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Clinical Trial Details — Status: Not yet recruiting

Administrative data

NCT number NCT05761197
Other study ID # 851149
Secondary ID
Status Not yet recruiting
Phase
First received
Last updated
Start date July 1, 2024
Est. completion date August 31, 2028

Study information

Verified date February 2024
Source University of Pennsylvania
Contact Yuan Liu, DDS, MS, PhD
Phone 215-573-6248
Email liuyuan1@upenn.edu
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

The overall objective of this study is to investigate the association of early Candida infection (known as oral thrush or oropharyngeal candidiasis, OPC) in children during the first year of life with the onset and severity of severe early childhood caries (S-ECC).


Description:

The overall goal of this study is to conduct a longitudinal observational study to investigate the association of early OPC with the onset and severity of S-ECC to better understand the role of Candida (particularly C. albicans) in severe childhood caries. The investigators will test the hypothesis that OPC is associated with S-ECC by modifying the plaque microbiota and enhancing virulence in a manner that is conducive to the early development of the disease. For this study, a total of 60 infants (aged 6-15-month-old) with or without a history of OPC in their first year of life will be enrolled, based on the inclusion and exclusion criteria. Subjects will have their medical/dental history reviewed from medical records. At each study visit (Baseline, 6-month, 12-month, 18-month, and 24-month follow-ups), an oral examination including soft tissue and caries exam will be performed by a calibrated evaluator. Dental plaque/oral swab samples will be collected at each study visit. In addition, a comprehensive survey including demographic status, oral hygiene, diet, delivery, and feeding method as well as current medication usage will also be collected.


Recruitment information / eligibility

Status Not yet recruiting
Enrollment 60
Est. completion date August 31, 2028
Est. primary completion date August 31, 2028
Accepts healthy volunteers Accepts Healthy Volunteers
Gender All
Age group 6 Months to 15 Months
Eligibility Inclusion Criteria: - Male or female individuals at the age of 6-15-month-old - Must have at least one fully erupted tooth at baseline visit - Parent/guardian willing and able to provide informed consent - With or without a history of OPC (the study team will enroll 30 participants with and 30 participants without a history of OPC) Exclusion Criteria: - Presence of a systemic medical condition (e.g. Down syndrome etc.) - Presence of an orofacial deformity - Presence of dental caries - Use of systemic antimicrobial therapy within 30 days of the baseline visit - Presence of any condition which, in the opinion of the investigator, makes participation in the project not in the individual's best interest.

Study Design


Locations

Country Name City State
United States University of Pennsylvania Philadelphia Pennsylvania

Sponsors (2)

Lead Sponsor Collaborator
University of Pennsylvania Children's Hospital of Philadelphia

Country where clinical trial is conducted

United States, 

References & Publications (28)

American Academy on Pediatric Dentistry; American Academy of Pediatrics. Policy on early childhood caries (ECC): classifications, consequences, and preventive strategies. Pediatr Dent. 2008-2009;30(7 Suppl):40-3. No abstract available. — View Citation

Bowen WH, Burne RA, Wu H, Koo H. Oral Biofilms: Pathogens, Matrix, and Polymicrobial Interactions in Microenvironments. Trends Microbiol. 2018 Mar;26(3):229-242. doi: 10.1016/j.tim.2017.09.008. Epub 2017 Oct 30. — View Citation

Broffitt B, Levy SM, Warren J, Cavanaugh JE. Factors associated with surface-level caries incidence in children aged 9 to 13: the Iowa Fluoride Study. J Public Health Dent. 2013 Fall;73(4):304-10. doi: 10.1111/jphd.12028. Epub 2013 Jul 26. — View Citation

de Carvalho FG, Silva DS, Hebling J, Spolidorio LC, Spolidorio DM. Presence of mutans streptococci and Candida spp. in dental plaque/dentine of carious teeth and early childhood caries. Arch Oral Biol. 2006 Nov;51(11):1024-8. doi: 10.1016/j.archoralbio.2006.06.001. Epub 2006 Aug 7. — View Citation

