Chemotherapeutic effect of zinc on streptococcus mutans and rat dental caries

A Combination of Zinc and Arginine Disrupt the Mechanical Integrity of Dental Biofilms

Mechanical cleaning remains the standard of care for maintaining oral hygiene. However, mechanical cleaning is often augmented with active therapeutics that further promote oral health. A dentifrice, consisting of the "Dual Zinc plus Arginine" (DZA) technology, was found to be effective at controlling bacteria using in vitro laboratory studies, translating to clinical efficacy to deliver plaque and gingivitis reduction benefits. Here, we used biophysical analyses and confocal laser scanning microscopy to understand how a DZA dentifrice impacted the mechanical properties of dental plaque biofilms and determine if changes to biofilm rheology enhanced the removal of dental plaque. Using both uniaxial mechanical indentation and an adapted rotating-disc rheometry assay, it was found that DZA treatment compromised biofilm mechanical integrity, resulting in the biofilm being more susceptible to removal by shear forces compared to treatment with either arginine or zinc alone. Confocal laser scanning microscopy revealed that DZA treatment reduced the amount of extracellular polymeric slime within the biofilm, likely accounting for the reduced mechanical properties. We propose a model where arginine facilitates the entry of zinc into the biofilm, resulting in additive effects of the two activities toward dental plaque biofilms. Together, our results support the use of a dentifrice containing Dual Zinc plus Arginine as part of daily oral hygiene regimens. IMPORTANCE Mechanical removal of dental plaque is augmented with therapeutic compounds to promote oral health. A dentifrice containing the ingredients zinc and arginine has shown efficacy at reducing dental plaque both in vitro and in vivo. However, how these active compounds interact together to facilitate dental plaque removal is unclear. Here, we used a combination of biophysical analyses and microscopy to demonstrate that combined treatment with zinc and arginine targets the matrix of dental plaque biofilms, which destabilized the mechanical integrity of these microbial communities, making them more susceptible to removal by shear forces.

A mouthwash formulated with o-cymen-5-ol and zinc chloride specifically targets potential pathogens without impairing the native oral microbiome in healthy individuals

Background

Many antimicrobial compounds in mouthwashes can have a negative impact on the oral microbiome. O-cymen-5-ol, a compound derived from a phytochemical, has a targeted mode of action and is being used as an alternative. However, its effect on the native oral microbiome is unknown.

Aim

To assess the effect of a mouthwash formulated with o-cymen-5-ol and zinc chloride on the oral microbiome of healthy individuals.

Methods

A mouthwash formulated with o-cymen-5-ol and zinc chloride was administered to a cohort of 51 volunteers for 14 days, while another cohort of 49 volunteers received a placebo. The evolution of the oral microbiome in both groups was analysed using a metataxonomic approach.

Results

Analysis of the oral microbiome showed that the mouthwash selectively targeted potential oral pathogens while maintaining the integrity of the rest of the microbiome. Specifically, the relative abundance of several potentially pathogenic bacterial taxa, namely Fusobacteriota, Prevotella, Actinomyces, Granulicatella, Abiotrophia, Lautropia, Lachnoanaerobaculum, Eubacterium (nodatum group) and Absconditabacteriales (SR1) decreased, while the growth of Rothia, a nitrate-reducing bacterium beneficial for blood pressure, was stimulated.

Conclusions

The use of o-cymen-5-ol and zinc chloride as antimicrobial agents in oral mouthwashes is a valuable alternative to classical antimicrobial agents.

ZccE is a Novel P-type ATPase That Protects Streptococcus mutans Against Zinc Intoxication

