Effect of mutanase and dextranase on biofilms of cariogenic bacteria: A systematic review of in vitro studies

Abstract

Matrix-degrading enzymes are promising non-biocidal adjuncts to dental biofilm control and caries prevention. By disrupting the biofilm matrix structure, enzymes may prevent biofilm formation or disperse established biofilms without compromising the microbial homeostasis in the mouth. This study reviewed whether treatment with mutanase and/or dextranase inhibits cariogenic biofilm growth and/or removes cariogenic biofilms in vitro. An electronic search was conducted in PubMed, EMBASE, Scopus, Web of Science, Cochrane, and LIVIVO databases. Manual searches were performed to identify additional records. Studies that quantitatively measured the effect of mutanase and/or dextranase on the inhibition/removal of in vitro cariogenic biofilms were considered eligible for inclusion. Out of 809 screened records, 34 articles investigating the effect of dextranase (n = 23), mutanase (n = 10), and/or combined enzyme treatment (n = 7) were included in the review. The overall risk of bias of the included studies was moderate. Most investigations used simple biofilm models based on one or few bacterial species and employed treatment times ≥30 min. The current evidence suggests that mutanase and dextranase, applied as single or combined treatment, are able to both inhibit and remove in vitro cariogenic biofilms. The pooled data indicate that enzymes are more effective for biofilm inhibition than removal, and an overall higher effect of mutanase compared to dextranase was observed.

Keywords: Bacterial adhesion; Biofilm matrix; Dental caries; Dextrans; Enzymes; Extracellular polymeric substance.

Fig. 1

Flow chart of the screening process (PRISMA 2020) [24].

Fig. 2

Distribution of scores (Y: information was described, N: information was unclear, not reported, or incomplete) for each item of the risk of bias tool for the included studies.

Fig. 3

Highest biofilm inhibition (A–C) and removal (D–F) effects of mutanase and/or dextranase observed by the included studies and their respective risk of bias. Studies where the quantitative results were not reported with numerical values and could not be extracted are not listed.