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Streptococcus mutans: has it become prime perpetrator for oral

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 Journal of Microbiology & Experimentation

Review Article Open Access

Streptococcus mutans: has it become prime

perpetrator for oral manifestations?
Abstract Volume 7 Issue 4 - 2019

Human beings have indeed served as an incubator for a plethora of microorganisms and
Vasudevan Ranganathan, CH Akhila
the prominence of oral microbiome from the context of the individual’s health and well
Department of Microbiology, Aurora’s Degree and PG College,
being cannot be denied. The environmental parameters and other affiliated physical
India
conditions decide the fate of the microorganism and one of the niches in humans
that supports innumerable amount of microorganisms is the oral cavity which houses Correspondence: Vasudevan Ranganathan, Department of
beneficial and pathogenic microorganisms. However, majority of microorganism Microbiology, Aurora’s Degree and PG College (Affiliated to
associated with humans are opportunistic pathogens which are otherwise referred to Osmania University), India-500020, Tel 8121119692,
as facultative pathogens. This level of transformation in the microorganism depends Email
upon the physical conditions of the oral cavity and personal hygiene maintained by
the individual. The contemporary review tries to disclose the role of streptococcus Received: June 09, 2019 | Published: July 17, 2019
mutans in dental clinical conditions. The current review focuses on the prominence
of Streptococcus mutans and its influence on the oral cavity. The article attempts
to comprehend the role of the bacteria in causing clinical oral manifestations which
depends upon the ability of the organism to utilize the substrate. The review also
encompasses features like molecular entities and they role in the breakdown of the
substrates leading to the formation of acids which could in turn lead to demineralization
which as a consequence can negatively influence the enamel quality.

Keywords: Streptococcus mutans, dental Biofilms, microbial interactions, oral

microflora

Introduction microbial biota and twenty five different types of Streptococci have
been found to inhabit the oral cavity of humans. They represent twenty
The oral cavity of humans and animals is a perfect ecological percent of total oral bacteria and can be hospitable or hostile. Each of
niche for a range of microbial agents and some of these are capable these species is capable exhibiting properties that endow them with
of inflicting severe clinical conditions. These clinical conditions can abilities to inhabit different oral sites and also enable them to compete
lead to manifestations which could escort dire consequences. It could against the other oral microflora.
in fact be claimed that the major vicinity of the oral facet has been
dominated by several microorganisms. Niches like teeth, gingival Studies also reveal that the bacteria have developed properties
sulcus, tongue, cheeks, hard and soft palates, and tonsils are prime that allow them to overcome host factors like immune system,
spots for the microbes to reside. In fact these areas are dominated physico-chemical shocks, and mechanical frictions. However further
by certain species of bacteria and one of the prime contenders that evidences are needed to substantiate these claims. Unsteadiness in
invade these oral areas is Streptococcus species. Among these species, the native microbial flora leads to oral conditions resulting in clinical
S. mutans are widely regarded as one of the most dominant agent.1,2 manifestations under appropriate conditions. Under certain conditions
Several demonstrative attempts and scientific studies have validated the commensal nature of the organism gets transformed to hostile
that the oral cavity harbors a plethora of microbial agents of many nature which is associated with oral diseases. Hence, they are labeled
Streptococci species and it is undeniable fact that many of these as opportunistic pathogens that initiate disease and inflict damage
species share some common facets. These features could range from to the host. The group of mutans streptococci was regarded as the
their habitat to their feeding habits and their basic mode of survival.3 most important etiological agent leading to the formation of clinical
condition called dental caries. Despite the fact that the bacteria are
Studies have also revealed that these similarities among the species natural resident of the oral flora, they are associated with carious
could pose a threat in the identification and characterization. However lesions.4
a range of biochemical analysis plays a vital role in comprehending the
organism and studies have also employed the genetic and molecular Does the human oral cavity decide the status
level analysis for accurate flawless characterization. The prominence of of the microorganism?
biochemical test cannot be refuted as it provides a better understanding
in terms of sugar fermentation ability of the organism and also endows Resident microbes have evolved and coexisted with humans
the biochemical nature of the organism.3 One group of Streptococci for millions of years which are usually considered as a symbiotic
that is commonly affiliated with oral niche is S. mutans and various relationship. It would be difficult to sequester ourselves from our
studies have confirmed the association of this organism with humans. microbiome and we are not distinct. The oral microbiome plays a
In fact the human oral eco system encompasses a highly diverse oral vital role in the physiology and health. It is believed that humans

