Natural products in caries research: current (limited) knowledge, challenges and future perspective

Dual antibacterial drug-loaded nanoparticles synergistically improve treatment of Streptococcus mutans biofilms

Dental caries (i.e., tooth decay), which is caused by biofilm formation on tooth surfaces, is the most prevalent oral disease worldwide. Unfortunately, many anti-biofilm drugs lack efficacy within the oral cavity due to poor solubility, retention, and penetration into biofilms. While drug delivery systems (DDS) have been developed to overcome these hurdles and improve traditional antimicrobial treatments, including farnesol, efficacy is still modest due to myriad resistance mechanisms employed by biofilms, suggesting that synergistic drug treatments may be more efficacious. Streptococcus mutans (S. mutans), a cariogenic pathogen and biofilm forming model organism, has several key virulence factors including acidogenicity and exopolysaccharide (EPS) matrix synthesis. Flavonoids, such as myricetin, can reduce both biofilm acidogenicity and EPS synthesis. Therefore, a nanoparticle carrier (NPC) DDS with flexibility to co-load farnesol in the hydrophobic core and myricetin within the cationic corona, was tested in vitro using established and developing S. mutans biofilms. Co-loaded NPC treatments effectively disrupted biofilm biomass (i.e., dry weight) and reduced biofilm viability by ~3 log CFU/mL versus single drug-only controls in developing biofilms, suggesting dual-drug delivery exhibits synergistic anti-biofilm effects. Mechanistic studies revealed that co-loaded NPCs synergistically inhibited planktonic bacterial growth compared to controls and reduced S. mutans acidogenicity due to decreased atpD expression, a gene associated with acid tolerance. Moreover, the myricetin-loaded NPC corona enhanced NPC binding to tooth-mimetic surfaces, which can increase drug efficacy through improved retention at the biofilm-apatite interface. Altogether, these findings suggest promise for co-delivery of myricetin and farnesol DDS as an alternative anti-biofilm treatment to prevent dental caries.

The effect of polyphenol-containing solutions on in situ biofilm formation on enamel and dentin

OBJECTIVES

To investigate the effects of Chinese gallnut extracts and pure tannic acid on in situ biofilm formation on enamel and dentin samples over 24 h.

METHODS

Bovine enamel and dentin samples were buccally fixed on maxillary splints. Six volunteers wore the splints for 24 h, and rinsed their mouths with tap water (control), 1% tannic acid- and 1% Chinese gallnut extracts-containing solution twice a day, 3 min after the splints were placed in the mouth and before night sleep. Live/dead staining was used for fluorescence microscopic (FM) visualization and quantification of bacteria viability of biofilms formed on enamel and dentin samples. Biofilm coverage was evaluated and recorded by FM and scanning electron microscopy (SEM). In addition, biofilms were analyzed by transmission electron microscopy (TEM). The Kruskal-Wallis test was used to analyze biofilm data.

RESULTS

Rinsing with tannic acid- and Chinese gallnut extracts-containing solutions significantly reduced in situ biofilm coverage on enamel and dentin samples (P < 0.05). The bacterial viability of biofilms formed on enamel samples was significantly reduced compared to the control (P < 0.05). TEM analysis revealed an increase in pellicle's electron density and thickness and only few or no bacteria adherent to the pellicle in the experimental samples.

CONCLUSIONS

Rinsing with tannic acid- and Chinese gallnut extracts-containing solutions can effectively inhibit in situ biofilm formation, modify the ultrastructure of biofilms on enamel and dentin surfaces and significantly reduce the bacterial viability of biofilm on enamel surfaces.

CLINICAL SIGNIFICANCE

Tannic acid- and Chinese gallnut extracts-containing solutions might be used for dental biofilm management.

Synergistic effect on anti-methicillin-resistant Staphylococcus aureus among combinations of α-mangostin-rich extract, lawsone methyl ether and ampicillin

α-Mangostin-rich extract (AME) exhibited satisfactory inhibitory activities against all tested MRSA strains, with minimum inhibitory concentrations (MICs) of 7·8-31·25 µg ml^-1 , whereas lawsone methyl ether (LME) and ampicillin revealed weak antibacterial activity with MICs of 62·5-125 µg ml^-1 . However, the combination of AME and LME showed synergistic effects against all tested MRSA strains with fractional inhibitory concentration index (FICI) values of 0·008-0·009, while the combination of AME and ampicillin, as well as LME and ampicillin produced synergistic effects with FICIs of 0·016-0·257. A time-kill assay against MRSA (DMST 20654 strain) revealed a 6-log reduction in CFU per ml, which completely inhibited bacterial growth for the combinations of AME and LME, AME and ampicillin, and LME and ampicillin at a 8-h incubation, while those against MRSA (2468 strain) were at 10-h incubation. The combination of α-mangostin and LME as well as the combinations of each compound with ampicillin synergized the alteration of membrane permeability. In addition, α-mangostin, LME and ampicillin inhibited the biofilm formation of MRSA. These findings indicated that the combinations of AME and LME or each of them in combination with ampicillin had enhanced antibacterial activity against MRSA. Therefore, these compounds might be used as the antibacterial cocktails for treatment of MRSA.

Inhibitory effects on Streptococcus mutans of antibacterial agents mixed with experimental fluoride varnish

We investigated the inhibitory effect of antibacterial agents mixed with experimental fluoride varnish (EFV) on Streptococcus mutans. The antibacterial agents used were (1 and 10) mM of xanthorrhizol, bakuchiol, bavachalcone, isobavachromene, and bavachromene. Agar diffusion tests were performed on S. mutans (1.1×10¹⁰ CFU/mL), using antibacterial agents without and with EFV. Bavachalcone showed the highest inhibition zone without and with EFV at both (1 and 10) mM (p<0.05). All EFV with antibacterial agents showed greater inhibition and semi-inhibition zones than EFV alone (p<0.05). The cell viability of each antibacterial agent was not significantly different from the vehicle controls (p>0.05), except xanthorrhizol and bakuchiol at 1 mM. All antibacterial agents were effective, while antibacterial agents with EFV co-formulations were more effective than EFV alone. Bavachalcone was the most effective agent against S. mutans, indicating its potential usefulness with fluoride varnish in preventing dental caries.

Brazilian Red Propolis Is as Effective as Amoxicillin in Controlling Red-Complex of Multispecies Subgingival Mature Biofilm In Vitro

This study investigated the effects of Brazilian Red Propolis (BRP) extract on seven-day-old multispecies subgingival biofilms. Mixed biofilm cultures containing 31 species associated with periodontal health or disease were grown for six days on a Calgary device. Then, mature biofilms were treated for 24 h with BRP extract at different concentrations (200-1600 µg/mL), amoxicillin (AMOXI) at 54 µg/mL (positive control) or vehicle (negative control). Biofilm metabolic activity was determined by colorimetry, and bacterial counts/proportions were determined by DNA-DNA hybridization. Data were analyzed by Kruskal-Wallis and Dunn's tests. Treatment with BRP at 1600, 800 and 400 μg/mL reduced biofilm metabolic activity by 56%, 56% and 57%, respectively, as compared to 65% reduction obtained with AMOXI. Mean total cell counts were significantly reduced in all test groups (~50-55%). Lower proportions of red, green and yellow complex species were observed upon treatment with BRP (400 µg/mL) and AMOXI, but only AMOXI reduced the proportions of Actinomyces species. In conclusion, BRP extract was as effective as AMOXI in killing seven-day-old multispecies biofilm pathogens and did not affect the levels of the host-compatible Actinomyces species. These data suggest that BRP may be an alternative to AMOXI as an adjunct in periodontal therapy. In vivo studies are needed to validate these results.