Zinc is a trace metal that is essential to all forms of life, but that becomes toxic at high concentrations. Because it has both antimicrobial and anti-inflammatory properties and low toxicity to mammalian cells, zinc has been used as a therapeutic agent for centuries to treat a variety of infectious and non-infectious conditions. While the usefulness of zinc-based therapies in caries prevention is controversial, zinc is incorporated into toothpaste and mouthwash formulations to prevent gingivitis and halitosis. Despite this widespread use of zinc in oral healthcare, the mechanisms that allow Streptococcus mutans, a keystone pathogen in dental caries and prevalent etiological agent of infective endocarditis, to overcome zinc toxicity are largely unknown. Here, we discovered that S. mutans is inherently more tolerant to high zinc stress than all other species of streptococci tested, including commensal streptococci associated with oral health. Using a transcriptome approach, we uncovered several potential strategies utilized by S. mutans to overcome zinc toxicity. Among them, we identified a previously uncharacterized P-type ATPase transporter and cognate transcriptional regulator, which we named ZccE and ZccR respectively, as responsible for the remarkable high zinc tolerance of S. mutans. In addition to zinc, we found that ZccE, which was found to be unique to S. mutans strains, mediates tolerance to at least three additional metal ions, namely cadmium, cobalt, and copper. Loss of the ability to maintain zinc homeostasis when exposed to high zinc stress severely disturbed zinc:manganese ratios, leading to heightened peroxide sensitivity that was alleviated by manganese supplementation. Finally, we showed that the ability of the ΔzccE strain to stably colonize the rat tooth surface after topical zinc treatment was significantly impaired, providing proof of concept that ZccE and ZccR are suitable targets for the development of antimicrobial therapies specifically tailored to kill S. mutans.

Dental caries is an overlooked infectious disease affecting more than 50% of the adult population. While several bacteria that reside in dental plaque have been associated with caries development and progression, Streptococcus mutans is deemed a keystone caries pathogen due to its capacity to modify the dental plaque environment in a way that is conducive with disease development. Zinc is an essential trace metal to life but toxic when encountered at high concentrations, to the point that it has been used as an antimicrobial for centuries. Despite the widespread use of zinc in oral healthcare products, little is known about the mechanisms utilized by oral bacteria to overcome its toxic effects. In this study, we discovered that S. mutans can tolerate exposure to much higher levels of zinc than closely related streptococcal species, including species that antagonize S. mutans and are associated with oral health. In this study, we identified a new metal transporter, named ZccE, as directly responsible for the inherently high zinc tolerance of S. mutans. Because ZccE is not present in other bacteria, our findings provide a new target for the development of a zinc-based therapy specifically tailored to kill S. mutans.

Zinc import mediated by AdcABC is critical for colonization of the dental biofilm by Streptococcus mutans in an animal model

Trace metals are essential to all domains of life but toxic when found at high concentrations. Although the importance of iron in host-pathogen interactions is firmly established, contemporary studies indicate that other trace metals, including manganese and zinc, are also critical to the infectious process. In this study, we sought to identify and characterize the zinc uptake system(s) of Streptococcus mutans, a keystone pathogen in dental caries and a causative agent of bacterial endocarditis. Different than other pathogenic bacteria, including several streptococci, that encode multiple zinc import systems, bioinformatic analysis indicated that the S. mutans core genome encodes a single, highly conserved, zinc importer commonly known as AdcABC. Inactivation of the genes coding for the metal-binding AdcA (ΔadcA) or both AdcC ATPase and AdcB permease (ΔadcCB) severely impaired the ability of S. mutans to grow under zinc-depleted conditions. Intracellular metal quantifications revealed that both mutants accumulated less zinc when grown in the presence of a subinhibitory concentration of a zinc-specific chelator. Notably, the ΔadcCB strain displayed a severe colonization defect in a rat oral infection model. Both Δadc strains were hypersensitive to high concentrations of manganese, showed reduced peroxide tolerance, and formed less biofilm in sucrose-containing media when cultivated in the presence of the lowest amount of zinc that support their growth, but not when zinc was supplied in excess. Collectively, this study identifies AdcABC as the major high affinity zinc importer of S. mutans and provides preliminary evidence that zinc is a growth-limiting factor within the dental biofilm.

Synthesis and characterization of new copper(II) complex compounds with chlorhexidine. Part I

Three new copper(II) complex compounds with chlorhexidine diacetate as a ligand have been prepared and characterized by elemental and thermogravimetrical analyses, molar conductances, magnetic susceptibility measurements, infrared, electronic and EPR spectra. The complexes correspond to the formulas: [Cu2(CHX)Cl4]·2C2H5OH, [Cu2(CHX)Br4]·2C2H5OH and [Cu2(CHX)(CH3COO)2] (CH3COO)2·2C2H5OH, where CHX = chlorhexidine, their composition and stereochemistry depending on the reaction conditions and the metal salt used. Chlorhexidine acts as neutral tetradentate NNNN donor, coordinating through the four imine nitrogen atoms. Investigations on antimicrobial activity in vitro show that all the complexes are active against the tested microorganisms, the complex with chloride being more active against Gram negative bacteria than chlorhexidine diacetate..