Submit Manuscript | http://medcraveonline.com J Microbiol Exp. 2019;7(4):207‒213. 207

© 2019 Ranganathan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and build upon your work non-commercially.
 Copyright:
Streptococcus mutans: has it become prime perpetrator for oral manifestations? ©2019 Ranganathan et al. 208

harbor over 700 species of bacteria that are capable of colonizing natural contender of the oral ecosystem in addition to 25 other species
the hard surface of the teeth and soft areas of the mucous epithelial that inhabit the oral cavity. However, the process of classification
cells. Novel technologies employed by scientific investigators have and characterization that are associated with the taxonomy are still
indeed deciphered the intricate facets of the oral microbiome and speculative.16 In simple terms the taxonomy is yet to be made cohesive.
have provided prominent insights affiliated to health and disease. It is a widely accepted fact that different areas of the oral cavity are
Agitations of the oral ecological niche can lead to dire consequences extremely contrasting and have a range of ecological niche which in
because it will have an impact on the normal equilibrium of turn decide the fate of microorganism in terms of their survival rates.
microflora which could in turn hike up the population of undesirable Each of these species has specific properties which allow them to
microorganisms capable of clinical manifestations. The modern day claim over an area in the oral ecological niche. Scientific investigators
life has been stated as a major reason’s that has opened the doors though their demonstrative studies have validated the dominance of
for microorganisms to influence the oral ecosystem of an individual. S. mutans on the depressions of the tooth surface otherwise called as
Infections such as dental cries, gum inflammation and periodontitis pits and studies have proclaimed the presence of these organisms in
have become common due to alteration of oral backdrop favoring the the grooves of the biting surface which is also called as fissures. This
undesirable microorganisms.5 in turn constitute to 39% of streptococci in the oral ecosystem. Apart
from these claims, studies also confirm the presence of Streptococcus
Oral microflora is the common term given to the microorganism
mutans in the alimentary canal which in turn opens in to pharynx and
found in the human oral cavity. However, terms like oral microbiota
esophagus which constitute to 2-9%.17 Some studies also substantiate
or oral microbiome have been recently used to refer these organisms
the existence of a symbiotic relationship among bacteria and fungi
affiliated with the oral cavity.6 The term microbiome is in fact a
which results in bacterial fungal co-aggregation. This symbiotic
recently introduced term and is often used from the context of human
relationship enhances the ability of cariogenic potentiality of S.
microbiome project. Several scientific investigators believed that
mutans. A symbiotic relationship between S. mutans and Candida
this would enhance the understanding of human health and diseases.
albicans has been authenticated by several scientific demonstrators
Researchers consider the oral microbiome to be a vital aspect which
which lead to elevated production of glucan which in turn is directly
explores oral flora and provides a better scope of identification
proportional to the extent of biofilm formation. It is also believed that
and characterization of these organisms. It is also believed that
this aspect boosts the carcinogenic effect of S. mutans.18 However,
this information also serves as a prerequisite in understanding the
the presence of harmful and harmless counterparts of Streptococci
phylogeny of the oral flora. It is estimated that the oral cavity harbors
in the oral cavity cannot be denied. Therefore, they are referred as
several hundred species and almost half of these can be cultivated
opportunistic pathogens which occur under certain conditions which
under anaerobic condition in labs.7 Molecular studies have also been
transforms commensal streptococci in to a pathogenic one which
employed to comprehend the microorganism and the commonly
could be an indication of the onset of the oral manifestations (Figure
used analysis is the 16S r RNA gene based studies which involve the
1).
cloning of the 16S r RNA. The molecular methods are highly sensitive
ad accurate and will provide a strong validation from the context of
identification and characterization. The oral cavity encompasses
several areas like gums, teeth, tongue, palates and is in fact the major
gateway of the human system. Various clinical manifestations as a
consequence of infectious disease have been like to oral microflora
that is capable of invading the teeth, gums and root canal.8
In fact many microorganisms colonize the human oral ecosystem
and it is estimated that an average human system comprises of a
microbial population of as much as ten folds.9,10 Some of them are
commensal which will coexist with our system with causing any
harm and other studies have revealed the existence of mutualism with
humans.11,12 However, the significance of the oral ecosystem cannot be
denied because the alteration in the normal condition will hamper the
normal microbial population which could in turn influence the balance
of the oral ecosystem creating conditions favorable for undesirable
microorganism to cause dire oral consequences leading to oral clinical Figure 1 Microscopic depiction of streptococcus mutans.13
manifestations.