Evaluation of total phenol and flavonoid content and antimicrobial and antibiofilm activities of Trollius chinensis Bunge extracts on Streptococcus mutans

Dental caries is a chronic disease with multiple bacterial infections, Streptococcus mutans is the main cariogenic bacteria. Trollius chinensis Bunge is a common folk medicine in the Xinjiang area of China. In this study, we investigated the total flavonoid content and total phenol content in four types of T. chinensis Bunge extracts and the inhibitory effects of these extracts on S. mutans. Agar diffusion method was used to measure the inhibition zone diameters, and the minimum inhibitory concentration and minimum bactericidal concentration were determined by the twofold dilution method. Water extracts from T. chinensis Bunge and ethanol (30, 60, and 90%) extracts at different concentrations could significantly inhibit the growth of S. mutans. Among them, 30% ethanol extract exhibited the best antibacterial and antibiofilms effect. Biofilm research (crystal violet staining and CLSM) showed that 30% ethanol extract of T. chinensis Bunge plays an important role in inhibiting S. mutans growth and the number of biofilms. The results indicate that T. chinensis Bunge extract has good antibacterial and anti-biofilm activity on S. mutans. It has the potential to be developed for the treatment of caries in clinical application.

Modulation of Lipoteichoic Acids and Exopolysaccharides Prevents Streptococcus mutans Biofilm Accumulation

Dental caries is a diet–biofilm-dependent disease. Streptococcus mutans contributes to cariogenic biofilms by producing an extracellular matrix rich in exopolysaccharides and acids. The study aimed to determine the effect of topical treatments with compound 1771 (modulates lipoteichoic acid (LTA) metabolism) and myricetin (affects the synthesis of exopolysaccharides) on S. mutans biofilms. In vitro S. mutans UA159 biofilms were grown on saliva-coated hydroxyapatite discs, alternating 0.1% sucrose and 0.5% sucrose plus 1% starch. Twice-daily topical treatments were performed with both agents alone and combined with and without fluoride: compound 1771 (2.6 µg/mL), myricetin (500 µg/mL), 1771 + myricetin, fluoride (250 ppm), 1771 + fluoride, myricetin + fluoride, 1771 + myricetin + fluoride, and vehicle. Biofilms were evaluated via microbiological, biochemical, imaging, and gene expression methods. Compound 1771 alone yielded less viable counts, biomass, exopolysaccharides, and extracellular LTA. Moreover, the combination 1771 + myricetin + fluoride decreased three logs of bacterium counts, 60% biomass, >74% exopolysaccharides, and 20% LTA. The effect of treatments on extracellular DNA was not pronounced. The combination strategy affected the size of microcolonies and exopolysaccharides distribution and inhibited the expression of genes linked to insoluble exopolysaccharides synthesis. Therefore, compound 1771 prevented the accumulation of S. mutans biofilm; however, the effect was more pronounced when it was associated with fluoride and myricetin.

A Review of the Pharmacological Efficacy and Safety of Licorice Root from Corroborative Clinical Trial Findings

Since ancient times, licorice, the root of Glycyrrhiza glabra, has been known to have a wide spectrum of therapeutic effects. Glycyrrhizin is cleaved to glycyrrhizic acid, which is subsequently converted to glycyrrhetic acid by human intestinal microflora. Glycyrrhetic acid is a potent inhibitor of 11β-hydroxysteroid dehydrogenase (11β-HSD) and performs a range of corticosteroid-like activities. The pharmacologic effects of licorice contribute to its anti-inflammatory, antioxidative, anti-allergenic, and antimicrobial properties. Licorice has been used to treat liver disease, gastrointestinal disorders, oral disease, and various skin disorders and has been used in gum, candy, herbs, alcoholic beverages, and food supplements. Licorice and its extracts, especially glycyrrhizin, can be taken orally, through the skin (in the form of gels and oils), and intravenously. Licorice demonstrates mineralocorticoid-like activity not only by inhibiting 11β-HSD2, but also by binding to a mineralocorticoid receptor, leading to potentially adverse risks of mineralocorticoid-like overactivity. Chronic use of licorice can lead to hypokalemia and hypertension, and some people are more sensitive to licorice exposure. Based on clinical trials, this review summarizes the positive effects of licorice and other reported side effects.

Antimicrobial and antibiofilm activities of Casearia sylvestris extracts from distinct Brazilian biomes against Streptococcus mutans and Candida albicans

Background

Dental caries is a biofilm-diet-dependent worldwide public health problem, and approaches against microorganisms in cariogenic biofilms are necessary.

Methods

The antimicrobial and antibiofilm activities of 12 Casearia sylvestris extracts (0.50 mg/mL) from different Brazilian biomes (Atlantic Forest, Cerrado, Caatinga, Pampa, and Pantanal) and varieties (sylvestris, lingua, and intermediate) were tested against two species found in cariogenic biofilms (Streptococcus mutans and Candida albicans). The extracts effective against S. mutans were used to evaluate the "adhesion strength" of this bacterium to the salivary pellicle and initial glucan matrix and the S. mutans-GtfB activity. Also, the antimicrobial activity against S. mutans of three fractions (methanol, ethyl acetate, and hexane; 0.25 mg/mL) from the extracts was evaluated.

Results

Three extracts from the Atlantic Forest variety sylvestris (FLO/SC, GUA/CE, PRE/SP) reduced ≥50% (> 3 logs) S. mutans viable population (p < 0.0001 vs. vehicle), while two extracts from the same biome and variety (PAC/CE, PRE/SP) decreased ≥50% of the viable counts of C. albicans (p < 0.0001 vs. vehicle). For S. mutans biofilms, three extracts (GUA/CE, PAC/CE, PRE/SP) reduced the biomass by ≥91% (p > 0.0001 vs. vehicle) and 100% of the microbial population (p < 0.0001 vs. vehicle). However, for the fungal biofilm, two extracts (PAC/CE, PRE/SP) reduced the viable counts by ≥52% (p < 0.0001 vs. vehicle), but none reduced biomass. The extracts with higher antimicrobial and antibiofilm activities presented higher content of clerodane-type diterpenes and lower content of glycosylated flavonoids than the less active extracts. The extracts had no effect on the removal of cells adhered to the pellicle (p > 0.05 vs. vehicle) while promoted the detachment of a larger number of S. mutans cells from GtfB-glucan matrix (p < 0.0031 vs. vehicle), and FLO/SC, GUA/CE and PRE/SP reduced the quantity of glucans (p < 0.0136 vs. vehicle). Only the ethyl acetate fractions reduced the microbial population of S. mutans (p < 0.0001 vs. vehicle), except for one (PAC/CE). Among the ethyl acetate fractions, three from var. lingua (two from Cerrado, and one from Cerrado/Caatinga) reduced ≥83% of the microbial population.

Conclusions

C. sylvestris extracts from Atlantic Forest var. sylvestris and ethyl acetate fractions from Cerrado and Cerrado/Caatinga var. lingua may be used as a strategy against cariogenic microorganisms.

Efficacy of Liquorice and Propolis Extract Used as Cavity Cleaning Agents against Streptococcus mutans in Deciduous Molars Using Confocal Microscopy: An In Vitro Study

Background/introduction

Cavity disinfection before restoration aids in reducing the number of residual bacteria, thus, decreasing the rate of secondary caries. Propolis, at low concentrations, inhibits the growth of cariogenic bacteria. Liquorice roots are known to have antimicrobial, anti-inflammatory, and antioxidant properties.

