This document discusses dental caries vaccines. It begins by describing primary and secondary immune responses. It then discusses antigenic components of Streptococcus mutans, the main cause of dental caries, including adhesins, glucosyl transferases, and glucan binding proteins. The mechanisms of action and routes of immunization for caries vaccines are presented, including oral, systemic, active gingivo-salivary, and passive routes. Recent advances in caries vaccine development are also summarized, such as sub-unit vaccines, DNA vaccines, plant-derived vaccines, and strain replacement therapy. The conclusion states that as caries vaccines are introduced, the dentist's role will shift from caries management to prevention.

2. Presented by
Dr.D.Venkatesh kumar

3. CONTENTS
 IMMUNE RESPONSE
 ANTIGENIC CONCEPTS OF MS
 MECHANISM OF ACTION OF CARIES VACCINE
 ROUTES OF IMMUNIZATION
 RECENT ADVANCES IN CARIES VACCINE
 CONCLUSION
 REFERENCES

4. IMMUnE response
Primary immune response:
 Cell proliferation & differentiation upon first antigen
exposure
 Lag period: 3 to 6 days
 Peak levels of plasma antibody are reached in 10 days
 Antibody levels then decline.
Secondary immune response:
 Reexposure to same antigen gives faster, more prolonged,
more effective response
 Sensitized memory cells respond within hours
 Antibody levels peak in 2 to 3 days at much higher levels
 Antibodies bind with great affinity.

5. Antigenic Components of MS
1. Adhesins:
 Enables-adherence of bacteria - salivary pellicle-tooth surface &
aggregation-streptococcus mutans by salivary components.
2. Glucosyl transferases (GTF):
 GTF of bacteria convert sucrose-water soluble & water
insoluble glucans.
 Glucans bind- food debris, epithelial cells, mucous and bacteria
- tooth surface.

6. 3. Glucan binding protein:
 Binding - insoluble glucan -bacterial cell surface.
 GBP produced by MS.
 MS secretes 3 distinct proteins
 GBP-A, GBP-B, and GBP-C.
 Only GBP-B- protective immune response -experimental
dental caries.

7. Mechanism of action of caries vaccine:
Vaccines- from Cell wall antigen, Glucan binding protein and
Dextranase .
Inhibit colonization of bacteria & against glycosyl transferase inhibit
the acid production.
 Caries immunization can be active or passive.

8. Routes of immunization
4 routes of immunization
 1. Oral
 2. Systemic (subcutaneous)
 3. Active gingivo-salivary
 4. Passive dental immunization

9. Oral route
Earlier studies relied-oral induction of immunity-GALT-
protective salivary IgA antibody responses.
Antigen was applied by:
oral feeding,
gastric intubation, or
vaccine containing capsules

10. Although-oral route-not ideal for reasons:
 Stomach acidity on antigen, or
 Inductive sites were relatively distant,
 Experiments - mucosal immunity alone - sufficient
to change - course of infection - S. mutans &
disease in animal models and in humans.

11. Intranasal route
 NALT- induce immunity to many bacterial antigens including
those associated with mutans Streptococcal colonization and
accumulation.
 Protective immunity after infection with cariogenic mutans
streptococci -induced in rats by the intranasal route with many
S. mutans antigens or functional domains associated with these
component

12. Tonsillar route
 Topical application of formalin-killed Streptococcus sobrinus
cells in rabbits - induce a salivary immune response - decrease
the consequences of infection with cariogenic Streptococcus
sobrinus.
 Repeated tonsillar application of a particulate antigen - induce
the appearance of IgA antibodies producing cells in both the
major & minor salivary glands of the rabbit.

13. Minor salivary gland
 Streptococcus sobrinus GTF was topically administered onto
the lower lips of young adults - route may have potential for
dental caries vaccine delivery.
 labial application of GTF - significantly lower proportion of
indigenous S. mutans/total Streptococcal flora in their whole
saliva –during 6-week period following a dental prophylaxis
compare with placebo group.

14. Systemic route
 Subcutaneous administration of S. mutans was used
successfully in monkeys and elicited predominantly serum IgG,
IgM, and IgA antibodies.
 The antibodies find their way into the oral cavity via gingival
crevicular fluid and are protective against dental caries.

15.  A subcutaneous injection of killed cells of S. mutans in
Freundís incomplete adjuvant or aluminium hydroxide elicits
IgG, IgM, and IgA classes of antibodies.
 Studies have shown that IgG antibodies are well maintained at a
high titer, IgM antibodies progressively fall and IgA antibodies
increase slowly in titer.