About Streptococcus mutans

How does the organism compromise the
superficial structure of the teeth?
The bacterium is a common affiliate of the human oral niche and is
facultative anaerobic, Gram positive cocci. It is very often related to It is indeed a widely accepted fact that the ability of the organism
oral manifestation and is widely regarded as a significant contributor to inhabit and invade various areas of the oral cavity makes it a prime
of tooth decay. The existence of this organism came in t lime light perpetrator of tooth decay which can in turn have a deep seated
when it was described by J. Kilian Clarke in 1924.14 It is believed impact on the human oral cavity and the health of the individual.19
that this organism can coexist with Streptococcus sobrinus and their The organism is mesophillic and temperatures ranging from 18-
collaborative effort leads to a range of oral clinical conditions. The 400C are appropriate. The temperature within this range is more
same kind of coexistence can also be seen in case of Streptococcus convenient for the organism to survive and S. mutans is a cariogenic
viridians.15 As exclaimed by several demonstrative studies S. mutans is microorganism that is capable of breaking down sugar for its energy

Citation: Ranganathan V, Akhila CH. Streptococcus mutans: has it become prime perpetrator for oral manifestations? J Microbiol Exp. 2019;7(4):207‒213.
DOI: 10.15406/jmen.2019.07.00261
 Copyright:
Streptococcus mutans: has it become prime perpetrator for oral manifestations? ©2019 Ranganathan et al. 209

requirement resulting in the production of acids. This in turn leads to mutans can be passed on among individuals through horizontal or
an acidic environment which might deleterious to the teeth as they vertical transmission. The organism initially colonize and tries to
have the ability to demineralize the teeth. The acidic environment acclimatize in the human host which is then followed by the onset of
produced as a consequence of sugar breakdown due to microbial the infection which occurs over a period of time and severe cases can
action disintegrates the teeth leading to the dissolving of calcium also lead to the infection of the gums and tongue. Though individuals
creating a hole. Individuals of all age groups are vulnerable but are are all age group are infected the most vulnerable targets are infant
more common in infants and children. and children and studies claim that this is a consequence of vertical
transmission. The infection is common in infants because the non
Some studies synchronize the vertical transmission as a major
shedding surfaces favor the organism to establish permanent colonies
factor where mother can transmit the organism from her to the infant.
and the presence of the organism will be undetected till primary teeth
The transfer of genotypes during child birth from mother to infant is
extravagate.26 Recent studies also claim that the organism is known
also cited as a major factor that leads to S. mutans infection. Studies
to inhabit the furrows of the tongue in infants which usually occurs
also reveal the existence of variations among different populations.20
during the teething process. This usually occurs at the age when infant
Healthy individuals is known to harbor 10000 CFU of S. mutans per
develop one or two teeth which allows the organism to colonize and
ml in their oral cavity on an approximate basis.21 The virulent factors
cause cavities. This could be the indication of cavity formation as a
present in the organism fortify the organism in terms of diseases causing
consequence of detectable levels of S. mutans on teeth. Presence of
abilities. The three main virulent factors that are often cited from the
the organism on the furrows of the tongue implies the transmission
context of the organism are water insoluble glycans, acid tolerance and
of the organism vertically from mother to infant which occurs shortly
lactic acid production.22 The most commonly experienced symptom
after birth.
of tooth decay is toothache which is a consequence of the tooth pulp
irritation leading to toothache. X rays can be used to comprehend
the extent of damage caused on the tooth before they transform in
to cavities. The easiest way to prevent these dire oral consequences
is to lessen the amount of acid fermentation in the mouth. Since the
bacteria is a part of natural flora of the oral cavity and is a facultative
pathogen as it turn out to be pathogenic under certain condition, is
also referred to as opportunistic pathogen and appropriate measure are
inevitable to avoid oral clinical manifestations.