Aim and objectives

Evaluation and comparison of antimicrobial efficacy of liquorice and propolis extract gels used as cavity cleaning agents against Streptococcus mutans in deciduous molars by confocal laser scanning microscopy (in vitro study).

Materials and methods

Liquorice and propolis extracts were converted into gels after recording the minimum inhibition concentration. Class I cavity was prepared on 135 extracted deciduous molars and subjected to inoculation with S. mutans. Teeth were randomly divided into groups I, II, and III which were treated with gels of liquorice, propolis, and distilled water, respectively, for 60, 120, and 180 seconds each. Specimens were sectioned and stained with fluorescent dyes and observed under a confocal laser scanning microscopy (CLSM). The data obtained were statistically evaluated.

Results

The mean nonviable/viable bacterial count and the depth of penetration were found to be maximum in group I and minimum in group III. A statistically significant difference was found to be between groups I and II and groups I and III, while with groups II and III, it was nonsignificant at all 60, 120, and 180 seconds. The bacterial depth penetration between groups I and II at 180 seconds was nonsignificant.

Conclusion and clinical significance

Though liquorice showed better antimicrobial potential as compared to propolis extract, both can be used efficiently as cavity disinfectants.

How to cite this article

Godbole E, Tyagi S, et al. Efficacy of Liquorice and Propolis Extract Used as Cavity Cleaning Agents against Streptococcus mutans in Deciduous Molars Using Confocal Microscopy: An In Vitro Study. Int J Clin Pediatr Dent 2019;12(3):194–200.

Iranian propolis efficiently inhibits growth of oral streptococci and cancer cell lines

Background

Propolis is a natural bee product with a wide range of biological activities that are related to its chemical composition. The present study investigated the quantification of quercetin (Q) in Ardabil ethanol extract of propolis (AEEP), and then compared its anti-bacterial, anti- biofilm and cytotoxic effects on cancer and normal cell lines.

Method

In the present study, the chemical composition of AEEP was determined through the high-performance liquid chromatography (HPLC). The AEEP and its main component, quercetin (Q), were evaluated in vitro against 57 oral streptococci by a broth micro-dilution method. The biofilm formation was assessed through the crystal violet staining and MTT assays. The impact of AEEP and Q anti-proliferative effect were evaluated on the fibroblast as normal and cancer cell lines (KB and A431).

Results

The Q concentration in the composition of AEEP was 6.9% of all its components. The findings indicated that the AEEP and Q were efficient against the cariogenic bacteria and were able to inhibit the S.mutans biofilm adherence at a sub-MIC concentration. Moreover, electron micrographs indicated the inhibition of biofilms compared to control biofilms. In addition, the AEEP and Q indicated a dose-dependent cytotoxic effect on A431 and KB cell lines. On the contrary, they had no cytotoxic effect on fibroblast cells.

Conclusion

The results indicated that the synergistic impact of main components of AEEP was related to the inhibition of the cancer cell proliferation, cariogenic bacteria and oral biofilm formation. It may play a promising role in the complementary medicine and, it is suggested to be used as food additives.

The effect of magnesium oxide nanoparticles on the antibacterial and antibiofilm properties of glass-ionomer cement

Objectives

This study examined the antibacterial and antibiofilm properties of conventional glass-ionomer cement (GIC) modified by the addition of magnesium oxide (MgO) nanoparticles.

Materials and methods

MgO nanoparticles were characterised by XRD, FTIR, and SEM analysis and tested for its activity against Streptococcus mutans and Streptococcus sobrinus. MgO nanoparticles were incorporated into GIC powder (Ketac Molar Easymix) at different concentrations and the antibacterial and antibiofilm activity was evaluated using agar disk diffusion and biofilm-CFU counting assays. ANOVA and Tukey's post hoc tests were used for the analysis, and the level of significance was set at p < 0.05.

Results

MgO nanoparticles showed antibacterial activity against both microorganisms (MIC = 500 μg/ml and MBC = 1000 μg/ml). A significant difference in the zones of inhibition was detected (p < 0.005). The effect was evident in the 2.5% MgO nanoparticle modified GIC while the CFU counting biofilm assay showed the effect of the added nanoparticles from 1% with a significant difference between the tested material groups (p < 0.005).

Conclusions

The MgO nanoparticle modified GIC showed effective antibacterial and antibiofilm activity against two cariogenic microorganisms and could be considered for further development as a biocompatible antibacterial dental restorative cement.

Assessing the impact of curcumin on dual-species biofilms formed by Streptococcus mutans and Candida albicans

Streptococcus mutans and Candida albicans are often isolated from plaques associated with early childhood caries. However, there are limited studies examining how these microorganisms interact with one another and how best to manage them. Recent studies have shown that curcumin (CUR), a natural compound, has the potential to independently control both of these microorganisms. The purpose of this study was to investigate how S. mutans and C. albicans respond in mono‐ and dual‐species biofilms challenged with CUR. Quantitative biofilm biomass and viability were first evaluated and supported by live–dead PCR to assess biofilm composition. Confocal laser scanning microscopy (CLSM) was used to evaluate the exopolysaccharide (EPS) content and thickness of the biofilms, and the structure of the biofilms and morphology of the cells were observed by scanning electron microscopy (SEM). Quantitative real‐time PCR (qRT‐PCR) was applied to assess relative gene expression. The 50% minimum biofilm eradication concentration (MBEC₅₀) of CUR against S. mutans and C. albicans was 0.5 mM. The biomass and viability decreased after treatment with CUR both in dual‐species biofilms and in mono‐species biofilm. CUR inhibited S. mutans and C. albicans in both mono‐ and dual‐species biofilms. Streptococcus mutans was more sensitive to CUR in dual‐species biofilm than in mono‐species biofilms, whereas C. albicans was less sensitive in dual‐species biofilms. EPS production was decreased by CUR in both mono‐ and dual‐species biofilms, which coincided with the downregulation of glucosyltransferase and quorum sensing‐related gene expression of S. mutans. In C. albicans, the agglutinin‐like sequence family of C. albicans was also downregulated in dual‐species biofilms. Collectively, these data show the potential benefit of using a natural antimicrobial, CUR, to control caries‐related dual‐species plaque biofilms.

Antimicrobial Activity of Cinnamaldehyde on Streptococcus mutans Biofilms

Streptococcus mutans is considered the most relevant bacteria in the transition of non-pathogenic commensal oral microbiota to biofilms which contribute to the dental caries process. The present study aimed to evaluate the antimicrobial activity of a natural plant product, cinnamaldehyde against S. mutans biofilms. Minimum inhibitory concentrations (MIC), minimal bactericidal concentration (MBC), and growth curves were determined to assess its antimicrobial effect against planktonic S. mutans. The biofilm biomass and metabolism with different concentrations of cinnamaldehyde and different incubation time points were assessed using the crystal violet and MTT assays. The biofilms were visualized using confocal laser scanning microscopy (CLSM). Bacterial cell surface hydrophobicity, aggregation, acid production, and acid tolerance were evaluated after cinnamaldehyde treatment. The gene expression of virulence-related factors (gtfB, gtfC, gtfD, gbpB, comDE, vicR, ciaH, ldh and relA) was investigated by real-time PCR. The MIC and MBC of cinnamaldehyde against planktonic S. mutans were 1000 and 2000 μg/mL, respectively. The results showed that cinnamaldehyde can decrease biofilm biomass and metabolism at sub-MIC concentrations. CLSM images revealed that the biofilm-covered surface areas decreased with increasing concentrations of cinnamaldehyde. Cinnamaldehyde increased cell surface hydrophobicity, reduced S. mutans aggregation, inhibited acid production, and acid tolerance. Genes expressions in the biofilms were down-regulated in the presence of cinnamaldehyde. Therefore, our data demonstrated that cinnamaldehyde at sub-MIC level suppressed the microbial activity on S. mutans biofilm by modulating hydrophobicity, aggregation, acid production, acid tolerance, and virulence gene expression.

