacteria (mutans streptococci and lactobacilli) were measured employing the saliva test. The
relationships between the number of cariogenic bacteria and plaque pH of the natural tooth and between the number of cariogenic
bacteria and plaque pH of the tooth covered with a complete cast crown were investigated. Results. The plaque pH of the tooth
covered with a complete cast crown decreased as the numbers of SM and LB increased. The natural tooth were also influenced
by the number of SM. Conclusion. Secondary caries are likely to develop from the marginal region of the crown in the oral cavity
with a high caries risk unless a preventive program is prepared and the oral environment is improved following the program.
1. Introduction Kholer and Hager reported that mutans streptococci¨
adhere to the margins of the restorations early after the
Secondary caries from the margin of fixed prostheses is often cementing in high-risk group regarding the cariogenic
bacteria counts [1]. When fixed prostheses are left in the high
caries activities, the possibility of the incidence of secondary
noted in daily clinical cases, occasionally leading to tooth caries becomes high.
extraction due to the development of subgingival carious performed, the oral environment does not improve. The
cavities. The secondary caries is considered to occur from secondary caries will occur from the margin of the
various factors, such as the poorly fitting margin, and plaque restorations when the oral environment does not improve.
accumulation. After the result of repetitive retreatment, multiple teeth will
be lost. This is because the “process” during which for measuring the pH values of dental plaque. The dental
prostheses are cemented and appropriate treatment is not plaque was collected one hour or longer after completing
performed. brushing. The cervicobuccal area of subject teeth was wiped
Preceding studies clarified that caries development is with sterilized swabs about ten times. They were
strongly associated with caries factors, particularly microbial immediately put into the culture solution. The culture
factors [4]. However, in performing “treatment of process” solution was cultivated in an incubator at 37 degrees for 48
for the prevention of secondary caries, the influence of the hours. Then, the pH values were measured using a pH meter
SM and LB counts on the pH value of plaque in the crown (B-212, Horiba, Tokyo, Japan) to obtain the pH values of the
margin has not been clarified. dental plaque (Figure 1).

2 International Journal of Dentistry

Level
Oral environmental factors
0 1 2 3

mutans streptococci (CFU/ml) <1 × 105 1 >1 × 106

lactobacilli (CFU/ml) 1 103 104
Table 1: Classification of oral environmental factors.

× × ×
CFU: colony forming units. Regarding measurement of the cariogenic bacteria
counts, such as mutans streptococci (SM) and lactobacilli
(LB), stimulated saliva was collected using the spit-out
method after chewing 1 gram of paraffin wax for 5 minutes.
The collection of saliva was performed between nine thirty
and eleven thirty in the morning more than 1 hour after
breakfast.
The stimulated saliva was cultivated using a simplified
The collection of the dental culture kit (Dentocult SM, LB, Diagnostics Co.). After

Figure 1: Measurement of the pH values of dental plaque.

