The end of caries?

[GoGatorsDMD]

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I don't know how many of you all are familiar with new developments in dental technology, but I thought some folks might be interested in what will be hitting the market in another 4-5 years, assuming everything goes ok with the FDA approval.

www.oragenics.com


The main product of this company is an engineered strain of Strep mutans. This strain produces an antibiotic specific to natural S. mutans, the causative agent of most caries. Additionally, the metabolic pathway of this strain is tweaked to produce ethanol instead of acid. The inventor, Dr. Hillman, is a professor of oral biology here at UF. A group of us is going to hear him give a talk about this new bacteria on Tuesday. Does anyone have any good questions for me to ask him?


What do you all think about something like this?

- Are you concerned that it will "put dentists out of business" as I've heard some people say? (I know this is an exaggeration)

- Do you think it will usher in a new golden age of dentistry, further increasing demand?

- Not make a damn difference?

 

[3rdMolarRoller]

As far as I know, everytime we beat the bugs they laugh at us and find a way around it. Nature evolves much to fast for a product like this to last a lifetime... just my humble opinion

Look at how many bacteria are already resistant to antibiotics. So I would ask him, when do you think the bugs will have enough genetic mutation to fight back and do what they did in the past?

And if they do mutate to another form, do you run the risk of creating super-bugs that will do more damage?

 

[3rdMolarRoller]

How about: What other systemic affects does this have?

Will this destroy the flora in other parts on the body such as the gut?

This, to me, seems like it will rechavoc on the body.

 

[GoGatorsDMD]

Broc,


I certainly see how questions/concerns such as yours would affect the marketability of replacement therapy. Hopefully I'm going to learn more about it on tuesday. Supposedly the nature of the dental biofilm keeps these bacteria pretty isolated from the body and the amount of alcohol they produce is negligible.

 

[3rdMolarRoller]

Yeah, but people do eat and when you eat some of this bio-film will enter other parts of the body. mastication is a pretty rough process and I would assume this bio-film would mix up with the food in your mouth

 

[GatorDMD]

As far as I know, everytime we beat the bugs they laugh at us and find a way around it. Nature evolves much to fast for a product like this to last a lifetime... just my humble opinion

Look at how many bacteria are already resistant to antibiotics. So I would ask him, when do you think the bugs will have enough genetic mutation to fight back and do what they did in the past?

And if they do mutate to another form, do you run the risk of creating super-bugs that will do more damage?

Yeah I agree with this guy.


___________________________________
UFCD 2006

 

[Dr.SpongeBobDDS]

I think it would be awesome if this could work, but I don't see the
FDA approving something like this anytime soon. Even if it did become legal, there'd still be plenty of work for most of us. I mean, we already have a cure for caries and periodontal disease; it's called brushing and flossing. We all know how effective that has been. If people don't care enough about their teeth to do that, what makes you think people are going to line up to get live genetically mutated superbacteria squirted in their mouth every few weeks? Serious compliance issue there.

 

[no2thdk999]

Does anyone have any good questions for me to ask him?

What happens when I take an antibiotic for pneumonia (or anything else) or use an antimicrobial mouthrinse? Do the super bugs stay around or will I need to be reinocculated? Is it for life or for how long? Is it contagious like other forms of strep?

Personally I would welcome such a thing if all the kinks get worked out. This sounds intriguing but the promise of a caries vaccine has been 5-10 years out for a LONG time.

Rob

 

[ItsGavinC]

Dr. SpongeBob is absolutely correct. Prevention of caries is quite simple for the most part, yet people still won't brush their teeth. When it comes to flossing that's a whole other issue. Take a poll in your dental school class to see how many people floss their teeth each day. I bet the results will surprise you (my guess is less than 30%)--and these are people that are going to be dentists!

But above and beyond all of that, I don't think the FDA will approve the product. And even if they did, who is going to pay for it? Will it be covered by insurance companies? Will groups lobby against the product in the same way they lobby against vaccines? How often does the product have to be exposed to the oral cavity?

My vote: it won't make a damn bit of difference.

 

[GoGatorsDMD]

Gavin,

I think you're missing the point. I'm sure that the inventing scientist (who is also a dental school grad) realizes that caries prevention is available right now. The revolutionary principle behind replacement S. mutans is that it does not require compliance on the part of the patient. It removes the major causative agent.

