Sensitivity of Candida albicans biofilm cells grown on denture acrylic to antifungal proteins and chlorhexidine

Synthesis and Characterization of Cassava Gum Hydrogel Associated with Chlorhexidine and Evaluation of Release and Antimicrobial Activity

Hydrogels from natural sources are attracting increasing interest due to their ability to protect biologically active molecules. Starch extracted from cassava tubers is a promising material for synthesizing these hydrogels. Copolymerization of cassava gum and incorporation of chlorhexidine digluconate (CLX) into the hydrogels is confirmed by changes in the crystallographic profile, as observed through X-ray diffraction, and a shift in the 1000 cm-1 band in the Fourier-transform infrared spectroscopy spectrum. The differential scanning calorimetry reveals changes in the decomposition temperature of the synthesized hydrogels related to CLX volatility. Micrographs illustrate the material's porosity. Release tests indicate a constant linear release over 72 h, while antimicrobial activity against Staphylococcus aureus, Escherichia coli, and Candida albicans is satisfactory, with 100% effectiveness from 0.5% CLX and the formation of inhibition halos. Toxicity and biocompatibility studies show no cytotoxicity. The continuous release of chlorhexidine is promising for components of biomedical implants and applications as it can ensure antimicrobial action according to specific therapeutic needs.

Flexural strength, surface roughness, and biofilm formation of ceramic-reinforced PEEK: An in vitro comparative study

PURPOSE

This in vitro study aimed to compare flexural strength, surface roughness, and biofilm formation of ceramic-reinforced polyetheretherketone (PEEK) with conventionally heat-compressed and milled polymethylmethacrylate (PMMA) denture base materials.

MATERIALS AND METHODS

Thirty strips (6.4 mm × 10 mm × 3 mm) and 30 discs (10 mm × 1 mm) were fabricated from a heat-compressed PMMA, milled PMMA, and ceramic-reinforced PEEK, 10 each. One surface of each sample was polished to mimic the laboratory procedure for denture base materials. Strips were then subjected to a three-point bend test using a universal testing machine at a crosshead speed of 5.0 mm/min. An optical profilometer was used to assess the Ra value (mm) of the discs on polished and unpolished sides. Biofilm formation behavior was analyzed by measuring the colony-forming unit (CFU)/mL of Candida albicans on the unpolished surface of the discs. One-way ANOVA followed by Tukey multiple comparison tests were used to compare the flexural strength, Ra value, and biofilm formation of the studied materials (a = 0.05).

RESULTS

Ceramic-reinforced PEEK showed significantly higher flexural strength (178.2 ± 3.2 MPa) than milled PMMA (89.6 ± 0.8 MPa; p < 0.001) and heat-compressed PMMA (67.3 ± 5.3 MPa; p < 0.001). Ceramic-reinforced PEEK exhibited a significantly higher Ra value than the other groups on unpolished sides; however, the polishing process significantly reduced the Ra values of all studied groups (p < 0.05). There was no significant difference in C. albicans adhesion among the groups (p < 0.05).

CONCLUSION

The flexural strength of tested materials was within acceptable limits for clinical use as a denture base material. Ceramic-reinforced PEEK had the highest surface roughness; however, its similarity in biofilm formation to other groups indicates its clinical acceptability as denture base material.

Antifungal therapy of Candida biofilms: Past, present and future

Virtually all Candida species linked to clinical candidiasis are capable of forming highly resistant biofilms on different types of surfaces, which poses an additional significant threat and further complicates therapy of these infections. There is a scarcity of antifungal agents, and their effectiveness, particularly against biofilms, is limited. Here we provide a historical perspective on antifungal agents and therapy of Candida biofilms. As we reflect upon the past, consider the present, and look towards the future of antifungal therapy of Candida biofilms, we believe that there are reasons to remain optimistic, and that the major challenges of Candida biofilm therapy can be conquered within a reasonable timeframe.

Candida albicans enriched in orthodontic derived white spot lesions and shaped focal supragingival bacteriome

White spot lesions (WSLs) are common enamel infectious diseases in fixed orthodontic treatment, which might attribute to the dysbiosis of oral microbiome. However, the correlation of Candida albicans with oral bacteriome in WSLs still remains unrevealed. This study investigated the carriage of C. albicans and how it shaped the bacterial community in disease or healthy supragingival plaque, to explore the potential role of interkingdom interaction in orthodontic WSLs. In this study, 31 patients with WSLs (WSLs) and 23 healthy patients (Health) undergoing fixed orthodontic treatment were enrolled. The supragingival microbiota in both groups were determined using 16S rRNA gene sequencing. Colonization and abundance of C. albicans in the plaque were determined via culture-dependent and -independent methods. Among WSLs patients, the correlation of C. albicans and bacteriome was analyzed under QIIME2-based bioinformatics and Spearman's correlation coefficient. The raw reads were deposited into the NCBI Sequence Read Archive (SRA) database (Accession Number: SRP404186). Significant differences in microbial diversity as well as composition were observed between WSLs and Health groups. Leptotrichia remarkably enriched in the WSLs group, while Neisseria and Cardiobacterium significantly enriched in the Health group. In addition, 45% of WSLs patients were C. albicans carriers but none in patients without WSLs. Among all WSLs patients, beta diversity and microbial composition were distinguished between C. albicans carriers and non-carriers. In C. albicans carriers, Corynebacterium matruchotii and Streptococcus mutans significantly enriched whereas Saccharibacteria_TM7_G-1 significantly depleted. The abundance of C. albicans was positively associated with bacteria such as Streptococcus mutans, while the negative correlation was detected between C. albicans and several bacteria such as Cardiobacterium hominis and Streptococcus sanguinis. Our study elucidated the distinguished supragingival plaque microbiome between orthodontic patients with and without WSLs. C. albicans frequently existed and enriched in orthodontic derived WSLs. The carriage of C. albicans shape plaque bacterial community in demineralized lesions and might play roles in WSLs pathogenesis.

