Comparison of methods for monitoring changes in the pH of human dental plaque

Telemetric methods using ion-specific electrodes

The use of telemetric methods for obtaining data from the human oral cavity has increased dramatically T over the last two decades. Measurement of intra-oral pH from plaque or saliva has been the most common application of ion-specific telemetry in dental research. Economics and technical problems such as durability requirements have led to wire-telemetric approaches for most clinical studies. However, limitation of subject mobility by the wire connection has led to further development of radio-telemetric methods. The use of custom-fabricated FM transmitters with ion-sensitive field effect transistors (ISFETS) has allowed for increased subject mobility during measurement of the activities of hydrogen, calcium, fluoride, and other ions of dental interest. Data can be transmitted to a small pocket receiver/recorder as digital data and later transcribed by means of a tape reader. Applications of ion-specific telemetry are described as well as possible future developments, including glucose measurement with enzyme-linked electrodes such as glucose-oxidase-coated gates on ISFETS. An intra-oral device for storage of these data within the appliance will be described. Although not yet evaluated in human subjects, this approach may eliminate the need for carrying a receiver/recorder for data collection and may have a wide variety of applications for intra-oral ion-specific measurement. Possible uses of this technology for diagnosis and therapeutics in dentistry may be limited to "special" patient populations, but it is likely to provide a wealth of information to research investigators and may suggest new therapeutic approaches toward dental diseases.

Membrane ATPases and acid tolerance of Actinomyces viscosus and Lactobacillus casei

Lactobacillus casei ATCC 4646 and Actinomyces viscosus OMZ105E were found to differ markedly in acid tolerance. For example, pH profiles for glycolysis of intact cells in dense suspensions indicated that glycolysis by L. casei had an optimal pH of about 6.0 and that glucose degradation was reduced by 50% at a pH of 4.2. Comparable values for A. viscosus cells were at pHs of about 7.0 and 5.6. The difference in acid tolerance appeared to depend mainly on membrane physiology, and the addition of 40 microM gramicidin to cell suspensions increased the sensitivity of the glycolytic system by as much as 1.5 pH units for L. casei and up to 0.5 pH unit for A. viscosus. L. casei cells were inherently somewhat more resistant to severe acid damage than were A. viscosus cells, in that Mg release from L. casei cells in medium with a pH of 3.0 occurred only after a lag of some 4 h, compared with rapid release from A. viscosus cells. However, the major differences pertinent to the physiology of the organisms appeared to be related to proton-translocating ATPases. Isolated membranes of L. casei had about 3.29 U of ATPase per mg of protein, compared with only about 0.06 U per mg of protein for those of A. viscosus. Moreover, the ATPase of L. casei had a pH optimum for hydrolytic activity of about 5, compared with an optimal pH of about 7 for that of A. viscosus.(ABSTRACT TRUNCATED AT 250 WORDS)

In-vitro urea-dependent pH-changes by human salivary bacteria and dispersed, artificial-mouth, bacterial plaques

The pH effects of urea metabolism were studied in washed salivary-sediment bacteria from subjects that had up to 10-fold variation in oral ureolytic activity, and in dispersed artificial-mouth plaques. Adequate evaluation required analysis of the [OH-] as well as the pH curve. An initial constant rate of pH-change, lasting until pH 7.8, was derived from the pH curve; this gave the best correlation (r = 0.95) with the ureolysis rate. From the [OH-]-curve, between pH 7.8 and 8.3 (approx.), a constant and maximal rate of change in [OH-] was determined. Although theoretically this was directly related to the rate of ammonia release, it was 10(-2) to 10(-3) times its value and correlated less well (r = 0.83) with ureolysis. Together with the initial and final pH, these two rates largely described urea-induced pH changes. After 12.5-fold dilution of the cells, changes in the pH curve were minor. Although the rate of ureolytic ammonia release was proportional to cell-protein concentration, the reduction in ureolytic activity was compensated by a corresponding reduction in cell pH-buffering. Consequently, in order to relate pH and [OH-] changes to ureolysis, it was necessary to control, or correct for, variations in the cell mass present. Buffering capacity in plaques was greater than in sediments. The 10-fold range in oral ureolytic activity by salivary bacteria gave a 10-20-fold range in base changes.

