Diversity of Streptococcus mutans serotypes isolated from dental plaque of Brazilian patients with a history of acute myocardial infarction

Authors

  • Francisco Ruliglésio Rocha Universidade Federal do Ceará. Programa de Pós-Graduação em Microbiologia Médica. Departamento de Patologia e Medicina Legal.
  • Wanessa Fernandes Matias Regis Universidade Federal do Ceará. Faculdade de Farmácia, Odontologia e Enfermagem. Programa de Pós-Graduação em Odontologia. Departamento de Odontologia Restauradora.
  • Rochelle Pinheiro Ribeiro Hospital Universitário Walter Cantídio.
  • João Eudes Teixeira Pinho Filho Universidade Federal do Ceará. Faculdade de Farmácia, Odontologia e Enfermagem. Programa de Pós-Graduação em Odontologia. Departamento de Odontologia Restauradora.
  • Tiago Lima Sampaio Universidade Federal do Ceará. Faculdade de Farmácia, Odontologia e Enfermagem. Departamento de Análises Clínicas e Toxicológicas.
  • Raquel Carvalho Montenegro Universidade Federal do Ceará. Faculdade de Medicina. Departamento de Fisiologia e Farmacologia.
  • Ana Paula Negreiros Nunes Alves Universidade Federal do Ceará. Faculdade de Farmácia, Odontologia e Enfermagem. Programa de Pós-Graduação em Odontologia. Departamento de Odontologia Restauradora.
  • Lidiany Karla Azevedo Rodrigues Universidade Federal do Ceará. Programa de Pós-Graduação em Microbiologia Médica. Departamento de Patologia e Medicina Legal.

DOI:

https://doi.org/10.1590/1678-7765-2025-0077

Keywords:

Streptococcus mutans, Dental caries, Cardiovascular diseases, Serotyping, Collagen-binding genes

Abstract

Background:  Streptococcus mutans serotypes (c, e, f, k) are linked to dental caries, with less common serotypes (e, f, k) and collagen-binding genes (CBG: cnm and cbm) suggested to be associated with cardiovascular diseases. Objective:  This study investigated the presence of S. mutans serotypes and collagen-binding genes (CBGs) in dental plaque and their possible association with acute myocardial infarction (AMI) in adults. Methodology:  A total of 31 infarcted and 17 non-infarcted patients underwent oral and blood examinations. DNA from plaque samples was analyzed using PCR to identify S. mutans serotypes and cnm/cbm genes. S. mutans was detected in 22.6% (7/31) of infarcted patients and 11.8% (2/17) of non-infarcted patients. Results:  Serotype c was the most prevalent in infarcted patients (57.1%, 4/7), followed by e (42.9%, 3/7) and k (14.3%, 1/7); serotype f was not detected. Only serotype c was found in non-infarcted patients. Less common serotypes (e, k) and co-occurring serotypes (c, k) were exclusive to infarcted patients. No CBGs were detected in any serotypes. No association was found between S. mutans and dental caries in either group. Patients with cholesterol levels <190 mg/dL and no S. mutans had a 47.4% lower risk of infarction. Conclusion:  Although S. mutans, including less common serotypes, was more prevalent in infarcted patients, no significant association with AMI was observed. Further research is needed to elucidate the role of S. mutans in cardiovascular diseases.

Downloads

Download data is not yet available.

References

1Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, et al. Dental caries. Nat Rev Dis Primers. 2017;3(1):17030. doi: 10.1038/nrdp.2017.30

» https://doi.org/10.1038/nrdp.2017.30

2Neculae E, Gosav EM, Valasciuc E, Dima N, Floria M, Tanase DM. The oral microbiota in valvular heart disease: current knowledge and future directions. Life. 2023;13(1):182. doi: 10.3390/life13010182

» https://doi.org/10.3390/life13010182

3Oliveira FA, Forte CP, Silva PG, Lopes CB, Montenegro RC, Santos ÂK, et al. Molecular analysis of oral bacteria in heart valve of patients with cardiovascular disease by real-time polymerase chain reaction. Medicine (Baltimore). 2015;94(47):e2067. doi: 10.1097/MD.0000000000002067.