Combination of Cetylpyridinium Chloride and Chlorhexidine Acetate: A Promising Candidate for Rapid Killing of Gram-Positive/Gram-Negative Bacteria and Fungi

Combined use of the present antimicrobial drugs has been proved to be an alternative approach for antimicrobial agents' development since the co-existed of the drugs working in different mechanism have been demonstrated potentially enhance their antimicrobial activity. In this work, antibacterial and antifungal activity of the cetylpyridinium chloride (CPC)/chlorhexidine acetate (CHA) combination was evaluated for the first time, while a universal concentration for the rapid killing of gram-positive/gram-negative bacteria and fungi was also proposed. The minimum inhibitory concentrations (MIC) of CPC and CHA used alone or in combination were first measured, showing that the combined treatment decreased the MIC against tested gram-positive/gram-negative bacteria and fungi to 1/8-1/2. Growth curve assays demonstrated CPC and CHA had dynamic combined effects against the tested microorganisms at the concentration equal to MIC. Besides, combined use of these two drugs could also enhance their biocidal activity, which was illustrated by fluorescence microscopy and SEM images, as well as soluble protein measurement. More importantly, in vitro acute eye and skin irritation tests showed short-term contact with CPC/CHA combination would not cause any damage to mammalian mucosa and skin. In a word, CPC/CHA combination exhibited broad-spectrum antibacterial and antifungal activity against tested gram-positive/gram-negative bacteria and fungi while without any acute irritation to mammalian mucosa and skin, providing a new perspective on the selection of personal disinfectants.

Antimicrobial Peptides-Mechanisms of Action, Antimicrobial Effects and Clinical Applications

The growing emergence of antimicrobial resistance represents a global problem that not only influences healthcare systems but also has grave implications for political and economic processes. As the discovery of novel antimicrobial agents is lagging, one of the solutions is innovative therapeutic options that would expand our armamentarium against this hazard. Compounds of interest in many such studies are antimicrobial peptides (AMPs), which actually represent the host's first line of defense against pathogens and are involved in innate immunity. They have a broad range of antimicrobial activity against Gram-negative and Gram-positive bacteria, fungi, and viruses, with specific mechanisms of action utilized by different AMPs. Coupled with a lower propensity for resistance development, it is becoming clear that AMPs can be seen as emerging and very promising candidates for more pervasive usage in the treatment of infectious diseases. However, their use in quotidian clinical practice is not without challenges. In this review, we aimed to summarize state-of-the-art evidence on the structure and mechanisms of action of AMPs, as well as to provide detailed information on their antimicrobial activity. We also aimed to present contemporary evidence of clinical trials and application of AMPs and highlight their use beyond infectious diseases and potential challenges that may arise with their increasing availability.

Antimicrobial Peptides with Anti-Candida Activity

Mycoses are accountable for millions of infections yearly worldwide. Invasive candidiasis is the most usual, presenting a high morbidity and mortality. Candida albicans remains the prevalent etiologic agent, but the incidence of other species such as Candida parapsilosis, Candida glabrata and Candida auris keeps increasing. These pathogens frequently show a reduced susceptibility to commonly used antifungal drugs, including polyenes, triazoles and echinocandins, and the incidence of emerging multi-drug-resistant strains of these species continues to increase. Therefore, the need to search for new molecules that target these pathogenic species in a different manner is now more urgent than ever. Nature is an almost endless source of interesting new molecules that could meet this need. Among these molecules, antimicrobial peptides, present in different sources in nature, possess some advantages over conventional antifungal agents, even with their own drawbacks, and are considered as a promising pharmacological option against a wide range of microbial infections. In this review, we describe 20 antimicrobial peptides from different origins that possess an activity against Candida.

Envisaging Antifungal Potential of Histatin 5: A Physiological Salivary Peptide

Fungi are reported to cause a range of superficial to invasive human infections. These often result in high morbidity and at times mortality. Conventional antifungal agents though effective invariably exhibit drug interactions, treatment-related toxicity, and fail to elicit significant effect, thus indicating a need to look for suitable alternatives. Fungi thrive in humid, nutrient-enriched areas. Such an environment is well-supported by the oral cavity. Despite this, there is a relatively low incidence of severe oral and periodontal fungal infections, attributed to the presence of antimicrobial peptides hosted by saliva, viz. histatin 5 (Hstn 5). It displays fungicidal activity against a variety of fungi including Candida albicans, Candida glabrata, Candida krusei, Cryptococcus neoformans, and unicellular yeast-like Saccharomyces cerevisiae. Candida albicans alone accounts for about 70% of all global fungal infections including periodontal disease. This review intends to discuss the scope of Hstn 5 as a novel recourse for the control of fungal infections.

Should local drug delivery systems be used in dentistry?

