Dental caries vaccination – A revolution in the world of Dentistry.

Dental caries, an infectious disease of bacterial aetiology, is a prevalent and costly disease in both developing and industrialised countries. It is an irreversible, multifactorial opportunistic infection. Treatment of dental caries continues to remain one of the most expensive treatments making it a major public health issue.

Researchers have focused on the development of a vaccine that would prevent this disease. Research efforts during the past 25 years have concentrated on determining the methods and mechanisms for inducing salivary immune responses to S. mutans in humans. Over 25 years several researches have been conducted for developing an effective vaccination against dental caries.

Advancements in molecular biology and understanding of the mucosal immune system have led to a significant progress in developing of this vaccine.

Advancements in molecular biology have facilitated the cloning and functional characterisation of virulence factors of the mutans streptococci, including the cell-surface fibrillar proteins, which mediate adherence to the tooth surface, and the glucosyltransferase enzymes, which synthesise adhesive glucans and allow microbial accumulation on the teeth.

The tooth surfaces are continually bathed by saliva in which secretory immunoglobulin A (S-IgA) is the principal immunoglobulin present. Therefore, the induction of a salivary S-IgA response against the mutans streptococci would provide a first line of defence against the colonisation of these bacteria on tooth surfaces.

Streptococcus mutans, principle bacteria causing this disease, start colonizing the oral cavity as early as 5 to 6 months of age. Specific secretory immunoglobulin A (IgA), present in the saliva, provides a specific immune defence against these cariogenic bacteria.

Current strategies for immunisation against dental caries are using these virulence factors as key antigens and incorporating them into novel mucosal vaccine systems and delivering them with or without adjuvants to mucosal IgA inductive sites. The most popular routes of mucosal immunisation are via the oral or nasal route.

The mucosal immune system is functional in new-born infants, who develop salivary IgA antibodies as they become colonised by oral micro-organisms. Mucosal immunisation strategies result in the induction of salivary IgA antibody responses and pose fewer problems than parenteral injection of antigen. Therefore, mucosal immunisation of infants prior to the appearance of their first teeth may be a well-tolerated and effective way to induce immunity against the colonisation of teeth by mutans streptococci and protection against subsequent dental caries.

In recent years some promising vaccines such as pGJA-P/VAX,LT derivatives/Pi36-512, KFD3-rPAc and DBR/GBR-CMV-nirB have been developed and tested in animals. A study reveals that the rats who were vaccinated showed higher concentration of IgA in their saliva.

In order to further develop and introduce it into the mainstream pharmaceutical companies, multiple collaborative studies, human clinical trials, interest from funders and public health professionals are required.

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Dr. Zareen Fatima

Dr Zareen is an ambitious general dentist working and residing in UAE. She is able to handle multiple tasks on a daily basis. Alongside her busy work schedule, she is a vivid reader, researcher, writer editor and is currently pursuing Masters in Public Health. In her leisure she brings out the forgotten history in the field of medicine and associated disciplines.

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