Maybe I should have asked:

"ASSUMING this works as intended, how do you think it would affect dentistry?"

 

[ItsGavinC]

Here are some previous threads on the same topic of discussion, regarding Dr. Hillman and his work at UF:

http://forums.studentdoctor.net/showthread.php?s=&threadid=30250

http://forums.studentdoctor.net/showthread.php?s=&threadid=66201

http://forums.studentdoctor.net/showthread.php?s=&threadid=69115

 

[GoGatorsDMD]

Wow thanks for the links Gavin. I guess I should get to know that search feature a little better.

 

[ItsGavinC]

No big deal. Your post is a little unique because you are going to meet with the professor. Hopefully you can return and give us all some better insight on the work that he is doing!

Thanks for your posts!

 

[sxr71]

If reinoculations are needed I hope we will be the ones doing it. I wonder what happens if an innoculated person kisses an uninoculated person.

 

[GoGatorsDMD]

If reinoculations are needed I hope we will be the ones doing it. I wonder what happens if an innoculated person kisses an uninoculated person.

This was an interesting point that was raised. The replacement bacteria could perhaps have a metabolic deficiency worked in, available only by perscription.

 

[Dr.SpongeBobDDS]

Maybe I've read too much Michael Crichton and Robin Cook, but this whole idea just kind of gives me the willies. Part of me thinks it's brilliant and part of me thinks "what are we getting ourselves into here?" There are just so many ways this could turn horribly, horribly wrong. I really don't see the FDA giving this thing the go ahead.

 

[Dr. Pedo]

Microbiologist, cardiologist and nearly all "ologists" will have a field day with this magic potion!

S. Mutans are principle bacteria in caries but are only one of tens to hundreds that are problematic and release lactic acid on enamel. Can you imagine wiping out bad S. Mutans and for the first time accessory bacteria get a face full of carbohydrates/sugars. Messing the oral equilibrium good or bad lends itself to major problems. Microbiologists have long known that bugs will adapt and conquer when necessary and allowing tens or hundreds of other bacteria a more nutrient environment is ridiculous.

As a D4 and peds dentist applicant I can't imagine the conversation with parents of little jonny regarding this potion. I mean convincing them to place sealants (which were suppose to end dentistry like this potion) is a tiresome process. Imagine trying to explain giving bacteria that is good bacteria to fight bad bacteria and may have consequences (as all supplements do) but could prevent cavities just like sealants and good ol' brushing and flossing wanna try? Hell, many parents are now fighting normal vaccinations at birth do you really think a microbial rinse will appeal to the majority?

This will never happen-----3 years ago several other scientists in the North East were developing a vaccination-----after 10 years of research----it went down in flames. When the FDA looks at dental caries, a non-life threatening, easily cured, and easily prevented disease--they will never take a risk on a potion. If one precious child has an adverse reaction or death the wrath of god would fall down on the manufacture, the dentist, the government, and the FDA. YIKEEEES. 😱

 

[c132]

Guys, don't believe everything you read. They have been working on a vaccine for caries for years, every year saying they have it etc.... I went to a research meeting where they did everything but promise that it works and then 6 months later, the clinical trials failed drastically. I dunno about you guys, BUT if the Navy has been spending BILLIONS of dollars trying to keep biofilm bugs from growing on the hulls of the ships, then a research company claiming to keep strep mutans off the teeth might be a fraud.

It reminds me of an IGIA zit zapper 😱 I bought a few years back. It was FDA approved, and did it work NO> I sat with this little electrode on my zits for hours and it NEVER made them go away faster than normal, even though they said it will have them gone in a day or less.

FDA clearance does NOT mean it works too. I looked into this and it only means that it doesn't cause detectable harm to the body at the stage that it was tested.

 

[Dr_Oh_DMD]

Please note that they say: "reduce tooth decay". Reduce by how much - 1%; 5%; 10% or 50%? They don?t specify nor they say: ?eliminate tooth decay?. If you ask me it may reduce tooth decay but only by a little and most people wont even bother to spend the extra $ to reduce the risk of cavity by some miserable few %. Someone is trying to make money ?

