Does assessment of microbial composition of plaque/saliva allow for diagnosis of disease activity of individuals?

Microbiological tests are limited in their applicability in the assessment of caries activity and in caries prediction. They can be effective in group of persons with high or low caries experience. The reasons for the limitation of microbiological tests rests with unique characteristics of the microflora and local environments of the oral cavity, which will modify the cariogenicity of plaque in an individual. Thus, high numbers of S. mutans may be associated with the development of a lesion at a site, while a second susceptible site with high levels of this organism in the same subject will remain caries free. This paper identifies some aspects of oral bacteria which can contribute to the unique nature of the microflora associated with plaque in an individual. Firstly, the range of bacteria potentially involved in caries has widened and now includes, for example, 'low pH' non-mutans streptococci. The presence of such organisms in plaque in an individual may influence early enamel demineralization. Most significantly, Streptococcus mutans, Streptococcus mitis and Actinomyces naeslundii have been shown to be comprise many distinct clones, with different distribution among subjects. Little is known of the impact of clonal diversity on caries activity but in some bacterial diseases particular clones are associated with virulence. Therefore, possession of a particular clone or clones by an individual could be related to caries activity. Also, the extent of clonal diversity may reflect the nature of the oral environment. Recent studies suggest that cells are released from biofilms, during adherence and growth, i.e. the early phases of development. Thus, determination of the numbers of a given species in non-stimulated saliva may indicate whether it is actively growing in plaque. Microbiological tests on the oral flora should perhaps be used to monitor the status of the oral cavity, after establishing a norm for the individual patient. Research on species and clonal diversity of oral bacteria among human populations; diversity and its role in the caries process; and the liberation of biofilm cells could provide data to allow better appreciation and evaluation of the results of microbiological testing.