Identification of endophytic bacteria in medicinal plants and their antifungal activities against food spoilage fungi

Endophytes are fungi or bacteria living in the intracellular parts of the plants. In this study, 12 medicinal plants were examined for the presence of endophytic bacteria. Antifungal activities of the isolates were determined against Aspergillus flavus PTCC 5006, Penicillium citrinum PTCC 5304, Aspergillus fumigatus PTCC 5006, Fusarium oxysporum MTCC 284, and Rhizopus stolonifer. In order to determine the metabolites characteristics of these isolates, catalase and proteolytic enzyme treatments were assessed. Moreover, approximate molecular weights of the antifungal substance were measured by fractionation method and the volatile compounds were determined by using GC-mass spectroscopy. Finally, 16s rRNA gene sequencing confirmed the strain of the bacteria. Twenty-one endophytic bacteria, out of a total of 82 isolates, showed antifungal activities against all five spoilage fungi. The results of the PCR assay revealed two species: Bacillus pumilus and B. safensis. Proteolytic enzyme activities and the fractionation of the supernatants proved that more than one compound was responsible for the antifungal activities. This compound could be proteins, peptides, and other low-molecular compounds, such as Butanal, 3-methyl-, Propene, 2-butene, 2-heptanone, 6-methyl-5-methylene-, and 6-oxabicyclo[3.1.0] hexane, which all were identified in the headspace of the GC-mass spectroscopy.

Cytotoxic and antibacterial effect of a red propolis mouthwash, with or without fluoride, on the growth of a cariogenic biofilm

OBJECTIVE

To evaluatein vitro the antibacterial activity, the antibiofilm effect and the cytotoxic potential of mouthwashes containing Brazilian red propolis with or without fluoride.

METHODS

The minimum inhibitory and bactericidal concentrations (MIC and MBC) against S. mutans, S. sanguinis, S. salivarius and L. casei were determined for RPE mouthwashes. A cariogenic biofilm with the aforementioned bacteria was formed over cellulose membrane disks (N = 30, 13 mm), which were submitted for 1 min to the following mouthwashes: plain mouthwash base; 0.05% NaF; 0.8% RPE; 0.8% RPE + 0.05% NaF and 0.12% chlorhexidine (CHX). The bacterial viability and the production of extracellular polysaccharide (EPS) were measured. Cytotoxic potential of the mouthwashes was also evaluated. For bacterial viability and EPS production, Mann-Withney and one-way ANOVA tests were performed followed by Tukey, with results considered significant when p ≤ 0.05.

RESULTS

MIC and MBC values of RPE mouthwashes ranged from 7.44 to 29.76 mg/mL and from 7.44 to ≥59.52 mg/mL, respectively, presenting better action against S. salivarius. RPE mouthwashes showed 44% of viable cells after 1 min of contact with fibroblasts. RPE (7.74) had the greatest reduction of viable total microorganisms and did not differ from the RPE + NaF (7.95) (p = 0.292). CHX (7.54) was the most effective in reducing Streptococcus spp, but did not differ from RPE (p = 0.521) and RPE + NaF (p = 0.238). There was no difference between the treatments regarding EPS production.

CONCLUSION

RPE and RPE + NaF mouthwash showed similar antibacterial activity, toxicity level and antibiofilm effect compared to CHX.

Preparation and Characterization of Natural Bleaching Gels Used in Cosmetic Dentistry

The novelty of this study consists of the formulation and characterization of three experimental bleaching gels with hydroxylapatite oxides and fluorine (G28®, G29®, G30®) based on natural fruit extracts compared to the commercial Opalescence 15% (GC, Ultradent, South Jordan, UT, USA). Studies have been conducted on the effect that the experimental bleaching gels have on the color and morphology of different restorative materials (Nanofill®-Schulzer, P.L. Superior Dental Materials GmbH, Hamburg, Germany, and experimental nanocomposites (P11®, P31®, P61®)), immersed in coffee and artificial saliva (for 10 days and 30 days). The study also includes a cytotoxicity test on the gels and nanocomposites after bleaching, with ISO 109993-5 protocols on human dental follicle stem cells. UV-VIS spectroscopy, computerized measurement, and fluorescence spectrometry were used in order to observe the color changes, while the microstructure of the surface was investigated by Scanning Electron Microscopy (SEM). All of the samples immersed in coffee showed the highest color shift in comparison to the baseline. The color difference ΔE values obtained using the two methods (UV-Vis, computerized based on digital images) both after coloring and bleaching, respectively, were different for all four types of nanocomposites stored in the coffee, while no difference was observed in those stored in artificial saliva. The studied experimental gels and nanocomposites had a low cytotoxic effect on cell cultures after bleaching.

Spontaneously Arising Streptococcus mutans Variants with Reduced Susceptibility to Chlorhexidine Display Genetic Defects and Diminished Fitness

Chlorhexidine (CHX) has been used to control dental caries caused by acid-tolerant bacteria such as Streptococcus mutans since the 1970s. Repeat CHX exposure for other bacterial species results in the development of variants with reduced susceptibility that also become more resistant to other antimicrobials. It has not been tested if such variants arise when streptococci are exposed to CHX. Here, we passaged S. mutans in increasing concentrations of CHX and isolated spontaneously arising reduced susceptibility variants (RSVs) from separate lineages that have MICs that are up to 3-fold greater than the parental strain. The RSVs have increased growth rates at neutral pH and under acidic conditions in the presence of CHX but accumulate less biomass in biofilms. RSVs display higher MICs for daptomycin and clindamycin but increased sensitivity to dental-relevant antimicrobials triclosan and sodium fluoride. Plate-based assays for competition with health-associated oral streptococci revealed decreased bacteriocin production by the RSVs, increased sensitivity to hydrogen peroxide, and diminished competitive fitness in a human-derived ex vivo biofilm consortium. Whole-genome sequencing identified common single nucleotide polymorphisms (SNPs) within a diacylglycerol kinase homolog and a glycolipid synthesis enzyme, which could alter the accumulation of lipoteichoic acids and other envelope constituents, as well as a variety of mutations in other genes. Collectively, these findings confirm that S. mutans and likely other streptococci can develop tolerance to CHX but that increased tolerance comes at a fitness cost, such that CHX-induced variants that spontaneously arise in the human oral cavity may not persist.

Dextran-Coated Zinc-Doped Hydroxyapatite for Biomedical Applications

Dextran-coated zinc-doped hydroxyapatite (ZnHApD) was synthesized by an adapted sol-gel method. The stability of ZnHApD nanoparticles in an aqueous solution was analyzed using ultrasonic measurements. The analysis of the evolution in time of the attenuation for each of the frequencies was performed. The X-ray diffraction (XRD) investigations exhibited that no impurity was found. The morphology, size and size distribution of the ZnHApD sample was investigated by transmission electron microscopy (TEM) and scanning electron microscopy (SEM). The TEM and SEM results showed that the ZnHApD particles have an ellipsoidal shape and a narrow distribution of sizes. The cell growth and toxicity of HEK-293 cells were investigated on the ZnHApD solution for four different concentrations and analyzed after 24 and 48 h. The ZnHApD solution presented a non-toxic activity against HEK-293 cells for all analyzed concentrations. The antibacterial assay revealed that all the tested microorganisms were inhibited by the ZnHApD dispersion after 24 and 48 h of incubation. It was observed that the effect of the ZnHApD solution on bacteria growth depended on the bacterial strain. The Porphyromonas gingivalis ATCC 33277 bacterial strain was the most sensitive, as a growth inhibition in the presence of 0.075 μg/mL ZnHApD in the culture medium was observed.

