3 months delay of S. mutans = vaccine?

[Freddy King]

"Imagine never needing to have another tooth drilled and filled...Such a vaccine has been made and successfully tested on humansand rats by researchers at the Forsyth Institute, an affiliate of the Harvard School of Dental Medicine in Boston."

Reading down several lines...

"The tests proved the safety of the vaccine, and it delayed accumulation of S. mutans in plaque for several months, Smith says."

full story available at <a href="http://www.news.harvard.edu/gazette/2001/10.04/01-dentalvax.html" target="_blank">http://www.news.harvard.edu/gazette/2001/10.04/01-dentalvax.html</a>

If accumulation of bacteria is delayed for only several months, how can they begin the article by claiming a vaccine exists which will eliminate the need for drilling another tooth?

Those Harvard guys are smarter than me, so tell me what I'm missing.

Freddy

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[DrJeff]

Never fear, there will always be plenty of work for dentists to do. Even if a vaccine can delay mutans accumulation for a period of months, there will always be folks that don't stop by and see you for YEARS There will also be folks saying that this vaccine will cause detrimental harm to those that take it(see the anti flouride folks about this one <img border="0" alt="[Pity]" title="" src="graemlins/pity.gif" /> ) Then, not everyone will be able to receive the vaccine due to many reasons. You can also throw in the fact that the average american diet is getting worse and worse with greater and greater sugar consumption. Then, there are the BILLIONS of existing restorations that at some point will need to be replaced . I still haven't even mentioned the treatment of perio disease, occlussal related trauma, and my personel favorite, the cosmetic rehabilitation All things considered, even if this vaccine becomes widespread, dentists will see very little, if any changes in their practices for decades to come

 

[groundhog]

Don't worry. Like Dr Jeff pointed out, this could have a positive impact on the dental profession. I bet huge numbers of underserved populations would begin to visit the dentist on a regular basis if this procedure proves successful. This is the noble side of captitalism. New low cost products attract more customers which generates more revenues. A win-win situation.

 

[none]

Let's consider the best (and not all that unlikely) case scenario: a permanent single treatment of some sort is created that prevents the accumulation of S. mutans anywhere within the oral cavity. This, in turn, nearly completely eliminates cavities, maybe down to 10% of their current levels, maybe lower. What impact would this have on the dental profession? Well, think for a moment about how much the profession is centered around cavities. Not just treatment, that's probably only a small part of the focus, but the dental profession is amazingly centered around the prevention of cavities. This includes education, cleanings and product/academic research. Well, suddenly that's all wiped out. It's a different situation than fluoride. In fact, it's amazingly different. The reason that we saw an increased use of dental services with the introduction of fluoride was because of increased dental education being coupled with an extreme increase in the overall standard of living. That's not going to happen again, at least not nearly at the same levels. Now the argument that people would suddenly spend more on the more cosmetic side of dentisty is pretty flawed as well. If you were to suddenly give everyone in the country $100...how many do you think would invest it in non-mandatory, often painful and universally uncomfortable dental services? Very few. The difference is that quite simply cavities MUST be filled, teeth need not be straightened or whitened. As for the diet issue...I don't understand that at all. If the bacteria aren't in the mouth to turn sugar into lactic acid...what difference does it make how much sugar is coming in? Do you honestly believe diabetes related dental complications will rival the old-fashioned cavity? I don't.
Now I don't think a vaccine is the way any of this is going to happen, but the introduction of GM bacteria certainly holds the promise to permanently keep S. mutans as well as perhaps the standard periodental bugs out of the mouth.

 

[DrJeff]

Reality check. Look at the immunization rates for children in the US. One of the worst off all the industrialized countries of the world. I have faith in the lack of initiative of the average american! You tell americans how bad smoking is, how we all should eat a low fat diet, get plenty of exercise, and take all of a prescription when given, and frankly compliance on these issues is pathetic. What will likely happen is that if the caries vaccine is marketed, the folks who will who get is are the folks already at very low caries risk, the same folks who you'll only treat with 2 prophies and exams per year and bite wings every 24 or so months. Maybe once every 5 to 7 years you'll replace an existing restoration on them, and maybe about every 10 years or so they'll break a cusp and need a crown. These are the folks that your hygenists will love(easy and quick visits) and you'll like, but not really since you'd rather be doing some work on them. The reality of the business side of dentistry.