» https://doi.org/10.1097/MD.0000000000002067

4Kesavalu L, Lucas AR, Verma RK, Liu L, Dai E, Sampson E, et al. Increased atherogenesis during Streptococcus mutans infection in ApoE-null mice. J Dent Res. 2012;91(3):255-60. doi: 10.1177/0022034511435101

» https://doi.org/10.1177/0022034511435101

5Fernandes Forte CP, Oliveira FA, Lopes CB, Alves AP, Mota MR, Barros Silva PG, et al. Streptococcus mutans in atherosclerotic plaque: molecular and immunohistochemical evaluations. Oral Dis. 2022;28(6):1705-14. doi: 10.1111/odi.13869

» https://doi.org/10.1111/odi.13869

6Nakano K, Nomura R, Nemoto H, Lapirattanakul J, Taniguchi N, Grönroos L, et al. Protein antigen in serotype k Streptococcus mutans clinical isolates. J Dent Res. 2008;87:964-8. doi: 10.1177/154405910808701001

» https://doi.org/10.1177/154405910808701001

7Nakano K, Ooshima T. Serotype classification of Streptococcus mutans and its detection outside the oral cavity. Future Microbiol. 2009;4(7):891-902. doi: 10.2217/fmb.09.64

» https://doi.org/10.2217/fmb.09.64

8Nakano K, Nemoto H, Nomura R, Homma H, Yoshioka H, Shudo Y, et al. Serotype distribution of Streptococcus mutans, a pathogen of dental caries, in cardiovascular specimens from Japanese patients. J Med Microbiol. 2007;56(4):551-6. doi: 10.1099/jmm.0.47051-0

» https://doi.org/10.1099/jmm.0.47051-0

9Sato Y, Okamoto K, Kagami A, Yamamoto Y, Igarashi T, Kizaki H. Streptococcus mutans strains harboring collagen-binding adhesin. J Dent Res. 2004;83(7):534-9. doi: 10.1177/154405910408300705.

» https://doi.org/10.1177/154405910408300705

10Nomura R, Nakano K, Naka S, Nemoto H, Masuda K, Lapirattanakul J, et al. Identification and characterization of a collagen-binding protein, Cbm, in Streptococcus mutans. Mol Oral Microbiol. 2012;27(5):308-23. doi: 10.1111/j.2041-1014.2012.00649.x

» https://doi.org/10.1111/j.2041-1014.2012.00649.x

11Lima AR, Ganguly T, Walker AR, Acosta N, Francisco PA, Pileggi R, et al. Phenotypic and genotypic characterization of Streptococcus mutans strains isolated from endodontic infections. J Endod. 2020;46(12):1876-83. doi: 10.1016/j.joen.2020.09.002

» https://doi.org/10.1016/j.joen.2020.09.002

12Abranches J, Miller JH, Martinez AR, Simpson-Haidaris PJ, Burne RA, Lemos JA. The collagen-binding protein Cnm is required for Streptococcus mutans adherence to and intracellular invasion of human coronary artery endothelial cells. Infect Immun. 2011;79(6):2277-84. doi: 10.1128/IAI.00767-10

» https://doi.org/10.1128/IAI.00767-10

13Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction. Circulation. 2018;138(20):e618-51. doi: 10.1161/CIR.0000000000000617

» https://doi.org/10.1161/CIR.0000000000000617

14Nomura R, Nakano K, Taniguchi N, Lapirattanakul J, Nemoto H, Grönroos L, et al. Molecular and clinical analyses of the gene encoding the collagen-binding adhesin of Streptococcus mutans. J Med Microbiol. 2013;62(Pt 4):590-7. doi: 10.1099/jmm.0.053132-0

» https://doi.org/10.1099/jmm.0.053132-0

15Elyassi M, Babaeekhou L, Ghane M. Streptococcus mutans and Streptococcus sobrinus contributions in dental caries in Iranian and Afghan children: a report from serotype distribution and novel STs. Arch Oral Biol. 2022;139:105431. doi: 10.1016/j.archoralbio.2022.10543

» https://doi.org/10.1016/j.archoralbio.2022.10543

16Hsu CC, Hsu RB, Oon XH, Chen YT, Chen JW, Hsu CH, et al. Streptococcus mutans PrsA mediates AtlA secretion contributing to extracellular DNA release and biofilm formation in the pathogenesis of infective endocarditis. Virulence. 2022;13:1379-92. doi: 10.1080/21505594.2022.2105351

» https://doi.org/10.1080/21505594.2022.2105351

17Alves LA, Harth-Chu EN, Palma TH, Stipp RN, Mariano FS, Höfling JF, et al. The two-component system VicRK regulates functions associated with Streptococcus mutans resistance to complement immunity. Mol Oral Microbiol. 2017;32:419–31. doi: 10.1111/omi.12183.

