Jpn. J. Infect. Dis., 54, 2001

Laboratory and Epidemiology Communications

Controlling Opportunistic Pathogens in the Oral Cavlty Of

PreschooI Children by the Use of 3DS
Yoshiaki Nomura, Hidenobu Senpuku, Shimpei Tsugel , Masaki Hayashi1 , Akihiro Sasakil ,Hiroshi TamuraI , Hirohisa Ida2, Eiji Yoshikawa2, Fusao Nishikawara,
Sachie Kawamura, Kazuhiro Kokubo3 and Nobuhiro Hanada*
Department of Oral Science, National Institute oflnfectious Diseases,
Toyama I‑23‑1, Shinjuku‑ku, Too/0 162‑ 8640,
1 Glfu Dental Association,

1‑1 8 Kano‑Jounann‑dori, Glfu‑shi, Glfu 500‑8486,

2BML Co. Ltd., Sendagaya 5‑21‑3, Shibuya‑ku, To&0 151‑0051 and3Tono Region Public Center,Ueno‑cho, Tajimi‑shi, Glfu 507‑8708
Communicated by Nobuhiro Hanada(Accepted December 6, 200 1)

by rinslng With water and handflosslng. The subjects wereDental cariesand periodontal diseaseare two major diseases
that affect the oral cavity. StylePtOCOCCuS mutanS and Lactoba‑

then advised not to eat or drink for 2 h after the treatment.

cillus areknown as major pathogens for dental caries, while

Followlng 3DS, all subjects were provided with a new tooth‑

PoTPhwomonow gingivalisand A ctinobacillw actinomycetem‑brush to prevent re‑infection by S. mutans, and were also given

comitans have been shoⅥm to be involved with periodontal

instmctions regarding the application or a commerciallydisease･ Other types of bacterial infectioT also have clinicalavailable 0.4% povidone iodine (Isogin nodoflesh: Meij iseika)

significance in aged groups ( 1 ) predisposlng them to serious

by drug retainer for 5 min a洗er tooth brushing at night. Thissystemic infection (2). Staphylococcus aweus may cause

home care was continued for 1 month.

Dental plaque samples were obtained at a private dental

pneumonia in older veterans (3)･

Thoughdata on the prevalence of oral bacteria inthe elderly

ofrlCe followlng the home care period. The plaque samples(4‑6) are available, such data regarding young people are few･

were placed in transport fluid (0.4% agar, 0. I 5%thioglycollate/In the present study, We focused on opportunlStic pathogens

phosphate buffered saline) and taken to Bio Medical Labora‑

in the oral cavities of preschool children.

tory (Tokyo) for analysis. There, each sample was poured

Deciduous teethare replaced by permanent teeth generally

directly onto chocolate agar, blood agar, OPA staphylococcus,

at the age of 5 to 16. During this period, immunologicaland drigalski agarplates (Nippon Becton Dickinson Co･, Ltd･,

activities agalnSt pa仙ogens as well as mineralization on toothTokyo) using a stick･ The plates were incubated in an atmワs‑

surfaces develop. Formation ofbiofilmby pathogenic microbes

phere of 5% COつ in H2 at 37oC fわr 24‑48 h･ RepresentatlVeon surfaces in the oral cavity and changes in micronora may

microbial colonies from each plate were gram stained andtake placeand cause systemic diseases (7) such as endocarditis

isolated by identification of their characteristic appearance,(8) and rheumatic diseases (9).

as well as by their hemolytic, catalytic, and oxidase reactions

Inthis study, 645 children during medical check‑ups prior toentrance to elementary school were surveyed for their salivary
levels of S. mutans and Lactobacillus. Informed consent was(1 3). Those species found in a majorityof the subjects weresuspended in 1 ml ofO.5% saline, gently shaken, and tested
using microbial detection kits. The following bacteriaandfungi

obtained丘om the parents pnor to the suⅣey. Salivary levels

Were identified in the detection plates: S. aureus (methicillin

greaterthan 105 CFU/ml saliva for S. mutansand greater thansensitive 【MSSA】 and resistant [MRSA】) by PS latex, rabbit

1 03 CFU/ml saliva for Lactobacillus were considered to indicate

plasma,孤d MRSA scrmig plates (Nippon Becton Dickinson) ;a highrisk for dental caries (10). Fo止y‑seven of the subjects

Pseudomonas sp. by VITEK (BioMerieux Vitek Japan lBVJ],

fulfilling these criteria were then randomly selected for treat‑Tbkyo); β‑hemolytic streptococcus by a Seroidenstrepto kit

mentwiththe Dental Drug Delivery System (3DS) td eliminate(Eiken Chemical Co., Ltd., Tokyo), Apt strepto (BVJ), andVITEK; S. pneumoniae by a Streptococcus identification disk

the opportunistic bacteria (1 1 , 12).