Antimicrobial Effects of Zinc Oxide in an Orthodontic Bonding Agent

Objective: To test the null hypothesis that the addition of zinc oxide (ZnO) has no effect on the antimicrobial benefits and shear bond strength of a light-cured resin-modified glass ionomer.

Materials and Methods: ZnO was added to Fuji Ortho LC to create mixtures of 13% ZnO and 23.1% ZnO. Specimen discs of the modified bonding agent were incubated with Streptococcus mutans for 48 hours in a disc diffusion assay that was used to measure zones of bacterial inhibition. In addition, brackets were bonded to bovine deciduous incisors with the modified bonding agents, and shear bond strength was evaluated with a universal testing machine.

Results: The modified samples showed that antimicrobial activity increased as the concentration of ZnO increased. There were significant differences (P < .05) in antimicrobial activity. Post hoc tests showed that the antibacterial effects were 1.6 times greater with 23.1% ZnO than with 13% ZnO. There was no difference between Transbond and 0% ZnO (the negative control). After 1 month of daily rinsing, the antibacterial effects of 23.1% ZnO and 13% ZnO decreased 65% and 77%, respectively, but both maintained significant effects over the negative controls. There were no significant differences (P = .055) in shear bond strength between any of the mixture comparisons.

Conclusions: The incorporation of ZnO into Fuji Ortho LC added antimicrobial properties to the original compound without significantly altering the shear bond strength. ZnO holds potential for preventing decalcification associated with orthodontic treatment.

Antimicrobial effects and human gingival biocompatibility of hydroxyapatite sol-gel coatings

The sol-gel method was employed to synthesize hydroxyapatite (HAp) coatings modified with Ag or Zn ions onto Ti-6Al-4V substrate. A bacterial strain Streptococcus mutans (S. mutans) and a human gingival fibroblast (HGF-1) cell line were used to investigate the antimicrobial effect and biocompatibility, respectively. HAp coatings containing 100 ppm Ag(+) ions suppressed the growth of S. mutans. An apparent inhibition zone around the HAp coating was further observed at Ag(+) concentration up to 10,000 ppm. However, for coatings containing Zn(2+) ions, a clear inhibition zone was observed at Zn(2+) concentration of 10,000 ppm. Nevertheless, the results of HGF-1 cultivation demonstrated that the Zn(2+)-modified HAp coatings exhibited better attachment and spread of HGF-1 than did the Ag(+)-modified coatings. Zn(2+) modified HAp coatings also increased the plating efficiency of HGF-1 cells. The cytotoxicity associated with the addition of Ag and the cell-conductive capacity associated with the addition of Zn are proportional to the added concentration, from 100 to 10,000 ppm. The dosages of both Ag(+) and Zn(2+) ions that should be added to HAp coatings were considered to prevent infection and improve biocompatibility. The results of this study ensure that HAp coatings modified with a moderate amount of Ag/Zn efficiently resist microorganisms and improve biocompatibility.

Zinc sulfate addition to glass-ionomer-based cements: influence on physical and antibacterial properties, zinc and fluoride release

OBJECTIVES

The aim of this study is to evaluate the effect of ZnSO(4) addition to a conventional glass ionomer and a resin-modified glass ionomer on solubility, flexural strength, zinc and fluoride (F) release, and Streptococcus mutans growth inhibition.

METHODS

5 or 10% ZnSO(4) was added to Vitremer and Ketac-Fil powders. Solubility test was performed based on ISO 7489. Flexural strength was determined by 3-point bending test based on ISO 4049. Zn release/uptake was determined by atomic emission spectrometry; F release/uptake was measured using a F-specific electrode. Both release measurements were performed for 15 d before and 15 d after recharging. Antibacterial test was conducted according to agar plate methods against S. mutans, by measuring the inhibition halos in 1-h and 15-d specimens. Data were analyzed by ANOVA.

