Published via Bharati Vidyapeeth (Deemed to

Open Access Review Article be University), Pune

Contemporary Trends and Future Prospects of

Genetically Engineered Vaccines in the
Received 06/25/2025
Management and Prevention of Dental Caries
Review began 06/27/2025
Review ended 07/21/2025 Sayem A. Mulla 1 , Waseem Z. Khan 2 , Laresh N. Mistry 3, Amit H. Patil 4 , Parag Gangurde 2, Tanvi Shukla 2
Published 07/22/2025

© Copyright 2025 1. Dentistry, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, IND 2.
Mulla et al. This is an open access article Orthodontics and Dentofacial Orthopaedics, Bharati Vidyapeeth (Deemed to be University) Dental College and
distributed under the terms of the Creative Hospital, Navi Mumbai, IND 3. Pedodontics and Preventive Dentistry, Bharati Vidyapeeth (Deemed to be University)
Commons Attribution License CC-BY 4.0., Dental College and Hospital, Navi Mumbai, IND 4. Conservative Dentistry and Endodontics, Bharati Vidyapeeth
which permits unrestricted use, distribution,
(Deemed to be University) Dental College and Hospital, Navi Mumbai, IND
and reproduction in any medium, provided
the original author and source are credited.
Corresponding author: Sayem A. Mulla, sayemmullaa@[Link]
DOI: 10.7759/cureus.88491

Abstract
Despite conventional preventive measures including dental sealants, dietary changes, and fluoride
treatments, dental caries (DC) is still a global health issue. An important pathogen in DC development,
Streptococcus mutans, forms biofilms and demineralizes enamel in acidic oral conditions. Promising
substitutes are provided by new preventative techniques such as genetic engineering, probiotics, and
antibacterial peptides. A potential long-term remedy is the genetically altered BCS3-L1 strain, which is
intended to outcompete S. mutans and stop the generation of acid. Even though these developments have
the potential to completely transform oral healthcare, further study is required to guarantee their efficacy,
safety, and public acceptability. The aim of this review is to highlight the salient features, the probable
mechanism behind it, while also exploring the limitations associated with it and shedding light on the future
prospects of the strain.

Categories: Genetics, Dentistry, Oral Medicine

Keywords: bcs3-l1, caries vaccine, dental caries, dental caries prevention, genetically modified vaccine, prevention of
dental caries

Introduction And Background

The fact that dental caries (DC) is still a major worldwide health issue emphasizes the shortcomings of
current preventative strategies and the intricate interactions between various factors that contribute to its
development [1]. Although fluoride treatment has dramatically decreased the prevalence of dental cavities
in many communities, its efficacy is sometimes hampered by uneven application, limited access to
fluoridated water, and inequalities in the availability of dental care. Similar to this, dietary changes like
cutting back on sugar call for long-term behavioral adjustments that can be difficult to carry out, especially
in cultures where processed foods and sugar-filled drinks are common [2]. Although dental sealants offer an
extra degree of security, especially for kids, their application necessitates expert assistance, which may not
always be available to marginalized groups. These difficulties highlight the need to investigate alternate
approaches that tackle both personal habits and more extensive structural impediments to successful caries
prevention [3].

Lack of access to dental treatment increases the burden of DC in many underprivileged and disadvantaged
populations, resulting in a circle of untreated oral health problems that can cause pain, infection, and a
decline in general well-being. Higher rates of untreated decay and related consequences arise from people's
inability to seek prompt preventative treatment due to financial limitations, a lack of awareness, and an
inadequate healthcare infrastructure. Inequalities in oral health education also led to a lack of knowledge
about the significance of early intervention, appropriate hygiene habits, and dietary choices [4]. The surge of
DC cases worldwide in spite of preventative measures indicates that creative, affordable solutions catered to
the particular requirements of these susceptible groups must be added to standard techniques.

