*Review* **The Pathogenic Factors from Oral Streptococci for Systemic Diseases**

### **Hiromichi Yumoto 1,\*, Katsuhiko Hirota 2, Kouji Hirao 3, Masami Ninomiya 1, Keiji Murakami 4, Hideki Fujii 4 and Yoichiro Miyake 5**


Received: 9 August 2019; Accepted: 14 September 2019; Published: 15 September 2019

**Abstract:** The oral cavity is suggested as the reservoir of bacterial infection, and the oral and pharyngeal biofilms formed by oral bacterial flora, which is comprised of over 700 microbial species, have been found to be associated with systemic conditions. Almost all oral microorganisms are non-pathogenic opportunistic commensals to maintain oral health condition and defend against pathogenic microorganisms. However, oral Streptococci, the first microorganisms to colonize oral surfaces and the dominant microorganisms in the human mouth, has recently gained attention as the pathogens of various systemic diseases, such as infective endocarditis, purulent infections, brain hemorrhage, intestinal inflammation, and autoimmune diseases, as well as bacteremia. As pathogenic factors from oral Streptococci, extracellular polymeric substances, toxins, proteins and nucleic acids as well as vesicles, which secrete these components outside of bacterial cells in biofilm, have been reported. Therefore, it is necessary to consider that the relevance of these pathogenic factors to systemic diseases and also vaccine candidates to protect infectious diseases caused by Streptococci. This review article focuses on the mechanistic links among pathogenic factors from oral Streptococci, inflammation, and systemic diseases to provide the current understanding of oral biofilm infections based on biofilm and widespread systemic diseases.

**Keywords:** Streptococci; Biofilm; Pathogenic factor; Oral infection; Systemic Diseases