RESULTS

Solubility increased with higher ZnSO(4) content, but remained below the ISO 7489 limit. Flexural strength was not affected by ZnSO(4) addition, and Vitremer performed better than Ketac-Fil. The control materials released no zinc. Vitremer with 10% ZnSO(4) released the highest amount of zinc. Fluoride release was similar for Ketac-Fil and Vitremer. In both cases, the highest amounts were released in the first 24 h. The growth inhibition halo of S. mutans was similar for both materials with highest content of ZnSO(4) and occurred only with 1-h specimens.

SIGNIFICANCE

Zinc addition decreased microorganisms growth and improved fluoride release, without significantly affecting the materials' flexural strength and solubility.

Inhibitory effect of ZnCl(2) on glycolysis in human oral microbes

Although the inhibition of bacterial glycolysis by zinc ions might be expected to moderate dental caries, there has not been a comparison of the effect of Zn on different organisms under both fixed pH and free-fall conditions. Here, the effect of ZnCl(2) on Streptococcus salivarius, Strep. mutans, Strep. sobrinus, Actinomyces naeslundii and Lactobacillus casei, as well as on mixtures of oral organisms outgrown from human dental plaque and saliva, was surveyed. pH-stat experiments were performed at pH 7, 6 or 5 in a solution containing 5% glucose and a suspension of the test organism; pH-fall experiments started at pH 7. In both cases, acid production was monitored for 60 min, when samples were taken for Zn and lactate determinations. Under pH-stat conditions, acid production was inhibited by Zn most strongly in Strep. sobrinus and Strep. salivarius. In terms of total acid production averted, however, the effect of Zn under both pH-stat and pH-fall conditions was clearly greatest with Strep. salivarius. A. naeslundii was inhibited the least strongly under pH-stat conditions. Cultured oral organism mixtures were more sensitive to moderate concentrations of zinc (0.2-0.3mM initial concentration) than were the single species to higher concentrations (1mM). Packed cell layers responded to Zn quite differently from suspensions, the pH often falling in the presence of 1mM Zn at a rate similar to the no Zn control. As streptococci had the highest acidogenesis rates in both pH-stat and pH-fall experiments, it seems likely that inhibition of acid production with these organisms would be of more value in moderating caries than the inhibition of less acidogenic organisms such as A. naeslundii.

Identification of zinc proteins in rat parotid saliva

The presence of unique zinc-binding proteins in human saliva is well documented. These observations have not, however, been extended to other species. The rat has been used extensively to study the salivary gland and its secretion, and it is therefore important to determine if the spectrum of zinc-binding proteins in this experimental model resembles that found in humans. To begin the analysis of zinc-binding proteins in stimulated rat parotid saliva, the saliva was fractionated by DEAE Sephadex and Sepharose 6B chaelate chromatography and the protein patterns analysed by electrophoresis. Zinc-binding proteins from the parotid saliva were identified by incubating Western blots with 65Zn and identifying any bound zinc by autoradiography. Comparison of the autoradiograms with the Coomassie blue-stained filter revealed several proteins with zinc-binding capacity. Isolation of the major zinc-binding proteins revealed an amino acid composition of proline 28%, glutamine 19% and glycine 15%, which is consistent with the amino acid composition of rat salivary acidic proline-rich protein. In addition to the proline-rich proteins, one other zinc-binding protein was analysed. The N-terminal sequence of this protein was found to bear a striking similarity (16 out of 20 amino acids) to secreted carbonic anhydrase VI of the mouse, a known zinc-binding protein. These data demonstrate that rat acidic proline-rich proteins, having an amino acid composition similar to that in humans, have zinc-binding potential. The data also confirm previous reports suggesting secreted carbonic anhydrase in rat parotid saliva.

Combined effects of Zn(2+)-chlorhexidine and Zn(2+)-cetylpyridinium chloride on caries incidence in partially desalivated rats

