Sunday, Feb 10 2013 01:49
The field of dentistry has seen a number of hallmark innovations, ranging from public water fluoridation to the ongoing development of increasingly lifelike restorative materials. Two announcements made over the past year boldly claim to make all of those advancements irrelevant to the dental care of the future with the development of molecules that could someday eliminate caries—entirely.
In July, an article published in the Chilean periodical Diario Financiero detailed the discovery of a molecule dubbed “Keep 32,” a nod to its purpose of preserving the 32 teeth in the mouth. The molecule, discovered by two Chilean researchers, is reported to specifically target the Streptococcus mutans bacteria that spearhead caries development, and could be engineered into mouthwash, gum, or even foods. One of the researchers, Erich Astudillo, says that they are ready for clinical trials and could be on the shelf in 14-16 months. So we should all pack up our caries removal instruments and start focusing more on periodontal disease, fracture repair, and purely esthetic dentistry, right?
Not so fast. Closer inspection of the Keep 32 article yields too few details to render the claims as indisputable, at least for now. Primarily, the original newspaper article remains the only public source of information about Keep 32, as it has not been published scientifically. That means that a great deal of uncertainty surrounds the molecule’s structure, method of action, and effect on the other resident flora. Moreover, the article only presents the perspective of one of the molecule’s creators, who also happens to be the CEO of Top Tech Innovations, the company now trying to draw interest from financial backers in the U.S.
This is not the first time someone has claimed to have designed a molecule that specifically targets Strep mutans. UCLA researcher Dr. Wenyuan Shi and his collaborators have published several papers, including one in Antimicrobial Research and Chemotherapy in 2011 that detailed how they had used “STAMPs,” or specifically targeted antimicrobial peptides, to selectively kill Strep mutans—even within biofilms (Eckert RL, et. al.). According to the UCLA School of Dentistry’s webpage, the resulting mouthwash has undergone small scale trials and was scheduled for more extensive clinical trials in March of this year. The STAMP molecule, with the lessglitzy moniker “C16G2,” is the subject of repeated experiments and clinical data; so it’s somewhat surprising that it has flown under the radar while Keep 32 popped up in dozens of prominent blogs, The Huffington Post, and FoxNews.com.
While the idea that a molecule could selectively kill Strep mutans in the oral environment could be proven with further testing, touting it as the cure for caries remains grandiose. Dr. Elaine Mokrzan, an OSU researcher who studies the bacteria responsible for caries, explains: “Caries is a complex disease involving mixed bacterial biofilms. S. mutans is only one bacterium that is associated with caries. You can have bad caries without S. mutans, and you can carry S. mutans in your mouth and not have any caries. Elimination of S. mutans from the mouth, even if it were possible, would not be a cure for caries.” In favor of this viewpoint, Dr. Mokrzan pointed out two papers in the Journal of Clinical Microbiology that have shown that Strep mutans is present in the mouths of caries-free individuals (Gross EL, et. al.) and is not even detectable in 10% of cases of rampant caries (Aas, JA, et. al.). For these reasons, today’s practitioners stress limiting or removing those food products that can shift the balance of power in favor of acid producing bacteria, like Strep mutans. In the past, attempts to completely eradicate harmful bacteria as a method of caries control were associated with a host of other problems, including harming beneficial bacteria and the omnipresent possibility of selecting for antimicrobial resistant strains.
Since the etiology of caries is complex and the role of specific bacteria varies between cases, it is safe to say that a miracle molecule, while unquestionably a scientific breakthrough, would not herald the end of caries cases walking into dental offices. In the meantime, it is important that the dental community stay informed of such advances and their possible repercussions. More alarming than the news that caries might someday disappear from our society is the response from some social outlets suggesting that dentists would be disappointed by the findings, or would actively try to discredit the research. One need only look to dentistry’s promotion of community water fluoridation, and note that most of this research takes place in dental schools, to know that isn’t the case. Nonetheless, it is imperative that society knows unequivocally that we are on the same side in the ongoing battle with dental caries, whatever new molecules in shining armor may, or may not, be riding to our aid in the near future.
~Mark Schibler '15
Originally published in ASDA OSU's The Quarterly Rinse