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Abstract

Streptococcus mutans (S. mutans) is a Gram-positive, facultatively anaerobic bacterium primarily recognized as a key etiological agent in dental caries, one of the most prevalent and chronic oral diseases globally. Dental caries, commonly known as tooth decay, results from the complex interplay between acidogenic bacterial species, host susceptibility, diet, and oral hygiene practices. S. mutans thrives in the oral cavity by adhering to the tooth enamel surface, where it forms biofilms and metabolizes dietary carbohydrates, primarily sucrose, into lactic acid. This acid production lowers the pH in the local environment, leading to enamel demineralization and subsequent cavity formation. S. mutans exhibits a unique genetic capacity for sugar metabolism, extracellular polysaccharide (EPS) synthesis, and acid tolerance, enhancing its virulence and resilience within the dental biofilm community. The bacterium’s role in cariogenesis is influenced by various factors, including quorum sensing, horizontal gene transfer, and environmental adaptability. Specific virulence factors, such as glucosyltransferases, facilitate the synthesis of EPS, which contributes to biofilm stability and adherence. Additionally, S. mutans employs several acid resistance mechanisms to survive in low-pH conditions, promoting long-term colonization on dental surfaces. Recent studies have highlighted the potential of probiotic therapies, antimicrobial peptides, and vaccine development as alternative approaches to traditional fluoride-based caries prevention. Advances in genomic and proteomic analyses have furthered our understanding of S. mutans pathogenic mechanisms, offering insights into targeted therapeutic strategies aimed at mitigating caries progression. However, S. mutans does not act alone in the carious lesion formation; it interacts dynamically with other microbial species, host factors, and environmental stimuli within the oral microbiome. The ecological perspective of dental caries underscores the need for holistic approaches to prevention and treatment, considering microbial communities rather than single-pathogen eradication. Emerging research also suggests a correlation between S. mutans colonization and systemic health conditions, such as cardiovascular diseases and adverse pregnancy outcomes, broadening the bacterium’s clinical relevance. Overall, S. mutans remains a focus of dental and microbiological research, with ongoing studies aimed at addressing the complexities of cariogenesis and improving oral health outcomes worldwide.