Drury TF, Horowitz AM, Ismail AI, Maertens MP, Rozier RG, Selwitz RH. Diagnosing and reporting early childhood caries for research purposes. A report of a workshop sponsored by the National Institute of Dental and Craniofacial Research, the Health Resources and Services Administration, and the Health Care Financing Administration. J Public Health Dent. 1999 Summer;59(3):192-7. doi: 10.1111/j.1752-7325.1999.tb03268.x. No abstract available. — View Citation

Duangthip D, D D. Early childhood caries and candida albicans. Evid Based Dent. 2018 Dec;19(4):100-101. doi: 10.1038/sj.ebd.6401337. Erratum In: Evid Based Dent. 2019 Mar;20(1):13. D, Duangthip [corrected to Duangthip D]. — View Citation

Falsetta ML, Klein MI, Colonne PM, Scott-Anne K, Gregoire S, Pai CH, Gonzalez-Begne M, Watson G, Krysan DJ, Bowen WH, Koo H. Symbiotic relationship between Streptococcus mutans and Candida albicans synergizes virulence of plaque biofilms in vivo. Infect Immun. 2014 May;82(5):1968-81. doi: 10.1128/IAI.00087-14. Epub 2014 Feb 24. — View Citation

GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017 Sep 16;390(10100):1211-1259. doi: 10.1016/S0140-6736(17)32154-2. Erratum In: Lancet. 2017 Oct 28;390(10106):e38. — View Citation

Gugnani N, Pandit IK, Srivastava N, Gupta M, Sharma M. International Caries Detection and Assessment System (ICDAS): A New Concept. Int J Clin Pediatr Dent. 2011 May-Aug;4(2):93-100. doi: 10.5005/jp-journals-10005-1089. Epub 2010 Apr 15. — View Citation

Hajishengallis E, Forrest CB, Koo H. Early Childhood Caries: Future Perspectives in Risk Assessment. JDR Clin Trans Res. 2016 Jul;1(2):110-111. doi: 10.1177/2380084416637577. Epub 2016 Mar 7. No abstract available. — View Citation

Hajishengallis E, Parsaei Y, Klein MI, Koo H. Advances in the microbial etiology and pathogenesis of early childhood caries. Mol Oral Microbiol. 2017 Feb;32(1):24-34. doi: 10.1111/omi.12152. Epub 2016 Feb 4. — View Citation

Hedrick VE, Comber DL, Estabrooks PA, Savla J, Davy BM. The beverage intake questionnaire: determining initial validity and reliability. J Am Diet Assoc. 2010 Aug;110(8):1227-32. doi: 10.1016/j.jada.2010.05.005. — View Citation

Hwang G, Liu Y, Kim D, Li Y, Krysan DJ, Koo H. Candida albicans mannans mediate Streptococcus mutans exoenzyme GtfB binding to modulate cross-kingdom biofilm development in vivo. PLoS Pathog. 2017 Jun 15;13(6):e1006407. doi: 10.1371/journal.ppat.1006407. eCollection 2017 Jun. — View Citation

Jean J, Goldberg S, Khare R, Bailey LC, Forrest CB, Hajishengallis E, Koo H. Retrospective Analysis of Candida-related Conditions in Infancy and Early Childhood Caries. Pediatr Dent. 2018 Mar 15;40(2):131-135. — View Citation

Kassebaum NJ, Smith AGC, Bernabe E, Fleming TD, Reynolds AE, Vos T, Murray CJL, Marcenes W; GBD 2015 Oral Health Collaborators. Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990-2015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors. J Dent Res. 2017 Apr;96(4):380-387. doi: 10.1177/0022034517693566. — View Citation

Kim D, Sengupta A, Niepa TH, Lee BH, Weljie A, Freitas-Blanco VS, Murata RM, Stebe KJ, Lee D, Koo H. Candida albicans stimulates Streptococcus mutans microcolony development via cross-kingdom biofilm-derived metabolites. Sci Rep. 2017 Jan 30;7:41332. doi: 10.1038/srep41332. — View Citation

Kim HE, Liu Y, Dhall A, Bawazir M, Koo H, Hwang G. Synergism of Streptococcus mutans and Candida albicans Reinforces Biofilm Maturation and Acidogenicity in Saliva: An In Vitro Study. Front Cell Infect Microbiol. 2021 Feb 19;10:623980. doi: 10.3389/fcimb.2020.623980. eCollection 2020. — View Citation

