ISSN: 2084-3577 TMKARPIŃSKI Journal of Biology

PUBLISHER and Earth Sciences

MEDICINE REVIEW

Microbiology of dental caries

Tomasz M. Karpiński 1 , Anna K. Szkaradkiewicz2
1University of Medical Sciences in Poznań, Department of Medical Microbiology, Poznań, Poland
2University of Medical Sciences in Poznań, Department of Conservative Dentistry and Periodontology, Poznań, Poland

ABSTRACT
Dental caries is one of the most prevalent chronic diseases of people worldwide. The disease process
may involve enamel, dentin and cement, causing decalcification of these tissues and disintegration of
the organic substances. It is believed that bacteria of the species Streptococcus mutans is the main
factor that initiates caries, and the bacteria of the genus Lactobacillus are important in further caries
development, especially in the dentin. Caries can also be caused by other bacteria, including members
of the mitis, anginosus and salivarius groups of streptococci, Enterococcus faecalis, Actinomyces
naeslundii, A. viscosus, Rothia dentocariosa, Propionibacterium, Prevotella, Veillonella, Bifidobacterium
and Scardovia.

Key words: Dental caries; Dental plaque; Streptococcus mutans; Streptococcus sobrinus; Lactobacillus.
J Biol Earth Sci 201 3; 3(1 ): M21 -M24

Corresponding author:
Tomasz M. Karpiński
University of Medical Sciences in Poznań
Department of Medical Microbiology
Wieniawskiego 3, str., 61 -71 2 Poznań, Poland
e-mail: tkarpin@interia.pl

Original Submission: 09 February 201 3; Revised Submission: 06 March 201 3; Accepted: 08 March 201 3
Copyright © 201 3 Author(s). Journal of Biology and Earth Sciences © 201 3 Tomasz M. Karpiński. This is an open-access article
distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction
in any medium, provided the original work is properly cited.

http://www.journals.tmkarpinski.com/index.php/jbes or http://jbes.strefa.pl
e-mail: jbes@interia.eu