The effects of Zn2+ combined with either chlorhexidine or cetylpyridinium chloride (CPC) on caries incidence in partially desalivated rats were investigated. Seven groups of 12 animals each received topical applications for 20 s with a saturated swab (0.2 ml) of the following aqueous solutions twice daily on weekdays (10 a.m. and 3 p.m.) and once daily during weekends (12 a.m.) for 5 wk: deionized water (placebo); 40 mM zinc acetate; 2.2 mM chlorhexidine diacetate; 4.4 mM CPC; 40 mM zinc acetate and 2.2 mM chlorhexidine diacetate; 40 mM zinc acetate and 4.4 mM CPC; and 20 mM NaF (positive control). Coronal caries was scored by the method of Keyes. All treatments except CPC alone resulted in significantly (P less than 0.05, ANOVA) less smooth-surface caries than did the placebo. NaF treatment resulted in significantly less smooth-surface caries than did Zn2+, chlorhexidine, CPC, and Zn(2+)-CPC. The inclusion of zinc ions did not significantly increase the caries-inhibitory efficacy of chlorhexidine (CH). The combination of Zn(2+)-CPC decreased smooth-surface scores significantly more than did CPC alone. Significant differences in sulcal-surface caries were not observed among the groups. Zn(2+)-CPC suppressed the Streptococcus sobrinus counts significantly more than did the separate agents. Animals treated with Zn(2+)-CH harbored the lowest populations of S. sobrinus.

Stimulation of the growth of Streptococcus sanguis (NCTC 7864) by zinc in vitro

Zinc, which is present in many materials used in dentistry, including restorative and endodontic materials and mouthwashes, is reputedly bactericidal. However, the addition of this element at concentrations in the range 10-50 ppm to cultures of Streptococcus sanguis (NCTC 7864) stimulated the growth of the micro-organism relative to that of controls. A second antibacterial element, namely fluoride, reduced growth. Similar results were obtained whether the organism was grown aerobically or anaerobically. In view of the susceptibility of some organisms to zinc, the results of this study may help to explain conflicting reports in the literature; the results will vary depending on which organism is predominant.

Inhibition of plaque formation and plaque acidogenicity by zinc and chlorhexidine combinations

Zinc ions and chlorhexidine (CH) were found to exhibit a synergistic inhibitory effect on in vitro growth of S. sobrinus OMZ 176 and of S. sanguis 10556. A clinical mouthrinsing experiment was performed in a group of 10 volunteers to assess the plaque-inhibiting capacity of this combination. Sucrose enhanced plaque accumulations were assessed (Plaque Index, Silness & Löe) after 4 days of twice daily mouthrinses with 10 ml aqueous solutions of either 10.0 mM zinc or 0.55 mM CH, or with a combination of zinc ions and CH, during which period no mechanical toothcleaning was performed. The Zn-CH combination showed improved inhibition properties compared to the individual agents. The effects on plaque acidogenicity of 8.0 mM zinc, 0.44 mM CH, and of zinc and CH in combination were also assessed in a test panel of five volunteers. The Zn-CH combination inhibited acid production by dental plaque significantly (P less than or equal to 0.05) more than the individual agents 1 h 30 min after a single rinse.

Anti-bacterial determinants of stannous fluoride

The growth of bacteria on stainless steel wires was used as a model to investigate which properties of SnF2 produced anti-bacterial effects against S. mutans. Wire-adherent bacteria were exposed for one min, twice a day, to various fluoride or control compounds having similar ions, pH, valence, or atomic weights. After two days, the thickness of adherent bacteria was scored visually, and the decrease in pH of the growth medium was determined. Bacteria from each wire were then dried, weighed, and analyzed for metal content. Electron microscopy and electron microprobe were used to identify the location of heavy metal deposits in the bacteria. Only SnF2 dramatically altered S. mutans growth and metabolism, and this anti-bacterial effect was associated with a large uptake of tin into the bacterial cells. The fluoride salts of sodium, lead, zinc, and copper had little influence on S. mutans growth in this test system. The pH of the various fluoride salts or controls generally had no effect on the activity of the test compounds, except for the noted inactivation of SnF2 at elevated pH's. Since SnF4 did not alter the growth or metabolism of S. mutans, a unique property of SnF2--possibly the reactivity in an aqueous environment--may be responsible for its anti-bacterial properties.

Human oral retention of zinc from mouthwashes containing zinc salts and its relevance to dental plaque control

Subjects using 30 mM zinc phenolsulphonate as a mouthwash retained 12 per cent of the zinc. Salivary zinc concentration was increased by using mouthwashes containing 17-35 mM zinc as the sulphate, phenolsulphonate or citrate. For 17 mM zinc sulphate or phenolsulphonate, the effect lasted 3-4 h. Zinc retained in the mouth gave visible fluorescence after rinsing with 8-hydroxyquinoline and was particularly evident on the tongue, cheek mucosa and dental plaque. The concentration of zinc in plaque was increased 13-19-fold 1 h after using 31 or 18 mM zinc phenolsulphonate. A 3-fold increase was still present 6 h later for the 31 mM mouthwash. Zinc salts inhibited acid production from [14C]-glucose in vitro by plaque at concentrations which were found in plaque in vivo after using the mouthwashes. The effect of zinc on the metabolic activity of plaque may reduce the growth rate of plaque-bacteria and so decrease plaque growth.

