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Presented by: Sachin Rai

Department Of Oral Medicine and Radiology


DSCDS
Bangalore
Contents

Introduction
Etiology
Vaccines
Mechanism of action of vaccine
Routes of Immunization
Types of caries vaccine
Attempts using Antibodies
Risks of Using Caries Vaccine
Conclusion
Introduction

As wild as it may sound, dental caries have a profound effect on

our country also in a political way. Worldwide, it is estimated


that five billion people suffer from tooth decay. A vaccine would
also be cheaper than purchasing dental care and cleaning
materials. A vaccine would also help people in many poor
countries where dental care is not available.
DENTAL CARIES

Dental caries is an infectious microbiologic disease of the teeth

that results in localized dissolution and destruction of the


calcified tissue (Sturduent) .
Etiology

A wide group of microorganisms are identified from carious

lesions of which Streptococcus mutans , Lactobacillus


acidophilus, and Actinomyces viscosus are the main
pathogenic species involved in the initiation and development of
dental caries.
Vaccines

Vaccines are an immuno-biological substance designed to

produce specific protection against a given disease. It stimulates


the production of a protective antibody and other immune
mechanisms. Vaccines are prepared from live modified
organisms, inactivated or killed organisms, extracted cellular
fractions, toxoids, or a combination thereof.
The prevention and control of dental caries is the main aim of

public health, eventually the ultimate objective of public health


is the elimination of the disease itself. Recently, dental caries
vaccines have been developed for the prevention of dental
caries. These dental caries vaccines are still in the early stages.
Mechanism of Action of Vaccine

Saliva contains approximately 1-3% of immunoglobulin


concentration, a majority of which is secretary IgA. In addition,
cellular components of the immune system such as lymphocytes,
macrophages, and neutrophils are also present in gingival sulcus.

Some of the possible ways antibodies might control bacterial growth


are listed below.
Continued

The salivary immunoglobulin may act as a specific agglutinin

interacting with the bacterial surface receptors and inhibiting


colonization and subsequent caries formation.

The salivary glands produce secretory IgA antibodies by direct

immunization of the gut associated lymphoid tissue (GALT), from


where sensitized B-cells may be home to the salivary glands.
Continued

The gingival crevicular mechanism involves all the humoral and


cellular components of the systemic immune system, which may
exert its function at the tooth surface.

The organism is phagocytosed and undergoes antigenic


processing by macrophages. In the lymphoid tissue, T and B-
lymphocytes are sensitized by the macrophages preventing the
antigen HLA Class-II complex and releasing IL-I.
Routes of Immunization

In general, 4 routes of immunization have been used with

S. mutans:

Oral.

Systemic (subcutaneous).

Active gingivo-salivary.

Passive dental immunization.


1. Oral route

Many of the earlier studies relied on oral induction of immunity

in the GALT to elicit protective salivary IgA antibody responses.

A significant reduction in caries was related to an increased level

of salivary IgA antibodies to S. mutans, as the serum antibody


titer was minimal.

Daily administration of 10 cells of S. mutans in capsules

produced a small increase in secretory IgA.


2. Intranasal route

More recently, attempts have been made to induce protective

immunity in mucosal inductive sites that are in closer anatomical


relationship to the oral cavity.

These include intranasal installation of antigen which targets

nasal associated lymphoid tissue(NALT).


3. Tonsillar route

Tonsilar application of antigen generates a good anti-microbial

response with the help of IgG.

Palatine and nasopharyngeal tonsils contribute precursor cells to

mucosal sites.
4. Minor salivary gland

These have been selected as their ducts can facilitate retrograde

access of bacteria and their products.


Passive immunization

As the name suggests, passive immunization involves passive or external


supplementation of the antibodies. This carries the disadvantage of
repeated applications, as the immunity conferred is temporary.

Several approaches tried were:


Monoclonal antibodies.

Bovine milk and whey.

Egg-yolk antibodies.

Transgenic plants.
Continued

The latest in these developments in passive immunization is the

use of transgenic plants to give the antibodies. The researchers


have developed a caries vaccine from a genetically modified
(GM) tobacco plant. The vaccine, which is colourless and
tasteless, can be painted onto the teeth rather than injected and
is the first plant derived vaccine from GM plants.
Continued

The advantages of passive immunization are listed below:

The genetic material can be easily exchanged.

It is possible to manipulate the antibody structure so that while


the specificity of the antibody is maintained, the constant region
can be modified to adapt to human conditions, thus avoiding
cross reactivity.
Large scale production is possible as it would be quite
inexpensive
TYPES OF CARIES VACCINE

Subunit vaccines.

Recombinant vaccines.

Conjugated vaccines.
Attempts using antibodies

Early attempts followed a traditional approach to vaccination

where normal S. mutans was introduced to promote a reaction


from the immune system, stimulating antibody production.

The corporation planet biotechnology has developed a

synthetic antibody against S. mutans, branded CaroRx, which


it produces using transgenic tobacco plants. This product may be
considered a theraputic vaccine, applied once every several
months, and is in Phase II clinical trials as of October 2007.
Risks of Using Caries Vaccine

All vaccines, even if properly manufactured and

administered, seem to have risks. The most serious is that


sera of some patients with rheumatic fever who show
serological cross-reactivity between heart tissue antigens
and certain antigens from hemolytic Streptococci.
Conclusion

Clearly, there is strong evidence that S. mutans and Streptococcus

sobrinus are closely associated with dental caries. Fluoride


treatment has successfully limited caries progression, but was not
sufficient to control this infectious disease even when used
together with professional tooth cleaning and dietary counseling.

Along with established methods of caries prevention, caries

vaccines have the potential of making a highly valuable


contribution to disease control.
References

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Clifford MS. The art and science of Operative dentistry. 4th ed. Mosby
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Krasse B, Emilson CG, Gahnberg L. An anticaries vaccine: Report on the status
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Harris R. Vaccines for dental caries. Aust Dent J 1983;28:115-6
Newman, Nisengard. Oral microbiology and immunology. W.B. Saunder's
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Textbook of pediatric dentistry (Nikhil Marwah).2nd ed.Jaypee publishing
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