In order to enhance oral health outcomes, emerging caries prevention strategies emphasize the use of
innovative technology, community-based therapies, and microbiome-targeted techniques. New
developments in probiotics, antimicrobial peptides, and customized preventive treatment present viable
substitutes for lowering the burden of cariogenic bacteria and strengthening the body's defences against
dental decay. Community-driven oral health initiatives, tele dentistry, and mobile dental clinics can all
assist close the access gap and make sure that people who need preventative treatment can get it [5].
Furthermore, including oral health education into public health campaigns and school curriculum can
promote enduring behaviours that support long-term caries prevention. These cutting-edge strategies have
the potential to lessen the worldwide burden of DC and advance universal oral health by targeting the
biological and socioeconomic factors of DC [6].

How to cite this article

Mulla S A, Khan W Z, Mistry L N, et al. (July 22, 2025) Contemporary Trends and Future Prospects of Genetically Engineered Vaccines in the
Management and Prevention of Dental Caries. Cureus 17(7): e88491. DOI 10.7759/cureus.88491
 Published via Bharati Vidyapeeth (Deemed to
be University), Pune

Review
Methodology
A literature search was carried out on multiple scholarly databases such as PubMed, ScienceDirect, Web of
Science and Google Scholar to identify scholarly articles. The keywords used included "genetically
engineered vaccines", "dental caries", and "genetically modified vaccines" in various combinations of
Boolean operators. Only studies available in the English language were selected, and no restriction on
publication year was applied. The initial search results were then screened by authors SAM, WZK and LNM
for their relevance for inclusion in this narrative article. After careful assessment, a total of 28 articles were
included in this narrative synthesis.

Role of Streptococcus mutans in DC

DC, as we all know, is a multifactorial disease (Table 1) [7]. However, Streptococcus mutans, a gram-positive
facultative anaerobe that is essential to the creation of plaque and the generation of acid, is the main culprit
in the pathophysiology of DC. An extremely versatile and opportunistic bacterium, S. mutans flourishes in
the oral cavity, especially when fermentable carbohydrates like sucrose, glucose, and fructose are present [8].
It produces extracellular polysaccharides, mostly glucans, which promote the formation of biofilm (dental
plaque), giving it a remarkable capacity to stick to the enamel surface. Plaque development produces a
confined microenvironment in which S. mutans may grow while evading the host's immune system and
salivary purification systems. The bacteria produce organic acids, mostly lactic acid, as a result of their
effective glycolysis process, which turns dietary carbohydrates into energy [9]. Because of its acidogenic
properties, the biofilm's pH decreases, increasing the acidity of the oral environment. Since hydroxyapatite,
the main mineral component of enamel, dissolves in low pH settings, the enamel becomes demineralized as
a result of the ongoing acidic circumstances. Repeated acid assaults erode the enamel over time, eventually
resulting in the development of cavities [8].

Factor Impact on dental caries

Streptococcus mutans colonization Forms biofilm and initiates plaque development

Carbohydrate metabolism Converts sugars into lactic acid, leading to enamel erosion

Acid production Causes demineralization of enamel

Fluoride therapy Increases enamel resistance but requires continuous application

Socioeconomic status Affects access to preventive care and treatment

TABLE 1: Relationship between various etiological factors and dental caries.

Apart from being acidogenic, S. mutans is also aciduric, which means that it can live and grow in acidic
environments that would be harmful to other oral bacteria. It has a competitive edge thanks to this
capability, which enables it to control the microbial population in plaque. In addition, S. mutans has
virulence factors such as bacteriocins, which prevent the development of competing bacteria, and
glucosyltransferases, which help produce sticky glucans that promote bacterial colonization. High levels of
S. mutans are closely linked to a higher risk of DC, particularly in cases where frequent use of carbohydrates
and poor oral hygiene are present. In order to prevent plaque buildup and neutralize acid production,
preventive methods including consistent brushing, flossing, fluoride treatment, and dietary changes are
essential [8-10]. Specifically, fluoride reduces the cariogenic potential of S. mutans by inhibiting bacterial
metabolism and aiding in the remineralization of enamel. Knowing how this bacterium contributes to the
pathophysiology of DC emphasizes how crucial it is to preserve oral health in order to stop tooth decay from
getting worse [11].

