الفهرس 
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Abstract
Severe early childhood caries is a particularly aggressive form of dental caries affecting toddlers and pre-school children with several etiological factors at play including socioeconomic status, maternal oral health, children’s nursing and dietary habits and level of awareness and practice of oral hygiene measures. Moreover, pathogenic microorganisms are of paramount importance in the ecology of dental caries, yet the microbial composition of plaque has shown major differences in children from different socio-economic backgrounds and in different countries. Scarce literature was available on the microbial composition of dental plaque among Egyptian children, although this information may help enhance caries preventive modalities and improve risk minimization.
Considering the fact that, the incidence of S-ECC is progressively increasing in developing countries, added to the
economic burden posed by its increased incidence in different countries even the developed ones, it is quite crucial to adopt an antibacterial approach for prevention of S-ECC. Miswak, among other plant products, is recognized in the Middle East and adjoining areas of Africa for its antibacterial role against oral pathogens. Moreover, the concept of restoring and maintaining oral health by using beneficial bacteria (probiotics) against oral pathogens has been asserted, yet new strains arise continuously that need to be investigated and compared to the already available strains.
Subsequently, this study aimed generally to investigate the various possible risk factors related to development of S-ECC. Moreover it aimed to identify the most common pathogenic microbiota among children suffering from S-ECC, and to evaluate and compare the potential antimicrobial effects of three different probiotic Lactobacilli strains and miswak on bacterial strains identified to be associated with the disease.
In the current study, 70 children were enrolled from the Pediatric Dentistry and Dental Public Health Department clinic, Faculty of Dentistry, Ain Shams University, 50 of which suffered from S-ECC, and 20 were caries free. Subjects were recruited according to certain inclusion criteria, and a written consent was signed by their parents before conducting the research. A questionnaire interview was done by one operator aiming at investigating the main risk factors causing S-ECC and children were diagnosed to assess their caries experience. Plaque samples were collected from 25 children with S-ECC and 15 who were caries free to identify the most common microbiota found in children suffering from S-ECC. A Disc Diffusion method was conducted to measure the effect of 20% aqueous miswak extract, and three probiotic Lactobacilli strains (LAC.rhamnosus, LAC.plantarum, and LAC.reuteri) on the microbiota identified in advance.
Based on data from questionnaire interviews, the most common risk factors associated with the development of S-ECC were
improper nursing habits including on demand feeding, night feeding, and sharing utensils, along with lack of proper oral hygiene measures.
Microbiological testing of plaque samples revealed that the most common microbiota of S-ECC were Streptococcus mutans, and Streptococcus sorbinus respectively. Some other strains were found at a lower degree such as Enterococcus faecalis, Streptococcus sanguinus, Streptococcus viridans, and Streptococcus parasanguinus.
In regards to the antibacterial therapy, it was proved that all studied probiotic Lactobacilli strains had some inhibitory effect on Streptococcus mutans and Streptococcus sorbinus with varying degrees. LAC.rhamnosus showed the highest inhibitory effect followed by LAC.plantarum then LAC.reuteri.
Miswak was also shown to possess antibacterial effects against both bacterial strains associated with S-ECC (Streptococcus mutans and Streptococcus sorbinus). Though it was found to be less effective compared to LAC.rhamnosus, but still it had higher antibacterial potentials than both LAC.plantarum, and LAC.reuteri.
Interestingly, the effects of the tested probiotic Lactobacilli strains can be also potentiated when added to miswak thereby enhancing oral health promotion at minimal costs.