» https://doi.org/10.1111/omi.12183

18Misaki T, Naka S, Hatakeyama R, Fukunaga A, Nomura R, Isozaki T, et al. Presence of Streptococcus mutans strains harbouring the cnm gene correlates with dental caries status and IgA nephropathy conditions. Sci Rep. 2016;6:36455. doi: 10.1038/srep36455

» https://doi.org/10.1038/srep36455

19Garcia BA, Acosta NC, Tomar SL, Roesch LF, Lemos JA, Mugayar LR, et al. Association of Candida albicans and Cbp+ Streptococcus mutans with early childhood caries recurrence. Sci Rep. 2021;11:10802. doi: 10.1038/s41598-021-90198-3

» https://doi.org/10.1038/s41598-021-90198-3

20Momeni SS, Ghazal T, Grenett H, Whiddon J, Moser SA, Childers NK. Streptococcus mutans serotypes and collagen-binding proteins Cnm/Cbm in children with caries analysed by PCR. Mol Oral Microbiol. 2019;34:64-73. doi: 10.1111/omi.12254

» https://doi.org/10.1111/omi.12254

21Faludi AA, Izar M, Saraiva J, Chacra A, Bianco HT, Afiune A, et al. Atualização da diretriz brasileira de dislipidemias e prevenção da aterosclerose. Arq Bras Cardiol. 2017;109(2Supl.1):1-76. doi: 10.5935/abc.20170121

» https://doi.org/10.5935/abc.20170121

22Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499–502.

23Guidelines of the Brazilian Society of Diabetes. Brazilian Society of Diabetes. Clannad Scientific Editor; 2019. Available from: http://www.saude.ba.gov.br/wp-content/uploads/2020/02/Diretrizes-Sociedade-Brasileira-de-Diabetes-2019-2020.pdf

» http://www.saude.ba.gov.br/wp-content/uploads/2020/02/Diretrizes-Sociedade-Brasileira-de-Diabetes-2019-2020.pdf

24Ismail AI, Sohn W, Tellez M, Amaya A, Sen A, Hasson H, et al. The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries. Community Dent Oral Epidemiol. 2007;35:170-8. doi: 10.1111/j.1600-0528.2007.00347.x

» https://doi.org/10.1111/j.1600-0528.2007.00347.x

25Gold OG, Jordan HV, Van Houte J. A selective medium for Streptococcus mutans. Arch Oral Biol. 1973;18:1357-64. doi: 10.1016/0003-9969(73)90109-x

» https://doi.org/10.1016/0003-9969(73)90109-x

26Lapirattanakul J, Nakano K, Nomura R, Nemoto H, Kojima A, Senawongse P, et al. Detection of serotype k Streptococcus mutans in Thai subjects. Oral Microbiol Immunol. 2009;24(6):431-3. doi: 10.1111/j.1399-302X.2009.00530.x

» https://doi.org/10.1111/j.1399-302X.2009.00530.x

27Nomura R, Ogaya Y, Nakano K. Contribution of the collagen-binding proteins of Streptococcus mutans to bacterial colonization of inflamed dental pulp. PLoS One. 2016;11(7):e0159613. doi: 10.1371/journal.pone.0159613

» https://doi.org/10.1371/journal.pone.0159613

28Shin JH. Nucleic acid extraction techniques. In: Advanced techniques in diagnostic microbiology. Boston, MA: Springer; 2013. p. 209-25.

29Villhauer AL, Lynch DJ, Drake DR. Improved method for rapid and accurate isolation and identification of Streptococcus mutans and Streptococcus sobrinus from human plaque samples. J Microbiol Methods. 2017;139:205-9. doi: 10.1016/j.mimet.2017.06.009

» https://doi.org/10.1016/j.mimet.2017.06.009

30Oho T, Yamashita Y, Shimazaki Y, Kushiyama M, Koga T. Simple and rapid detection of Streptococcus mutans and Streptococcus sobrinus in human saliva by polymerase chain reaction. Oral Microbiol Immunol. 2000;15:258-62. doi: 10.1034/j.1399-302x.2000.150408.x

» https://doi.org/10.1034/j.1399-302x.2000.150408.x

31Shibata Y, Ozaki K, Seki M, Kawato T, Tanaka H, Nakano Y, et al. Analysis of loci required for determination of serotype antigenicity in Streptococcus mutans and its clinical utilization. J Clin Microbiol. 2003;41:4107-12. doi: 10.1128/JCM.41.9.4107-4112.2003