Antimicrobial Effect of Thymus capitatus and Citrus limon var. pompia as Raw Extracts and Nanovesicles

In view of the increasing interest in natural antimicrobial molecules, this study screened the ability of Thymus capitatus (TC) essential oil and Citrus limon var. pompia (CLP) extract as raw extracts or incorporated in vesicular nanocarriers against Streptococcus mutans and Candida albicans. After fingerprint, TC or CLP were mixed with lecithin and water to produce liposomes, or different ratios of water/glycerol or water/propylene glycol (PG) to produce glycerosomes and penetration enhancer vesicles (PEVs), respectively. Neither the raw extracts nor the nanovesicles showed cytotoxicity against human gingival fibroblasts at all the concentrations tested (1, 10, 100 μg/mL). The disc diffusion method, MIC-MBC/MFC, time-kill assay, and transmission electron microscopy (TEM) demonstrated the highest antimicrobial potential of TC against S. mutans and C. albicans. The very high presence of the phenol, carvacrol, in TC (90.1%) could explain the lethal effect against the yeast, killing up to 70% of Candida and not just arresting its growth. CLP, rich in polyphenols, acted in a similar way to TC in reducing S. mutans, while the data showed a fungistatic rather than a fungicidal activity. The phospholipid vesicles behaved similarly, suggesting that the transported extract was not the only factor to be considered in the outcomes, but also their components had an important role. Even if other investigations are necessary, TC and CLP incorporated in nanocarriers could be a promising and safe antimicrobial in caries prevention.

10-undecynoic acid is a new anti-adherent agent killing biofilm of oral Streptococcus spp

In the search for novel agents against oral pathogens in their planktonic and biofilm form, we have focused our attention on 10-undecynoic acid as the representative of the acetylenic fatty acids. Using macro-broth susceptibility testing method we first established MIC value. Next, the MBC value was determined from a broth dilution minimum inhibitory concentration test by sub-culturing it to BHI agar plates that did not contain the test agent. Anti-biofilm efficacy was tested in 96-well plates coated with saliva using BHI broth supplemented with 1% sucrose as a standard approach. Based on obtained results, MIC value for 10-undecynoic acid was established to be 2.5 mg/ml and the MBC value to be 5 mg/ml. The MBIC₉₀ showed to be 2.5 mg/ml, however completed inhibition of biofilm formation was achieved at 5.0 mg/ml. MBBC concentration revealed to be the same as MBC value, causing approximately 30% reduction at the same time in biomass of pre-existing biofilm, whereas application of 7.0 mg/ml of 10-undecynoic acid crossed the 50% eradication mark. Strong anti-adherent effect was observed upon 10-undecynoic acid application at sub-MBC concentrations as well, complemented with suppression of acidogenicity and aciduricity. Thus, we concluded that 10-undecynoic acid might play an important role in the development of alternative or adjunctive antibacterial and anti-biofilm preventive and/or therapeutic approaches.

Cranberry Polyphenols: Natural Weapons against Dental Caries

Bioactive polyphenol components of cranberry (Vaccinium macrocarpon) are known to have virulence attenuating effects against several cariogenic virulence properties responsible for dental caries pathogenesis. In particular, cranberry A-type proanthocyanidins and flavonols have demonstrated potent inhibitory effects against cariogenic virulence targets such as bacterial acidogenicity, aciduricity, glucan synthesis, and hydrophobicity. Cranberry phenols have the ability to disrupt these cariogenic virulence properties without being bactericidal, a key quality essential for retaining the benefits of the symbiotic resident oral microbiome and preventing the emergence of resistant microbes. This review discusses the cariostatic mechanisms of specific cranberry phytochemicals and their potential use as therapeutic agents against cariogenic bacteria in the prevention and control of dental caries.

Compounds from Olea europaea and Pistacia lentiscus inhibit oral microbial growth

BACKGROUND

In view of the increasing antibiotic resistance, the introduction of natural anti-infective agents has brought a new era in the treatment of bacterially derived oral diseases.

METHODS

The aim of this study was to investigate the antimicrobial potential of five natural constituents of Olea europaea (oleuropein, maslinic acid, hydroxytyrosol, oleocanthal, oleacein) and three compounds of Pistacia lentiscus (24Z-isomasticadienolic acid, oleanolic acid, oleanonic aldehyde) against ten representative oral bacterial species and a Candida albicans strain. After the isolation and quality control of natural compounds, the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) assay were performed.

RESULTS

Among all O. europaea-derived constituents, maslinic acid was the most active (MIC = 4.9-312 μg mL^- 1, MBC = 9.8-25 μg mL^- 1) one against oral streptococci and anaerobic pathogenic bacteria (Porphyromonas gingivalis, Fusobacterium nucleatum, Parvimonas micra), while oleuropein, hydroxytyrosol, oleocanthal and oleacein showed milder, yet significant effects against P. gingivalis and F. nucleatum. Among all P. lentiscus compounds, oleanolic acid was the most effective one against almost all microorganisms with MIC values ranging from 9.8 μg mL^- 1 (P. gingivalis) to 625 μg mL^- 1 (F. nucleatum, P. micra). In the presence of 24Z-isomasticadienolic acid, a mean inhibitory concentration range of 2.4 μg mL^- 1 to 625 μg mL^- 1 was observed for strict anaerobia. The MIC value for 24Z-isomasticadienolic acid was estimated between 39 μg mL^- 1 (Streptococcus sobrinus, Streptococcus oralis) and 78 μg mL^- 1 (Streptococcus mutans). All tested compounds showed no effects against Prevotella intermedia.

CONCLUSIONS

Overall, maslinic acid and oleanolic acid exerted the most significant inhibitory activity against the tested oral pathogens, especially streptococci and anaerobic oral microorganisms.

Inhibitory Effects of Lingonberry Extract on Oral Streptococcal Biofilm Formation and Bioactivity

Phenolic compounds in fruits such as cranberries have been shown to promote a number of biological activities. The purpose of this study was to investigate the effects of polyphenolic compound-containing lingonberry extract on oral streptococci and compare them with the known anti-cariogenic activity of cranberries. Water-soluble and polyphenol-rich fractions (Fractions I and II, respectively) were isolated from cranberries and lingonberries. The effects of those fractions on the biofilm formation ability and bioactivity of Streptococcus mutans MT8148R, Streptococcus sobrinus 6715, and Streptococcus sanguinis ATCC 10556 were then evaluated. Cranberry or lingonberry Fraction II (at 0.5-1 mg/ml) significantly reduced biofilm formation by S. mutans, S. sobrinus, and S. sanguinis. In contrast, cranberry or lingonberry Fraction I (at 0.5-2 mg/ml) increased biofilm formation by S. mutans and S. sobrinus, but not by S. sanguinis. Fractions I and II (at 1-2 mg/ml) also reduced the bioactivity of S. mutans, while Fraction II (at 0.5 mg/ml) enhanced the bioactivity of all tested strains. The results revealed that lingonberries contained a larger amount of polyphenol than cranberries and that they showed almost the same level of activity against the biofilm formation ability and bioactivity of oral streptococci. This indicates that polyphenol-rich lingonberry fraction offers a promising natural food derivative for prevention of dental caries.