Traditional and emerging prevention strategies

The main goals of traditional oral health techniques are to lessen acid production and bacterial colonization,
which are the main causes of periodontal disorders and tooth caries. A key component of these strategies is
the mechanical removal of plaque by brushing and flossing, which inhibits the production of biofilms and
stops the growth of germs. By encouraging remineralization and preventing bacterial metabolism, chemical
treatments like fluoride are essential for improving enamel resilience [12]. Regular patient adherence is
necessary for these techniques to be successful, even if they are highly advised and work well when applied
regularly. However, the overall efficacy of these preventative measures may be impacted by the wide
variations in compliance caused by variables including age, educational attainment, availability to dental
care, and personal motivation (Table 2) [13]. Inequities in oral health can also be exacerbated by
socioeconomic differences that restrict access to dental treatment and goods.

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Prevention method Mechanism Limitations

Fluoride therapy Enhances enamel remineralization Requires frequent application

Dental sealants Creates a protective barrier Expensive and needs professional application

Dietary modifications Reduces sugar intake Difficult to enforce consistently

Probiotics Alters oral microbiome Limited clinical validation

Genetic engineering Modifies Streptococcus mutans to reduce cariogenicity Requires further research and regulatory approval

TABLE 2: Preventive methods, mechanisms, and limitations of traditional dental caries

management techniques.

In light of these difficulties, there is an increasing need to investigate long-term, alternative preventative
strategies that do not only depend on patient compliance. By more sustainably addressing the underlying
causes of oral disorders, innovations like biomimetic materials, probiotics, and new antimicrobial peptides
provide encouraging remedies. For instance, without needing patient effort, bioactive compounds that
release calcium and phosphate ions can help with enamel repair [14]. In a similar vein, probiotics that add
good bacteria to the oral microbiome can aid in the suppression of dangerous pathogens, lowering the risk of
gum disease and cavities. Furthermore, methods based on gene therapy and nanotechnology are being
researched for their capacity to alter bacterial behavior and strengthen defences. The future of preventive
dentistry may provide more egalitarian and successful techniques for preserving oral health by reorienting
the focus from conventional, behaviour-dependent approaches to sophisticated, self-sustaining solutions
[15].

Genetically engineered vaccines: mechanisms and development

By specifically targeting S. mutans, the main bacterial cause of tooth decay, genetic engineering has
transformed the creation of vaccinations and probiotic therapies meant to prevent DC. Researchers have
looked into genetically altered vaccines that trigger an immune response against important S. mutans
virulence proteins, such as glucosyltransferases, which are necessary for the development of biofilms and
the production of acid [16]. Researchers want to create protective immunity that lessens S. mutans
colonization in the oral cavity by using recombinant antigens or live attenuated bacterial strains.
Furthermore, preclinical research has demonstrated the possibility for long-term resistance to cariogenic
bacteria with DNA-based vaccinations that promote mucosal immunity. Instead of only treating the
symptoms of DC, these genetic engineering advancements provide a proactive approach to prevent disease
at its source (Table 3) [17-19].

Type of genetic engineering Mechanism Example

Live attenuated strains Reduces acidogenicity while retaining colonization ability BCS3-L1 strain

Recombinant antigen-based vaccines Uses specific S. mutans antigens to elicit an immune response GTFs, PAc, Antigen I/II

DNA vaccines Introduces genetic material encoding S. mutans antigens In development

Passive immunization Uses monoclonal antibodies to neutralize S. mutans Experimental

TABLE 3: Types of genetic engineering with their mechanisms and examples.

In addition to vaccinations, probiotic treatments that outcompete S. mutans or counteract its negative
effects have also been developed through genetic engineering. To prevent S. mutans from adhering to tooth
surfaces and forming cariogenic biofilms, researchers have altered beneficial bacterial strains, such as
Lactobacillus species, to create antimicrobial peptides or enzymes that specifically target S. mutans.
Introducing genetically altered S. mutans strains that are unable to produce lactic acid is another novel
strategy that lessens acid-induced enamel demineralization [20]. In place of conventional fluoride
treatments and mechanical plaque removal, these designed probiotic therapies offer a sustainable and
perhaps self-replicating method of preventing DC. Such treatments have enormous potential to
revolutionize oral healthcare and lessen the prevalence of DC worldwide, provided that genetic engineering
continues to improve [21].