Arginine deiminase system and bacterial adaptation to acid environments

The arginine deiminase system in a variety of streptococci and in Pseudomonas aeruginosa was found to be unusually acid tolerant in that arginolysis occurred at pH values well below the minima for growth and glycolysis. The acid tolerance of the system allowed bacteria to survive potentially lethal acidification through production of ammonia to raise the environmental pH value.

Acid tolerance, proton permeabilities, and membrane ATPases of oral streptococci

Differences in acid tolerance among representative oral streptococci were found to be related more closely to the dynamic permeabilities of the bacteria to protons than to differences in the sensitivities of cell membranes to gross damage caused by environmental acidification. For Streptococcus mutans GS-5, Streptococcus sanguis NCTC 10904, and Streptococcus salivarius ATCC 13419, gross membrane damage, indicated by the release of magnesium from whole cells, occurred at pH values below about 4 and was rapid and extensive at pH values of about 3 or less. A more aciduric, lactic acid bacterium, Lactobacillus casei ATCC 4646, was more resistant to environmental acidification, and gross membrane damage was evident only at pH values below 3. Assessments of the movements of protons into S. mutans cells after an acid pulse at various pH values indicated that permeability to protons was minimal at a pH value of about 5, at which the average half time for pH equilibration across the cell membrane was about 12 min. The corresponding values for the less aciduric organism S. sanguis were pH 7 and 8.2 min, and the values for the intermediate organism S. salivarius were pH 6 and 6.6 min. The ATPase inhibitor dicyclohexylcarbodiimide acted to increase markedly the permeability of each organism to protons, and this action indicated that permeability involved not only the passive inflow of protons but also active outflow through the proton-translocating membrane ATPase. Membranes were isolated from each of the bacteria, and pH profiles for ATPase activities indicated pH optima of about 7.5, 7.0, 6.0, and 5.0 for S. sanguis, S. salivarius, S. mutans, and L. casei, respectively. Thus, the pH profiles for the enzymes reflected the acid tolerances of the bacteria and the permeabilities of whole cells to protons.

Effects of fluorides on in vitro acid production by dental plaque

A method that holds human dental plaque on a glass micro-electrode has been used to measure the pH depressions in plaque samples exposed to different concentrations of fluoride from sodium fluoride or sodium monofluorophosphate. Fluoride from both sources gave some inhibition of sucrose-induced acid formation at levels as low as 10 ppm and parallel results at other test concentrations of up to 200 ppm F. Repeated exposures of plaque to fluoride solutions did not interfere with its subsequent ability to ferment sucrose.

A laboratory microcosm (artificial mouth) for the culture and continuous pH measurement of oral bacteria on surfaces

A laboratory microcosm has been designed for the cultivation of bacteria on surfaces subjected to an adjustable supply of fluids. Bacteria are grown as a microbial film on halved premolar teeth, mounted back to back. Synthetic saliva is dropped slowly over the teeth throughout experiments. A nutrient supplement is provided at regular intervals. The drops of fluid retained by the teeth can be sampled for metabolic end-products. Alternatively, a miniature glass electrode may be set into one half of a tooth assembly to monitor the pH continuously at the stagnation site between tooth segments. Up to six replicate culture flasks and six electrodes can be accommodated in a single experiment. Satisfactory electrode performance was maintained during 66 h experiments. In initial 48 h experiments, teeth were inoculated with Streptococcus rattus BHT or 'Streptococcus mitior' LPA-1 in pure culture and provided with 1% (w/v) glucose for 1 h every 6 h. Bacteria produced typical responses to glucose feeds leading to the formation of 'Stephan'-like curves of pH-fall. Under these conditions, 'Strep. mitior' was more acidogenic than Strep. rattus and the pattern of acid production was distinct for each organism.