In dentistry, the use of biomaterial-based drug delivery systems (DDS) aiming the release of the active compounds directly to the site of action is slowly getting more awareness among the scientific and medical community. Emerging technologies including nanotechnological platforms are offering novel approaches, but the majority are still in the proof-of-concept stage. This study critically reviews the potential use of DDS in anesthesiology, oral diseases, cariology, restorative dentistry, periodontics, endodontics, implantology, fixed and removable prosthodontics, and orthodontics with a special focus on infections. It also stresses the gaps and challenges faced. Despite numerous clinical and pharmacological advantages, some disadvantages of DDS pose an obstacle to their widespread use. The biomaterial's biofunctionality may be affected when the drug is incorporated and may cause an additional risk of toxicity. Also, the release of sub-therapeutic levels of drugs such as antibiotics may lead to microbial resistance. Multiple available techniques for the manufacture of DDS may affect drug release profiles and their bioavailability. If the benefits outweigh the costs, DDS may be potentially used to prevent or treat oral pathologies as an alternative to conventional strategies. A case-by-case approach must be followed.

Quality of Life of Complete Denture Wearers-A Comparative Study between Conventional Dentures and Acrylic Dentures with Vitamin B12 Incorporated

Background and objectives: This paper is a sequel to the studies that focused on the optimization of the structure of classical acrylates with vitamin B12 as a template and their impact on patients’ general and local health. In this context, we aim to investigate the relationships between attitudes and behavior regarding oral health, oral health status, and quality of life related to oral health in the case of patients with conventional dentures and those with dentures improved with vitamin B12. Material and Methods: The sample size was estimated from previous studies, and 252 participants were enrolled and divided into two groups, one of which received as a treatment complete dentures with B12, and the other group was represented by complete edentulous patients treated with conventional complete dentures. The impact of oral health in general on patient satisfaction and quality of life was assessed using Oral Health Impact Profile OHIP-14 questionnaires. The descriptive statistical analysis was performed using SPSS 20.0. A value of p < 0.05 was considered statistically significant. Results: Differences registered between the two groups were statistically significant in all evaluated dimensions. The largest differences were recorded for physical, psychological, and social disability as well as for the level of disability, all in favor of denture B12 wearers. Conclusions: The materials used in the treatment of complete edentation can be a future research direction that can not only improve their mechanical strength but can contribute to maintaining the superior health of the oral mucosa and can also be a way of transporting substances necessary for the normal development of the metabolism of the whole body, such as vitamin B12 in our case.

Inhibition of Candida albicans and Mixed Salivary Bacterial Biofilms on Antimicrobial Loaded Phosphated Poly(methyl methacrylate)

Biofilms play a crucial role in the development of Candida-associated denture stomatitis. Inhibition of microbial adhesion to poly(methyl methacrylate) (PMMA) and phosphate containing PMMA has been examined in this work. C. albicans and mixed salivary microbial biofilms were compared on naked and salivary pre-conditioned PMMA surfaces in the presence or absence of antimicrobials (Cetylpyridinium chloride [CPC], KSL-W, Histatin 5 [His 5]). Polymers with varying amounts of phosphate (0–25%) were tested using four C. albicans oral isolates as well as mixed salivary bacteria and 24 h biofilms were assessed for metabolic activity and confirmed using Live/Dead staining and confocal microscopy. Biofilm metabolism was reduced as phosphate density increased (15%: p = 0.004; 25%: p = 0.001). Loading of CPC on 15% phosphated disks showed a substantial decrease (p = 0.001) in biofilm metabolism in the presence or absence of a salivary pellicle. Salivary pellicle on uncharged PMMA enhanced the antimicrobial activity of CPC only. CPC also demonstrated remarkable antimicrobial activity on mixed salivary bacterial biofilms under different conditions displaying the potent efficacy of CPC (350 µg/mL) when combined with an artificial protein pellicle (Biotene half strength).

Histatin 5 variant reduces Candida albicans biofilm viability and inhibits biofilm formation

Candida albicans is a commensal organism and opportunistic pathogen that can form biofilms that colonize surfaces of medical devices, such as implants, catheters, and dentures. Compared to planktonic C. albicans cells, cells in biofilms exhibit increased resistance to treatment. Histatin 5 (Hst-5) is an antimicrobial peptide that is natively secreted by human salivary glands and has strong antifungal activity against C. albicans. However, C. albicans produces secreted aspartic proteases (Saps) that can cleave and inactivate Hst-5, limiting its antifungal properties. We previously showed that residue substitutions K11R and K17R within Hst-5 improve its antifungal activity and prevent proteolytic degradation by Saps when treating planktonic C. albicans. Here, we investigated the use of the K11R-K17R peptide as an alternative therapeutic against C. albicans biofilms by assessing its ability to reduce viability of pre-formed biofilms and to inhibit the formation of biofilms and showed that K11R-K17R had improved activity compared to Hst-5. Based on these results, we incorporated K11R-K17R and Hst-5 into polyelectrolyte multilayer (PEM) surface coatings and demonstrated that films functionalized with K11R-K17R reduced the formation of C. albicans biofilms. Our results demonstrate the therapeutic potential of the K11R-K17R Hst-5 variant in preventing and treating biofilms.