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The BCS3-L1 strain: a case study in genetic modification

An important development in the fight against DC is the genetically modified strain of S. mutans known as
BCS3-L1. Because of their capacity to convert carbohydrates into lactic acid, which breaks down tooth
enamel, traditional S. mutans strains are a significant cause of dental decay. In order to eradicate the
damaging acid production that causes cavities, BCS3-L1 has been engineered to colonize the oral cavity and
outcompete native S. mutans strains [22]. Researchers intend to offer a long-term, preventative oral health
solution that does not rely exclusively on fluoride treatments or mechanical plaque removal by substituting
this manufactured alternative for the native strains [23].

The generation of mutacin-1140, a strong lantibiotic that selectively targets and inhibits unmodified S.
mutans strains, is a crucial characteristic of BCS3-L1. BCS3-L1 has a competitive advantage because of its
selective antibacterial function, which enables it to dominate oral biofilms without endangering beneficial
oral bacteria. Mutacin-1140 offers a more focused approach than broad-spectrum antibiotics, which have the
potential to upset the equilibrium of the oral microbiota and cause secondary infections [24,25]. In order to
preserve a healthy oral environment and stop dangerous S. mutans strains from recolonizing, this specificity
is essential. BCS3-L1 is a novel tool for managing oral health since it employs such a tailored antibacterial
approach [22].

Beyond preventing cavities, BCS3-L1 may have further advantages. This strain may lessen problems
associated with oral acidity, such as dentin erosion and hypersensitivity, by decreasing the amount of acid
produced in dental biofilms. Furthermore, BCS3-L1 colonization in the oral cavity over time may lessen the
need for regular dental procedures, which would save money for both private citizens and public health
systems [11]. To guarantee its safety, efficacy, and long-term stability in a variety of populations,
comprehensive clinical trials and regulatory authorization are required prior to broad use. If BCS3-L1 is
effective, it might completely transform dental treatment by offering a biological, sustainable way to stop
tooth decay at its source (Table 4).

BCS3-L1 strain features Benefits

No lactic acid production Prevents enamel demineralization

Mutacin-1140 production Inhibits unmodified Streptococcus mutans strains

Long-term colonization Provides sustained protection

Affordable treatment Estimated cost under $100 per application

TABLE 4: Features and benefits of BCS3-L1.

An innovative method of avoiding DC brought on by S. mutans is provided by the BCS3-L1 strain, which is a
breakthrough in dental microbiology. To inhibit S. mutans and lower the risk of tooth decay, traditional
techniques like fluoride treatments and antimicrobial rinses must be used consistently. These therapies do
not, however, permanently change the makeup of the oral microbiome, making patients susceptible to
recurring infections. BCS3-L1 is a genetically altered bacterial strain that, on the other hand, is intended to
outcompete S. mutans and create a stable, non-cariogenic microbial habitat [26]. After a single application,
BCS3-L1 offers a lifetime preventive effect by colonizing the oral cavity and displacing harmful bacteria,
obviating the need for recurring treatments.

A single injection can result in the steady replacement of S. mutans with a harmless bacterial population,
according to research on BCS3-L1 in animal models. By occupying the same ecological niche as S. mutans,
BCS3-L1 prevents its recolonization through a process known as competitive exclusion [22]. BCS3-L1 creates
a persistent presence in the oral microbiome, providing long-term protection against DC, in contrast to
traditional probiotics that need to be taken on a regular basis [24]. Furthermore, research shows that the
strain improves oral health by supporting a balanced microbial environment rather than impairing total
microbial diversity. This strategy fits in with the increasing interest in microbiome-based treatments, which
try to use good bacteria to prevent illness [16].

Beyond affecting a person's oral health, BCS3-L1 may lessen the prevalence of DC, one of the most common
infectious illnesses in the world. BCS3-L1 may considerably reduce the need for restorative dental
treatments and the medical expenses related to cavity treatment by offering a one-time, permanent solution
[27]. In addition, its use in public health campaigns may increase access to preventive care in
underprivileged areas where fluoride treatments and routine dental checkups may be scarce. However,
further clinical research is required to verify its long-term safety, effectiveness, and regulatory approval
prior to broad use. By changing the focus from ongoing preventative care to a single, long-lasting
intervention, BCS3-L1 has the potential to completely transform dental care if it is properly adopted [2].