Ok here is some more info about all this:

http://abcnews.go.com/sections/scitech/DailyNews/cleanteeth020220.html

"When Hillman squirted the strain on rats, the substance appeared to prevent tooth decay in the animals for the entire six-month period of the tests. He has also squirted a version of the bacterium on three human volunteers.

The strain these people harbor in their mouths kills off the S. mutans bacterium, but does not prevent decay since it also produces lactic acid. Tests show the strain has successfully warded off all S. mutans bacteria since the early 1980s. And none of the three subjects have passed on their unique mouth bacteria to their spouses or children".

Note that the only thing they mention is that the 3 human subject did not pass the mutant to their relatives. However they dont say that these people are decay free - hmmm... interesting.

Also the article ends with this:
And while the thought of a decay-ending agent may cause unease among some dentists who make a living on the problem, Burrell points out the rinse could actually end up improving business.

"If this rinse really works, it could mean the average person will have their teeth for a longer time," he said. "Then they might have various gum infections that they wouldn't have experienced if they lost their teeth to tooth decay, and they'll need dentists for that."

 

[GoGatorsDMD]

Please note that they say: "reduce tooth decay". Reduce by how much - 1%; 5%; 10% or 50%? They don?t specify nor they say: ?eliminate tooth decay?. If you ask me it may reduce tooth decay but only by a little and most people wont even bother to spend the extra $ to reduce the risk of cavity by some miserable few %. Someone is trying to make money ?

Ok here is some more info about all this:

http://abcnews.go.com/sections/scitech/DailyNews/cleanteeth020220.html

"When Hillman squirted the strain on rats, the substance appeared to prevent tooth decay in the animals for the entire six-month period of the tests. He has also squirted a version of the bacterium on three human volunteers.

The strain these people harbor in their mouths kills off the S. mutans bacterium, but does not prevent decay since it also produces lactic acid. Tests show the strain has successfully warded off all S. mutans bacteria since the early 1980s. And none of the three subjects have passed on their unique mouth bacteria to their spouses or children".

Note that the only thing they mention is that the 3 human subject did not pass the mutant to their relatives. However they dont say that these people are decay free - hmmm... interesting.

Also the article ends with this:
And while the thought of a decay-ending agent may cause unease among some dentists who make a living on the problem, Burrell points out the rinse could actually end up improving business.

"If this rinse really works, it could mean the average person will have their teeth for a longer time," he said. "Then they might have various gum infections that they wouldn't have experienced if they lost their teeth to tooth decay, and they'll need dentists for that."

The three people who volunteered to receive the bacteria don't have cavity protection because the bacteria still produces lactic acid. The theraputic strain has it's metabolic pathway modified to produce ethanol instead. All that article says is that those people do not harbor natural S. mutans anymore.

 

[Jone]

yeah, ask him "why is it that most PhD's are very book smart but have no common sense?"

this guy has to be fooling himself to think this will really fly. there are many reasons why this is a bad idea....

. Does anyone have any good questions for me to ask him?

 

[GoGatorsDMD]

Actually, Jone, he is a graduate of dental school as well. Does that give him SOME common sense? 🙄

After meeting with Jeff Hillman today let me address some of the concerns given here:

Why do they only say "reduce" tooth decay?

- Well, it certainly wouldn't be prudent to make a blanket statement by saying "eliminate". That would make you a liar if one out of one million people receiving it were to develop a cavity. If you were to read the animal research, you would see that reduce would probably mean by about 99%.


About upsetting the balance of oral flora

- The effector strain IS a strain of S. mutans. Therefore, it will occupy the same niche on the surface of the tooth, and consume as much sugar as wild type S. mutans would. The antibiotic produced by the effector strain will only have an effect in that niche. It is diluted too much to kill other colonies of bacteria in the biofilm by the time it diffuses away. Don't forget, this strain (while still acidogenic) was isolated in nature from a perfectly healthy individual. Volunteers have had the natural, acidogenic effector strain in their mouths since the early 80's, and it has only served to totally eliminate wild type S. mutans from their mouths.