pH-dependent fluoride inhibition of peroxidase activity

Fluoride was found to be a potent inhibitor of bovine lactoperoxidase and of salivary peroxidase at acid pH values. Inhibition was reversible at neutral pH, and appeared to involve HF binding by the enzyme. Fluoride inhibition of lactoperoxidase occurred with all reductants tested, including thiocyanate, iodide, and guaiacol. Fluoride concentrations for 50% inhibition of enzymatic activity with iodide as reductant were: less than 0.05 mM at a pH value of 4.0, 0.3 mM at 5.0, 4.0 mM at pH 6.0, and more than 10.0 mM at pH 7.0. Salivary peroxidases were found to have lower pH optima but to be approximately as sensitive to acid-dependent fluoride inhibition as was purified bovine lactoperoxidase. The findings suggest that the fluoride in dental plaque may be inhibitory to the antimicrobial peroxidase system.

Enamel microhardness change and plaque pH measurements in an intra-oral model in humans

Changes in plaque pH and microhardness of bovine enamel slabs were evaluated with a seven-day intra-oral cariogenicity test (ICT). The test enamel slabs were mounted in prosthetic appliances with a Dacron mesh cover for enhancement of microbial colonization. Three percent solutions of sucrose, sorbitol, and xylitol were evaluated as four daily extra-oral immersions of 10 min each, for seven days, and the results were compared with baseline experiments (no daily immersions). The pH was measured with antimony electrodes on one-day and seven-day ICT plaque samples that were challenged with a one-minute immersion in the studied substrates. Plaque samples in the baseline experiments were challenged with 3% sucrose. The enamel softening was assessed with measurements of microhardness. Sucrose challenge caused pH depression with both the baseline and the sucrose-immersed plaque. Sorbitol and xylitol challenge did not depress the plaque pH. Compared with the baseline, sucrose immersions caused enamel softening; sorbitol and xylitol did not.

Reduction of acidurance of streptococcal growth and glycolysis by fluoride and gramicidin

The acidurance of glycolysis by intact cells of Streptococcus mutans GS-5, Streptococcus salivarius ATCC 25925, and Streptococcus sanguis NCTC 10904 was found to be highly dependent on membrane functions affected by gramicidin, which increases the proton permeability of cell membranes. Plots of % glucose utilized during two hours against suspension pH values for cells suspended in 100 mM phosphate buffer plus 1 mM MgCl2 plus 13.9 mM glucose indicated, for 50% glucose utilization, pH values of 5.0 for S. mutans, 5.7 for S. salivarius, and 6.2 for S. sanguis. Gramicidin treatment shifted these values to 6.0, 6.3, and 6.9, respectively. Growth of S. mutans and S. salivarius in complex media proved to be more acid-sensitive than was glycolysis, and in batch cultures, there was a well-defined, post-growth phase of glycolysis. Minimum pH values for growth and for glycolysis in medium with excess glucose were approximately 4.8 and 4.4, respectively, for S. mutans, and 4.9 and 4.3 for S. salivarius. S. sanguis was less aciduric and showed little differential acid sensitivity, with minimum pH values of about 5.2 for both growth and glycolysis. Fluoride acted to eliminate the differences in acidurance of growth and glycolysis for S. mutans or S. salivarius and to render both processes more acid-sensitive. Thus, glycolysis was more fluoride-sensitive than was growth. Growth was found to be acid-limited in media with initial glucose levels greater than 0.2, 0.3, and 0.5% (weight/volume) for S. sanguis, S. mutans, and S. salivarius, respectively, and to be glucose-limited at lower levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental cariogenic evaluation of foods using human plaque pH and an experimental rat-caries model

