Insight into Oral Biofilm: Primary, Secondary and Residual Caries and Phyto-Challenged Solutions

Abstract

Introduction: Dental caries is known to be one of the most widespread, chronic infections affecting all ages and populations worldwide. The plethora of oral microbial population paves way for various endogenous infections and plays a crucial role in polymicrobial interactions contributing to biofilm-mediated diseases like caries and periodontal diseases.

Methods: Extensive literature survey was conducted using the scientific databases like PubMed, Google scholar, Science Direct, etc. using the key words like dental caries, orodental infections, dental microbes, dental biofilm, secondary caries, phytotherapy, etc. The literature was analyzed thoroughly and critical review was performed.

Results: The risk of development of secondary caries and residual caries further results in treatment failure. Drug resistance developed by oral microbes and further side effects pose serious hurdles in the current therapeutic strategies. The hyperactivities of various MMPs and the resulting massive ECM degradation are the challenging part in the design of effective therapeutic approaches. Anticariogenic phytotherapy is well appreciated owing to lesser side effects and versatility of their action. But appreciable outcomes regarding the phytochemical bioavailability and bioretention are still challenging. Site-specific delivery of phytoagents at the infected site may enhance the efficiency of these drugs. Accordingly emerging phytodentistry can be promising for the management of secondary and residual caries.

Conclusion: This article presents major cariogens and their mechanisms in initiating and aggravating dental caries. Effectiveness of phytotherapy and different mode of action of phytochemicals against cariogens are outlined. The article also raises major concerns and possibilities of phytochemical based therapeutics to be applied in the clinical arena of caries management.

Keywords: Dental caries; Odontoblasts; Oral biofilm; Phytotherapy; Secondary caries; Transmissible chronic infections.

Fig. (1)

Morphological organization and fluid channeling in biofilm. The schematic representation shows the structure of a mature biofilm showing the mushroom shaped structure adhering to the substratum. The fluid traffic shows the nutrient circulating channels between the micro colonies. The mature biofilm erodes/sloughs off and occasionally forms bridges between the nearest colonies forming a tunnel like morphology.

Fig. (2)

Biochemical events in dental biofilm formation. The fermentation of dietary sugars by the action of bacterial enzymes increase the pool of organic acids and a subsequent drop in pH which in turn activates demineralization and paves way to caries..

Fig. (3)

Microbial adhesion and dental plaque formation. Tooth decay is initiated by the pellicle formation at the surface followed by the recruitment, adhesion, proliferation and biofilm deposition. The low pH induced demineralization provides more room for invading bacteria to colonize and eventually leads to decay.

Fig. (4)

The figure describes well-defined events of initial microbial adhesion to tooth surface favoring biofilm formation. Initial process being the formation of acquired pellicle rich in salivary glycoproteins, mucin and other components on the tooth surface followed by the interaction and adhesion of primary colonizers. Different means of cell-cell interactions among the microbes are also depicted.

Fig. (5a)

Figs. A and B. Structure of phytochemicals having anti-cariogenic properties. The active phyto-components possess unique side chains with highly reactive but stable functional groups which imparts their biological function. These moieties or their metabolites can bind to cellular or extra cellular components to elicit their biological function.

Fig. (5b)

Figs. A and B. Structure of phytochemicals having anti-cariogenic properties. The active phyto-components possess unique side chains with highly reactive but stable functional groups which imparts their biological function. These moieties or their metabolites can bind to cellular or extra cellular components to elicit their biological function.