Genetic and cellular toxicology of dental resin monomers

Risk aspects of dental restoratives: From amalgam to tooth-colored materials

Dental materials’ choice of patients has considerably changed. Whereas cast gold and amalgam have been the predominant biomaterials for decades, today tooth-colored materials like resin-based composites and ceramics are more and more successful. However, are we going to replace a good but biologically questionable material (amalgam) with an equal material (resin composite) being more esthetic but also biologically questionable For amalgam, long-term clinical studies reported some significant hints that in single cases amalgam may be a health hazard for patients, finally Norway banned amalgam completely. The main advantage of a resin-based composite over amalgam is its tooth-like appearance and more or less absence of extensive preparation rules. For many years it was believed that resin-based composites may cause pulpal injury. However, pulpal injury associated with the use of resin-based composites is not correlated with their cytotoxic properties. Nevertheless, resin-based composites and other dental materials require rigorous safety evaluation and continuous monitoring to prevent adverse events similar like with amalgam. Because of non-biocompatible pulp responses to resin-based composites and amalgam, they should not be placed in direct contact with the dental pulp. The less dentin remaining in the floor of preparations between resin-based composites or other dental materials is more likely to cause pulpitis. Percentage of patients and dental practitioners who display allergic reactions is between 0.7% and 2%. The release of cytotoxic monomers from resin-based materials is highest after polymerization and much lower after 1 wk. Substances released from resin-based composites have been shown to be toxic in cytotoxicity tests. Nevertheless, in vitro cytotoxicity assays have shown that amalgam has greater toxic effects than resin-based composites, sometime 100-700-fold higher. Altogether, the risk of side-effects is low, but not zero, especially for dental personnel.

Butein protects human dental pulp cells from hydrogen peroxide-induced oxidative toxicity via Nrf2 pathway-dependent heme oxygenase-1 expressions

Rhus verniciflua Stokes is a plant that is native to East Asian countries, such as Korea, China, and Japan. Butein, a plant polyphenol, is one of the major active components of R. verniciflua. Reactive oxygen species (ROS), produced via dental adhesive bleaching agents and pulpal disease, can cause oxidative stress. Here, we found that butein possesses cytoprotective effects on hydrogen peroxide (H2O2)-induced dental cell death. H2O2 is a representative ROS and causes cell death through necrosis in human dental pulp (HDP) cells. H2O2-induced cytotoxicity and production of ROS were blocked in the presence of butein, and these effects were dose dependent. Butein also increased heme oxygenase-1 (HO-1) protein expression and HO activity. In addition, butein-dependent HO-1 expression was required for the inhibition of H2O2-induced cell death and ROS generation. Furthermore, butein treatment caused nuclear accumulation of nuclear factor-E2-related factor 2 (Nrf2) and increased the promoter activity of antioxidant response elements (AREs). Treatment of HDP cells with a c-Jun NH2-terminal kinase (JNK) inhibitor also reduced butein-induced HO-1 expression, and butein treatment led to increased JNK phosphorylation. These results indicate that butein may be used to prevent functional dental cell death and thus may be useful as a pulpal disease agent.

Photocrosslinked alginate with hyaluronic acid hydrogels as vehicles for mesenchymal stem cell encapsulation and chondrogenesis

Ionic crosslinking of alginate via divalent cations allows for high viability of an encapsulated cell population, and is an effective biomaterial for supporting a spherical chondrocyte morphology. However, such crosslinking chemistry does not allow for injectable and stable hydrogels which are more appropriate for clinical applications. In this study, the addition of methacrylate groups to the alginate polymer chains was utilized so as to allow the free radical polymerization initiated by a photoinitiator during UV light exposure. This approach establishes covalent crosslinks between methacrylate groups instead of the ionic crosslinks formed by the calcium in unmodified alginate. Although this approach has been well described in the literature, there are currently no reports of stem cell differentiation and subsequent chondrocyte gene expression profiles in photocrosslinked alginate. In this study, we demonstrate the utility of photocrosslinked alginate hydrogels containing interpenetrating hyaluronic acid chains to support stem cell chondrogenesis. We report high cell viability and no statistical difference in metabolic activity between mesenchymal stem cells cultured in calcium crosslinked alginate and photocrosslinked alginate for up to 10 days of culture. Furthermore, chondrogenic gene markers are expressed throughout the study, and indicate robust differentiation up to the day 14 time point. At early time points, days 1 and 7, the addition of hyaluronic acid to the photocrosslinked scaffolds upregulates gene markers for both the chondrocyte and the superficial zone chondrocyte phenotype. Taken together, we show that photocrosslinked, injectable alginate shows significant potential as a delivery mechanism for cell-based cartilage repair therapies.