The 3DS method consists of individual trays, called drug(Nippon Becton Dickinson); Haemophilus injluenzae by aretainers, that fit onto teeth and deliver small amounts of anti‑
bacterial drugs. A洗er the oral biofilm was removed by physicalHaemophilus ID4 plate (Nippon Becton Dickinson); Senlatia
marcescens by VITEK; and Candida sp. by a Candida checktreatment,known as Professional Mechanical Tooth Cleanlng(1atron Laboratories lnc., Tokyo). The levels of detection for(PMTC), a commercially available 1 O% povidone iodine gel(ISODrNE GEL: Meijiseika Co. Ltd., Tokyo) was applied toeach organism were determined according to the manufacturer'sinstmctions.

the dentition uslng a drug retainer for 3 min.Any gel remainlng

Asshown in Table 1, among the 47 subjects investigated,on the tooth su血ces or in the inteトdental spaces was removed

2 1 (44･7%) had species of bacteria that w?re not designated*Corresponding author: Tel: +8 1‑3‑5285‑I 1 I I , Fax: +8 I‑3‑52851

bacteria w?re higher in higher grade children (data not show叶as a part ofnormalflora (14). The detectlOn rates Ofthese1 1 72, E‑mail:nhanada@nih.go.jp

Three specleS, Haemophilus sp. , Enterobacter sp･, and Candida

199

Jpn. J. Infect. Dis., 54, 2001
Table I. Opportunistic pathogens detected before and after 3DS treatment

septlCemia or bacteremia in 1991‑1998. Application ofwith 10% povidone iodine gel
Before〃Haemophl'Lus sp.

7 ′▲U 4 ‑ 2 tJ 1 I 1 1 0 0

Medicare claims血ta. Ann. Epidemio1., ll, 1 18‑126.
trcatmcnt%

4 2 0 2 4 ′‑U 2 2 2 2 0 0 9 8 5 ｣ 3 4 ｣ ｣ ｣ ｣ 0 0

A氏er/J

6. Abudu, L., Blair, I., Praise, A. and Cheng, K. K. (2001):
Methicillin‑resistant Staphylococcus aweus (MRSA): atreatment%

0 0 4 2一1 1 4一‑ ▲1 ‑community‑based prevalence survey. Epidemiol. Infect. ,00000 4220 222 0 0 53｣ 5｣ ｣126, 351‑356.

Enterobacter sp.

7. Yoneyama, T., Yoshida, M., Matsui, T., Sasaki, H. and theCandida sp.

oral care working group. ( 1 999): Oml careand pneumonia.
Lancet, 354, 515.

SenTatia sp.

S. aureus (MSSA)

8. Meyer, D. H. and Fives‑Taylor, P. M. (1998): Oral path0‑S. FyOgeneS

gens:from dental plaque to cardiac disease. Curr. Opin.

Flavobacterium sp.

Microbio1., 1, 88‑95.

Klebsiella sp.
Pseudomonas sp.

9. Spagnuolo, M., Pastemack, 良. and Taranta, A. (1971):

P. aerugLnOSa

Risk of rheumatic‑fever recurrences after streptococcal

AcinetobacEer sp.

infections. Prospective study of clinical and social

factors. N. Engl. J. Med., 285, 641‑647.

M(B). catarrhalis

10. Roeters, F. J., van der Hoeven, J. S., Burgersdijk, R. C.
and Schaeken, M. J. (1995): Lactobacilli, mutants strepto‑sp., that showed high frequencies in plaque samples werecocci and dental caries: a longitudinal study in 2‑year‑

eliminated by the SOS treatment, though other species was
not affected by the treatment.

272‑279.

old children up to the age of5 years. Caries Res., 29,

1 1. Takeuchi, H., Fukushima, K., Senpuku, H., Nomura, Y.,

Kaneko, N., Yano, A., Morita, E., lmai, S., Nisizawa, T.,

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