Five well-characterized foods were used to compare two systems for estimating the cariogenic potential of food: human plaque-acidity using interdental metallic touch electrodes, and cariogenicity testing in rats. Both systems identified the same food as the least cariogenic or acidogenic food and identified the same three foods as being both cariogenic in rats and acidogenic in man, although the ranking of these foods differed. The systems differed in their assessment of potato chips, a food high in cooked starch and low in free sugars. The results confirmed that non-acidogenic foods are non-cariogenic, but that foods acidogenic in man may exhibit a greater range of cariogenicity in rats. Data from both human plaque pH studies and rat caries models may permit better assessment of cariogenic potential of foods containing fermentable carbohydrates.

Salivary clearance of sugar and its effects on pH changes by Streptococcus mitior in an artificial mouth

We recently developed a computer model of oral sugar clearance (Dawes, 1983), and an artificial mouth has now been constructed which will allow variation in the salivary parameters identified in the model and the study of their effects on bacterial acid production. Using a thin layer of S. mitior, strain 572, over a miniature Sb electrode to measure bacterial pH changes during sugar clearance from the "mouth", we found that three consecutive sets of "Stephan curves" could be obtained with the same bacteria during one day. In each of several experimental series, one salivary parameter was varied, while other parameters were held constant. The maximum pH decrease and the surface area of the registered Stephan curve (delta pH.min) were used as measures of acid production. The results indicate that the volume of "saliva" in the mouth before and after swallowing, the unstimulated salivary flow rate, and the buffer capacity had significant influences on the extent of the pH changes. Other factors, such as the maximum flow rate, the delay between start of stimulation and maximum flow, the volume of saliva in the mouth at time zero, and the taste threshold for sugar, were of lesser importance, confirming some predictions from the computer model.

Growth and acid tolerance of human dental plaque bacteria

Pure cultures of representative strains of cariogenic and non-cariogenic plaque bacteria were assessed for their ability to initiate and maintain growth in broths, adjusted to initial pH levels of 7.0, 5.5 or 5.0, and to produce lactic acid from sucrose or glucose in resting-cell suspensions at pH 6.5, 5.0, 4.5 and 4.0. Streptococcus mutans, Lactobacillus casei and Streptococcus faecalis showed greater acid tolerance than strains of Streptococcus sanguis, Streptococcus salivarius, Streptococcus mitis and Actinomyces viscosus. For all species, growth initiation in broth was more acid sensitive than lactic-acid production in resting-cell suspensions. These data confirm and extend previous observations that the species of plaque bacteria most closely associated with the initiation or progression of dental caries are more aciduric than non-cariogenic species.

In vivo forces on dental implants: hard-wiring and telemetry methods

Methods are presented for measuring vertical force components on bridged titanium dental implants in dog mandibles. These methods have included custom-made strain-gauge transducers, plus hard-wiring and telemetric schemes for data collection. The essential components of the measurement system are described, and typical bite force data are illustrated.

Plaque pH measurements by different methods on the buccal and approximal surfaces of human teeth after a sucrose rinse

Changes in plaque pH after a sucrose rinse were simultaneously monitored by plaque sampling, touching of the plaque with antimony and glass electrodes, and telemetry. The minimum pH at approximal sites was approximately 0.7 pH units lower than that on buccal surfaces. The pH at the approximal site remained below resting levels after 120 min, and the area under the pH response curves from this site was five times greater than that from the buccal surfaces.

The acidogenic potential of reference foods and snacks at interproximal sites in the human dentition

Telemetry was used to evaluate changes in plaque pH at interproximal sites in the dentition of five human subjects following the ingestion of a variety of reference foods and snacks. Short-term telemetry (30 min) revealed that most of the substrates yielded both pH minima and total responses similar to that obtained with a 10% sucrose rinse. Aged Cheddar cheese and skim milk were much less acidogenic than were the other foods.