Pathogenesis
The pathogenesis from the context of a disease involves progressive
biological mechanism which enhances the advancement of the clinical
manifestation encompassing a range of morphological features ending
up in a diseased state. Based on the extent of impact imposed on the Figure 2 Schematic representation of different stages of bacterial plaque
individual, it can be termed as acute, chronic or recurrent.23 In view biofilm formation.25
of the fact that S. mutans is naturally affiliated with the oral niche, it
Studies also claim that mothers with history of dental manifestation
is capable of causing a range of oral condition that is a consequence
are at higher scope of transferring the condition to the infants that
of complicated biological correspondence. It is a widely accepted
are likely to possess same levels of virulence. Mothers with salivary
fact that S. mutans are known for their biofilm forming abilities and
samples with a count of over 105 CFU are known to transmit the
this phenomenon makes them much more stringent and difficult to
condition to the infants which is found to be nine time greater when
tackle. These microbial biofilms in fact serve as microscopic rims
compared to normal circumstances (Figure 3 & 4).27
which offer protection to the microbial population enclosed within the
rim. Some studies reveal that the disease causing characteristic also Colonization
depends on the extent of communication between these opportunistic
pathogens which is a very intricate network and is poorly understood.24 Colonization is a vital process which is one of the steps employed
Microbial biofilms indeed is highly complicated and involves a series by the organism to complete it manifestation course. S. mutans is
of morphological and biochemical changes during the course of known for its ability of altering the environmental conditions of the
transformation from a planktonic form to a biofilm producer. These oral flora during its growth and metabolism which in turn enhances the
biological films are complex amalgamation organic substance and are fastidious nature promoting the colonization of the organism leading
in fact a polysaccharide matrix which enables the microorganisms to to dental plaques. The organism is equipped with specific receptors
anchor on a platform which could be biotic or abiotic.25 which promote its attachment to the surface of the teeth and this
can be referred as the onset of dental biofilm formation. Following
Stages of dental biofilms attachment, the organism begins to produce microbial colonies within
the slimy biofilm network. S. mutans growth and development results
(Figure 2)
in the formation of dextran with the assistance of dextransucrase which
Transmission of the clinical condition binds to the enamel content of the teeth. This enzyme plays a vital role
in the metabolism of sucrose resulting in the formation of glucose and
Dental manifestations as a consequence of S. mutans are a common fructose. The organism ferments fructose and polymerizes glucose
phenomenon and can progress in to severe outcomes if not treated. In in to an extracellular dextran polymer. This polymer in turn affixes
fact dental caries are infectious and transmissible dental manifestations the organism to the enamel resulting in the formation of intricate
can infect individuals of all age groups. Studies also claim that S.