Efficacy of low-molecular weight chitosan against Candida albicans biofilm on polymethyl methacrylate resin

BACKGROUND

Candida biofilm is a major cause of denture stomatitis. We aimed to compare the efficacy of low-molecular-weight chitosan solutions against Candida albicans biofilm on polymethyl methacrylate (PMMA) resin.

METHODS

Various types of chitosan were tested for anti-Candida activity by broth dilution. Two types were selected for further testing on 24-hour C.albicans biofilm formed on PMMA specimens. Specimens were randomly distributed among experimental groups, including 0.1% and 0.2% acetic acid, 3 and 6 mg/mL of oligomer chitosan and 30 kDa chitosan solutions, effervescent tablet (Polident), and 0.2% chlorhexidine, and immersed for 5 min to 12 h. The viability of C. albicans after cleansing were determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays. Remaining viability was calculated into percentage relative to respective controls and analyzed using ANOVA with Tukey post-hoc tests. Live/dead fluorescence microscopy was also performed.

RESULTS

Chitosan solutions had high efficacy against C. albicans biofilm on PMMA. The mean relative viability compared to control after 12-h immersion was 6.60 ± 4.75% and 12.72 ± 6.96% for 3 and 6 mg/mL oligomer, respectively, and 11.68 ± 4.81% and 18.08 ± 6.20% for 3 and 6 mg/mL 30 kDa chitosan, respectively.

CONCLUSIONS

Low-molecular-weight chitosan solution is an effective antifungal denture cleanser that can significantly reduce C. albicans viability in biofilm on PMMA.

Host Defense Peptides as Templates for Antifungal Drug Development

Current treatment for invasive fungal diseases is limited to three classes of antifungal drugs: azoles, polyenes, and echinocandins. The most recently introduced antifungal class, the echinocandins, was first approved nearly 30 years ago. The limited antifungal drug portfolio is rapidly losing its clinical utility due to the inexorable rise in the incidence of invasive fungal infections and the emergence of multidrug resistant (MDR) fungal pathogens. New antifungal therapeutic agents and novel approaches are desperately needed. Here, we detail attempts to exploit the antifungal and immunoregulatory properties of host defense peptides (HDPs) in the design and evaluation of new antifungal therapeutics and discuss historical limitations and recent advances in this quest.

Surface Characterization, Antimicrobial Activity, and Biocompatibility of Autopolymerizing Acrylic Resins Coated with Reynoutria elliptica Extract

We conducted surface characterization to assess the biocompatibility and investigate the antimicrobial activity against oral pathogens in autopolymerizing acrylic resins, coated with light-curable coating resin, containing various concentrations of Reynoutria elliptica extract (0, 200, 400, and 600 µg/mL). The R. elliptica extract powder was prepared using a freeze-drying technique. Further, a goniometer and microhardness tester were used to determine the water contact angle, and Vickers hardness, respectively; color measurements were performed on the uncoated and coated acrylic resin disks. The polyphenol content of the extracts from the coated acrylic resin disk was analyzed using UV-VIS spectroscopy. The antimicrobial activity of the coated acrylic resin disk against Streptococcus mutans and Candida albicans was observed for 24 and 48 h by measuring the optical density using spectrophotometry. In addition, biocompatibility was confirmed by testing the cell viability according to ISO 10993-5. The water contact angle, Vickers hardness, and color change values of the coated acrylic resin disks were not significantly different from the control. Polyphenol was detected in all experimental groups, with no significant differences between the experimental groups. The experimental groups exhibited significant antimicrobial activity against S. mutans and C. albicans compared to the control group, after 48 h of incubation. The cell viability between the control and experimental groups was not significantly different. The proposed coating resin containing R. elliptica extract is applicable on dental acrylic resins, due to their antimicrobial properties and excellent biocompatibility, with no deterioration of surface characteristics.

Innate Inspiration: Antifungal Peptides and Other Immunotherapeutics From the Host Immune Response

The purpose of this review is to describe antifungal therapeutic candidates in preclinical and clinical development derived from, or directly influenced by, the immune system, with a specific focus on antimicrobial peptides (AMP). Although the focus of this review is AMP with direct antimicrobial effects on fungi, we will also discuss compounds with direct antifungal activity, including monoclonal antibodies (mAb), as well as immunomodulatory molecules that can enhance the immune response to fungal infection, including immunomodulatory AMP, vaccines, checkpoint inhibitors, interferon and colony stimulating factors as well as immune cell therapies. The focus of this manuscript will be a non-exhaustive review of antifungal compounds in preclinical and clinical development that are based on the principles of immunology and the authors acknowledge the incredible amount of in vitro and in vivo work that has been conducted to develop such therapeutic candidates.

Mezoneuron benthamianum inhibits cell adherence, hyphae formation, and phospholipase production in Candida albicans

The aim of this study was to evaluate the phytochemical constituents, antioxidant, antifungal, and anti-virulence activities of traditionally used Mezoneuron benthamianum leaves. Extracts were prepared using acetone and methanol, and the preliminary phytochemical screening was performed. The antioxidant activity was studied using the DPPH method. Anti-Candida albicans activity was established and the effect on the germ tube and phospholipase production, as well as on the host cell adherence was assessed. The extracts showed the presence of anthraquinones, cardiac glycosides, flavonoids, reducing sugars, saponins, steroids, tannins, and terpenoids. Gallic acid and trans-resveratrol were among the predominant phytochemicals found in M. benthamianum. The crude extracts presented significantly higher antioxidant activity than the ascorbic acid standard. At 0.39 mg/mL, acetone extract inhibited the growth of Candida albicans. At lower concentrations (200-50 µg/mL), it significantly inhibited the adherence ability (up to 51%), formation of hyphae (up to 65%), and the production of phospholipase. In conclusion, at high concentrations, M. benthamianum kills C. albicans, and at lower concentrations, it can inhibit the virulence properties of this pathogen. This study on crude extract validates the traditional use of this plant. However, further research is required to establish the anti-virulence activity of the two compounds and their therapeutic potential.

