Immunological responses to bacterial plaque in the mouth.

A heavy load of bacteria, referred to as dental plaque, accumulates at the junction between the teeth and gum. Bacterial plaque may be considered to have three functional components: (a) cariogenic organisms, (b) organisms inducing gingival inflammation and periodontal disease, and (c) adjuvant and tolerizing agents, such as lipopolysaccharides, dextrans and levans. Sequential investigation of plaque accumulation in man has shown a correlation between gingival inflammation and both lymphocyte transformation and macrophage migration inhibition. An adjuvant effect of in vivo plaque accumulation was manifested by the enhancement of T lymphocytes in the mixed leucocyte culture reaction and of B lymphocytes, as shown by the increased response to lipopolysaccharide. It may be significant that a substantial component of bacterial plaque consists of dextrans and levans, produced by certain streptococci and actinomyces, and lipopolysaccharides from Gram-negative bacteria. These bacterial products are B cell mitogens which may have an adjuvant or tolerizing effect on immune responses. The relationships between immunogenicity, mitogenicity, adjuvanticity and tolerogenicity of lipopolysaccharides, levan and dextran have not been clearly defined. However, important variables of the polyglycans are the molecular weight, type of branching, negative charge, epitope density, degradability, dosage and the sequence between mitogen and antigen. Dental plaque in man is a focus of B cell mitogens and T cell antigens which may modulate the immune responses in such a way as to induce a protective response in the development of caries and a damaging response in periodontal disease.