2-Hydroxyethyl methacrylate inflammatory effects in human gingival fibroblasts

AIM

To investigate the inflammatory response in human gingival fibroblasts (HGFs) treated with a relatively low 2-hydroxyethyl methacrylate (HEMA) concentration by studying reactive oxygen species (ROS) production, cyclooxygenase-2 (COX-2) and tumour necrosis factor-alpha (TNF-α) gene expression, and prostaglandin E2 (PGE₂) release.

METHODOLOGY

Cultured HGFs were exposed to 3 mmol L⁻¹ HEMA for 0, 24 or 96 h. ROS production was investigated by flow cytometry; TNF-α and COX-2 gene expression was determined by RT-PCR, and prostaglandin E2 production was detected by an enzyme immunoassay.

RESULTS

After 24- or 96-h HEMA incubation, ROS levels were approximately eightfold and elevenfold higher than controls, whilst COX-2 gene expression was approximately twofold or fourfold higher than controls, respectively. Twenty-four-hour exposure enhanced TNF-α mRNA levels by approximately 66%, whilst after 96-h incubation, TNF-α gene expression was fivefold higher than controls. Ninety-six-hour HEMA treatment increased PGE₂ concentration in the culture medium by around 17% compared with controls.

CONCLUSIONS

2-Hydroxyethyl methacrylate treatment (3 mmol L⁻¹) induced an inflammatory response in HGFs modulated by ROS production, as well as by the increase in TNF-α and COX-2 gene expression and by PGE₂ release.

Dental composite restorations and neuropsychological development in children: treatment level analysis from a randomized clinical trial

BACKGROUND

Resin-based dental restorations may intra-orally release their components and bisphenol A. Gestational bisphenol A exposure has been associated with poorer executive functioning in children.

OBJECTIVES

To examine whether exposure to resin-based composite restorations is associated with neuropsychological development in children.

METHODS

Secondary analysis of treatment level data from the New England Children's Amalgam Trial, a 2-group randomized safety trial conducted from 1997 to 2006. Children (N=534) aged 6-10 y with ≥2 posterior tooth caries were randomized to treatment with amalgam or resin-based composites (bisphenol-A-diglycidyl-dimethacrylate-composite for permanent teeth; urethane dimethacrylate-based polyacid-modified compomer for primary teeth). Neuropsychological function at 4- and 5-year follow-up (N=444) was measured by a battery of tests of executive function, intelligence, memory, visual-spatial skills, verbal fluency, and problem-solving. Multivariable generalized linear regression models were used to examine the association between composite exposure levels and changes in neuropsychological test scores from baseline to follow-up. For comparison, data on children randomized to amalgam treatment were similarly analyzed.

RESULTS

With greater exposure to either dental composite material, results were generally consistent in the direction of slightly poorer changes in tests of intelligence, achievement or memory, but there were no statistically significant associations. For the four primary measures of executive function, scores were slightly worse with greater total composite exposure, but statistically significant only for the test of Letter Fluency (10-surface-years β=-0.8, SE=0.4, P=0.035), and the subtest of color naming (β=-1.5, SE=0.5, P=0.004) in the Stroop Color-Word Interference Test. Multivariate analysis of variance confirmed that the negative associations between composite level and executive function were not statistically significant (MANOVA, P=0.18). Results for greater amalgam exposure were mostly nonsignificant in the opposite direction of slightly improved scores over follow-up.

CONCLUSIONS

Dental composite restorations had statistically insignificant associations of small magnitude with impairments in neuropsychological test change scores over 4- or 5-years of follow-up in this trial.

Dental composite restorations and psychosocial function in children

BACKGROUND AND OBJECTIVE

Resin-based dental materials may intraorally release their chemical components and bisphenol A. The New England Children's Amalgam Trial found that children randomized to amalgam had better psychosocial outcomes than those assigned to composites for posterior tooth restorations. The objective of this study was to examine whether greater exposure to dental composites is associated with psychosocial problems in children.