Synergistic inhibitory effect of zinc and hexetidine on in vitro growth and acid production of Streptococcus mutans

The combined effect of Zn and hexetidine on Streptococcus mutans OMZ 176 growth and acid production was investigated in vitro. Since the minimum inhibitory and bactericidal concentration of zinc and hexetidine in combination was significantly, lower than when applied separately, a synergistic antimicrobial action was evident.

Antibacterial activity of gutta-percha cones attributed to the zinc oxide component

Growth of several species of bacteria was inhibited by the presence of endodontic gutta-percha cones. Microbiologic analysis, measurement of osmolarity, microscopy, x-ray diffraction analysis, and scanning electron micrography were used to identify the biologically active component that slowly leaches from gutta-percha cones. This component is zinc oxide in the form of small solid particles, from which active, soluble Zn2+ ion is mobilized by hydrolysis. A hypothesis on the "depot" effect of the ZnO particles is formulated, and is used to discuss some earlier reported literature on toxic and antibacterial activity of zinc oxide-containing materials. It is concluded that zinc oxide is not to be considered an inert compound. Its widespread uses in medicine and dentistry seem to reside in its "inert," biocompatible, and astringent properties mainly. The biologically active role of zinc oxide, however, merits further investigation.

Effect of trace metals on growth of Streptococcus mutans in a teflon chemostat

Correlations between the presence of certain trace metals in dental enamel or in drinking water and the incidence of human dental caries have been demonstrated; therefore, the effects of several trace metals on growth of the cariogenic organism Streptococcus mutans OMZ176 were determined. For continuous growth in a chemically defined medium (treated with Chelex-100 to lower trace metal contamination and supplemented with high-purity trace metal salts) used in a chemostat constructed of Teflon, S. mutans required input of carbon dioxide and supplementation with magnesium (126 microM) and manganese (18 to 54 microM). Addition of iron (3.6 microM) increased the level of steady-state growth by a factor of 2.8 (stimulation index [SI]); zinc at 0.4 microM nearly doubled equilibrium growth (SI = 0.9). Higher concentrations of iron and zinc (5.4 and 0.8 microM, respectively) were less stimulatory (SI values of 1.95 and 0.3, respectively). Small (but statistically significant) increases in steady-state growth were effected by cobalt (SI = 0.3 at 5.1 to 20.4 microM) and tin (SI = 0.4 at 5.1 to 10.2 microM). These data suggest nutritional requirements for these metals. Copper at a concentration of 0.16 microM was inhibitory. These results show significant effects of these metals on growth of S. mutans and may confirm epidemiological evidence suggesting a role for certain trace metals in the incidence of dental caries.

Thiol groups and reduced acidogenicity of dental plaque in the presence of metal ions in vivo

Metal ions are known to influence the cariogenicity of dental plaque. Inhibition of acid metabolism in plaque may be of importance in this respect. Metal ions inhibit the acidogenicity of dental plaque to a different extent and it has been suggested that an enzyme inhibition based on oxidation of thiol groups may explain this observation. The aim of the present study was to evaluate the significance of oxidation of thiol groups in the inhibition of acid production in plaque by silver, tin and zinc salts. Nine subjects with 3-d sucrose induced plaque received topical applications of the metal ions. Cysteine or glutathione, which are known to reverse thiol oxidations, were then applied in one side of the mouth. Plaque pH measurements, in the presence of sucrose, were performed prior to and up to 2 h after treatment. The results showed that the acid production inhibited by the metal ions was reactivated by cysteine or glutathione. Iodoacetamide and p-chloromercuribenzoate were also shown to inhibit acid formation in dental plaque. The high affinity silver, tin and zinc have for SH groups, the observed inhibitory effect of these metals, the reactivation of the metabolism by monothiols and the fact that organic sulfhydryl reagents inhibit acid formation in plaque indicate that oxidation of thiol groups may be the mechanism by which these metals exert their effect.