» https://doi.org/10.1128/JCM.41.9.4107-4112.2003

32Nakano K, Nomura R, Shimizu N, Nakagawa I, Hamada S, Ooshima T. Development of a PCR method for rapid identification of new Streptococcus mutans serotype k strains. J Clin Microbiol. 2004;42:4925-30. doi: 10.1128/JCM.42.11.4925-4930.2004

» https://doi.org/10.1128/JCM.42.11.4925-4930.2004

33Chismirina S, Sungkar S, Adlim M, Darmawi D. Streptococcus mutans serotype analysis from dental plaque of caries patients in banda aceh based on the GTF Gene. Rep Biochem Mol Biol. 2023;12(1):205-10. doi: 10.52547/rbmb.12.1.205

» https://doi.org/10.52547/rbmb.12.1.205

34Swedan SF, Obeidat HM, Shakhatreh MA. Molecular typing and detection of collagen binding genes among Streptococcus mutans isolated from diabetic and non-diabetic individuals in Northern Jordan. Jordan J Biol Sci. 2018;11:293-300.

35Rosero NS, Seoane Prado R, Aguilera Guirao A, Santos Y. Molecular and serological typing of Streptococcus mutans strains isolated from young Galician population: relationship with the oral health status. Int Microbiol. 2020;23:589-96. doi: 10.1007/s10123-020-00132-2

» https://doi.org/10.1007/s10123-020-00132-2

36Seymour RA, Lowry R, Whitworth JM, Martin MV. Infective endocarditis, dentistry and antibiotic prophylaxis: time for a rethink? Br Dent J. 2000;189:610-6. doi: 10.1038/sj.bdj.4800845

» https://doi.org/10.1038/sj.bdj.4800845

37Sounah SA, Madfa AA. Correlation between dental caries experience and the level of Streptococcus mutans and lactobacilli in saliva and carious teeth in a Yemeni adult population. BMC Res Notes. 2020;13:112. doi: 10.1186/s13104-020-04960-3

» https://doi.org/10.1186/s13104-020-04960-3

38Boateng S, Sanborn T. Acute myocardial infarction. Dis Mon. 2013;59:83-96. doi: 10.1016/j.disamonth.2012.12.004

» https://doi.org/10.1016/j.disamonth.2012.12.004

39Pucar A, Milasin J, Lekovic V, Vukadinovic M, Ristic M, Putnik S, et al. Correlation between atherosclerosis and periodontal putative pathogenic bacterial infections in coronary and internal mammary arteries. J Periodontol. 2007;78:677-82. doi: 10.1902/jop.2007.060062

» https://doi.org/10.1902/jop.2007.060062

40Lüscher TF, Landmesser U, von Eckardstein A, Fogelman AM. High-density lipoprotein: Vascular protective effects, dysfunction, and potential as therapeutic target. Circ Res. 2014;114:171-82. doi: 10.1161/circresaha.114.300935.

» https://doi.org/10.1161/circresaha.114.300935

41Hope CK, Wilson M. Analysis of the effects of sonication on oral biofilm bacteria. J Microbiol Methods. 2004;57(1):9-14.

42Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet. 2000 Mar 4;355(9206):773-8. doi: 10.1016/S0140-6736(99)08415-9

» https://doi.org/10.1016/S0140-6736(99)08415-9

43Selvin E, Marinopoulos S, Berkenblit G, Rami T, Brancati FL, Powe NR, et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med. 2005;141(6):421-31. doi: 10.7326/0003-4819-141-6-200409210-00007

» https://doi.org/10.7326/0003-4819-141-6-200409210-00007

Downloads

Published

2026-02-25 — Updated on 2026-02-02

Issue

Vol. 34 (2026)

Section

Original Articles

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Todo o conteúdo do periódico, exceto onde está identificado, está licenciado sob uma Licença Creative Commons do tipo atribuição CC-BY.

 

 

How to Cite

Rocha, F. R., Regis, W. F. M., Ribeiro, R. P., Pinho Filho, J. E. T., Sampaio, T. L., Montenegro, R. C., Alves, A. P. N. N., & Rodrigues, L. K. A. (2026). Diversity of Streptococcus mutans serotypes isolated from dental plaque of Brazilian patients with a history of acute myocardial infarction. Journal of Applied Oral Science, 34, e20250077. https://doi.org/10.1590/1678-7765-2025-0077