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Safety and ethical considerations

The use of genetically modified bacterial strains, despite their promise, presents a number of issues, mostly
related to biosafety, environmental effects, and ethical considerations. One significant concern is the
possibility of unforeseen outcomes, such as horizontal gene transfer, in which altered genes may infiltrate
native microbial populations and cause ecological disruption or the rise of infections resistant to antibiotics.
Furthermore, because the long-term impacts of modified bacteria are yet unknown, their introduction into
the environment presents containment and control issues [26]. The possible abuse of genetic engineering in
bioterrorism or unintentional harm to human health also raises ethical questions. Widespread acceptance is
also hampered by public image and regulatory issues, since concerns about genetic engineering and
inadequate supervision may impede biotechnology advancement. Thorough safety evaluations, open
legislation, and continuous research to guarantee the appropriate use of genetically modified bacterial
strains are necessary to allay these worries (Table 5) [28].

Concern Potential risk

Oral dysbiosis Disrupting the natural microbiome may lead to other infections

Horizontal gene transfer Risk of genetic material spreading to other bacteria

Systemic health effects Potential bloodstream infections and endocarditis

Public acceptance Skepticism toward genetically modified organisms (GMOs)

TABLE 5: Concerns and risks associated with genetically modified vaccines.

Future prospects and research directions

Several important research topics need to be solved before genetically modified vaccinations are adopted as
a common caries prevention technique. First and foremost, a comprehensive assessment of these vaccines'
long-term safety and effectiveness is required to make sure they do not result in off-target effects or
unexpected immune reactions. In addition, for efficient defence against cariogenic bacteria like
Streptococcus mutans, delivery mechanisms such as mucosal vaccination must be optimized. To ensure
widespread efficacy, research is also required to comprehend any differences in immunological responses
across various groups. It is also necessary to investigate ethical and regulatory issues, such as public
acceptability and adherence to health regulations. Finally, in order to avoid disturbances that can result in
additional oral or systemic health problems, the possible influence on the oral microbiota should be
investigated (Table 6).

Research focus Key considerations

Longitudinal clinical trials Assess safety, efficacy, and microbiome stability

Regulatory approvals Establish clear guidelines for monitoring and approval

Combination therapies Integrate with existing preventive methods for enhanced efficacy

Synthetic biology innovations Develop bacteria with enhanced biofilm disruption properties

Public health policy Increase education and awareness to gain acceptance

TABLE 6: Future studies that can improve the literature for genetically modified vaccines.

Conclusions
A revolutionary method of preventing dental cavities is represented by genetically modified vaccinations
and bacterial strains. An innovative illustration of the potential for modified S. mutans to offer long-term
cavity prevention is the BCS3-L1 strain. However, before these technologies can be extensively used, safety
issues, moral dilemmas, and legal barriers need to be resolved. Genetically modified vaccinations have the
potential to transform oral healthcare and drastically lower the prevalence of DC worldwide with more study
and advancements in technology.

Additional Information

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Author Contributions
All authors have reviewed the final version to be published and agreed to be accountable for all aspects of the
work.

Concept and design: Sayem A. Mulla, Waseem Z. Khan, Amit H. Patil, Parag Gangurde, Tanvi Shukla

Acquisition, analysis, or interpretation of data: Sayem A. Mulla, Waseem Z. Khan, Laresh N. Mistry

Drafting of the manuscript: Sayem A. Mulla, Amit H. Patil

Critical review of the manuscript for important intellectual content: Sayem A. Mulla, Waseem Z. Khan,
Laresh N. Mistry, Parag Gangurde, Tanvi Shukla

Supervision: Sayem A. Mulla, Waseem Z. Khan

Disclosures
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the
following: Payment/services info: All authors have declared that no financial support was received from
any organization for the submitted work. Financial relationships: All authors have declared that they have
no financial relationships at present or within the previous three years with any organizations that might
have an interest in the submitted work. Other relationships: All authors have declared that there are no
other relationships or activities that could appear to have influenced the submitted work.

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