Mucoadhesive Electrospun Fibre-Based Technologies for Oral Medicine

Oral disease greatly affects quality of life, as the mouth is required for a wide range of activities including speech, food and liquid consumption. Treatment of oral disease is greatly limited by the dose forms that are currently available, which suffer from short contact times, poor site specificity, and sensitivity to mechanical stimulation. Mucoadhesive devices prepared using electrospinning offer the potential to address these challenges by allowing unidirectional site-specific drug delivery through intimate contact with the mucosa and with high surface areas to facilitate drug release. This review will discuss the range of electrospun mucoadhesive devices that have recently been reported to address oral inflammatory diseases, pain relief, and infections, as well as new treatments that are likely to be enabled by this technology in the future.

Bioactive Peptides Against Fungal Biofilms

Infections caused by invasive fungal biofilms have been widely associated with high morbidity and mortality rates, mainly due to the advent of antibiotic resistance. Moreover, fungal biofilms impose an additional challenge, leading to multidrug resistance. This fact, along with the contamination of medical devices and the limited number of effective antifungal agents available on the market, demonstrates the importance of finding novel drug candidates targeting pathogenic fungal cells and biofilms. In this context, an alternative strategy is the use of antifungal peptides (AFPs) against fungal biofilms. AFPs are considered a group of bioactive molecules with broad-spectrum activities and multiple mechanisms of action that have been widely used as template molecules for drug design strategies aiming at greater specificity and biological efficacy. Among the AFP classes most studied in the context of fungal biofilms, defensins, cathelicidins and histatins have been described. AFPs can also act by preventing the formation of fungal biofilms and eradicating preformed biofilms through mechanisms associated with cell wall perturbation, inhibition of planktonic fungal cells’ adhesion onto surfaces, gene regulation and generation of reactive oxygen species (ROS). Thus, considering the critical scenario imposed by fungal biofilms and associated infections and the application of AFPs as a possible treatment, this review will focus on the most effective AFPs described to date, with a core focus on antibiofilm peptides, as well as their efficacy in vivo, application on surfaces and proposed mechanisms of action.

Peel bond strength and antifungal activity of two soft denture lining materials incorporated with 1% chlorhexidine diacetate

Two soft denture lining materials (SC-Soft Confort and TS-Trusoft) were investigated with and without the addition of 1.0% of chlorhexidine diacetate (1.0% CHX). To assess peel bond strength, specimens (75×10×6 mm) were submitted to a peel test at 10 mm/min immediately and after 24 h. To evaluate Candida albicans growth inhibition, disc of specimens (10×3 mm) were immersed in a solution with 3×10⁶ CFU/mL of C. albicans, and spectral measurements were made following immersion in MTT solution for 2, 4, and 6 days. The agar diffusion test was performed by investigating the diameters of inhibition zones around the disc of specimens (10×3 mm)after 48 h. Data were submitted to statistical analysis (α=0.05) and the failure modes were visually classified. The incorporation of 1.0% CHX significantly decreased the peel bond strength for TS (p=0.001) and SC (p=0.005) for immediate test and for TS after 24 h (p=0.010), but not for SC. C. albicans growth was decreased for both materials over time (p<0.05). SC presented inhibition zones approximately 2.0 times larger than TS. The incorporation of 1.0% CHX inhibited fungal growth without impairment to the peel bond strength for SC after 24 h.

An overview of application of silver nanoparticles for biomaterials in dentistry

Oral cavity is a gateway to the entire body and protection of this gateway is a major goal in dentistry. Plaque biofilm is a major cause of majority of dental diseases and although various biomaterials have been applied for their cure, limitations pertaining to the material properties prevent achievement of desired outcomes. Nanoparticle applications have become useful tools for various dental applications in endodontics, periodontics, restorative dentistry, orthodontics and oral cancers. Off these, silver nanoparticles (AgNPs) have been used in medicine and dentistry due to its antimicrobial properties. AgNPs have been incorporated into biomaterials in order to prevent or reduce biofilm formation. Due to greater surface to volume ratio and small particle size, they possess excellent antimicrobial action without affecting the mechanical properties of the material. This unique property of AgNPs makes these materials as fillers of choice in different biomaterials whereby they play a vital role in improving the properties. This review aims to discuss the influence of addition of AgNPs to various biomaterials used in different dental applications.

Antifungal Efficacy and the Mechanical Properties of Soft Liners against Candida albicans after the Incorporation of Garlic and Neem: An In vitro Study

Objectives:

To evaluate the in vitro growth inhibition of Candida albicans, in the soft-liner material and Shore A hardness from resin-based denture soft lining materials modified by neem or garlic incorporation.