Novel Approaches to the Control of Oral Microbial Biofilms

Effective management of biofilm-related oral infectious diseases is a global challenge. Oral biofilm presents increased resistance to antimicrobial agents and elevated virulence compared with planktonic bacteria. Antimicrobial agents, such as chlorhexidine, have proven effective in the disruption/inhibition of oral biofilm. However, the challenge of precisely and continuously eliminating the specific pathogens without disturbing the microbial ecology still exists, which is a major factor in determining the virulence of a multispecies microbial consortium and the consequent development of oral infectious diseases. Therefore, several novel approaches are being developed to inhibit biofilm virulence without necessarily inducing microbial dysbiosis of the oral cavity. Nanoparticles, such as pH-responsive enzyme-mimic nanoparticles, have been developed to specifically target the acidic niches within the oral biofilm where tooth demineralization readily occurs, in effect controlling dental caries. Quaternary ammonium salts (QAS) such as dimethylaminododecyl methacrylate (DMADDM), when incorporated into dental adhesives or resin composite, have also shown excellent and durable antimicrobial activity and thus could effectively inhibit the occurrence of secondary caries. In addition, custom-designed small molecules, natural products and their derivatives, as well as basic amino acids such as arginine, have demonstrated ecological effects by modulating the virulence of the oral biofilm without universally killing the commensal bacteria, indicating a promising approach to the management of oral infectious diseases such as dental caries and periodontal diseases. This article aims to introduce these novel approaches that have shown potential in the control of oral biofilm. These methods may be utilized in the near future to effectively promote the clinical management of oral infectious diseases and thus benefit oral health.

Therapeutic Strategies Targeting Cariogenic Biofilm Microenvironment

Cariogenic biofilms are highly structured microbial communities embedded in an extracellular matrix, a multifunctional scaffold that is essential for the existence of the biofilm lifestyle and full expression of virulence. The extracellular matrix provides the physical and biological properties that enhance biofilm adhesion and cohesion, as well as create a diffusion-modulating milieu, protecting the resident microbes and facilitating the formation of localized acidic pH niches. These biochemical properties pose significant challenges for the development of effective antibiofilm therapeutics to control dental caries. Conventional approaches focusing solely on antimicrobial activity or enhancing remineralization may not achieve maximal efficacy within the complex biofilm microenvironment. Recent approaches disrupting the biofilm microbial community and the microenvironment have emerged, including specific targeting of cariogenic pathogens, modulation of biofilm pH, and synergistic combination of bacterial killing and matrix degradation. Furthermore, new "smart" nanotechnologies that trigger drug release or activation in response to acidic pH are being developed that could enhance the efficacy of current and prospective chemical modalities. Therapeutic strategies that can locally disrupt the pathogenic niche by targeting the biofilm structure and its microenvironment to eliminate the embedded microorganism and facilitate the action of remineralizing agents may lead to enhanced and precise anticaries approaches.

The antibacterial efficacy of a foam mouthwash and its ability to remove biofilms

OBJECTIVES/AIMS

To evaluate the antimicrobial activity of a newly developed foam mouthwash containing a modified lactoperoxidase system in vitro.

MATERIALS AND METHODS

Biofilms of five bacterial species were developed on hydrophobic and hydrophilic surfaces whilst salivary-based biofilm was grown on tooth enamel. Each surface was exposed to the foam mouthwash or saline in vitro. Optical density and scanning electron microscopy (SEM) was used to determine retention of the biofilm following 5 or 30 s exposure time.

RESULTS

The foam mouthwash was active against biofilms formed by S. aureus, K. rhizophila, M. thailandicus, E. coli, and C. violaceum and eliminated significant amount of biofilm from each surface; immature 4 h biofilm was less resistant than 24 h biofilm. A 30 s rinse showed best performance, with removal of up to 66% of biofilm from the hydrophilic surface. SEM imaging confirmed oral biofilm removal from the enamel surface after a 5 s rinse with the foam mouthwash.

DISCUSSION

Foam mouthwash demonstrated a significant impact on growing biofilm when compared against saline solution. Growing biofilms were more susceptible to the action of the foam mouthwash, which justifies after-meal use of the mouthwash when traditional dentifrices may not be accessible.

CONCLUSIONS

Foam mouthwash can be a convenient on-the-go format of oral care products that can be used after meals or when needed to reduce the risk of biofilm-associated oral conditions.

Impact of dental cement on the peri-implant biofilm-microbial comparison of two different cements in an in vivo observational study

BACKGROUND

The type of cement used in cemented fixed implant-supported restorations influences formation of undetected excess cement and composition of the peri-implant biofilm. Excess cement and dysbiosis of the biofilm involve the risk of peri-implant inflammation.

PURPOSE

The aim of the study was to investigate the impact of two different cements on the peri-implant biofilm and inflammation.

MATERIALS AND METHODS

In an observational study, the suprastructures of 34 patients with cemented fixed implant-supported restorations were revised. In 20 patients, a methacrylate cement (Premier Implant cement [PIC]) and in 14 patients, a zinc oxide eugenol cement (Temp Bond [TB]) were used. After revision, TB was used for recementation. During revision and follow-up after 1 year, microbial samples were obtained.

RESULTS

Excess cement was found in 12 (60%) of the 20 patients with PIC. Suppuration was observed in two (25%) implants with PIC without excess cement (PIC-) and in all 12 (100%) implants with PIC and excess cement (PIC+). Implants cemented with TB had neither excess cement nor suppuration. The taxonomic analysis of the microbial samples revealed an accumulation of periodontal pathogens in the PIC patients independent of the presence of excess cement. Significantly, fewer oral pathogens occurred in patients with TB compared to patients with PIC. TB was used in all cases (PIC and TB) for recementation. In the follow-up check, suppuration was not found around any of the implants with PIC-, only around one implant with PIC+ and around one implant with TB. Bacterial species associated with severe periodontal infections that were abundant in PIC- and PIC+ samples before the revision were reduced after 1 year to levels found in the TB samples.

CONCLUSIONS

The revision and recementation with TB had a positive effect on the peri-implant biofilm in cases with PIC. The cementation of suprastructures on implants with TB is an alternative method to be considered.

A terpenoid isolated from sarang semut (Myrmecodia pendans) bulb and its potential for the inhibition and eradication of Streptococcus mutans biofilm

Background

Dental caries remains a serious problem due to its detrimental effects on individual health and quality of life. The bulbs of Myrmecodia pendans (Merr & Perry), native plants of Papua, have been used as natural remedies for tumours, gout, diarrhoea, and fever. In this study, one of the active compounds of M. pendans was isolated, and its biological activity against the formation of Streptococcus mutans ATCC 25175 biofilm was tested.

Methods

M. pendans was extracted with ethyl acetate using a Soxhlet apparatus. The extract was then separated, and chromatographic purification provided the isolated compound. The structure of the active compound was then characterized using UV, IR, NMR, and MS spectrometry. The obtained compound was added to S. mutans biofilms to determine the MBIC and MBEC values.

Results

The compound isolated from M. pendans was determined to be a labdane diterpene derivative with the formula C₃₁H₅₀O₃. The MBIC value of the terpenoid towards the S. mutans biofilms was 50 ppm, and the MBEC value for the 1 min induction time was 40%.