Koo H, Andes DR, Krysan DJ. Candida-streptococcal interactions in biofilm-associated oral diseases. PLoS Pathog. 2018 Dec 13;14(12):e1007342. doi: 10.1371/journal.ppat.1007342. eCollection 2018 Dec. No abstract available. — View Citation

Koo H, Bowen WH. Candida albicans and Streptococcus mutans: a potential synergistic alliance to cause virulent tooth decay in children. Future Microbiol. 2014;9(12):1295-7. doi: 10.2217/fmb.14.92. No abstract available. — View Citation

Kressin NR, Nunn ME, Singh H, Orner MB, Pbert L, Hayes C, Culler C, Glicken SR, Palfrey S, Geltman PL, Cadoret C, Henshaw MM. Pediatric clinicians can help reduce rates of early childhood caries: effects of a practice based intervention. Med Care. 2009 Nov;47(11):1121-8. doi: 10.1097/MLR.0b013e3181b58867. — View Citation

Metwalli KH, Khan SA, Krom BP, Jabra-Rizk MA. Streptococcus mutans, Candida albicans, and the human mouth: a sticky situation. PLoS Pathog. 2013;9(10):e1003616. doi: 10.1371/journal.ppat.1003616. Epub 2013 Oct 17. No abstract available. — View Citation

Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies. Pediatr Dent. 2016 Oct;38(6):52-54. No abstract available. — View Citation

Qiu R, Li W, Lin Y, Yu D, Zhao W. Genotypic diversity and cariogenicity of Candida albicans from children with early childhood caries and caries-free children. BMC Oral Health. 2015 Nov 17;15(1):144. doi: 10.1186/s12903-015-0134-3. — View Citation

Raja M, Hannan A, Ali K. Association of oral candidal carriage with dental caries in children. Caries Res. 2010;44(3):272-6. doi: 10.1159/000314675. Epub 2010 May 27. — View Citation

Shoaib L, Deery C, Ricketts DN, Nugent ZJ. Validity and reproducibility of ICDAS II in primary teeth. Caries Res. 2009;43(6):442-8. doi: 10.1159/000258551. Epub 2009 Nov 12. — View Citation

Xiao J, Huang X, Alkhers N, Alzamil H, Alzoubi S, Wu TT, Castillo DA, Campbell F, Davis J, Herzog K, Billings R, Kopycka-Kedzierawski DT, Hajishengallis E, Koo H. Candida albicans and Early Childhood Caries: A Systematic Review and Meta-Analysis. Caries Res. 2018;52(1-2):102-112. doi: 10.1159/000481833. Epub 2017 Dec 21. — View Citation

Xiao J, Moon Y, Li L, Rustchenko E, Wakabayashi H, Zhao X, Feng C, Gill SR, McLaren S, Malmstrom H, Ren Y, Quivey R, Koo H, Kopycka-Kedzierawski DT. Candida albicans Carriage in Children with Severe Early Childhood Caries (S-ECC) and Maternal Relatedness. PLoS One. 2016 Oct 14;11(10):e0164242. doi: 10.1371/journal.pone.0164242. eCollection 2016. — View Citation

Yang XQ, Zhang Q, Lu LY, Yang R, Liu Y, Zou J. Genotypic distribution of Candida albicans in dental biofilm of Chinese children associated with severe early childhood caries. Arch Oral Biol. 2012 Aug;57(8):1048-53. doi: 10.1016/j.archoralbio.2012.05.012. Epub 2012 Jun 18. — View Citation

* Note: There are 28 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Other To study the role of Candida on biofilm cariogenic properties Candida-bacterial interaction in modulating biofilm development and virulence will be evaluated using validated experimental models 24 months
Primary To explore the association between OPC and S-ECC onset and severity Caries will be measured by ICDAS scoring system; Plaque and oral swab samples will be collected at each study visit (Baseline, 6-month, 12-month,18-month and 24-month follow-ups); Candida strains will be detected using culturing-dependent and -independent sequencing techniques. 24 months
Secondary To evaluate the influence of OPC on the oral microbiota Microbiome profiling will be done by shot gun sequencing 24 months
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