Materials and Methods:

Resin discs were prepared with poly methyl methacrylate (PMMA) and soft liners incorporated with varying concentrations of neem or garlic. For antifungal activity, resin discs were placed on agar plates inoculated with C. albicans and were evaluated after 2, 4, and 7 days using the streaking method. The hardness of the PMMA was evaluated with the use of Shore A at 2, 4, and 7 days. Data were statistically processed by SPSS software (IBM Company, Chicago, USA) using Kruskal–Wallis test, and post hoc comparisons were done using Dunn's test. P <0.05 was considered statistically significant.

Results:

Neem and garlic added to PMMA soft liner had an inhibitory effect on C. albicans. Both the neem and garlic when added showed positive results against C. albicans when compared to the control group. The soft liner hardness increased statistically by time but not for the different plant extract concentrations.

Conclusions:

Within the limitations of this in vitro study, it was found that neem and garlic can be used as an additive to tissue conditioner to reduce the adherence of C. albicans without significantly affecting the hardness of the heat-polymerized acrylic resin.

Stability and efficacy of combined nystatin and chlorhexidine against suspensions and biofilms of Candida albicans

OBJECTIVE

Nystatin and chlorhexidine are extensively used in oral medicine; however, there is some controversy about the possibility of these drugs showing antagonism. To clarify this issue, this study investigated the efficacy and stability of nystatin and chlorhexidine in combination.

DESIGN

An in vitro study was conducted to analyze the effect of nystatin and chlorhexidine combined on Candida albicans ATCC 18804, using the drugs mixed as a single formulation and as independent formulations used sequentially with different time intervals between them. The minimum inhibitory concentration (MIC) and effects on C. albicans suspensions and biofilms were evaluated. Also, the stability of nystatin and chlorhexidine in a mixture was tested by high performance liquid chromatography (HPLC).

RESULTS

When nystatin and chlorhexidine were mixed in a single formulation, there was no significant difference in MIC compared to that of the drugs used alone (as the only treatment). However, when these drugs were used as independent formulations, sequentially with time intervals in between, their MICs were higher than the respective MIC of the drug used alone, except for the MIC of chlorhexidine with a 10-min interval. Nystatin/chlorhexidine combinations showed lower activity against C. albicans biofilms, except for that with a 30-min interval. The drugs when combined showed high percentages of degradation at all the times evaluated.

CONCLUSIONS

The combination of nystatin and chlorhexidine seems to interfere with the efficacy of the drugs and to increase their rate of degradation.

Evaluation of degradation mechanism of chlorhexidine by means of Density Functional Theory calculations

Chlorhexidine (CHD), a germicidal drug, has degradation products that can be hemotoxic and carcinogenic. However, there is no consensus in literature about the degradation pathway. In order to shed light on that mechanism, we have employed Density Functional Theory to study reactants, in different protonation states, products and intermediates involved in the different pathways. Based on free energy values comparison and frontier molecular orbital analysis, we have obtained the most stable structures in each protonation state. CHD in saturated form has HOMO localized in one p-chloroaniline, and, due to molecule's symmetry, HOMO-1 has contributions from the other side of the molecule, but mainly from the biguanide portion of the molecule, instead of from the p-chloroaniline. For the saturated form, we have studied two possible degradation pathways, starting from the monoprotonated structure, and three pathways starting from the neutral structure. We found out that the mechanisms proposed in literature, whose pathways lead to p-chloroaniline (PCA) formation in a smaller number of steps, are more likely than the mechanisms with more intermediate steps or pathways that do not predict PCA formation. Also, based on free energy results, we have found that the formation of another sub-product (PBG-AU) is favorable as well.

Antibiofilm peptides against oral biofilms

The oral cavity is a major entry point for bacteria and other microorganisms. Oral biofilms are formed by mixed communities of microorganisms embedded in an exopolysaccharide matrix. Biofilms forming on dental hard or soft tissue are the major cause of caries and endodontic and periodontal disease. Human oral biofilms exhibit high resistance to antimicrobial agents. Antibiofilm peptides constitute a diverse class of host-defense molecules that act to combat invasion and infection with biofilms. Different in vitro and in vivo biofilm models with quantitative analysis have been established to provide predictable platforms for the evaluation of the antibiofilm effect of oral antibiofilm peptides. These peptides have engendered considerable interest in the past decades as potential alternatives to traditional disinfecting agents due to their ability to target bacterial biofilms specifically, leading to the prevention of biofilm formation and destruction of pre-existing biofilms by Gram-positive and -negative bacterial pathogens and fungi. At the same time, challenges associated with the application of these antibiofilm peptides in dental practice also exist. The production of effective, nontoxic, and stable antibiofilm peptides is desired in both academic and industrial fields. This review focuses on the antibiofilm properties of current synthetic peptides and their application in different areas of dentistry.

Effectiveness of disinfectants on the adherence of Candida albicans to denture base resins with different surface textures

The aim of the present study was to compare the effects of some disinfectants, including ethanol extract of propolis (EEP), on the adhesion of Candida albicans to denture base resins. Seventy-two acrylic resin samples were prepared, half of which was polished and the other half was roughened. C. albicans strain ATCC 10231 was incubated on Sabouraud dextrose agar (SDA) at 37°C for 48 h. The adhesion period was completed by keeping the cells in this suspension for 90 min at 37°C. Specimens were then immersed in the following solutions: 1%, 2%, and 5% sodium hypochlorite; 4% chlorhexidine gluconate; and 10% EEP. Quantification of the antifungal activity of the chemical solutions was performed using the colorimetric MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) assay test. One-way ANOVA and post-hoc Tukey tests were performed to evaluate the effectiveness of chemical agents. Polished and roughened surfaces were compared using independent sample t-test. The mean surface roughness value was 0.35 (±0.04) µm for the polished group and 1.2 (±0.2) µm for the roughened group. The contact angles of both surfaces showed statistically significant difference, and 10% EEP solution exhibited significantly less removal of adherent viable C. albicans cells in both groups. All forms of sodium hypochlorite solutions yielded higher efficiency than 4% chlorhexidine gluconate and EEP solutions (P < 0.05). (J Oral Sci 58, 431-437, 2016).

