An anticaries vaccine: report on the status of research.

Abstract

The state of the art of the research on a vaccine against dental caries has been reviewed. The subject has been analysed both from the biological and from the public health point of view. It is concluded that <i>Streptococcus mutans</i> plays a key role for the development of dental caries and that a vaccine directed against this microorganism could be a valuable adjunct to existing preventive measures in some countries. In others it could be a major public health measure. The unique characteristics of dental caries partly explain why a vaccine is not yet available. Protection against dental caries by immunization could be achieved by protective antibodies from serum, by IgA antibodies in saliva or by a combined effect of serum and salivary components. In rodents both peroral and parenteral immunization has provided protection against <i>S. mutans</i> infection and dental caries. In primates only parenteral immunization has given positive results. In humans peroral immunization has led to an increased salivary antibody activity in some studies but not in others. There is no conclusive evidence which shows that antibodies against <i>S. mutans</i> can influence dental caries activity in man. As structures on the cell surface of <i>S. mutans</i> cross-react with human tissue much work has been concentrated on identification of candidate antigens. Some of these have been purified and tested in vitro and in animal systems. Some protein antigens have given a clear-cut caries protection in primates and one of these has been produced in large amounts and is ready for testing in humans. Another candidate antigen, the enzyme complex called glucosyltransferase has shown protection in rodents and the effect of peroral administration of this antigen is now being tested in man. A considerable amount of knowledge has been obtained and the activity in the research area is high. Some groups have focused on basic immunology and have little understanding of the disease. In other groups the reverse is true. A consequence of this is that collaborative studies ought to be organized. By such studies key information about the possible role of antibodies in the development of dental caries in man could be obtained within a reasonable period of time.