METHODS

Analysis of treatment-level data from the New England Children's Amalgam Trial, a 2-group randomized safety trial comparing amalgam with the treatment plan of bisphenol A-glycidyl methacrylate (bisGMA)-based composite and urethane dimethacrylate-based polyacid-modified composite (compomer), among 534 children aged 6 to 10 years at baseline. Psychosocial function at follow-up (n = 434) was measured by using the self-reported Behavior Assessment System for Children (BASC-SR) and parent-reported Child Behavior Checklist (CBCL).

RESULTS

Children with higher cumulative exposure to bisGMA-based composite had poorer follow-up scores on 3 of 4 BASC-SR global scales: Emotional Symptoms (β = 0.8, SE = 0.3, P = .003), Clinical Maladjustment (β = 0.7, SE = 0.3, P = .02), and Personal Adjustment (β = -0.8, SE = 0.2, P = .002). Associations were stronger with posterior-occlusal (chewing) surfaces, where degradation of composite was more likely. For CBCL change, associations were not statistically significant. At-risk or clinically significant scores were more common among children with greater exposure for CBCL Total Problem Behaviors (16.3% vs 11.2%, P-trend = .01) and numerous BASC-SR syndromes (eg, ≥ 13 vs 0 surface-years, Interpersonal Relations 13.7% vs 4.8%, P-trend = .01). No associations were found with compomer, nor with amalgam exposure levels among children randomized to amalgam.

CONCLUSIONS

Greater exposure to bisGMA-based dental composite restorations was associated with impaired psychosocial function in children, whereas no adverse psychosocial outcomes were observed with greater urethane dimethacrylate-based compomer or amalgam treatment levels.

Melatonin and oral cavity

While initially the oral cavity was considered to be mainly a source of various bacteria, their toxins and antigens, recent studies showed that it may also be a location of oxidative stress and periodontal inflammation. Accordingly, this paper focuses on the involvement of melatonin in oxidative stress diseases of oral cavity as well as on potential therapeutic implications of melatonin in dental disorders. Melatonin has immunomodulatory and antioxidant activities, stimulates the proliferation of collagen and osseous tissue, and acts as a protector against cellular degeneration associated with aging and toxin exposure. Arising out of its antioxidant actions, melatonin protects against inflammatory processes and cellular damage caused by the toxic derivates of oxygen. As a result of these actions, melatonin may be useful as a coadjuvant in the treatment of certain conditions of the oral cavity. However, the most important effect of melatonin seems to result from its potent antioxidant, immunomodulatory, protective, and anticancer properties. Thus, melatonin could be used therapeutically for instance, locally, in the oral cavity damage of mechanical, bacterial, fungal, or viral origin, in postsurgical wounds caused by tooth extractions and other oral surgeries. Additionally, it can help bone formation in various autoimmunological disorders such as Sjorgen syndrome, in periodontal diseases, in toxic effects of dental materials, in dental implants, and in oral cancers.

Effects of ethanol and dimethyl sulfoxide on solubility and cytotoxicity of the resin monomer triethylene glycol dimethacrylate

Several in vitro studies have reported contrasting values for triethylene glycol-dimethacrylate (TEGDMA) concentrations shown to induce cytotoxic effects. The aim of this study was to evaluate the effective concentrations of TEGDMA reached under the routine experimental conditions used in biocompatibility in vitro tests and determines changes in cytotoxicity and the associated production of reactive oxygen species (ROS) based on different TEGDMA solutions. TEGDMA was added to cell culture medium either directly or previously dissolved in dimethyl sulfoxide (DMSO) or ethanol (EtOH), both in the presence and absence of cells. Intracellular and extracellular TEGDMA concentrations were determined by high performance liquid chromatography (HPLC). The cytotoxicity effects of TEGDMA preparations were determined in 3T3-fibroblasts by 3-(4,5 dimethyiazol-2-1)-2-5-diphenyl tetrazolium bromide assay. The production of ROS was measured by flow cytometry. In the absence of cells the effective final TEGDMA concentrations obtained in Dulbecco's Modified Eagle Medium were significantly lower than the nominal one. When 2 mmol/L TEGDMA was first solubilized in DMSO or EtOH, a significant decrease in cell viability, and an increase in ROS production-compared to pure TEGDMA-was observed. After 2 h of incubation, TEGDMA previously dissolved in DMSO or ETOH was reduced by 15% and 20%, respectively, whereas otherwise it remained unaffected. Our results demonstrate that the effective concentration of TEGDMA dissolved in culture medium (in the presence or absence of solvents) does not concur with the nominal one. Therefore, the presence of the utilized solvents does not substantially alter the monomer solubility but eases its entrance into the cells thus improving its cytotoxic potency.

