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The microbiology of dental caries
Dental caries is a disease of a complex (metabolic) microbial activity within the
microbial communities on the teeth surfaces (termed dental biofilm or dental
plaque). The oral cavity is a unique ecological niche, which is warm, moist and
relatively opens to the outer environment, teeth as well as dental plaque are
constantly encounter different challenges through food and drink intake, speech,
and so on.

Microbial ecology in the oral cavity

Ecology is the study of the relationship between living organisms and their
environment. It has been estimated that the human body is made up of about
(1ⅹ1014) cells, of which only 10% are mammalian. The rest are the organisms
that comprise the resident microflora of the host.
Acquisition of the resident microflora is a natural process occurs from birth
during which all the environmentally exposed surfaces of the human body
becomes colonized. The resident microflora interacts dynamically with the
human body contributing, directly or indirectly, to the development, physiology,
nutrition and defenses of the host. The composition of the resident microflora is
multifarious consisting from a wide range of Gram-positive and Gram-negative
bacterial species, as well as yeasts and other types of microorganisms.

Acquisition of the resident oral microflora

The mouth of the newborn baby is usually sterile. Acquisition of the resident
oral microflora depends on the successive transmission of microorganisms to
their site of colonization. Studies have shown that a vertical transmission occurs
from the mother to their children at only a specific period of time (window of
infectivity), the acquisition of oral streptococci could take place at a period
between (19-31) months of baby life. The main route of this process is via
saliva, although microorganisms can be derived from water, food and other
nutrient substances.

Oral microbiology
The oral flora comprises a diverse array of organisms including bacteria, fungi,
mycoplasmas, protozoa, and possibly a viral flora that may persist from time to
time. These organisms are usually live in harmony in a range of habitats (sites)

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including the teeth, gingival sulcus, tongue, cheek, hard and soft palate, and
tonsils. The oral flora collectively named (oral microbiota). Bacteria are by far
the predominant organisms in the oral cavity with a probably 500-700 common
species. Oral bacteria can be classified primarily as Gram-positive and Gram-
negative organisms, and secondarily as aerobic, anaerobic or facultative
anaerobes. The diversity of the oral microflora increases during the first months
of baby life.
The earliest colonizers are termed "pioneers"; these are Gram-positive, aerobic
streptococci, particularly S. salivarius, S. mitis and S. oralis. With time, Gram-
negative anaerobes appear, including Prevotella, Fusobacterium and Veillonella
species. Adherence is a key ecological determinant in bacterial colonization, the
non-shedding teeth surfaces is optimal factor for microbial growth leading to an
extensive biofilm formation (dental plaque). The oral microflora continuous to
increase in diversity until, eventually, a suitable and homeostatic situation is
reached, called (the climax community).This process; however, reflects a
highly dynamic equilibrium between resident microflora with their
environmental conditions. Factors such as frequent sugar consumption, salivary
and anatomical factors can modulate microbial growth.

Dental plaque
Dental plaque is the microbial community that develops as a biofilm on the non-
shedding teeth surfaces, embedded in a self-produced matrix of polymers of
bacterial and salivary origins that helps the microbial community to gain
tolerance against antimicrobial agents and host defenses.

 The development of plaque biofilm

The development of a dental plaque biofilm can be subdivided arbitrarily into

several stages. However, it should be remembered that biofilm formation is a
dynamic process, the attachment; growth, removal, and reattachment of bacteria
are continuous processes.

1) Acquired pellicle formation

The earliest colonizers rarely come into contact with a naked tooth surface. As
soon as a tooth is cleaned, molecules from the oral environment, especially
salivary molecules, are adsorbed (surface adhesion phenomenon) forming a
surface-conditioning film, termed "acquired enamel pellicle". The major
constituents of pellicle are salivary glycoproteins, phosphoproteins and lipids
(as statherin, proline-rich peptides and host defense components). Several

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enzymes of host and bacterial source are immobilized in an active form within
the pellicle.
Some salivary molecules undergo conformational changes when they bind to
the tooth surface; leading to exposure of new surface receptors for bacterial
attachment (termed cryptitopes). Pellicle has several functions; it can act as a
diffusion barrier and as a buffer and plays a critical role in determining the
pattern of microbial colonization.