16. Active gingivo-salivary route
 In order to limit potential side effects, and to localize the
immune response, gingival crevicular fluid - route of
administration. Apart from the IgG, it is also associated with
increased IgA levels.

17. Systemic immunization of cows -vaccine using whole S.
mutans- the bovine milk and whey containing polyclonal IgG
antibodies.
added to the diet of a rat model
whey was also used in a mouth rinse, which resulted in a
lower percentage of S. mutans in the plaque.
immune whey brought a reduction in the caries level.
PASSIVE IMMUNIZATION

18. Egg-yolk antibodies:
 The novel concept of using hen egg-yolk antibodies against the cell-
associated glucosyltransferase of S. mutans was introduced by
Hamada.
 Vaccines used were formalin killed whole cells and cell associated
GTFs. Caries reduction has been found with both these treatments.

19. Transgenic plants:
 latest development - passive immunization - use of transgenic
plants to give the antibodies.
 researchers - developed a caries vaccine -genetically modified
(GM) tobacco plant.
 Vaccine - colorless and tasteless - painted onto the teeth
rather than injected - first plant derived vaccine from GM
plants.

20. Sub - unit
vaccines
DNA
Vaccines
Plantigens
and
Plantibodies
Strain
replacement
therapy
Recent advances in caries
vaccine production

21. Sub Unit Vaccines
 vaccine introduced into the host -potential disadvantage of cross-
reaction with heart muscle. To overcome - Sub unit vaccines are
introduced.
 particular protein antigen of the organism is used as an antigen.
 advantage - specifically attacking the antigenic surfaces.
 Antigenic proteins of a different disease causing organism can also
be joined together so that, these vaccines can be designed to induce
immunity to more than one infection.

22.  DNA Vaccines:
DNA vaccines - a specific DNA is administered into
the system
 The host Synthesize protein component coded by
DNA.
 Cell wall protein antigen of MS - virulence factor
 Anti caries DNA vaccine is developed to express cell
wall protein.
Reduce the acid production
-Lower number of carious lesions -high
levels of salivary IgA & serum IgG were
observed experimental animals .
-Thus further research is warranted to
detect the safety of these vaccines.

23. PLANTIGENS & PLANTIBODIES
 Plants can be used to synthesize plantigens (Antigens) and
plantibodies (Antibodies).
 Researches with transgenic plants started in 1983 with the
use of Tobacco plants.
 Later it was extended in various plants producing fruits and
vegetables.
 Thus eating a transgenic plant fruit (Banana, potato) -
have nutrients - protection against infectious diseases.

24. Advantages -
 large quantities of antibodies can be derived from plants.
 The possible transmission of Hepatitis B and HIV by
antibody production from animals - avoided.
 feasible and attractive to the general population.
Disadvantage :
 Rhizosecretion of Antigen which may contaminate the soil.
 Accidental transfer of genes to other plants via pollen
grains is also of great concern.

25. STRAIN REPLACEMENT THERAPY
Jeffrey Hillman
,University of Florida
- Modified strain -
Streptococcus mutans-
BCS3-L1, incapable of
producing lactic acid.
MU1140-lantibiotic-
produced by colonization
of BCS3-L1.
-lifetime protection.
-less cost @ 100$.
-developed by Oragenics
-Abondoned in 2014.
-regulatory concerns &
patient issues.
-causing heart infections
– unclear.

26. conclusion
 The present day dental practice is mainly
concentrated on management of carious lesions.
 As caries vaccines are introduced in the clinical
practice, the work of the dentist will transform from
caries management to mere caries prevention
methods.

27. References
 Text Book Of Oral Pathology- Shafers
 Art & Science Of Operative Dentistry – Sturdevant
4th Edition
 Textbook Of Operative Dentistry- Nisha Garg
 Principles Of Radiology – White & Phoroah
 Smith DJ. Dental caries vaccines: Prospects and
concerns. Crit Rev Oral Biol Med 2002;13:335-49.

28. References
 Kanda Swamy, Caries Vaccine,Todays
Myht,IAPHD,vol24,2004
 Kanda Swamy.caries vaccine.Tomorrow’s
Reality,IAPHD,VOL 24,2004.
 Jane Roy Brown ,Vaccine for Tooth Decay by
Caries Nation jan-feb 2002.
 KM Shiva kumar, Dental caries vaccine, Indian
J Dent Res, 20(1), 2009
 Smith DJ, Godiska R. Passive immunization
approaches for dental caries prevention.
Conference Proceedings. Egg Symposium;
2004. p. 1-6.