Direct cell encapsulation in biodegradable and functionalizable carboxybetaine hydrogels

Hydrogels provide three-dimensional (3D) frames with tissue-like elasticity and high water content for tissue scaffolds. They were commonly prepared from macromers such as poly(ethylene glycol) diacrylate (PEGDA) via free radical polymerization and used to encapsulate cells. Here, we report the direct encapsulation of cells into hydrogels using a low-toxic and water-soluble monomer, carboxybetaine methacrylate (CBMA), via redox polymerization. A disulfide-containing crosslinker was added to form a biodegradable carboxybetaine (CB) hydrogel, which can be self-degraded as cells grow or degraded in an accelerating way via adding of a cysteine-contained medium NIH-3T3 cells encapsulated in the CB hydrogel formed spherical aggregates that were recovered from hydrogel erosion. Furthermore, an RGD-containing peptide was also added to improve cell adhesion on the two-dimensional (2D) hydrogel surface and promote cell proliferation in the 3D hydrogel. The non-cytotoxic and biodegradable CB hydrogel with additional cell-adhesion moieties provides an excellent 3D environment for cell growth as tissue scaffolds.

Predicting clinical biological responses to dental materials

OBJECTIVES

Methods used to measure and predict clinical biological responses to dental materials remain controversial, confusing, and to some extent, unsuccessful. The current paper reviews significant issues surrounding how we assess the biological safety of materials, with a historical summary and critical look at the biocompatibility literature. The review frames these issues from a U.S. perspective to some degree, but emphasizes their global nature and universal importance.

METHODS

The PubMed database and information from the U.S. Food and Drug Administration, International Standards Organization, and American National Standards Institute were searched for prominent literature addressing the definition of biocompatibility, types of biological tests employed, regulatory and standardization issues, and how biological tests are used together to establish the biological safety of materials. The search encompassed articles published in English from approximately 1965-2011. The review does not comprehensively review the literature, but highlights significant issues that confront the field.

RESULTS

Years ago, tests for biological safety sought to establish material inertness as the measure of safety, a criterion that is now deemed naive; the definition of biocompatibility has broadened along with the roles for materials in patient oral health care. Controversies persist about how in vitro or animal tests should be used to evaluate the biological safety of materials for clinical use. Controlled clinical trials remain the single best measure of the clinical response to materials, but even these tests have significant limitations and are less useful to identify mechanisms that shape material performance. Practice-based research networks and practitioner databases are emerging as important supplements to controlled clinical trials, but their final utility remains to be determined.

SIGNIFICANCE

Today we ask materials to play increasingly sophisticated structural and therapeutic roles in patient treatment. To accommodate these roles, strategies to assess, predict, and monitor material safety need to evolve. This evolution will be driven not only by researchers and manufacturers, but also by patients and practitioners, who want to use novel materials in new ways to treat oral disease.

Carboxylesterase expression in human dental pulp cells: role in regulation of BisGMA-induced prostanoid production and cytotoxicity

Biocompatibility of dentin bonding agents (DBA) and composite resin may affect the treatment outcome (e.g., healthy pulp, pulpal inflammation, pulp necrosis) after operative restoration. Bisphenol-glycidyl methacrylate (BisGMA) is one of the major monomers present in DBA and resin. Prior studies focused on salivary esterase for metabolism and degradation of resin monomers clinically. This study found that human dental pulp cells expressed mainly carboxylesterase-2 (CES2) and smaller amounts of CES1A1 and CES3 isoforms. Exposure to BisGMA stimulated CES isoforms expression of pulp cells, and this event was inhibited by catalase. Exogenous addition of porcine esterase prevented BisGMA- and DBA-induced cytotoxicity. Interestingly, inhibition of CES by bis(p-nitrophenyl) phosphate (BNPP) and CES2 by loperamide enhanced the cytotoxicity of BisGMA and DBA. Addition of porcine esterase or N-acetyl-l-cysteine prevented BisGMA-induced prostaglandin E(2) (PGE(2)) and PGF(2α) production. In contrast, addition of BNPP and loperamide, but not mevastatin, enhanced BisGMA-induced PGE(2) and PGF(2α) production in dental pulp cells. These results suggest that BisGMA may induce the cytotoxicity and prostanoid production of pulp cells, leading to pulpal inflammation or necrosis via reactive oxygen species production. Expression of CES, especially CES2, in dental pulp cells can be an adaptive response to protect dental pulp against BisGMA-induced cytotoxicity and prostanoid release. Resin monomers are the main toxic components in DBA, and the ester group is crucial for monomer toxicity.

