Acquisition,

adherence of oral
micro ora

Ahmed Khaled
Dr Sai
ID. 411100757
Content

• Introduction
• Oral habitats
• Acquisition of the normal oral flora
• Acquisition of the resident oral microflora
• Microbial adherence
• Host and bacterial factors involved in adherence
• Host receptors
• Bacterial adhesins
• References
Introduction
The community of microbial residents in our body is called the microbiome.
oral microflora refers to the microorganisms found in the human oral cavity.
Genome is the genetic material of an organism. It is the complete set of DNA
including all of its genes.
Oral microbiome is defined as the collective genome of microorganisms that reside in
the oral cavity. After the gut, it is the second largest microbial community in the
humans. As compared with other body sites.
Human microbiome consists of a core microbiome and a variable microbiome. The
core microbiome is common to all the individuals, where as variable microbiome is
unique to individuals depending on the lifestyle and physiological differences. The
oral cavity has two types of surfaces on which bacteria can colonize : the hard and
the soft tissues of teeth and the oral mucosa, respectively. The teeth, tongue, cheeks,
gingival sulcus, tonsils, hard palate and soft palate provide a rich environment in
which microorganisms can flourish. The surfaces of the oral cavity are coated with a
plethora of bacteria, the proverbial bacterial biofilm.
An ideal environment is provided by the oral cavity and associated nasopharyngeal
regions for the growth of microorganisms. The normal temperature of the oral cavity
on an average is 37°C without significant changes, which provide bacteria a stable
environment to survive. Saliva also has a stable pH of 6.5–7, the favorable pH for
most species of bacteria.

The mouth, being an extension of an external body site, has a natural

microflora. This commensal (or indigenous, or resident) flora exists in harmony with
the host, but disease conditions supervene when this relationship is broken. The
predominant dental diseases in humans (caries and periodontal disease) are
caused in this manner. In addition to the commensal flora, there are others (such
as coliforms) that survive in the mouth only for short periods (transient flora). These
transient flora cannot get a foothold in the oral environment due to the ecological
pressure, i.e. the colonization resistance exerted by the resident flora

Oral habitats
Major oral habitats
• buccal mucosa
• dorsum of the tongue
• tooth surfaces (both supragingival and subgingival)
• crevicular epithelium
• prosthodontic and orthodontic appliances, if present.
Acquisition of the normal oral flora
1.The infant mouth is sterile at birth, except perhaps for a few organisms
acquired from the mother’s birth canal.
2. A few hours later, the organisms from the mother’s (or the nurse’s) mouth and
possibly a few from the environment are established in the mouth.
3. These pioneer species are usually streptococci, which bind to mucosal epithelium
(e.g. Streptococcus salivarius).
4. The metabolic activity of the pioneer community then alters the oral
environment to facilitate colonization by other bacterial genera and species. For
instance, Streptococcus salivarius produces extracellular polymers from sucrose, to
which other bacteria such as Actinomyces spp. can attach.
5. When the composition of this complex ecosystem (comprising several genera
and species in varying numbers) reaches equilibrium, a climax community is said to
exist. (Note: this is a highly dynamic system.)
6. Oral flora on the child’s first birthday usually consists of streptococci,
staphylococci, neisseriae and lactobacilli, together with some anaerobes such as
Veillonella and fusobacteria. Less frequently isolated are Lactobacillus, Actinomyces,
Prevotella and Fusobacterium species.
7. The next evolutionary change in this community occurs during and after tooth
eruption when two further niches are provided for bacterial colonization: the hard-
tissue surface of enamel and the gingival crevice. Organisms that prefer hard-tissue
colonization, such as Streptococcus mutans, Streptococcus sanguinis and
Actinomyces spp., then selectively colonize enamel surfaces, and those preferring
anaerobic environments, such as Prevotella spp., Porphyromonas spp. and
spirochaetes, colonize the crevicular tissues. However, the anaerobes do not appear
in significant numbers until adolescence. For instance, only 18–40% of 5-year-olds
have spirochaetes and black-pigmented anaerobes compared with 90% of 13- to 16-
year-olds.
8. A second childhood (in terms of oral bacterial colonization) is reached if all
teeth are lost as a result of senility. Bacteria that colonize the mouth at this stage are
very similar to those in a child before tooth eruption.
9. Introduction of a prosthetic appliance at this stage changes the microbial
composition once again. Growth of Candida species is particularly increased after the
introduction of acrylic dentures, while it is now recognized that the prevalence of
Staphylococcus aureus and lactobacilli is high in those aged 70 years or over. The
denture plaque is somewhat similar to enamel plaque; it may also harbour significant
quantities of yeast.
ACQUISITION OF THE RESIDENT ORAL MICROFLORA