Now for the real interesting part, will folks insurance plans cover the caries vaccine??? If your patients plans don't cover this "vaccine", alot more of them than you might think won't pay for it. I'd be real suprised of many HMO's covered this vaccine. Realistically the economics of insurance companies would look at this situation in the following light. Lets say the vaccine costs 50 per dose and is needed every 6 months. They'd pay 100 per year per person, plus the cost of 2 periodic exams, and 2 cleanings, 2 flouride treatments for kids, and bi-yearly x-rays. They'd then look at all their existing claims data and see if the $100 per year for the vaccine per covered member is greater or less than the cost per year for restorative treatment for each member. I'd bet that all those good patients will negate alot of the bad patients and it will end up being cheaper for the insurance companies to pay for restorative and not the vaccine. Is that right?? You be the judge, but realistically dentistry will flourish for a real long time to come.

 

[groundhog]

I think the S. mutans treatment that is grabbing the headlines is the one being developed by Dr Hillman in the Oral Biology department at the University of Florida Schoolof Dentistry. He has created an altered bacteria which emits a substance that is toxic to S. mutans, but does not appear to emit any substance that harms tooth enamel. The altered bacteria also needs to be provided a manufactured nutrient in order to survive. I would imagine that this treatment will undergo several years of clinical trials before it is ready for prime time.
However, the main concern in this thread seems to be whether or not a "one shot dental caries magic bullet" will have a negative impact on the practicing dental profession. I would say there is no immediate threat to the dental professsion because of all the reasons provided by Dr Jeff plus the fact that people in the USA are living longer. The leading edge of the post WWII baby boom generation is about 8 years away from age 65. The life expectancy of those folks is presently in the 80's and could improve dramatically given todays medical advancements. Well, those folks have molars and bi-cuspids that are maxed out with with amalgam restorations and will soon be needing crowns. They will also be in need of root canals and continuing peridontal treatments. So, as I see it, dentists will be kept very busy overseeing preventative measures for the young folks who are coming on line and providing restorative and curative services to those headed out the gate for at least another 30 years.
Here is an interesting fact. Elephants have no natural enemies except for man. When not killed by man, they tended to die of starvation after the last set of their six dentitions of teeth wore out.

 

[groundhog]

More points on this issue (some of which have already been brought up by others).

1. The special nutrient that the altered bacteria needs for survival may be ruled an FDA controlled substance requiring regular visits to the dental office for check ups and prescription refills. In fact, this will very likely happen because the absolute need for the special nutrient is what prevents the altered bacteria from infesting and thriving in other folks who have not requested its introduction to thier bodily habitat.

2. Many folks who would be inclined in the first place to use the effective standard treatments (florides, sealants, cleanings, checkups, orthodontics) may continue to do so until the long term consequences of the new treatment become fully known.

3. Back to point 1. Someone goes to a lab for a swab test for the new bug and discovers that they have been infected with it against their will. Is this scenario an attorney's gold mine or what? You can bet the new bug and its nutrient will be tightly controlled.

 

[DrJeff]

On the bright side, it would atleast give the anti amalgam folks/anti flouridation folks something new to get all worked up about! <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />

 

[none]

I concur that a moderate number of people would object to having the treatment, but that would dwindle quickly. Americans have shown an absolutely amazing acceptance of GMO. They put GMO in their mouths every day of the year. Further, does it really take a person with 8+ years of post-secondary education to swab a mouth? It sounds like a wonderful job for a hygienist, actually and one with very little supervision at that. I might be persuaded that such technology wouldn't drastically hurt the dental profession (key word: drastically), but I really don't see it helping whatsoever.

 

[groundhog]

None,
Help me out here. Can you provide me with examples of living reproductively viable GMO's that have been legally introduced into the healthcare market which can also be legally imparted to me without my prior knowledge and consent?