Dental methacrylates may exert genotoxic effects via the oxidative induction of DNA double strand breaks and the inhibition of their repair

Methacrylate monomers used in dentistry have been shown to induce DNA double strand breaks (DSBs), one of the most serious DNA damage. In the present work we show that a model dental adhesive consisting of 45% 2-hydroxyethyl methacrylate (HEMA) and 55% bisphenol A-diglycidyl dimethacrylate (Bis-GMA) at concentrations up to 0.25 mM Bis-GMA induced oxidative DNA in cultured primary human gingival fibroblasts (HGFs) as evaluated by the comet assay and probed with human 8-hydroxyguanine DNA-glycosylase 1. HEMA/Bis-GMA induced DSBs in HGFs as assessed by the neutral comet assay and phosphorylation of the H2AX histone and sodium ascorbate or melatonin (5-methoxy-N-acetyltryptamine) both at 50 μM reduced the DSBs, they also inhibited apoptosis induced by HEMA/Bis-GMA. The adhesive slowed the kinetics of the repair of DNA damage induced by hydrogen peroxide in HGFs, while sodium ascorbate or melatonin improved the efficacy of H₂O₂-induced damage in the presence of the methacrylates. The adhesive induced a rise in the G2/M cell population, accompanied by a reduction in the S cell population and an increase in G0/G1 cell population. Sodium ascorbate or melatonin elevated the S population and reduced the G2/M population. In conclusion, HEMA/Bis-GMA induce DSBs through, at least in part, oxidative mechanisms, and these compounds may interfere with DSBs repair. Vitamin C or melatonin may reduce the detrimental effects induced by methacrylates applied in dentistry.

Mechanisms of action of (meth)acrylates in hemolytic activity, in vivo toxicity and dipalmitoylphosphatidylcholine (DPPC) liposomes determined using NMR spectroscopy

We investigated the quantitative structure-activity relationships between hemolytic activity (log 1/H(50)) or in vivo mouse intraperitoneal (ip) LD(50) using reported data for α,β-unsaturated carbonyl compounds such as (meth)acrylate monomers and their (13)C-NMR β-carbon chemical shift (δ). The log 1/H(50) value for methacrylates was linearly correlated with the δC(β) value. That for (meth)acrylates was linearly correlated with log P, an index of lipophilicity. The ipLD(50) for (meth)acrylates was linearly correlated with δC(β) but not with log P. For (meth)acrylates, the δC(β) value, which is dependent on the π-electron density on the β-carbon, was linearly correlated with PM3-based theoretical parameters (chemical hardness, η; electronegativity, χ; electrophilicity, ω), whereas log P was linearly correlated with heat of formation (HF). Also, the interaction between (meth)acrylates and DPPC liposomes in cell membrane molecular models was investigated using (1)H-NMR spectroscopy and differential scanning calorimetry (DSC). The log 1/H(50) value was related to the difference in chemical shift (ΔδHa) (Ha: H (trans) attached to the β-carbon) between the free monomer and the DPPC liposome-bound monomer. Monomer-induced DSC phase transition properties were related to HF for monomers. NMR chemical shifts may represent a valuable parameter for investigating the biological mechanisms of action of (meth)acrylates.

Anti-adhesive and pro-apoptotic effects of 2-hydroxyethyl methacrylate on human gingival fibroblasts co-cultured with Streptococcus mitis strains

AIM

To evaluate and observe the cellular reactions that occur during the interaction/integration between 2-hydroxyethyl methacrylate/host tissue/microbial environment, in a co-culture of human gingival fibroblasts (HGF) and Streptococcus mitis strains.

METHODOLOGY

Streptococcus mitis were cultured with strains in the presence of 3 mmol L(-1) HEMA for 48 h and 72 h. Cytotoxicity was evaluated by the trypan blue dye exclusion test. Apoptosis was evaluated by TUNEL analysis. Adhesion was evaluated by immunofluorescence and western blot analyses. Quantitative analyses of the results were acquired by Qwin Plus 3.5 and QuantityOne I-D analysis software, respectively. The statistical significance of the results was evaluated using t-tests and linear regression tests.

