Department of Preventive Dentistry, BK 21 Program, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University, Jeonju, Republic of Korea.
Caries Res. 2011;45(3):243-63. doi: 10.1159/000327250. Epub 2011 May 12.
Dental caries is the most prevalent and costly oral infectious disease worldwide. Virulent biofilms firmly attached to tooth surfaces are prime biological factors associated with this disease. The formation of an exopolysaccharide-rich biofilm matrix, acidification of the milieu and persistent low pH at the tooth-biofilm interface are major controlling virulence factors that modulate dental caries pathogenesis. Each one offers a selective therapeutic target for prevention. Although fluoride, delivered in various modalities, remains the mainstay for the prevention of caries, additional approaches are required to enhance its effectiveness. Available antiplaque approaches are based on the use of broad-spectrum microbicidal agents, e.g. chlorhexidine. Natural products offer a rich source of structurally diverse substances with a wide range of biological activities, which could be useful for the development of alternative or adjunctive anticaries therapies. However, it is a challenging approach owing to complex chemistry and isolation procedures to derive active compounds from natural products. Furthermore, most of the studies have been focused on the general inhibitory effects on glucan synthesis as well as on bacterial metabolism and growth, often employing methods that do not address the pathophysiological aspects of the disease (e.g. bacteria in biofilms) and the length of exposure/retention in the mouth. Thus, the true value of natural products in caries prevention and/or their exact mechanisms of action remain largely unknown. Nevertheless, natural substances potentially active against virulent properties of cariogenic organisms have been identified. This review focuses on gaps in the current knowledge and presents a model for investigating the use of natural products in anticaries chemotherapy.
龋齿是全球最普遍且代价最高的口腔传染性疾病。牢固附着在牙齿表面的毒力生物膜是与该疾病相关的主要生物学因素。富含细胞外多糖的生物膜基质的形成、环境酸化以及牙齿-生物膜界面持续的低 pH 值是调节龋齿发病机制的主要毒力控制因素。每一个因素都为预防提供了一个选择性的治疗靶点。尽管以各种方式提供的氟化物仍然是预防龋齿的主要方法，但仍需要额外的方法来增强其效果。现有的抗菌斑方法基于使用广谱杀菌剂，例如洗必泰。天然产物为具有广泛生物学活性的结构多样的物质提供了丰富的来源，可用于开发替代或辅助抗龋齿疗法。然而，由于从天然产物中提取活性化合物的复杂化学和分离程序，这是一个具有挑战性的方法。此外，大多数研究都集中在一般抑制葡聚糖合成以及细菌代谢和生长的作用上，通常采用的方法不能解决疾病的病理生理方面（例如生物膜中的细菌）和在口腔中的暴露/保留时间。因此，天然产物在龋齿预防中的真正价值及其确切的作用机制在很大程度上仍不清楚。尽管如此，已经确定了一些针对致龋生物毒力特性的天然物质。本综述重点介绍了当前知识中的空白，并提出了一种用于研究天然产物在抗龋齿化学疗法中的应用的模型。