Citation: Ranganathan V, Akhila CH. Streptococcus mutans: has it become prime perpetrator for oral manifestations? J Microbiol Exp. 2019;7(4):207‒213.
DOI: 10.15406/jmen.2019.07.00261
 Copyright:
Streptococcus mutans: has it become prime perpetrator for oral manifestations? ©2019 Ranganathan et al. 210

biological network. The organism is also capable of de polymerizing pathogen enhances the process of attachment which includes the
glucose for its utilization as a carbon source leading to the production salivary elements of individual and the chemicals secreted by the
of lactic acid which further decalcifies the enamel resulting in dental organism. The process initially starts with the process of preliminary
caries. The advanced stage of this condition causes tooth decay due to attachment which slowly progresses in to a bridging of high
the combination of acid and plaque.29 specificity and affinity. This in turn triggers the process of microbial
communication through the process of quorum sensing resulting in
cell signaling. All these intricate processes play a significant role in
the establishment of the microorganism which indeed is vital for the
onset of infection.32

Figure 3 The above image depicts advanced tooth decay in a child.28

Figure 6 An upright pyramid depicting the hierarchical events during the

course of attachment.

Approaches to target streptococcus mutans

Figure 4 Image a depicts healthy teeth and gums and image b displays the It is a widely accepted fact that Streptococcus mutans resides
early signs of oral clinical manifestation.28 in dental biofilms which could sometimes be an amalgamation
of diverse species. Favorable environmental conditions are vital
Cell surface components are vital for the organism to rapidly produce acids by fermenting dietary
Demonstrative attempts to comprehend the adherence ability have carbohydrates. This in turn leads to demineralization of tooth causing
revealed various features affiliated with the organism responsible for tooth decay.33,34 It is therefore affiliated with oral manifestations and S.
its anchorage on to a surface. According to earlier studies that were mutans is commonly regarded as one of the prime perpetrators leading
carried out for cohesive understanding of this mechanism, it was to dental caries.35 Studies have also revealed the prominence of S.
believed that the salivary molecules were vital for the attachment to mutans in causing sub acute endocarditis.36 Nevertheless, studies have
the oral surface resulting in dental caries. However, certain cell surface stated and validated that dental caries is not life claiming and can be
molecules including proteins and other organic substances have a diagnosed on time for treatment which is possible by exterminating
prominent role in attachment. Studies have revealed that proteins and the undesirable microorganism. The eradication of S. mutans using
lipoteichoic acid served in accomplishing adherence of the organism wide range antimicrobial drug was not advisable because it would
under lab conditions. When human cells were cultured under in vitro also have an impact on the resident microflora leading to imbalance
conditions these molecules played a significant role in attachment of of the oral ecosystem which could in turn lead to clinical and
the organism to these cultured cells. Studies have also highlighted allergic consequences. Hence, there was a need for a novel strategy
the role fibronectin in anchorage which is a essential protein of the that could eliminate the undesirable microbe with influencing the
extracellular matrix (Figure 5 & 6).30 normal residents of the oral ecosystem. Therefore, prevention of S.
mutans and its affiliated manifestations stipulated the requirement
of alternative methods that could specifically target the undesirable
organism without interrupting the resident microflora within the oral
biofilm.
The recent times has witnessed several attempts to ensure target
specific antimicrobial therapy rather than pragmatic measures. The
target specific antimicrobial therapy was achieved by the combination
Figure 5 Diagrammatic representation of stages involved in anchorage
of the antibiotics that are species specific. This has also opened the
mechanism.31
doors for the engineering of species specific monoclonal antibodies
Steps involved in anchorage mechanism or by developing fusion peptides that recognize the bacterial binding
domains.37 These novel attempts have in turn lead to the formation of
The above diagrammatic depiction provides the sequential narrow spectrum antimicrobials. Due to their narrow range in terms
occurrences of various stages which allow the establishment of the of efficacy, they are highly selective on undesirable microorganism
organism. Various components associated with the host and the without a significant impact on the resident microflora. Pheromone