RESULTS

The trypan blue dye test revealed 47.3% and 46.5% of dead fibroblasts after 48 and 72 h HEMA treatment, respectively, while bacterial viability was not influenced by the presence of HEMA and fibroblasts. The expression of pro-collagen I, involved in fibroblast adhesion, in untreated samples ranged from 12.49% to 6.91% of the positive area after 48 and 72 h, respectively, dropping to below 2% of the positive area in the other experimental conditions. Unlike the trypan blue test, co-cultured samples treated with HEMA showed 20% and 25% versus 17% and 21% (after 48 and 72 h, respectively) of apoptotic cells.

CONCLUSIONS

The evidence for HEMA toxicity and anti-adhesive effects against eukaryotic cells was reduced in the presence of bacteria, suggesting that dental resins should be well polymerized to avoid the spread of toxic monomers within the mouth.

Apoptosis and survivability of human dental pulp cells under exposure to Bis-GMA

Objective

In the present study, we examined whether 2, 2-bis [4-(2-hydroxy-3methacryloxypropoxy) phenyl] propane (Bis-GMA) has effects on LSC2 cells, human dental pulp cell line.

Material and Methods

The viability, cell cycle, and morphology of LSC2 cells were analyzed after exposure to several different concentrations of Bis-GMA. The recovery of viability of Bis-GMA exposed cells was also analyzed in the condition without Bis-GMA. Further, penetration of Bis-GMA to dentin disc was examined using isocratic high-performance liquid chromatography.

Results

There was a concentration-dependent decrease in cell proliferation and an increase in cell number in the sub-G1 population after exposure to Bis-GMA. Furthermore, the cells showed typical characteristics of apoptotic cells after the exposure to high concentration of Bis-GMA. In contrast, cells exposed to lower concentrations of Bis-GMA recovered their viability after being cultured without Bis-GMA. We also found that Bis-GMA is capable of penetrating 1-mm-thick dentin discs, though the penetrated concentration was lower than that showing cytotoxicity.

Conclusion

These results suggest that Bis-GMA has cytotoxic effects, though dental pulp exposed to lower concentrations is able to recover their viability when Bis-GMA is removed.

Protective effect of chitosan oligosaccharide lactate against DNA double-strand breaks induced by a model methacrylate dental adhesive

Background

Monomers of methacrylates used in restorative dentistry have been recently reported to induce DNA double-strand breaks (DSBs) in human gingival fibroblasts (HGFs) in vitro. Because such monomers may penetrate the pulp and oral cavity due to the incompleteness of polymerization and polymer degradation, they may induce a similar effect in vivo. DSBs are the most serious type of DNA damage and if misrepaired or not repaired may lead to mutation, cancer transformation and cell death. Therefore, the protection against DSBs induced by methacrylate monomers released from dental restorations is imperative.

Material/Methods

We examined the protective action of chitosan oligosaccharide lactate (ChOL) against cytotoxic and genotoxic effects induced by monomers of the model adhesive consisting of 55% bisphenol A-diglycidyl dimethacrylate (Bis-GMA) and 45% 2-hydroxyethyl methacrylate (HEMA). We evaluated the extent of DSBs by the neutral comet assay and the phosphorylation of the H2AX histone test.

Results

ChOL increased the viability of HGFs exposed to Bis-GMA/HEMA as assessed by flow cytometry. ChOL decreased the extent of DSBs induced by Bis-GMA/HEMA as evaluated by neutral comet assay and phosphorylation of the H2AX histone. ChOL did not change mechanical properties of the model adhesive, as checked by the shear bond test. Scanning electron microscopy revealed a better sealing of the dentinal microtubules in the presence of ChOL, which may protect pulp cells against the harmful action of the monomers.

Conclusions

ChOL can be considered as an additive to methacrylate-based dental materials to prevent DSBs induction, but further studies are needed on its formulation with the methacrylates.

Decision-making and treatment with respect to surgical intervention in the context of a European Core Curriculum in Cariology

This paper is part of a series of papers towards a European Core Curriculum in Cariology for undergraduate dental students. The European Core Curriculum in Cariology is the outcome of a process starting in 2006 and culminating in a joint workshop of the European Organisation for Caries Research (ORCA) together with the Association for Dental Education in Europe (ADEE) which was held in Berlin from 27 to 30 June 2010. The present paper covers decision-making and treatment with respect to surgical intervention. In particular, it will provide some background information on this part of the European Core Curriculum. Undergraduate dental education should enable the student to become a competent, skilful and caring dentist who is able, upon graduation, to take professional responsibility for diagnosis, as well as effective safe, and long-lasting care in the best interests of the patient. With respect to decision-making around surgical intervention for dental caries, several factors have to be considered. These include, patient needs, preventive strategies, tooth preservation, caries management success and failure rates, as well as short-term and long-term treatment costs. With respect to surgical intervention, manual skills at a high level are required. This is of crucial importance for the graduating dentist allowed to practise dentistry in many EU countries.