Acquisition depends on the transmission of micro-organisms to the site of

potential colonization. Initially, in the mouth, this is by passive inoculation from the
mother, from other individuals in close proximity to the baby, and from ingested
milk and water. Acquisition of microorganisms such as yeasts and lactobacilli from
the birth canal itself may be only transient, but the role of saliva in the process of
acquisition has been confirmed conclusively.
The ability to type strains has confirmed the transfer of Streptococcus salivarius,
mutans streptococci and some other species from mother to child via saliva.
Similarly, comparisons of the DNA fingerprints (genotyping) of a variety of oral
bacterial species have shown that the same digest pattern (and hence presumably
the same clonal type) is commonly found within family groups, and that different
patterns are usually observed between such groups. Nevertheless, strains of
some bacteria can be acquired occasionally by young children from other family
members, while some strains seem to be distinct from any found in close
relatives. The genotypes of mutans streptococci found in children were identical to
those of their mothers in 71% of 34 infant-mother pairs examined (vertical
transmission). Little evidence of father- infant (or father–mother) transmission of
mutans streptococci was observed, although horizontal transmission between
spouses, and vertical trans- mission within family units, can occur with some
periodontal pathogens, such as Porphyromonas gingivalis and Aggregatibacter
actinomycetemcomitans.

• Ecological stages in the establishment of a microbial community. As microbial

diversity increases, the metabolism of the pioneer species modifies the local
environment making conditions suitable for secondary colonizers.
Microbial adherence

Adherence of a microbe to an oral surface is a prerequisite for colonization, and

it is the initial step in the path leading to subsequent infection or invasion of tissues.
The complex interaction of the factors that prevent microbial colonization on oral
surfaces

• Factors a ecting microbial colonization of the oral mucosa.

HOST AND BACTERIAL FACTORS INVOLVED IN ADHERENCE

Oral microorganisms do not encounter naked host surfaces. Molecules are

absorbed from saliva on to the tooth and mucosal surfaces to form a condition- ing
film (the acquired pellicle). The first stage of adherence involves the initial
interaction between the external surfaces of both the microbe and the
substrate, and adhesion will be influenced by the properties of the suspending
medium (saliva). The initial process can be described in terms of precise
physicochemical interactions of attraction and repulsion. Subsequently,
attachment involves specific molecular interactions between
complementary molecules on the microbial and host surface. In general, the
term ‘adhesin’ is used to describe the microbial components which function in
adherence while the host-derived factors are termed ‘receptors’. A microbial cell
surface can express multiple types of adhesin while the host
surface can contain several classes of receptor. Bacteria can also contain
receptors that react with adhesins on other microbial types during cell-cell
attachment coaggregation or coadhesion.
Host receptors

Epithelial cells, especially the buccal epithelium, have sialic acid exposed on their
surfaces which can interact with adhesins on bacteria such as S. mitis. If the
sialic acid residue is removed, for example, by bacterial neuraminidases, then
another receptor (a galactosyl residue) can be exposed which is recognised by
Actinomyces spp., and Gram negative bacteria including Fusobacterium nucleatum,
Prevotella inter- media and Eikenella corrodens. Collagen fibres, which are major
structural components of connective tissue, can also act as receptors for
certain mutans streptococci (S. cricetis, S. ratti) and Porphyromonas gingivalis,
while specific domains for the attachment of streptococci or spirochaetes can
be found on fibronectin.
Pellicles form on all oral surfaces (hard and soft) and are not identical; the
components that adsorb to cementum are not the same as enamel, and both
will differ from those that form on the oral mucosa. These differences are
sometimes acknowledged by the use of different terminologies, such as the acquired
enamel pellicle or the acquired cementum pellicle, while the pellicle that forms on
epithelial surfaces is referred to as the mucus coat. Pellicle forms as soon as a clean
surface is exposed to saliva; it takes around 90–120 minutes for the adsorption of
molecules to reach a plateau and cease. Pellicles contain proteins, lipids and
glycolipids; once formed, the composition and structure of pellicles will change and
be modified.
Within the enamel pellicle, acidic proline-rich proteins and statherin promote the
adherence of Actinomyces naeslundii, some S. mutans strains and black-
pigmented anaerobes. Amylase, lysozyme, albumin and immunoglobulins, as well
as some bacterial components, including glucosyltrans- ferases (GTFs) and
glucans, have also been detected in the acquired pellicle. The adsorbed enzymes
in the pellicle are still able to function and the glucans produced can bind to
molecules (glucan-binding proteins) on mutans streptococci, thereby increasing their
ability to colonize. The polymer synthesised by adsorbed GTF on the tooth surface
has a different chemical structure to that produced by free-living bacteria.
Bacterial adhesins