Potential applications of antimicrobial peptides and their mimics in combating caries and pulpal infections

Antimicrobial peptides (AMPs) are short cationic host-defense molecules that provide the early stage of protection against invading microbes. They also have important modulatory roles and act as a bridge between innate and acquired immunity. The types and functions of oral AMPs were reviewed and experimental reports on the use of natural AMPs and their synthetic mimics in caries and pulpal infections were discussed. Natural AMPs in the oral cavity, predominantly defensins, cathelicidins and histatins, possess antimicrobial activities against oral pathogens and biofilms. Incomplete debridement of microorganisms in root canal space may precipitate an exacerbated immune response that results in periradicular bone resorption. Because of their immunomodulatory and wound healing potentials, AMPs stimulate pro-inflammatory cytokine production, recruit host defense cells and regulate immuno-inflammatory responses in the vicinity of the pulp and periapex. Recent rapid advances in the development of synthetic AMP mimics offer exciting opportunities for new therapeutic initiatives in root canal treatment and regenerative endodontics.

STATEMENT OF SIGNIFICANCE

Identification of new therapeutic strategies to combat antibiotic-resistant pathogens and biofilm-associated infections continues to be one of the major challenges in modern medicine. Despite the presence of commercialization hurdles and scientific challenges, interests in using antimicrobial peptides as therapeutic alternatives and adjuvants to combat pathogenic biofilms have never been foreshortened. Not only do these cationic peptides possess rapid killing ability, their multi-modal mechanisms of action render them advantageous in targeting different biofilm sub-populations. These factors, together with adjunctive bioactive functions such as immunomodulation and wound healing enhancement, render AMPs or their synthetic mimics exciting candidates to be considered as adjuncts in the treatment of caries, infected pulps and root canals.

Human Antimicrobial Peptides in Bodily Fluids: Current Knowledge and Therapeutic Perspectives in the Postantibiotic Era

Antimicrobial peptides (AMPs) are an integral part of the innate immune defense mechanism of many organisms. Due to the alarming increase of resistance to antimicrobial therapeutics, a growing interest in alternative antimicrobial agents has led to the exploitation of AMPs, both synthetic and isolated from natural sources. Thus, many peptide-based drugs have been the focus of increasing attention by many researchers not only in identifying novel AMPs, but in defining mechanisms of antimicrobial peptide activity as well. Herein, we review the available strategies for the identification of AMPs in human body fluids and their mechanism(s) of action. In addition, an overview of the distribution of AMPs across different human body fluids is provided, as well as its relation with microorganisms and infectious conditions.

"Nature cures:" An alternative herbal formulation as a denture cleanser

BACKGROUND

Candida albicans is one of the microorganisms which harbor the oral cavity, especially in elderly. However, the incidence of existence of this increases in patients using removable dental prosthesis. There is therefore a need to test the anticandidal efficacy of these cost-effective, easily available products to be used as routine denture cleansers.

AIM AND OBJECTIVES

(1) To evaluate antifungal properties of triphala churna on the heat cure denture base material. (2) To evaluate the antifungal effect of chlorhexidine gluconate on the heat cure denture base material. (3) To compare the antifungal effect of triphala churna and chlorhexidine gluconate with a control. (4) To evaluate which among triphala churna and chlorhexidine gluconate has a better antifungal property on the heat cure denture base material.

MATERIALS AND METHODS

Study population consisted of sixty dentures wearers from those attending the Outpatient Department of Prosthodontics of the School of Dentistry, Krishna Institute of Medical Sciences Deemed University, Karad. Swabs were collected from the dentures before and after the use of triphala and chlorhexidine. The swabs were cultured on Sabouraud dextrose agar and the total Candida counts were determined.

CONCLUSION

Triphala as an antifungal is shown to have more efficacy than the conventional chlorhexidine mouthwash. Résumé Arrière-plan: Candida albicans est l'un des micro-organismes qui abritent la cavité buccale surtout chez les personnes âgées. Cependant, l'incidence de l'existence de cette augmentation chez les patients utilisant des prothèses dentaires amovibles. Il est donc nécessaire de tester l'efficacité anticancédique de ces produits rentables et faciles à utiliser pour être utilisés comme nettoyants de routine pour prothèses dentaires. Buts et Objectifs: (1) Évaluer les propriétés antifongiques de Triphala churna sur le matériau de base de la prothèse thermo-durcissable. (2) Évaluer l'effet antifongique du gluconate de chlorhexidine sur le matériau de base de la prothèse thermo-durcissable. (3) Comparer l'effet antifongique de Triphala churna et du gluconate de chlorhexidine avec un témoin. (4) Évaluer lequel parmi Triphala churna et le gluconate de chlorhexidine a une meilleure propriété antifongique sur le matériel de base de la prothèse de durcissement à chaud. Matériaux et Méthode: La population de l'étude était constituée de soixante porteurs de prothèses dentaires de ceux qui fréquentaient le Département de Prosthodontie de l'École des Sciences Dentaires de l'Institut Krishna des Sciences Médicales de l'Université de Karad. Des prélèvements ont été effectués sur les prothèses avant et après l'utilisation de Triphala et de chlorhexidine. On a cultivé les écouvillons sur de l'agar Sabouraud dextrose et on a déterminé le nombre total de candida.