2) Transport of microorganisms and reversible attachment

Oral microorganisms are generally transported passively to the tooth surface by
the flow of saliva; only a few oral bacterial species are actively motile (e.g.,
possess flagella), and these are mainly located subgingivally. Long-range but
relatively, reversible and weak physicochemical forces (van der Waal’s force)
are generated as a microorganism approaches the pellicle-coated surface.
Microorganisms are negatively charged because of the molecules on their cell
surface.

3) Initial pioneer microbial colonization

Within a short time, these weak forces may become stronger because of
molecules adhesions on the microbial cell surface engaging in specific short-
range interactions with complementary receptors in the acquired pellicle. These
receptors are highly specific, occur over short distances and make the
attachment more permanent. Irrespective of the type of tooth surface (enamel or
cementum), the initial colonizers constitute a highly selected part of the oral
microbiota. Within minutes, cocci appear on the surface, and these are mainly
streptococci (e.g. S. sanguinis, S. oralis and S. mitis). Streptococcus sanguinis
and S. oralis produce an "immunoglobulin A1-protease" which may help them
to survive and overcome the host defense components during the early stages of
biofilm formation. Actinomyces species are also commonly seen after two hours
as well as Haemophili and Neisseria.

4) Microbial succession
Over time, the plaque microbiology becomes more diverse; there is a shift away
from the initial preponderance of streptococci to a biofilm with proportional
increasing in Actinomyces and other Gram-positive bacilli. Some organisms that
were unable to colonize the pellicle-coated tooth surfaces become able to attach
to the already-adhered pioneer species via further and more complex adhesion-
receptor interactions (coaggregation and coadhesion). At this stage, the pioneer
community alters the local environment and makes conditions more suited to
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the growth of some fastidious bacteria. Gradually, the conditions within the
community become more favorable to the growth of obligately anaerobic
bacteria.
As dental biofilm develops, some of bacteria produce polysaccharides,
especially from the metabolism of sucrose contributing to the formation ob
biofilm matrix. The matrix is active biologically and is involved in retaining the
nutrients, water and key enzymes within the plaque biofilm. At this stage, the
bacteria can interact with each both in a conventional biochemical manner and
via specific signaling molecules.
As the bacterial deposits become thicker and oxygen concentration is lowered, a
progressive shift is observed from mainly aerobic and facultative anaerobic to
obligatory anaerobic species.

5) Maturation of the biofilm and matrix formation

The microbial diversity of plaque biofilm increases over time because of
successive waves of microbial succession and subsequent growth. A feature of
the maturation of a plaque biofilm is the development of an (extracellular matrix
of polymers). This matrix includes soluble and insoluble glucans, fructans,
proteins and extracellular deoxyribonucleic acid (eDNA).
A matrix is a common feature of all biofilms and is more than a chemical
scaffold to maintain the structure of the biofilm. It makes a significant
contribution to the structural integrity and general tolerance of the biofilm to
environmental conditions as well as to the antimicrobial agents.
As plaque matures, the microbiota becomes more diverse, a small sample of
plaque may contains up to 100 distinct species, although the bacterial
composition vary among the anatomical sites on the teeth because of the
prevailing biological conditions.
The longer the plaque biofilm remains undisturbed, the greater the pathogenic
potential for the host and more resistance to removal with tooth brush. At the
end of this stage, a typical "test-tube brushes" or corn-cob" array is produce.

 The type of diet and the composition of plaque biofilm

1/ a protein-rich diet: produce more alkaline plaque, associated with an increase

in Gram-negative bacteria and the presence of peptides, which may have an
offensive odor.
2/ a carbohydrates-rich diet: produce more acidic plaque favoring the
reduction in Gram-negative bacteria.