Citation: Ranganathan V, Akhila CH. Streptococcus mutans: has it become prime perpetrator for oral manifestations? J Microbiol Exp. 2019;7(4):207‒213.
DOI: 10.15406/jmen.2019.07.00261
 Copyright:
Streptococcus mutans: has it become prime perpetrator for oral manifestations? ©2019 Ranganathan et al. 211

guided antimicrobial peptides (PG-AMPs) have been greatly used often assumes sessile nature in response to sugars. It is believed that
from the context of selectivity because of its narrow spectrum which the biofilm formation exhibited by the microorganism is considered
depend on targeted killing of the undesirable microorganism.38 as one of the most thriving tactics employed for existence by the
organism. It is in fact the environment which also decides the extent
Significance of GTF of survival and other associated requisites. The prominence of lactose
Several demonstrative studies have also revealed the prominence in supporting the establishment of the microorganism by promoting
of oleic acid and the role of glucosyl transferase. In fact, glucosyl biofilm formation has been substantiated by several studies. Studies
transferase has been regarded as a prime target for anti caries therapy.39 have revealed the importance of lactose in enhancing the biofilm
Scientific studies and demonstrative analysis have emphasized on the formation. Growth of S. mutans in different mediums with varying
aspect of sucrose metabolism by S. mutans which provides a better concentrations of lactose had no significant difference on the growth
understanding of the oral clinical manifestation.40 Several enzymes of the organism and this in turn has validated the role of lactose in
associated with S. mutans enhance the sucrose utilization and these biofilm formation. However, the extracellular polysaccharides as a
enzymes have been known to be connected with the extracellular consequence of lactose metabolism were different when compared
region. Glucosyl transferase (GTF) is the major enzyme that to those produced as a consequence of sucrose breakdown. Hence,
favors the breakdown of sucrose and converts them in to adhesive it is quite obvious that these sugars are vital and have their own
glucans. This in turn contributes to significant amounts dental plaque significance in strengthening the organism in terms of growth,
formations which accumulate metabolic acids produced by bacterial establishment and biofilm formation. Studies have also disclosed the
colonies leading to demineralization of the enamel surface.41 GTF role of lactose in up regulation of vital genes in S. mutans that may
is a key component responsible for the formation of water soluble have a role in biofilm production and virulence.46 Therefore it could be
and insoluble glucose polymers through sucrose metabolism and also understood that the process of establishment and virulence involves a
serves as a prime factor in triggering virulence. S. mutans is known to cascade of reactions and a plethora of bio molecules which together
comprise of three kinds of GTFs that are responsible for the formation contributes to the hostile nature of the organism.
of water soluble and insoluble glucans. GTF B and C are accountable
for the formation of water insoluble glucans and GTF D synthesizes
water soluble glucans. Discussion
The unique feature of GTF B and C is the extent of similarities The oral ecosystem favors the growth of a variety of
in their nucleic acid and amino acid sequences and are independent microorganisms which ranges from mycoplasmas to fungi to bacteria
of glucan receptor and their enzyme activity is enhanced by the and virus in certain extreme cases. These microbes continue to survive
presence of dextran whereas GTF D is dependent on glucan acceptor. on the surfaces with the help of their biofilm forming abilities. This
Demonstrative studies have also validated the prominence of in turn contributes to the resident oral microbiome which resides
components at the genetic level and its role in prompting virulence.42 in synchronization with the host. The oral microbiome also offers
The enzyme has a complicated network consisting of various domains significant benefits from the context of overall health and well being.
including an independent functional domain which comprises of an Marsh et al.,47 have validated the extent of proximity among the
amino terminal and carboxyl terminal. The amino terminal serves microorganism within the dental biofilms. Studies have also revealed
as the catalytic center which binds to sucrose where as the carboxyl the prominence of proximity among the microorganism towards
terminal domain functions as glucan binding acceptor which plays a complicated level of interactions which could in turn lead to a
a vital role in establishing the nature of glucan synthesized.43 The positive or a negative outcome. The degree of microbial interaction
catalytic activity of the enzyme occurs in a sequential manner which is influenced by the conditions in the oral environment. Alterations
includes sucrase activity and transferase activity. The sucrase activity could lead to altered microbial interactions which could in turn have
involves the cleavage of sucrose in to fructose and enzyme bound a synergistic or an antagonistic impact on the host, thereby increasing
glucosyl moiety. The reaction further proceeds as a consequence of the scope for oral manifestations.48,49 Intake of dietary sugar has been
subsequent transfer of glucosyl moiety due to transferase activity.44 frequently associated with the formation of dental plaques because of
Several demonstrative studies have indeed attempted to highlight their nature of rapid breakdown and formation of acids resulting in
the prominence of GTF enzyme and have deciphered many affiliated reduced pH within the biofilms.
facets. The importance of gtf genes in cariogenesis was validated Some studies have also validated the existence of symbiosis
using some strains and one of those that have been studies in rat model among the microorganism which enables them to manifest the normal
is UA130 strain. It was revealed that S. mutans with a defective gene conditions. Subsistence of these microorganisms within the biofilms
gtfB and gtfC genes resulted in reduced carious lesions. These genes has been made possible through the phenomena of symbiosis and this
are vital and are required for the synthesis of insoluble glucan which has been substantiated in some cultures. Experimental evidence of
in turn contributes to smooth surface carious lesions. In addition to symbiosis in mixed cultures comprising of S. mutans and veillonella
gtfB and gtfC, another vital gene associated with S. mutans is gtfD has been disclosed by several studies.50 Certain studies have also
that codes for glucosyltransferase enzyme required for the synthesis illustrated prominence of veillonella in inhibiting certain species in
of water soluble glucans. A mutant with a defective gtfD gene resulted presence of an antagonist when added to mixed cultures. Veillonella
in fewer smooth surface lesions when compared to UA130 strain of added to a culture comprising of S. gordonii and S. mutans had a
the same organism which had a fully functional counterpart of the significant impact on the extent of sugar metabolism by S. gordonii
same gene. Based on these finding it is quite obvious that these genes and it also influenced the growth of S. mutans in the culture.51
are very vital in terms of virulence which was substantiated through
mutant studies on mutant strains.45 The prominence of pH has been a vital facet from the context of
the dental caries as experimental studies have disclosed an affirmative
Streptococcus mutans which is regarded as a cariogenic bacterium involvement in oral manifestations. Reduced pH will have a negative