Conclusion

The terpenoid extracted from M. pendans has the potential to be developed into an antibacterial agent particularly for preventing the formation of biofilms.

Growth Media Affect Assessment of Antimicrobial Activity of Plant-Derived Polyphenols

This study aimed to investigate the effects of different microbial growth media on the laboratory assessment of antimicrobial activity of natural polyphenolic compounds. The inhibition of the tea polyphenol EGCG on growth of selected oral microorganisms was evaluated in complex media and a protein-free chemically defined medium (CDM). Other antimicrobial agents (polyphenolic grape seed extract, plant alkaloid berberine, methyl salicylate, and chlorhexidine gluconate) were also tested in the study. The presence of proteins and their effects on the antimicrobial activity of EGCG were investigated by the addition of BSA to the CDM. The MICs of EGCG against test oral microorganisms were 4 to 64 times higher in complex media than in CDM. The polyphenolic grape seed extract exhibited similar discrepancies. However, the MICs of the nonpolyphenolic compounds (berberine, methyl salicylate, and chlorhexidine) were not significantly different between the two growth media. The MIC of EGCG against S. mutans UA159 in CDM with added BSA was 16 times higher than that in CDM alone. Therefore, nonproteinaceous CDM should be used to avoid interference of proteins with the active ingredients when testing the antimicrobial activity of plant-derived polyphenolic compounds against microorganisms. This will also minimize the discrepancies noted in results obtained by different investigators.

Oral spray containing plant-derived compounds is effective against common oral pathogens

OBJECTIVES

Plant-derived compounds are a good source of therapeutic agents and inhibitors of inflammatory process. Dental caries, periodontal diseases and candidiasis are common oral infections caused by virulent biofilms. The objectives of this study were to develop oral spray containing plant-derived compounds; α-mangostin (α-MG) and/or lawsone methyl ether (2-methoxy-1,4-naphthoquinone) (LME) and determine its antimicrobial, anti-biofilm, and anti-inflammatory activities.

DESIGN

Oral spray formulations were prepared containing α-MG (5 mg/ml) and/or LME (250 μg/ml). Antimicrobial activity against Candida albicans, Streptococcus mutans, and Porphyromonas gingivalis and anti-biofilm formation activities were determined as well as cytotoxicity and anti-inflammatory effects.

RESULTS

The oral spray demonstrated antimicrobial activity against all three of the oral pathogens tested with stronger effects on C. albicans and S. mutans than P. gingivalis. The formulation containing α-MG (2.5 mg/ml) and LME (125 ug/ml) reduced growth of the microorganisms about 1-2 Log CFU/ml at 1-3 h and the killing effects were complete at 24 h. Based on biofilm assay, the oral spray containing both α-MG and LME showed greater inhibitory effects than those with α-MG or LME. In addition, the oral spray containing both α-MG and LME demonstrated more inhibition of nitric oxide production than α-MG alone. All the formulations were safe and demonstrated greater anti-inflammatory activity at lower concentration (<6.25 μg/ml) than at a higher concentration.

CONCLUSION

Oral spray containing α-MG and/or LME is effective against common oral pathogens without significant cytotoxicity. Thus, it has the potential to prevent the infections and may serve as adjunctive treatment to conventional therapy.

Curcumin as a Promising Antibacterial Agent: Effects on Metabolism and Biofilm Formation in S. mutans

Streptococcus mutans (S. mutans) has been proved to be the main aetiological factor in dental caries. Curcumin, a natural product, has been shown to exhibit therapeutic antibacterial activity, suggesting that curcumin may be of clinical interest. The objective of this study is to evaluate the inhibitory effects of curcumin on metabolism and biofilm formation in S. mutans using a vitro biofilm model in an artificial oral environment. S. mutans biofilms were treated with varying concentrations of curcumin. The biofilm metabolism and biofilm biomass were assessed by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay and the crystal violet assay. Confocal laser scanning microscopy was used to analyse the composition and extracellular polysaccharide content of S. mutans biofilm after curcumin treatment. The biofilm structure was evaluated using a scanning electron microscope. The gene expression of virulence-related factors was assessed by real-time PCR. The antibiofilm effect of curcumin was compared with that of chlorhexidine. The sessile minimum inhibitory concentration (SMIC50%) of curcumin against S. mutans biofilm was 500 μM. Curcumin reduced the biofilm metabolism from 5 min to 24 h. Curcumin inhibited the quantity of live bacteria and total bacteria in both the short term (5 min) and the long term. Moreover, curcumin decreased the production of extracellular polysaccharide in the short term. The expression of genes related to extracellular polysaccharide synthesis, carbohydrate metabolism, adherence, and the two-component transduction system decreased after curcumin treatment. The chlorhexidine-treated group showed similar results. We speculate that curcumin has the capacity to be developed as an alternative agent with the potential to reduce the pathogenic traits of S. mutans biofilm.

A randomized triple-blind crossover trial of a hydrocolloid-containing dentifrice as a controlled-release system for fluoride

OBJECTIVE

To evaluate retention of intraoral fluoride in biofilm and saliva, an experimental dentifrice containing hydrocolloid (tara gum) was used as a controlled-release system for fluoride (F).

MATERIALS AND METHODS

In a triple-blind randomized crossover trial with washout, 18 individuals used the following different dentifrices for a week: 100-TGF (sodium fluoride NaF associated with tara gum, 1100 mg/L), 50-TGF (50% NaF associated with tara gum + 50% free NaF, 1100 mg/L), PC (free NaF, 1100 mg/L), TG (with tara gum and without F), and placebo (without F or tara gum). On the seventh day of dentifrice use, biofilm was collected at 1 and 12 h, and saliva was collected up to 60 min and 12 h after the last toothbrushing. F concentrations were determined by physico-chemical analysis of fluoride using the hexamethyldisiloxane-facilitated diffusion technique. Data were subjected to two-way analysis of variance (repeated measures) and Spearman's correlation coefficient (p < 0.05) testing.

RESULTS

No significant difference was observed with the same dentifrice regarding F retention in biofilm at 1 and 12 h after toothbrushing for the 100-TGF, placebo, and TG groups (p > 0.05). The highest area under the curve values in saliva were found for the 50-TGF, 100-TGF, and PC groups.

CONCLUSION

The dentifrice containing hydrocolloid as a controlled-release system for F promoted F retention in the oral cavity, even at 12 h after brushing.

CLINICAL RELEVANCE

Hydrocolloid added to dentifrices as a controlled-release system for F might contribute to a higher anti-caries effect.

TRIAL REGISTRATION

NCT02809014.

Effect of tt-farnesol and myricetin on in vitro biofilm formed by Streptococcus mutans and Candida albicans

BACKGROUND

Dental caries is considered a multifactorial disease, in which microorganisms play an important role. The diet is decisive in the biofilm formation because it provides the necessary resources for cellular growth and exopolysaccharides synthesis. Exopolysaccharides are the main components of the extracellular matrix (ECM). The ECM provides a 3D structure, support for the microorganisms and form diffusion-limited environments (acidic niches) that cause demineralization of the dental enamel. Streptococcus mutans is the main producer of exopolysaccharides. Candida albicans is detected together with S. mutans in biofilms associated with severe caries lesions. Thus, this study aimed to determine the effect of tt-farnesol and myricetin topical treatments on cariogenic biofilms formed by Streptococcus mutans and Candida albicans.

