Introduction

A big part of a synthetic biology project, apart from the science behind it, is the way that project reaches people and who this new idea might help. Therefore, integrated Human Practice is an important section that helps to enhance and improve a project directly from the feedback of the stakeholders and professionals. As you can imagine, dental caries is an oral disease that affects millions of people of different ages and lifestyles [1]. Whenever non-communicable diseases such as caries are left untreated, many negative long-term consequences such as pain, infection, abscesses or even sepsis can affect the person [2].
In the earliest moments of the project, we realized that a simple approach to destroy the causing caries biofilm is not enough. The problem we discovered with our method after an informal discussion with our professors was that the simple approach needed a better-defined plan that addressed the drawbacks and problems with having only enzymes involved in making the harmful biofilm disappear. That’s how we were able to develop our three-step plan, which shows our new and improved approach.
However, a solid foundation for the project plan was not enough, we needed direct feedback from the people we wanted to work with.

Tag der Wissenschaft

Science Day

Our first instance in which we engaged with different kinds of people and their opinions on our project was during the ‘Tag der Wissenschaft’ (‘Day of science’) held at our university. The participants who wanted to know more about our synthetic biological approach against caries helped us understand how our project is perceived by the public.
In order to catch the attention of by passers we built a stand with posters a wheel of fortune, a show bioreactor and our mascot, “Zahni”. Due to the weel of fortune, where we gave away awards relating to biology and dental health. One of those rewards was a tablet showing dental plaque on the teeth. Therefore, we caught the attention of hundreds of kids and their parents.
For several hours we had engaging discussions about oral hygiene and diseases. One important aspect we learned from these debates was that many more people have difficulty maintaining their daily hygiene. This included braces or jaw pain, as well as not being able to take care of hygiene as we age. This showed us that there is a the high interest and need for our project. After gaining these new perspectives, we realized that we wanted to address those who struggle with daily oral hygiene.

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Survey about dental hygiene and caries

To get an impression on how the population is affected by caries and how many people struggle with daily dental keep up, we conducted a survey. Additionally, we were interested in whether people would be willing to try a biotechnological approach for their dental care. The survey consisted of 21 questions grouped into four different categories: Questions about you, your experience with dental caries, Attitude and Knowledge about biofilms and dental caries, and Biotechnology in dental hygiene. This survey was performed in two different languages, English and German. We had a total of 94 completed German surveys and 27 English surveys. The data was analysed using excel. It is noteworthy that this survey was primarily filled out by people between the age of 20-29, who were mostly female (76%) and 58% people were studying or working in the fields of biology or medicine. Therefore, this survey has an age, gender, and knowledge bias. One of the relevant questions was, whether older people have experienced more caries, because we have an age bias this could not be shown by the amount of people having experienced caries, as seen in figure 1.

This led to the question, how often children and their primary teeth are infected. Therefore, we posed the question if the affected people experienced caries in their primary teeth or in their secondary teeth. The results are shown in figure 2.

As can be seen above adult teeth are affected slightly more often, but there still were 29 cases of caries in primary teeth. And most people only experience caries only in their adult teeth or their primary teeth. DentoZym could therefor help people at any stage of their life and furthermore ease the concern about reoccurring caries.
Therefore, it was of interest whether people who already experienced caries were more concerned about their dental health or not. This relation is presented in figure 3.

Figure 3 shows that people who already experienced caries are more likely to be either ‘rather concerned’, ‘even more concerned’ that people who never had caries, or ‘not concerned’ at all. Because the survey didn’t allow for the participants to provide elaborate answers to why they were concerned or not, we can only postulate the reasons. It’s very likely that the severity of the caries and what the treatment involved effect how much people fear getting caries other times. People who have had horrible and painful experiences with caries might be more concerned about their dental health. Another factor could be how recent they had caries. Figure 3: Concern about caries for persons who already experienced caries and weren't phased by caries. People who had it as a child and haven’t had any issues since, might not worry a much, because their dental hygiene routine seems to be working fine.
Lastly it was of interest if the public was open towards biotechnology and our project. Because we have a large amount of people knowledgeable about this topic the data was separated into two groups, people who study or work in biology and people who don’t (figure 4 & figure 5).

The attitude towards biotechnology is optimistic for both groups with many abstentions in the group of people who don’t work in or study biology. This shows that there is an uncertainty and lack of knowledge in public. Which could explain, why the attitude towards DentoZym is more positive in this group. Interestingly people who work in or study biology are more sceptical towards DentoZym. This could be explained, by the fact that the introduction of the survey did not go into great scientific detail. Additionally, persons versed in the field know the challenges connected to producing a biocompatible product.
Therefore, there were not only a lot of hopeful comments at the end of the survey, but also questions and concerns. “Are there side effects regarding to other, helpful microorganism in the mouth flora?” questions in the same manner as this one were the most frequent. This animated us to think about how to reassure the public about the specificity of our antimicrobial peptides.

In conclusion, caries is a disease that not only lot of persons struggle with. But is also a topic, where people would be willing to try new approaches. Because this was study was only spread via a link towards our friends, families and fellow students, it reached a lot of young people who are well versed in biology. To also get an impression of the struggles and opinions of the older generation we interviewed fifteen persons age 71-91. These interviews can be found below.

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Interviews with different people

An important step in integrated human practice is communicating with and interviewing our project's direct stakeholders. Through the knowledge gained from our previous surveys and interviews, as well as further research, we have found that people with disabilities and age-related limitations have oral health issues - a group of people that is often overlooked [3].
For this, we interviewed a total of 15 different people, all of whom were over 70 years old. Some of these people struggle with various disabilities, such as Alzheimer's disease, arthritis, and Parkinson's disease, which affect their oral care. They statedsaid they often already struggled with disabilities and age-related physical limitations, so they were not able to take such great care of their oral health. An important question we asked them was their general opinion on biotechnology and genetically modified products, as well as their opinion on our product DentoZym, which contains bioengineered compartments. The answers we received were quite interesting. Many of these candidates were skeptical of bioengineered products and their side effects, but when we asked them how likely they were to use DentoZym, their skepticism decreased. As much as our surveyed stakeholders wanted an ethically tested and safe product, they also expressed that they would use such a product that would help them reduce their caries risk even if it were to be bioengineered.

We also asked respondents which application form of our biofilm-eradicating mixture they preferred. In general, they indicated that they preferred mouthwashes or special toothpastes to a gum, as some of the respondents had problems chewing gum which can be seen in figure 6. To test how long people use mouth wash we gave the participants mouth wash and asked them to use it without them knowing the time (figure 7). This was done to test how long people use mouth wash and therefore how long our product would be able to stay in contact with the biofilm. When asked all participants were able to use the mouthwash for 90s when asked.
We also asked respondents which application form of our biofilm-eradicating mixture they preferred. In general, they indicated that they preferred mouthwashes or special toothpastes to a gum, as some of the respondents had problems chewing gum which can be seen in figure 6. To test how long people use mouth wash we gave the participants mouth wash and asked them to use it without them knowing the time (figure 7). This was done to test how long people use mouth wash and therefore how long our product would be able to stay in contact with the biofilm. When asked all participants were able to use the mouthwash for 90s when asked.

All in all, we saw that our idea and new method against caries would benefit a wide range of people, especially people with limitations who cannot maintain their oral hygiene. These people often fall under the radar when it comes to the need for an improved approach to tooth decay and its effects, and that's why we want to provide them with new and refined oral health through ‘DentoZym’.