 

[none]

I meant, as I believe you realized, GMO food products, not bacterial cultures. These are most assuredly introduced into your body without your prior knowledge in the United States and could easily have adverse effects.

 

[groundhog]

None,
Thanks for the reply. I do not know for sure, but I suspect that there might be a big difference in the regulatory laws that govern public exposure to genetically altered inanimate food products vs genetically altered living organisms capable of reproduction. Thus follows my argument regarding the potential impact on dentistry of the GMO being developed by Dr Hillman that kills S. mutans.

In order to survive and reproduce, Dr Hillman's GMO needs a special nutrient that is delivered on a regular basis. That is the means by which he hopes to insure that people do not become infected by the GMO without consent. Obviously then, in order to maintain control over the GMO, the special nutrient will not be something that anyone can just purchase off of the store shelf. It will have to be a FDA regulated substance available by prescription only. Furthermore, in regard to this matter of control, one has to derive a prudent amount of special nutrient doses that sould be in the hands of the public at one time.

In order to maintain control of the GMO as invisioned, I speculate that:

1. The the GMO will be applied under the supervision of a licensed dentist.
2. The prescription for the special nutrient will have to be authorized by a licensed dentist.
3. A maximum of one year's supply of the special nutrient will be made available to the user at one time (likely in the format of something along the lines of monthly automatic refills).
4. Prescriptions for successive years of supply of the special nutrient will require annual visits to a dental office for check ups.

 

[Dr. Pedo]

A wonderful thread however a lot of major issues have yet to be discussed.

1) I read the thread by Univeristy of Florida. Neat. However S. Mutans are aggressive, no doubt. So aggressive that the other 500-1000 gram pos. and more importantly gram neg. bacteria are left to pick-up the sugars left behind by the S. Mutants. In fact S. Mutants are 99% of the time located subgingivally and the rest are supra. Now lets wipe-out the nasty S.mutans and allow the other 499 problematic bacteria to get a face-full of frutose. Where one left off the other will pick up. Hmm, does anyone see a problem here? Darwin is rolling over in his grave <img border="0" alt="[Wowie]" title="" src="graemlins/wowie.gif" />

2) When you talk about the Biofilm you must consider it as an entity not just one part. The number one cause of Periodontal disease is plaque. Not just S.mutans. The average folk will actually think they are immune. They might even consider not brushing or flossing anymore. Some might even consider eating more sweets, ect... Gingivitis and Periodontitis knows no oganisms' names. They simply react to the overall plaque quantity. By wiping out S. Mutans you ARE NOT wiping out plaque.

3) I see nothing but great things for dentistry. This type of potion will only raise the awareness of society. Much like fluoride and sealants. It may delay the inevitable but I think it might actually increase the rate of dental problems, due to patient compliance and understanding. Drs. have a hard enough time getting people back for a 6 month cleaning, or a 10 year tetnus shot, let alone every 3 month for potion. Then just think of the persons response when you tell them this in NO WAY shape or form eliminates the need for brushing or flossing. In other words here is yet another way for those damn dentist to make more money. They give you a potion that kills one or 10 S. Mutans butr not the others, they give the others an opportunity to rise to the occassion and then tell you plaque will continue to build so brush those teeth. Its a conspiracy. And why would you want to come back every 3 months for a fee when you could simply have your teeth sealed. (and they will last 7-15yrs.) AHHH, as you can see dentistry is the place to be

rrb

 

[JML1DDS]

Dr.2B has some good points. As you can see that no one on this thread seems to agree 100% about this issue, I assure you the FDA and other politicians/lobbyists do not and will not agree on this issue either. I think we are very very far away from seeing any of these "vaccines" or treatments gaining FDA approval, and again long term prospective studies are hard to organize and complete. We have no idea of the long term effects of this type of treatment. By the time we receive data about a 10 or 20 year prospective study I will be most likely be retired. As it still stands, caries is the number one transmissable disease in mankind. More decay than you could shake a stick at.

 

[none]

Ah, but you're not wiping out S. mutans as one would be with a vaccine. You're replacing it with a bacteria better able to compete in the environment of the mouth. Why wouldn't such a bacteria also outcompete some other local fauna? Why couldn't it be made to do so?