COMPARATIVE EVALUATION OF ANTIMICROBIAL EFFICACY OF Ig Y IMMUNOGLOBULINS AND PROBIOTICS ON THE LEVELS OF S. MUTANS - AN IN-VITRO STUDY

INTRODUCTION:

Dental caries is one of the most prevalent dental problems across the world. With the gradual change in the life style and food habits adults and children are more prone for caries development. Approximately nearly 36% of world population are experiencing teeth decay. Therefore there is an increasing demand to develop new treatment method for dental caries.¹

Streptococcus mutans is considered one of the key organisms in causing caries, as it is isolated in large amounts from the caries lesion. They are more active especially in acidic environment as they are aciduric in nature. S. mutans produces glucosyltransferases which is the major virulence factor needed for the synthesis of water insoluable glucans. Hence the control of growth and development of s.mutans is important for the control of dental caries.²

During the last decade, the use of probiotics has gained interest within the dental research community with focus on caries development, periodontal health and halitosis. Bacteriotherapy in the form of probiotics is the natural way to maintain health and to protect the oral tissues from diseases.³

Ig Y immunoglobulins exist in the serum of chickens and eggs.⁴ IgY immunotherapy has advantages like lack of reactivity with human complement system. Passive immunotherapy with Ig Y produces rapid and local onset of action, high specific activity & can be used for both infants and adults. IgY immunotherapy has several attractive features including: lack of reactivity with the human complement system and human Fc- receptors thereby preventing non-specific inflammation.⁵

The present study evaluated the effectiveness of probiotic lozenge (Bifilac) with Ig Y Immunoglobulins (Nodecay tablets)

MATERIALS AND METHODS:

Three groups

Group A: Control

Group B: Probiotic (Bifilac Probiotic)

Group C: IgY (Nodecay tablet)

DRUG DILUTIONS:

Samples from group B and C were diluted using a saturated salt solutions of acidic pH to get five different dilutions (five different dilutions 25mg \ ml, 20mg\ml,10 mg\ ml, 5 mg \ ml, 2.5 mg\ml).³

Fresh plates of test bacteria (s.mutans) were isolated from the dental caries and cultured on blood agar medium, this serves as the control group. Colonies of s. mutans from fresh culture was suspended in 5ml bacteriological peptone broth in labelled sterile tubes. They were incubated for six hours. Blood agar plates were prepared and used for the susceptibility study. Sterile filter paper disks of 6mm soaked in different dilutions were used.⁶

RESULTS:

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Fig 1

GROUP A

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Fig 2

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STATISTICS:

DISCUSSION:

S.mutans is the main causative agent of dental caries because of its ability to adhere to the tooth structure and its ability to produce insoluable glucans. The agent which effectively reduces the level of s mutans should be recognized in order to prevent the caries. Several agents which helps in reduction of s mutans levels were chlorhexidine in the form of mouth wash, gel and varnishes⁸, povidone iodine mouth rinses, fluoride varnish.⁹ The effectiveness of antimicrobials like augmentin and amoxillin against s mutans were proved by Staves et al.¹⁰ Some of the natural agents like curcumin,¹¹ propolis, green tea,¹² has also proved effective in reducing the levels of s mutans.

Passive immunization of antibody to Streptococcus mutans glucan binding protein B (GBP-B) has been shown to induce protection against experimental dental caries in rats.¹³

IgY immunoglobulins were proved to be effective against s. mutans in the control of dental caries, periodontitis, oral candidiasis.¹⁴ Similarly study by Nguyen² Gandhimathi¹⁵ Mary¹⁶ also proved that anti CA GTF IgY were reducing the level of s mutans colinazition.

It has been shown that administration of probiotic drops containing strains of Lactobacillus reuteri during the first year of life had an impact on caries prevalence and Early childhood caries development could be reduced through daily administration of probiotic chewing tablets as adjunct to daily use of fluoride toothpaste in preschool children.¹⁷ Probiotics effectively reduces plaque index and s. mutans levels.¹⁸

Probiotics and Ig Y Immunoglobulins were proved to reduce the levels of s.mutans and to the best of our knowledge there are no literature comparing the effectiveness of these two drugs. Hence this invitro study was done to compare Bifilac probioticTM with Nodecay tabletsTM containing Ig Y.

Probiotic bacteriotherapy is the natural way to maintain health and to protect the oral tissues from diseases. Probiotics are defined as live microorganisms that confer a health benefit on the host when administrated in appropriate amounts.[18] Probiotics are emerging as a novel approach for the treatment of oral disorders, probiotic species act through a variety of mechanisms like exclusion and competition with potential pathogens, production of antimicrobial substance against oral pathogens, local and systemic immunomodulation's, enhancement of mucosal barrier functions.¹⁹ Studies by Sugumari et al proved the effectiveness of probiotics against periodontal pathogens.

Leslie and Clem first coined the term IgY in 1969. Specific IgY antibodies against CA-Gtf (cell associated glycosyltransferase) of s mutans are obtained by immunizing hens with CA-Gtf antigens of s. mutan, causing them to produce antibodies as a part of their normal immune response.²⁰ The antibodies thus produced are transferred to the egg yolk through maternal transfer. Egg yolk contains 99% fat and only 1% protein. These IgY antibodies, are extracted from the egg yolk laid by these hens, purified. Once formulated it is given orally to humans. Ig Y Immunoglobulins are reported to reduce the number of s mutans in the oral cavity by forming antigen antibody complexes in dental plaque and saliva.²¹

In this study Nodecay chewable tablets containing IgY immunoglobulins and Bifilic probiotic lozenges with Lactobacillus sporogenes, Streptococcus faecalis, Clostridium butyrium, and Bacillus mesentericus were used.

Elavarasu evaluated the antibacterial activity of Bifilac against P. gingivalis at various concentrations such as 2.5, 5, 10, and 20 μg/ml, of which 20 μg/ml showed a zone of 22 mm in accordance with this, bifilac lozenges and no decay chewable tablets were used in five different dilutions where only 25mg \ ml were susceptible and all the lower concentrations were resistant.³

The study results proved that a minimum of 25mg \ ml and above of both drugs should be used inorder to produce a significant reduction of s.mutans. Eventhough both the drugs showed suspectibility against s.mutans when used at the concentration of 25mg/ml but the results were not statistically significant.

CONCLUSION:

Ig Y are specially prepared against s. mutans and probiotics are commonly used now a days. No decay tablets are available as lozenges, while probiotics when used in the form of lozenges can also aid in a considerable protection against dental caries. As both the drugs shows susceptibility to s. mutans in the present study both can be used as an effective alternative for prevention of dental caries in children.