cultivation, the number of SM and LB was measured,

In this study, as the first step of the “treatment of
comparing with an attached model chart. The results were
process”, regarding caries risk, the relationship between the
divided into 4 classes (Table 1).
cariogenic bacteria counts and plaque pH was evaluated.
This study protocol was screened and approved on its
ethical acceptability by the Committee on Experimental
2. Material and Method Research on Human of Osaka Dental University.
2.1. Study Design and Subjects. Among middle-aged and
elderly patients who visited our hospital, 20 dentate (7 males 2.2. Statistical Analysis. We compared the pH values of
and 13 females, mean age: 51.1 ± 12.1 years, number of dental plaque and the SM and LB counts using one-way
remaining teeth: 25.8 ± 2.1) were selected as the subjects. ANOVA. Regarding combinations in which significant
They were performed using only fixed prostheses. In the oral differences were noted, a multiple comparison test was
situations of the subjects, both natural teeth and fixed performed using Fisher’s PLSD method (P < 0.05).
prostheses were present in the molar area on the contralateral
teeth in the same arch.
The subjects’ teeth consisted of 41 healthy teeth without 3. Results
caries or restorations (natural tooth group) and 69 molars in Figure 2 shows the result in the natural tooth groups.
which silver-palladium gold-alloy complete cast crown was In the natural tooth group, the pH values of dental plaque
cemented with a good fit (crown group). The adaptation of became lower with an increase in the SM counts, showing a
the complete cast crown was examined using the explorer significant difference. Therefore, a multiple comparison test
[5]. The Cariostat (Dentsply-Sankin, Tokyo, Japan) was used
was performed, and a significant difference was noted
between classes 0 and 1 and class 2 in SM. The pH value
became lower with an increase in the LB counts. However,
no statistically significant difference was observed between
the pH values and the LB counts.
Figure 3 shows the results in the crown groups.
In the crown group, the pH value became lower with an
increase in the SM counts, showing a significant difference.
Furthermore, the plaque pH values significantly became
lower with an increase in the LB counts. As a result of
multiple comparison tests, significant differences were
between classes 0 and 1 and class 2, and between classes 0
and 1 and class 3 in SM, showing decreases in the pH value
with increases in SM as a caries risk. Regarding LB, a
significant difference was noted between class 0 and classes
2 and 3. The pH values of dental plaque were lower with
increases in the LB counts.

4. Discussion
4.1. Method

4.1.1. Subjects. The subjects were selected; only fixed

restorative appliances were inserted. Our previous study
revealed that the cariogenic bacteria counts were high in
patients wearing removable dentures, in which the adhesion
of bacteria to the dentures wearers was considered [6].
Therefore, removable denture wearers were not selected as
the subjects in this study.
International Journal of Dentistry 3

(a) (b)

Figure 2: Relationship between the plaque pH values of molar teeth and oral environmental
factor in the natural teeth group.

(Class) (Class)
(a) (b)

Figure 3: Relationship between the plaque pH values of molar teeth and oral environmental
factor in the crown group.

0.1 2 3 0 1
2.3
(Class)(Class)
(Class)(Class)

4.1.2. Materials. Dentocult was used to investigate the oral solution with the reduced pH using acid. Okazaki et al. [11]
environment concerning caries. Its usefulness has been researched the reproducibility of the Cariostat method.
reported by clinical studies in many countries, and an The method of Yamaga et al. [12] where the pH values
epidemiological survey by the WHO, [7, 8] including not of cultures were measured with a pH meter was adopted in
only measurement of the flow rate and buffer capacity of order to make this study accurate.
stimulated saliva and cariogenic SM and LB counts but also
microbiological analysis has been performed. 4.2. Results. Previous studies confirmed that there is no
The Cariostat used in the experiments is widely used in significant difference in the pH of the plaque adhering to the
caries activity tests [9, 10]. With the Cariostat TM method, cervicobuccal area of natural molars between the
the dental plaque is put into a test solution containing a high contralateral teeth in the same arch [3]. Therefore, we
concentration of sucrose, and acid is generated as the plaque considered that there is no difference in the condition of tooth
constituting bacteria grow. The caries activity is evaluated brushing and flow of saliva between the contralateral teeth in
based on the changes in colors of the pH indicator in the test the same arch.
4 International Journal of Dentistry
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plaque pH in natural teeth and fixed prostheses was
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Acknowledgments oral science, vol. 48, no. 4, pp. 245–251, 2006.
[14] T. Hamasaki, S. Awano, T. Konoo et al., “Utility of a
A part of this study was at 108th General scientific meeting simplified caries risk test for patients with fixed orthodontic
of The Japan Prosthodontic Society. This study was appliances,” Journal of Dental Health, vol. 59, pp. 34–41,
supported by the Japan Society for the Promotion of Science, 2009 (Japanese).
Grant-inAid for Scientific Research 21592481.

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