Many bacterial adhesins are lectins (carbohydrate-binding proteins) that bind to

carbohydrate receptors on a surface. Often these adhesins are associated with
surface structures termed fibrils or fim- briae. Fibrils are short and narrow while
fimbriae have a measurable width (3–14 nm) and a variable length up to 20 µm. Some
cells possess both fibrils and fim- briae, and strains can have different functional
types of each structure. For example, S. salivarius has a complex fibrillar mosaic
comprising four different classes of fibril, each with a specific length. The 91 nm fibrils
are responsible for coaggregation with Veillonella parvula while the 73 nm fibrils
are involved with adhesion to buccal epithelial cells.The longest (178 nm) and
shortest (63 nm) fibrils have yet to be assigned a function. Similarly, A. naeslundii
possesses two types of fimbriae. Type 1 fimbriae mediate the binding of cells
to adsorbed proline-rich proteins and to statherin in salivary pellicle on enamel
whereas type 2 fimbriae are associated with a galactosyl-binding lectin which
mediates attachment to host cells and to other bacteria (coadhesion or
coaggregation). The presence of fibrils is not limited to Gram positive oral
bacteria. Strains of Prevotella spp. carry peritrichous fibrils, the morphology, cellular
density and length of which can vary markedly. A significant adhesin is the antigen
I/II family of cell surface-anchored polypeptides found in most oral streptococci.
These linear polypeptides are structurally complex, multi-functional adhesins, with
multiple receptor binding sites. Discrete regions within these peptides bind to human
salivary glycoproteins (agglutinins), other microbial cells coaggregation and
calcium. Sequences within the N-terminal region preferentially bind salivary
glycoproteins in solution, while the C-terminal half of the polypeptide contains
species-specific adhesion-mediating sequences that bind only to surface-
associated glycoproteins. Other bacterial adhesins include glucosyltrans-ferases
(GTFs) which are found on the surface of several oral streptococci. Some species
produce more than one GTF. These GTFs can interact with receptors in pellicle
such as blood group reactive proteins or adsorbed dextrans and glucans.

Scanning electron
micrograph to show brils
on the cell surface of
Prevotella nigrescens.
 The latter can also react with glucan-binding proteins expressed by other
streptococci. The polysaccharides synthesized by GTFs help consolidate
bacterial attachment to hard surfaces in the mouth and contribute to the plaque
biofilm matrix. GTFs are secreted and have been found both in pellicle and on the
surface of unrelated bacteria where they retain biological function. Thus, some
species may produce extracellular polysaccharides (EPS) in plaque using a
surrogate enzyme from another organism. Many oral Gram positive bacteria are
negatively charged due to the penetration of the cell wall by lipoteichoic acid (LTA).
These anionic polymers are composed of sugar phosphates, usually glycerol and
ribitol phosphate, and interact with blood group reactive substances in pellicle.
The surface of oral bacteria is a complex mosaic of multi-functional molecules, many
of which can play a role in attachment. The production of molecules such as
peptidoglycan, LTA, polysaccharide, proteins and lipoproteins can be influenced by
the growth environment. Oral bacteria may be able to detect that they are on
a surface, and there- fore modify their pattern of gene expression to suit the new
environmental conditions.

Diagram to illustrate the cell surface of a streptococcal cell showing adhesins and
receptors associated with adherence, and solute transport. (A) cell wall anchored
polypeptide; (B) membrane anchored polypeptide; (C) transmembrane polypeptide
(e.g. in transport of solutes); (D) extracellular polypeptide (e.g. GTF).
References