METHODS

In vitro dual-species biofilms were grown on saliva-coated hydroxyapatite discs, using tryptone-yeast extract broth with 1% sucrose (37 °C, 5% CO2). Twice-daily topical treatments were performed with: vehicle (ethanol 15%, negative control), 2 mM myricetin, 4 mM tt-farnesol, myricetin + tt-farnesol, myricetin + tt-farnesol + fluoride (250 ppm), fluoride, and chlorhexidine digluconate (0.12%; positive control). After 67 h, biofilms were evaluated to determine biofilm biomass, microbial population, and water-soluble and -insoluble exopolysaccharides in the ECM.

RESULTS

Only the positive control yielded a reduced quantity of biomass and microbial population, while tt-farnesol treatment was the least efficient in reducing C. albicans population. The combination therapy myricetin + farnesol + fluoride significantly reduced water-soluble exopolysaccharides in the ECM (vs. negative control; p < 0.05; ANOVA one-way, followed by Tukey's test), similarly to the positive control.

CONCLUSIONS

Therefore, the combination therapy negatively influenced an important virulence trait of cariogenic biofilms. However, the concentrations of both myricetin and tt-farnesol should be increased to produce a more pronounced effect to control these biofilms.

Anticaries Activity of Curcumin on Decay Process in Human Tooth Enamel Samples (In Vitro Study)

BACKGROUND

Dental caries is a big public health problem which is prevalent in the highest degree worldwide, especially in lower socioeconomic levels. This study aims to investigate the anti-caries effects of Curcumin in Turmeric on the caries model of enamel under laboratory conditions.

METHODS

In order to make a reliable model of caries, a Streptococcus mutans (ATCC 3568) bacterium was used. The biofilm was created on enamel slabs in 5 days. There were 5 groups of slabs. In order to create Cariogenic conditions, the slabs were exposed to Sucrose 10% three times a day and then, it was exposed to different concentrations of Curcumin (5, 10, 20 mg/ml). The slabs of one group were exposed to the normal saline after the exposure to Sucrose and called positive caries control group; and the other group was exposed to normal saline in each time of exposure which was called negative caries control groups. Environment PH was measured by PH meter two times in a day. After the laboratory phase, the slabs were washed and dried and Vickers hardness test was used to determine the superficial hardness and then the decrease rate of superficial hardness (SHL%) was measured by the approved formula. SPSS version 20 was used to analyse the data. Then, to analyse the data, One-way ANOVA with 95% confidence, Kolmogorov - Smirnov, and Tukey test was used.

RESULTS

The present study showed that Curcumin can have anti caries effect at the most level even in the least level of concentration used in this study (5 mg/ml). With regard to changes in PH of environment, we can declare that Curcumin results in reducing the dental caries by restraining the bacterial activity.

CONCLUSIONS

Regarding that these results were received in laboratory conditions, further studies are needed.

Ecological Approaches to Dental Caries Prevention: Paradigm Shift or Shibboleth?

Contemporary paradigms of dental caries aetiology focus on the ecology of the dental plaque biofilm and how local environmental factors can modulate this to cause disease. The crucial role that a healthy oral microbiome plays in preventing caries and promoting oral health is also being increasingly recognized. Based on these concepts, several ecological preventive approaches have been developed that could potentially broaden the arsenal of currently available caries-preventive measures. Many of these ecological approaches aim for long-term caries control by either disrupting cariogenic virulence factors without affecting bacterial viability, or include measures that can enhance the growth of health-associated, microbially diverse communities in the oral microbiome. This paper argues for the need to develop ecological preventive measures that go beyond conventional caries-preventive methods, and discusses whether these ecological approaches can be effective in reducing the severity of caries by promoting stable, health-associated oral biofilm communities.

Cymbopogon citratus essential oil: effect on polymicrobial caries-related biofilm with low cytotoxicity

The objective of this study was to evaluate the effects of Cymbopogon citratus essential oil and its main compound (citral) against primary dental colonizers and caries-related species. Chemical characterization of the essential oil was performed by gas chromatography/mass spectroscopy (GC/MS), and the main compound was determined. Antimicrobial activity was tested against Actinomyces naeslundii, Lactobacillus acidophilus, S. gordonii, S. mitis, S. mutans, S. sanguinis and S. sobrinus. Minimum inhibitory and bactericide concentrations were determined by broth microdilution assay for streptococci and lactobacilli reference, and for clinical strains. The effect of the essential oil on bacterial adhesion and biofilm formation/disruption was investigated. Negative (without treatment) and positive controls (chlorhexidine) were used. The effect of citral on preformed biofilm was also tested using the same methodology. Monospecies and microcosm biofilms were tested. ANOVA or Kruskal-Wallis tests were used (α=0.05). Cytotoxicity of the essential oil to human keratinocytes was performed by MTT assay. GC/MS demonstrated one major component (citral). The essential oil showed an inhibitory effect on all tested bacterial species, including S. mutans and L. acidophilus. Essential oil of C. citratus (10X MIC) reduced the number of viable cells of lactobacilli and streptococci biofilms (p < 0.05). The essential oil inhibited adhesion of caries-related polymicrobial biofilm to dental enamel (p < 0.01). Citral significantly reduced the number of viable cells of streptococci biofilm (p < 0.001). The essential oil showed low cytotoxicity to human keratinocytes. Based on these findings, this study can contribute to the development of new formulations for products like mouthwash, against dental biofilms.

Galla chinensis Compounds Remineralize Enamel Caries Lesions in a Rat Model

OBJECTIVES

To investigate the effect of Galla chinensis chemical compounds on enamel caries remineralization in rats.

METHODS

A total of 40 rats were inoculated with Streptococcus sobrinus 6715 and fed a cariogenic diet (Keyes 2000). The rats were randomly divided into 4 groups and treated topically twice a day with each of the following extracts (or control) for 5 weeks: distilled and deionized water (DDW, negative control); 1,000 ppm NaF (positive control); 4,000 ppm G. chinensis crude aqueous extract (GCE), or 4,000 ppm gallic acid (GA). After the experimental period, Keyes' caries diagnosis and scoring technique was applied as a preliminary evaluation on the molar teeth. For more accurate remineralization data, the residual enamel volume of the first molar and the mineral density (MD) of the enamel were further analyzed by micro-CT.

RESULTS

The severity of molar enamel caries decreased in the following order of treatment groups: DDW > GA > GCE > NaF (p < 0.05). In addition, the residual first molar enamel volume and MD values increased in the order of DDW, GA, GCE and NaF treatment groups (p < 0.05). In most molars, remineralization layers were observed on the surface of lesions.

CONCLUSION

G. chinensis compounds remineralize enamel caries lesions in a rat model.

Sugars and beyond. The role of sugars and the other nutrients and their potential impact on caries

The traditional concept of caries as a multifactorial transmittable and infectious disease has been challenged. Novel conceptual ideas have come to add to the complexity of this highly prevalent disease worldwide. Current etiological understanding of the disease has emphasized the pivotal role of sugars in caries. In fact, current definition points toward an ecological disease caused by the commensal microbiota that under ecological imbalances, mainly due to high and or frequent sugars consumption, creates a state of dysbiosis in the dental biofilm. This modern conceptual idea, however, tends to underrate a key issue. As humans are omnivore and consume a mix diet composed by a multitude of substances, the role of the diet in caries must not be restricted only to the presence of fermentable sugars. This review explores the contribution of other food components, ubiquitous to the diet, mostly as potentially protective factors. Anticaries nutrients might determine an environmental change, affecting the ecology of the oral microbiome and partially mitigating the effect of sugars. Understanding the function of the food usually consumed by the people will contribute new knowledge on the mechanisms associated with the onset of caries, on new caries risk variables and on potential novel strategies for the prevention and treatment of the disease.