Journal of Biology and Earth Sciences, 201 3, Vol 3, Issue 1 , M21 -M24 M21
Karpiński & Szkaradkiewicz Microbiology of dental caries
INTRODUCTION
Dental caries is a multifactorial, chronic bacterial
disease, that causes demineralization and
destruction of the hard tissues, usually by
production of acid by bacterial fermentation of the
food debris accumulated on the tooth surface.
Today, caries remain one of the most common
diseases of people worldwide. Individuals are
susceptible to this disease throughout their lifetime.
Worldwide, approximately 36% of the population
have dental caries in their permanent teeth. In baby
teeth it affects about 9% of the population [1 ].
Risk of caries includes physical, biological,
environmental, behavioural and lifestyle-related
factors [2].
REVIEW
The essence of the teeth carious process is
local demineralization of enamel, expressing in
degradation of hydroxyapatites. This process is
initiated within bacterial biofilm - dental plaque, that
covers a tooth surface. Caries lesions develop
where oral biofilms are allowed to mature and
remain on teeth for long periods. On environmental
acidification of the tooth, affects not only the
number and species of bacteria, but also the
release rate, viscosity and buffer capacity of saliva,
the presence of fluoride in enamel and plaque, type
of diet and the frequency of sugars consumption.
Lowering the pH of the plaque below the "critical
value" (5.5 to hydroxyapatite, 4.5 to fluoroapatite,
6.7 to cement) causes dissolution of calcium
phosphates included in the hydroxyapatite and
initializes loss of the tooth mineral substances [2, 3].
Over time the caries process may involve enamel,
dentin and cement, causing decalcification of these
tissues and disintegration of the organic
substances. Caries progression can give rise to
infection of the tooth pulp, which can spread to the
supporting tissues and the jaws [3].
About 700 different bacteria species have been
identified from the human oral microbiome [4]. In
the pathogenesis of dental caries an important role
play cariogenic bacteria, i.e. oral streptococci,
especially of group mutans and lactic acid bacteria
(Lactobacillus spp.). It is believed that bacteria of
the species Streptococcus mutans is the main
factor that initiates caries and very important factor
of enamel decay. The bacteria of the genus
Journal of Biology and Earth Sciences, 201 3, Vol 3, Issue 1 , M21 -M24
Lactobacillus are important in further caries
development, especially in the dentin. Mutans
streptococci and lactobacilli are characterized by
the ability to grow in an acid environment and the
property of rapid metabolism of sugars supplied in
the diet to organic acids, including lactic acid [5-7].
The microbial community from dentinal lesions is
diverse and contains many facultatively- and
obligately-anaerobic bacteria belonging to the
genera Actinomyces, Bifidobacterium, Eubacterium,
Lactobacillus, Parvimonas and Rothia. Streptococci
are recovered less frequently [4]. Caries can also
be caused by other bacteria, including members
of the mitis, anginosus and salivarius groups
of streptococci, Propionibacterium, Enterococcus
faecalis and Scardovia [8-1 0].
In molecular studies using 1 6S rRNA analysis
has been demonstrated, that the predominant
microbes in deep caries lesions were S. mutans
and genus Lactobacillus but also included
the genera Prevotella, Selenomonas,
Dialister, Fusobacterium, Bifidobacterium and
Pseudoramibacter [11 , 1 2]. In studies of Becker
et al. [1 3] and Aas et al. [1 4], they reported that
genera associated with dental caries in both primary
and permanent dentitions are Streptococcus
including S. mutans, S. sanguinis and non-S.
mutans streptococci, Veillonella, Actinomyces,
Bifidobacterium, Lactobacillus, Propionibacterium,
and Atopobium. In other study, has been shown that
in plaque significantly associated with dental caries
are the genera of Streptococcus, Veillonella,
Actinomyces, Granulicatella, Leptotrichia and
Thiomonas [1 5].
The development of the caries lesion is
conditioned by the carbohydrates supply frequency,
mainly sucrose and glucose from food, sometimes
impact of cariogenic factors, as well as the tooth
surface susceptibility. Recent studies confirm
participation of the genetic factors in the
pathogenesis of dental caries [1 6, 1 7].
Mutans streptococci
Mutans streptococci are the most cariogenic
pathogens as they are highly acidogenic, producing
short-chain acids which dissolve hard tissues of
teeth. They metabolize sucrose to synthesize
insoluble extracellular polysaccharides, which
enhance their adherence to the tooth surface and
encourage biofilm formation. The reactions are
catalyzed by three isozymes of glucosyltransferases
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Karpiński & Szkaradkiewicz Microbiology of dental caries
[1 8]. The most important mutans streptococci
isolated from tooth caries samples are S. mutans
and S. sobrinus. S. mutans is more cariogenic than
S. sobrinus because specific cell-surface proteins,
which aid in its primary attachment to the tooth.
S. sobrinus lacks such proteins [1 9].
Streptococcus mutans
S. mutans is able to metabolise a number of
sugars and glycosides such as glucose, fructose,
sucrose, lactose, galactose, mannose, cellobiose,
glucosides, trehalose, maltose and a previously
unrecognised, group of sugar-alcohols. In the
presence of extracellular glucose and sucrose,
S. mutans synthesizes intracellular glycogen-like
polysaccharides (IPSs) [20]. S. mutans produces
also mutacins (bacteriocins), what is considered
to be an important factor in the colonization
and establishment of S. mutans in the dental
biofilm [21 ].
Streptococcus sobrinus
S. sobrinus has been implicated in caries
development particularly in instances where caries
development appears to be independent of
S. mutans. It is interesting that S. sobrinus displays
higher acid production and acid tolerance compared
to S. mutans [1 9, 22].
Lactobacilli
Among the Lactobacillus rods in the oral cavity
occur: L. acidophilus, L. casei, L. fermentum,
L. delbrueckii, L. plantarum, L. jensenii, L. brevis,
L. salivarius and L. gasseri. Lactobacilli are divided
into two main groups:
- homofermentative which in the fermentation
process of glucose produce mainly lactic acid, e.g.
Lactobacillus casei, Lactobacillus acidophilus,
- heterofermentative which in addition to lactic acid
produce acetate, ethanol and carbon dioxide, e.g.
Lactobacillus fermentum [23, 24].
Lactobacilli are isolated from deep caries lesions
but rarely just before the development of dental
caries and in the early tooth decay. It is believed
that they are pioneering microorganisms in the
caries progress, especially in dentin [6]. Studies
have shown that Lactobacilli are a dominant part of
the flora inhabiting the deep cavities, and their
number correlates with the amount of
carbohydrates [25-27].
Recently it is known that lactobacilli demonstrate
Journal of Biology and Earth Sciences, 201 3, Vol 3, Issue 1 , M21 -M24
also antagonistic action against periodontopatho-
gens such as Aggregatibacter actinomycetem­
comitans, Prevotella intermedia and Porphyro­
monas gingivalis, inhibiting their growth [28-30].
This action consists in the production of acids
mainly lactic acid, lowering the pH of the
environment, release of hydrogen peroxide [31 , 32]
and bacteriocins [33-35]. Thus, Lactobacillus in
addition to a cariogenic activity also play a key role
in maintaining the microecological balance in the
mouth and gastrointestinal tract.
CONCLUSIONS
Dental caries is one of the most prevalent
diseases in the world, that causes demineralization
and destruction of the hard tissues of teeth. In the
development of caries a major role play bacteria of
the Streptococcus and Lactobacillus genera which
are acidogenic and aciduric. At the same time,
recent studies show that in the dental caries
development may also affect other bacteria.
TRANSPARENCY DECLARATION
The authors declare no conflicts of interest.
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