The cytotoxicity of methacryloxylethyl cetyl ammonium chloride, a cationic antibacterial monomer, is related to oxidative stress and the intrinsic mitochondrial apoptotic pathway

Antibacterial monomers incorporated in dentin bonding systems may have toxic effects on the pulp. Thus, the cytotoxicity of antibacterial monomers and its underlying mechanisms must be elucidated to improve the safety of antibacterial monomer application. The influence of an antibacterial monomer, methacryloxylethyl cetyl ammonium chloride (DMAE-CB), on the vitality of L929 mouse fibroblasts was tested using MTT assay. Cell cycle progression was studied using flow cytometry. Production of intracellular reactive oxygen species (ROS) after DMAE-CB treatment was measured using 2,7-dichlorodihydrofluorescein diacetate staining and flow cytometry analysis. Loss of mitochondrial membrane potential, disturbance of Bcl-2 and Bax expression, as well as release of cytochrome C were also measured using flow cytometry analysis or Western blot to explore the possible involvement of the mitochondrial-related apoptotic pathway. DMAE-CB elicited cell death in a dose-dependent manner and more than 50% of cells were killed after treatment with 30 µM of the monomer. Both necrosis and apoptosis were observed. DMAE-CB also induced G1- and G2-phase arrest. Increased levels of intracellular ROS were observed after 1 h and this overproduction was further enhanced by 6-h treatment with the monomer. DMAE-CB may cause apoptosis by disturbing the expression of Bcl-2 and Bax, reducing the mitochondrial potential and inducing release of cytochrome C. Taken together, these findings suggest that the toxicity of the antibacterial monomer DMAE-CB is associated with ROS production, mitochondrial dysfunction, cell cycle disturbance, and cell apoptosis/necrosis.

N-acetyl cysteine protects osteoblastic function from oxidative stress

We tested the protective potential of an antioxidant amino acid derivative, N-acetyl cysteine (NAC), in controlling oxidative stress against osteoblasts. Osteoblastic cells extracted from rat bone marrow were cultured. Oxidative stress was induced by adding 100 μM H₂O₂ into the culture media. Then, some H₂O₂-treated cultures were cotreated with 2.5 or 5 mM NAC. Addition of H₂O₂ decreased the number of cells to 50% of untreated cultures at days 2. Addition of 5 mM NAC into H₂O₂ cultures resulted in a dose-dependent increase in the number of cells, with the cell number being 50% greater than that in the 100 μM H₂O₂ culture. The gene expression levels of type I collagen, osteopontin, and osteocalcin were downregulated threefold by H₂O₂ on day 7. The H₂O₂-suppressed gene expression was fully recovered by NAC cotreatment. The mineralizing capability, assessed by Von Kossa staining on day 15, were approximately 1.8 times greater in the NAC + H₂O₂ cotreated group than in the culture with H₂O₂ alone. These NAC-mediated restorations were associated with an NAC dose-dependent increase of intracellular glutathione and a NAC dose-dependent decrease of intracellular reactive oxygen species. In conclusion, oxidative stress induced by H₂O₂ substantially impairs the proliferation, differentiation, and mineralization of osteoblasts. More importantly, the addition of NAC into the culture was found to restore these damages to a near normal level due to the improved redox balance, warranting further in vivo studies to test its therapeutic potential as a local antioxidative stress drug.

Perspectives on the use of melatonin to reduce cytotoxic and genotoxic effects of methacrylate-based dental materials

Melatonin (5-methoxy-N-acetyltryptamine), an indoleamine produced in the pineal gland and many other organs, displays a wide spectrum of protective effects against cell injury of various origins. Contemporary dental restorative materials mainly consist of methacrylate polymers with some additives. However, because of the incompleteness of polymerization process in situ as well as mechanical shearing and enzymatic degradation, methacrylate monomers are released from the restoration into the oral cavity and the pulp, from where they gain access to other tissues and organs. Such monomers have displayed toxic properties in many in vivo and in vitro studies, including cytotoxicity and genotoxicity and a considerable portion of these effects is underlined by the oxidative action of these compounds. As melatonin shows biocompatibility with the oral cavity and displays antioxidative properties, it may be considered as a protective agent against harmful effects of methacrylate monomers derived from dental restorations. Melatonin decreases cytotoxic and genotoxic effects of methacrylate monomers used in dentistry, and it does not influence the bond strength of dental composites. This opens a new possible application of melatonin to improve properties of biomaterials used in dentistry.

