Relationship between the IgA antibody response against Streptococcus mutans GbpB and severity of dental caries in childhood
Introduction
Dental caries is an infectious disease that results from the dissolution of tooth mineral by acids derived from bacterial fermentation of sucrose and other dietary carbohydrates (Loesche, 1996). When occurring in young children, this disease is called early childhood caries (ECC). According to the American Academy of Pediatric Dentistry (2014) ECC is characterized by the presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth of children under the age of six. However, in children younger than three years of age, any sign of smooth-surface caries is indicative of severe early childhood caries (S-ECC). From ages three through five, one or more cavitated, missing (due to caries) or filled smooth surfaces in primary maxillary anterior teeth or a decayed, missing or filled score of greater than or equal to four (age 3), five (age 4) or six (age 5) surfaces also constitutes severe S-ECC. The disease can progress and lead to destruction of the primary dentition affecting negatively children’s physical and mental health, as well as increasing the risk of new caries lesions in the permanent dentition (Ng & Chase, 2013; Isaksson, Alm, Koch, Birkhed, & Wendt, 2013).
The mutans streptococci (MS) group, mainly Streptococcus mutans, is most strongly associated with the pathogenic process of ECC because of its high presence in the biofilms and saliva of the affected children (Ge, Caufield, Fisch, & Li, 2008; Parisotto, Steiner-Oliveira, Silva, Rodrigues, & Nobre-dos-Santos, 2010b). Three important cell-associated antigens (Ags) are correlated directly with the ability of S. mutans to adhere and accumulate in the tooth surfaces forming dental biofilm: antigen I/II (AgI/II); glucosyltransferases (GtfB, GtfC, GtfD) and glucan-binding proteins (GbpA, GbpB, GbpC, GbpD) (Smith, 2002). Ag I/II promotes interaction of bacterial proteins and host-derived components; Gtf catalyzes glucan synthesis and Gbps increase the binding of S. mutans to each other and to glucans deposited on tooth surfaces, contributing to the sucrose-dependent adherence to teeth (Smith, 2002). Several studies have demonstrated that induction of specific antibodies against these antigens, mainly GtfB/C and GbpB, can prevent the development of dental caries in animal models (Jespersgaard et al., 1999; Koga, Oho, Shimazaki, & Nakano, 2002; Smith & Taubman, 1996) and modify infection in humans (Smith & Taubman, 1987).
Salivary immunoglobulins, particularly secretory IgA have major importance in the resistance of the mucosa to oral infections. The secretory IgA immune response represents the first line of adaptive immune defense against mutans streptococci, blocking microbial adhesins and potentially reducing oral colonization with this cariogenic microflora. Salivary IgA has also been shown to enhance the activity of several enzymes such as lactoferrins and lysozymes (Law, Seow, & Townsend, 2007). A clinical study showed that the IgA antibody response against S. mutans GbpB was predominant in the first year of life and frequently correlated with the delay in the oral infection with S. mutans (Nogueira, Alves, Napimoga, Smith, & Mattos-Graner, 2005). The intensity of IgA patterns against antigens of S. mutans was previously studied and lower levels of salivary IgA against GbpB were associated with higher caries risk (Parisotto et al., 2011). However, the relationship between IgA antibody levels against this antigen and different levels of caries has not yet been evaluated. The objective of this study was to explore the associations among the severity of dental caries in childhood, mutans streptococci levels and IgA response against S. mutans GbpB. Moreover, caries-related etiological factors were also investigated. The null hypotheses formulated was that immune response, MS levels, socio-economic-cultural aspects, hygiene and dietary habits presented by ECC and S-ECC are not different from that exhibited by CF children.
Section snippets
Subjects
The study population comprised 36- to 60-month-old children who attended the four public nursery schools in the city of Araçatuba, São Paulo, Brazil. The citýs population has access to public water supply with fluoride level of 0.7 ppm. Children’s parents as well as administrators at the preschools involved granted written permission for the study which was previously approved by the Research Ethics Committee of Araçatuba Dental School—Univ. Estadual Paulista (UNESP), Brazil (CAAE #
Results
Means/standard deviations obtained for caries levels (dmfs) were: CF (0), ECC (2 ± 1.06) and S-ECC (23.43 ± 17.17). Considering white spots lesions, dmfs were: CF (0), ECC (2.94 ± 1.67) and S-ECC (28.28 ± 18.76). There were no statistical differences among the groups in relation to age, gender, motheŕs education level, diet habits (artificial feeding and sugar intake) and total IgA levels (Table 1). Families of S-ECC children had reduced income compared to families of ECC and CF children showing a
Discussion
Early childhood caries has a complex etiology with biological, behavioral, and socioeconomic influences (Arora, Schwarz, & Blinkhorn, 2011; Ng & Chase, 2013). For this reason, in this study, some factors determining oral health were concomitantly analyzed. S-ECC children had a reduced family income compared to CF and ECC groups, however, no difference among the groups were found in relation to mother's education level. High prevalence of dental caries in children with adverse socio-economic
Conflict of interest
The authors declare that they have no conflict of interest.
Acknowledgements
This study was supported by grants (2012/19235-5; 2013/12167-7) from São Paulo Research Foundation (FAPESP), São Paulo, SP, Brazil and Coordination for the Improvement of Higher Education Personnel (CAPES).
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