Streptococcus Mutans
Illustration of Streptococcus mutans, which causes dental caries

By Emma Yasinski

An article published in a special issue of Advances in Dental Research, makes a case for using precision antibiotics to treat and prevent dental caries.

The authors also reviewed unpublished results from a clinical trial testing their own compound, which is designed to target a particular bacteria thought to be integral in the formation of dental caries.

"Precision medicine and microbiome are two hottest areas at the cutting edge of medical research and care. This is the right time for dentistry to be part of the wave," Wenyuan Shi, PhD, senior author and CEO and Chief Scientific Officer of The Forsyth Institute, told Incisor.

In the article, Dr. Shi and his team explain that, despite knowing that certain bacteria make up the biologic films that lead to dental caries, the only existing treatments are broad-spectrum antibiotics such as mouthwashes and fluorides.

There are three main characteristics of bacteria that tend to be associated with dental caries: first, they produce acids; second they tolerate acid; and third, they can form biofilms. One particular bacteria, Streptococcus mutans (S. Mutans), has frequently been associated with tooth decay.

"Most treatment tools we are using now were developed 40, 50, or 60 years ago," says Dr. Wenjuan Shi. "When it comes to managing the oral microbiome, we are still using mechanical removal (hygiene), which is a stone-age technology."

Dr. Wenyuan Shi, The Forsyth Institute
Dr. Wenyuan Shi, The Forsyth Institute

As a medical microbiologist, Dr. Shi said he was "surprised" by the limited innovations in dentistry. "Most treatment tools we are using now were developed 40, 50, or 60 years ago," he told Incisor. "When it comes to managing the oral microbiome, we are still using mechanical removal (hygiene), which is a stone-age technology."

Broad-spectrum antibiotics, the study explains, leave the mouth vulnerable to newer, antibiotic-resistant bacteria—specifically, fluoride-resistant S. Mutans. A bonus would be leaving the rest of the microbiome intact, as it is becoming more and more apparent how important a person's microbial community is to his or her overall health.

In addition to treating disease, the authors write that precision antibiotics would be instrumental as research tools. Using precision antibiotics, researchers could selectively kill one type of bacteria to discern its function. The process would be similar to the way scientists knock out a single gene in an animal to better understand disease and create new models.

The article in Advances in Dental Research discussed a variety of methods that researchers have sporadically tested over the past several years to target dental caries. It ends with a focus on C16G2, a specifically-targeted antimicrobial peptide (STAMP) that Dr. Shi has been developing for about a decade. In 2011, he and his team showed that it was able to selectively kill S. Mutans in vitro.

Since then, he's tested the STAMP in several forms, including a single-use varnish, mouthwash, oral gels, and strips. He found the single-use varnish to be the most effective so far, according to a Phase II trial [NCT02594254] completed in 2016. The results have not yet been published, and several other Phase II trials are ongoing.

Though funding and investors in innovative dentistry applications are limited, "new technology will change the way to practice dentistry in the future," he forecast.

 

Author: Contributing writer Emma Yasinski received her Master of Science (MS) in science and medical journalism from Boston University. Her articles have also appeared at TheAtlantic.com, Kaiser Health News, NPR Shots, and Genetic Engineering and Biotechnology News.

 

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