Insights Into the Role of Streptococcus mutans and Candida albicans in Dental Biofilm Formation and Cariogenicity: A Literature Review

Abstract

Dental caries is a widespread chronic disease that affects a large proportion of both adults and children globally. Streptococcus mutans is widely recognized as the primary pathogen responsible for dental caries, while Candida albicans frequently coexists with it, often forming a synergistic relationship. Despite this, the specific virulence mechanisms of these microorganisms, both individually and in coaggregation, as well as their collective impact on cariogenic potential, remain incompletely understood. This comprehensive review aims to examine both original and review articles addressing the virulence characteristics of these species, both independently and in coaggregation, and to assess how these interactions contribute to tooth demineralization, polysaccharide production, and the expression of virulence genes. The research reviewed here provides valuable insights into the physiological interactions between the two species, showing that these interactions lead to increased acid production within their coexisting biofilm, which enhances the cariogenic potential. These insights could guide future studies aimed at developing targeted strategies for preventing or mitigating dental caries.

Keywords: candida albicans; caries progression; dental caries; microbiota; polysaccharides; review article; streptococcus mutans; virulence.

Figure 1. Scanning electron micrograph showing co-adhesion of Streptococcus mutans with Candida albicans

Image acquired by Wanessa Fernandes Matias Regis

Figure 2. Overview of the key pathogenic mechanisms involved in the production of the glucan matrix by Streptococcus mutans and Candida albicans

S. mutans synthesizes the glucan matrix through the activity of its Gtfs enzymes. The presence of C. albicans enhances this process through interaction between C. albicans α-mannan and S. mutans Gtfs, thereby promoting increased matrix formation. Fungal-derived farnesol can also upregulate gtfB expression, thereby enhancing glucan production and biofilm matrix formation. Gtf: glucosyltransferase Image created by Wanessa Fernandes Matias Regis