الفهرس 
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Abstract
Early childhood caries (ECC) is a serious oral health condition that affects a large number of young children. If untreated, ECC can lead to serious health problems, significant pain, interference with eating, overuse of the emergency room, and loss of school time. Severe ECC can also affect a child’s ability to eat and grow properly, speak and communicate with others.
Several etiological factors play a significant role in the initiation and progression of the disease including children’s early feeding practices, dietary habits, level of awareness, and practice of oral hygiene measures, socioeconomic status and maternal oral health.
Breastfeeding has long been accused of being the main cause of ECC; although the cariogenicity of human milk is still the subject of some controversy. Many studies examined the association between breastfeeding and ECC, however, their findings produced conflicting results.
Probiotics have been widely used in general medicine to infer health benefits, and recently their use in dentistry was documented to decrease oral pathogenic bacteria causing caries.
Vehicles used for delivery of probiotics vary, as well as the strain of the probiotics used and their concentration. The use of formula milk as a vehicle for probiotics has proved to be beneficial in prevention and treatment of digestive diseases, feeding intolerance, diarrhea, and necrotizing enterocolitis. However, the use of probiotics in formula to prevent caries is still under investigation.
Subsequently, this study was designed to evaluate the cariogenicity of breast milk and two commercially available infant formulas, France Lait® 1 (plain formula) and Nan® 1 Optipro (probiotic supplemented formula), by detecting the counts of Streptococcus mutans (S.mutans) and Lactobacilli in
saliva of infants. Additionally, the growth of S.mutans and Lactobacilli in the three types of milk was evaluated.
The current study was based on two main phases, in phase I, 60 infants were enrolled from the Egyptian Ministry of Health, family care centers. Infants were recruited according to certain inclusion criteria and a written consent was signed by their parents before conducting the research. Three main groups were enrolled according to nursing type; breast milk, plain formula or probiotic supplemented formula. A saliva sample was taken by using a sterile cotton swab by gently rubbing the mucosa of the cheeks, alveolar ridge and tongue. The samples were then immediately transferred for the microbiology laboratory for culturing. Salivary samples were cultured and incubated for 72 hours to obtain cultures of both S.mutans and Lactobacilli. Following incubation the plates were assayed for colony forming unites CFU of S.mutans and Lactobacilli to assess bacterial counts.
In phase II of our study, the cariogenicity of breast milk and the two types of infant formulas, France Lait® 1, and Nan® 1, was evaluated. Mature human breast milk donations were collected from nursing mothers of infants of ages 6 weeks to 2 years. Milk specimens were then taken to the microbiology laboratory where the specimens were inoculated with S.mutans and Lactobacilli and incubated for 72 hours. Following incubation, plates were assayed for CFU of S.mutans and Lactobacilli to assess growth of both bacteria in each type of milk.
Microbiological testing showed that breast milk is not as cariogenic as infant formulas. In phase I of the study it was found that infants nursed exclusively by breast milk exhibited less counts of S.mutans and Lactobacilli when compared to children nursed exclusively by infant formulas.
Moreover, by comparing salivary bacterial counts of infants that were exclusively formula fed it was found that infants fed probiotic supplemented
formula exhibited less number of S.mutans and Lactobacilli when compared to infants nursed on plain formula.
These findings were further supported by second part of the study. The 3 types of milk were used as nutrient media for the growth of the 2 bacteria, and similar results were obtained.
There were no statistical significant differences in the counts of bacteria among infants delivered by natural delivery and by C-section. However, the odds ratio revealed a protective effect of C-section delivery over natural delivery.