Citation: Ranganathan V, Akhila CH. Streptococcus mutans: has it become prime perpetrator for oral manifestations? J Microbiol Exp. 2019;7(4):207‒213.
DOI: 10.15406/jmen.2019.07.00261
 Copyright:
Streptococcus mutans: has it become prime perpetrator for oral manifestations? ©2019 Ranganathan et al. 212

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Funding
21. Tooth Health: Cure for Cavities. Xenophilia.
None.
22. Howard K. Virulence factors of Mutans Streptococci: Role of Molecular
Acknowledgments genetics. Crit Rev Oral Biol Med. 1993;4(2):159-176.
23. Fox A. General aspects of bacterial pathogenesis. University of South
None.
Carolina School of Medicine: Microbiology and Immunology; 2010.
Conflicts of interest 24. Forssten SD, Björklund M, Ouwehand AC. Streptococcus mutans, Caries
and Simulation Models. Nutrients. 2010;2(3):290–298.
Authors declare that there is no conflict of interest.
25. Vasudevan R. Dental Plaques: Microbial Community of the Oral Cavity. J
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Citation: Ranganathan V, Akhila CH. Streptococcus mutans: has it become prime perpetrator for oral manifestations? J Microbiol Exp. 2019;7(4):207‒213.
DOI: 10.15406/jmen.2019.07.00261

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