Biofilm Formation in Dental Caries and Advancements in Biofilm-Targeted Therapies: A Decade of Progress

Abstract

Background: Dental caries is a widespread chronic disease globally, driven by the interaction of dietary sugars, host factors, and cariogenic bacteria such as Streptococcus mutans (S. mutans), alongside early colonizers like Streptococcus sanguinis and biofilm-initiating species such as Actinomyces. The formation of bacterial biofilms plays a central role in disease development by creating adhesive microbial communities that protect bacteria and facilitate acid production, leading to enamel demineralization. Traditional antimicrobial strategies often struggle to eliminate resilient biofilms, posing significant challenges for effective caries management. Objective: This review explores the structural components and functional dynamics of cariogenic biofilms, including acid tolerance, resistance mechanisms, and extracellular polymeric substance production. It integrates advancements in biofilm-targeted therapeutic strategies that emerged between 2015 and 2025. Methods: The review focuses on microbiological and experimental research published within this decade, analyzing strategies involving small molecule inhibitors, probiotics, bacteriocins, and enzymatic degradation techniques that specifically target S. mutans biofilms while maintaining oral microbiota balance. Results: Small molecule inhibitors such as ZY354, 3F1, and LCG-N25, along with probiotics like Lactobacillus reuteri and bacteriocins derived from Enterococcus faecalis (enterocins), have demonstrated significant inhibition of S. mutans biofilms. Enzymatic matrix degradation approaches have shown effectiveness in enhancing antimicrobial penetration and fluoride uptake, offering a promising addition to traditional therapies. Findings suggest that these emerging therapies can significantly reduce biofilm resilience and lower the incidence of dental caries. Conclusion: This decade-long analysis highlights the potential of precision-targeted interventions to advance dental caries prevention and management by improving biofilm control and supporting the maintenance of a healthier oral microbiome.