Toll-like Receptors, LPS, and Dental Monomers

Unreacted monomers released from dental resin-based composites at non-cytotoxic concentrations cause a depletion of glutathione and an increase of reactive oxygen species (ROS), leading to, e.g., DNA damage and apoptosis. ROS-sensitive MAP-kinases are activated by HEMA and TEGDMA. MAP-kinases are also involved in the bacteria-triggered cell responses of the innate immune system, e.g., after bacterial lipopolysaccharide (LPS) binding to the Toll-like receptor (TLR) 4. Therefore, both bacteria and monomers imply environmental stress to pulp tissue, and they may influence the target cell reactions in a combined way. In macrophages, cell-surface antigens and cytokines were up-regulated after exposure to LPS, but TEGDMA caused a significant down-regulation. Regulation was dependent on exposure time, indicating that LPS and TEGDMA act differently on MAP-kinases. Furthermore, the cell type played a decisive role. Inhibition of the immune response may result in a decrease in inflammatory symptoms and/or a reduced defense capacity against bacteria.

Effect of N-acetyl cysteine on orthodontic primers cytotoxicity

OBJECTIVES

The aims of this study were to evaluate the cytotoxicity of four orthodontic primers, including two hydrophilic and two hydrophobic materials, and to investigate the role of the reactive oxygen species (ROS) in induced cell damage. Moreover, the effects of the anti-oxidant N-acetyl cysteine (NAC) on primers toxicity was analyzed.

METHODS

Human gingival fibroblasts (HGF) were exposed to different concentrations of primers (0-0.25 mg/ml) in the presence or absence of NAC, and the cytotoxicity was assessed by the MTT assay, while cell death was quantified by flow cytometry after propidium iodide staining. The increase in the induced ROS levels was detected by flow cytometry measuring the fluorescence of the oxidation-sensitive dye 2',7'-dichlorofluorescein diacetate (DCFH-DA).

RESULTS

All materials decreased cell viability in a dose-related manner after a 24 h exposure period. Cytotoxicity of orthodontic primers based on concentrations which caused a 50% decrease in cell viability (TC₅₀) in HGF was ranked as follows (median values): Eagle Fluorsure (0.078 mg/ml)>Transbond XT (0.081 mg/ml)>Transbond MIP (0.128 mg/ml)>Ortho solo (0.130 mg/ml). Moreover, in HGF cells, all materials induced a dose-dependent increase in ROS levels compared to untreated cells. Incubation of HGF with NAC significantly reduced ROS production and decreased the cell damage and cytotoxicity caused by all materials tested (p<0.001).

SIGNIFICANCE

Our results suggested that hydrophilic primers were less cytotoxic than hydrophobic materials. Moreover, we demonstrated a major role of ROS in the induction of cell death since the antioxidant N-acetyl cysteine was able to prevent cell damage induced by all materials tested.

Translationally controlled tumor protein against apoptosis from 2-hydroxy-ethyl methacrylate in human dental pulp cells

2-Hydroxy-ethyl methacrylate (HEMA) is a major monomer released from resin-base dental restorative materials. HEMA is cytotoxic to pulp cells and leads to apoptosis. This study examined the effect of Translationally Controlled Tumor Protein (TCTP) against apoptosis from HEMA. TCTP from banana prawn (Penaeus merguiensis) was cloned and the protein was purified. It significantly increased the number of viable of HEMA-treated cells compared to HEMA-treated cells alone. Flow cytometry indicated the addition of TCTP at 10 μg/ml to 8 and 10 mM HEMA decreased the apoptotic cells from 20 to 10%. The proliferative property and anti-apoptotic activity against HEMA was concentration dependent. It was interesting that the added TCTP was not detected inside the cells and the native human TCTP was decreased after treated with HEMA and TCTP (20 μg/ml) + HEMA(10 mM) for 24 h. These results provided preliminary information, which may contribute to the development of less toxic dental materials.