Bugs finding a way around

- I'm sure we've all seen how easy it is for bugs to develop resistance to antibiotics like penicillin, but not all antibiotics are created equal. The antibiotic produced by the effector strain, Mutacin 1140, has been tested extensively on wild S. mutans and multiple-resistance strains of Staph aureus and Enterococci (real nasty boys). Upon testing of trillions of cells, not one has shown an ability to develop resistance to Mutacin 1140. If in the astronomically small chance someone were to develop bugs resistant to Mut 1140, well, you have one person that's going to have to keep brushing well.

Transfer of the effector strain

- Horizontal transfer (boyfriend/girlfriend) is pretty unlikely. I guess no one can really tell now until the FDA allows the company to do clinical testing. Vertical transfer (mother/child) is very likely, as the baby usually gets it's oral flora from the parents.


***

I agree with some of you that the FDA might be a roadblock, and that some people would be against receiving a "genetically engineered superbug". I just think that the FDA should give it a chance in clinical trials. The animal testing is there and it WORKS.

 

[Dr_Oh_DMD]

So, say all this works out perfectly how is it going to impact the business? I really dont want to graduate dental school with 200K in loans and be left out on the street...

 

[GoGatorsDMD]

I really dont want to graduate dental school with 200K in loans and be left out on the street...

That won't happen.

Dentistry, as a business, will make changes and find new ways to sell itself. The intended purpose of this thread was to see what some of you all think those may be.

 

[dental44]

I am slightly concerned not by the potential of this research, but by the concern that these findings may have on the dental profession (well, predents and dents). Do you feel that the profession is that weak?

 

[GoGatorsDMD]

Actually, no, I don't think it's weak because I know it can adapt. I am curious as to how though.

 

[groundhog]

GoGatorsDMD,
First, your answer lies in pure businesss economics. About 40% of the population does not get regular dental care. I would surmise that a big chunk of that 40% does not have access to affordable meaningful dental insurance. Get rid of the "caries threat" and I bet very affordable meaningful dental insurance that is designed to encourage preventative care will become available for all individuals via private or public means. Such insurance programs will have "join up ASAP, stay in, and use it as designed" incentives. Increasing market potential by 40% within a customer base that has been infused with a strong incentive to seek repetitive services on a regular basis will do wonders for any segment of business.

Second, there is still about thirty years of classical big time restoration and periodontal work in store for dentists as the Post WWII baby boom generation starts heading into their 60's and beyond in about two more years. I'm one of those folks. A big portion of us are maxed out on amalgam from cuspids on back and have significant chronic and/or acute peridontal issues. We enjoy the pleasures of chewing on various varities of food and we don't want dentures.

Finally, cosmetic dentistry is gaining a greater hold in the market place. Americans have become "appearance conscience" They want to look young and sexy as long as possible because we all know that looks matter in getting ahead in the USA today. No use in getting that facial flab tightened without investigating the need for a tooth redo too. Those new tighter cheeks will make your snagle tooth stand out like a sore thumnb.

So cheer up GoGatorsDMD a bright world awaits you even if S. mutans is doomed.

 

[ItsGavinC]

... a bright world awaits you even if S. mutans is doomed.

Which it isn't. 😀

 

[johnkimdmd]

That won't happen.

Dentistry, as a business, will make changes and find new ways to sell itself. The intended purpose of this thread was to see what some of you all think those may be.

I'm a skeptic. I don't think it will happen, but it's kind of fun to think What If...

I think we would see a large shift away from specialties. Generalists would pick up a lot of the work that they typically refer out. I'd personally do everything I thought I could safely do. I'd also do my own lab work. As long as people smoke and drink coffee I could run my in-office laser whitening clinic three days a week. I'd also learn how to do Invisalign. Orthodontists would be screaming at me of course, but we're talking about "What If hard times." We'd all be doing it. Because it doesn't make sense that GPs can do implants after taking a couple CE course but they can't order a plastic tray. You change those trays every two weeks, so if you make a mistake, you can just change it back. I'm not a genius, but I think I can figure out "straight." If I still couldn't make 200K a year (unlikely), I would hire a manicurist to do patient's nails while they were in the chair. I'd take, say 40% of that. Also, since I wouldn't have to talk while I'm working on the patient, I'd get one of those headsets and start a phone sex network. "Do you want to talk to hot, live, barely legal dentists?" You judge me perhaps, but we're talking about What If... Hell, I'm just trying to feed my kids.

 

[aggie-master]

lol, johnkimdmd