Caries vaccine

Since dental caries fulfills the criteria for an infectious disease, the possibility of vaccination have been considered. Goady was probably the first to advocate caries control in 1910, by inoculation of the mouth with organisms which would provide alkaline reaction. Thereafter many studies have been done and many are still under progress. Most of the immunological studies in caries have been concerned with the streptococcus mutans (organism responsible for caries initiation) and to a lesser degree with lactobacillus (organism responsible for progression of the caries). The subcellular units that are currently been studied seriously as vaccine are:

• Glucosyltransferase (GTF): These are group of extracellular enzymes involved in the synthesis of polymer from sucrose.
• Wall associated proteins: Two purified proteins from the surface of streptococcus mutans are currently been suggested for use as caries vaccine antigen A and antigen B.

Mechanism of Action

The immune response is through the saliva and systemic immune response. In saliva, with the production of secretory IgA, which plays an important role in preventing the colonization of streptococcus mutans by agglutination of the organism. The second mechanism involves the systemic immune system and the production of IgG antibodies that travel through the gingival epithelium into the gingival crevicular fluid (GCF) that bathes the tooth and the plaque.

Route of Administration

• Systemic

1. Periglandular salivary immunization.
2. Salivary gland immunization by combined periglandular injection and installation of streptococcus mutans into the parotid duct.
3. Parental immunization.
4. Oral submucous immunization

• Topical (painting the tooth with antibodies)

Type of Immunization

• Active immunization: Causes host tissue reactivity.
• Passive immunization: Direct introduction of specific pre-targeted antibodies in the mouth, e.g. monoclonal/polyclonal antibodies topically applied.

Limitations of Caries Vaccine

The following factors will explain why successful vaccine has not been developed:

1. Partial protection: Only certain percentage of disease is due to streptococcus mutans and vaccine are developed against streptococcus mutans, which will provide only partial protection.
2. Tolerance development: Since the disease is life long, the constant exposure to an antigen may lead to development of tolerance or to immune exclusion.
3. Disease of hard tissue: which does not bring contact of the organism with the immune system. The organism does not come in contact with phagocytes and complement system.
4. Cross reactivity: Antigen B has been suggested to have shown cross reactivity with the heart cells.
5. Caries is a multi-factorial disease.

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