CONCLUSION

Triphala comme un anti fongique est démontré pour avoir plus d'efficacité que le lavage de la bouche classique chlorhexidine.

Comparative assessment of the effectiveness of different cleaning methods on the growth of Candida albicans over acrylic surface

Context:

This study evaluated the efficacy of denture adhesive, cleanser, chlorhexidine, and brushing against Candida albicans biofilm developed on an acrylic surface and predicted the most effective, simple, and inexpensive way to maintain denture health, thereby preventing denture stomatitis.

Aims:

To find the best possible method for maintaining denture hygiene.

Settings and Design:

This retrospective analysis was conducted in the Guru Nanak Institute of Dental Sciences and Research, Kolkata, and this in vitro study was designed to minimize denture stomatitis among denture wearing population.

Subjects and Methods:

Sixty acrylic discs of equal dimensions after exposure to C. albicans were treated for a duration of 24 h with denture adhesive, cleanser, 0.2% chlorhexidine individually, or in combinations simulating clinical conditions dividing in six groups, ten samples each (n = 10).

Statistical Analysis Used:

After treatment, colony count was evaluated and statistically analyzed by post hoc Tukey's test and Dunnett's test to determine the most effective way of prevention.

Results:

The statistical post hoc analysis (Tukey's test and Dunnett's test) showed high significance (P < 0.0001). The group treated with adhesive showed high fungal growth compared to the control group, whereas chlorhexidine showed high potency to prevent C. albicans, whereas adhesive increased the adhesion of C. albicans to acrylic surface.

Conclusions:

Denture adhesive increases the adherence of C. albicans to denture surface. Other cleaning chemicals such as cleanser and chlorhexidine decrease the adherence. Moreover, among the all denture cleaning protocol, chlorhexidine drastically inhibit the adherence, as well as growth of C. albicans over denture surface.

Oral antimicrobial peptides: Types and role in the oral cavity

Antimicrobial peptides (AMPs) are a wide-ranging class of host-defense molecules that act early to contest against microbial invasion and challenge. These are small cationic peptides that play an important in the development of innate immunity. In the oral cavity, the AMPs are produced by the salivary glands and the oral epithelium and serve defensive purposes. The aim of this review was to discuss the types and functions of oral AMPs and their role in combating microorganisms and infections in the oral cavity.

Oral antimicrobial peptides: Types and role in the oral cavity

Antimicrobial peptides (AMPs) are a wide-ranging class of host-defense molecules that act early to contest against microbial invasion and challenge. These are small cationic peptides that play an important in the development of innate immunity. In the oral cavity, the AMPs are produced by the salivary glands and the oral epithelium and serve defensive purposes. The aim of this review was to discuss the types and functions of oral AMPs and their role in combating microorganisms and infections in the oral cavity.

Effect of Antimicrobial Denture Base Resin on Multi-Species Biofilm Formation

Our aims of the research were to study the antimicrobial effect of dimethylaminododecyl methacrylate (DMADDM) modified denture base resin on multi-species biofilms and the biocompatibility of this modified dental material. Candida albicans (C. albicans), Streptococcus mutans (S. mutans), Streptococcus sanguinis (S. sanguinis), as well as Actinomyces naeslundii (A. naeslundii) were used for biofilm formation on denture base resin. Colony forming unit (CFU) counts, microbial viability staining, and 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) array were used to evaluate the antimicrobial effect of DMADDM. C. albicans staining and Real-time PCR were used to analyze the morphology and expression of virulence genes of C. albicans in biofilm. Lactate dehydrogenase (LDH) array and Real-time PCR were conducted to examine the results after biofilm co-cultured with epithelial cell. Hematoxylin and eosin (HE) staining followed by histological evaluation were used to study the biocompatibility of this modified material. We found that DMADDM containing groups reduced both biomass and metabolic activity of the biofilm significantly. DMADDM can also inhibit the virulence of C. albicans by means of inhibiting the hyphal development and downregulation of two virulence related genes. DMADDM significantly reduced the cell damage caused by multi-species biofilm according to the LDH activity and reduced the expression of IL-18 gene of the cells simultaneously. The in vivo histological evaluation proved that the addition of DMADDM less than 6.6% in denture material did not increase the inflammatory response (p > 0.05). Therefore, we proposed that the novel denture base resin containing DMADDM may be considered as a new promising therapeutic system against problems caused by microbes on denture base such as denture stomatitis.

From Biology to Drug Development: New Approaches to Combat the Threat of Fungal Biofilms

Fungal infections constitute a major threat to an escalating number of critically ill patients. Fungi are eukaryotic organisms and, as such, there is a limited armamentarium of antifungal drugs, which leads to high mortality rates. Moreover, fungal infections are often associated with the formation of biofilms, which contribute to virulence and further complicate treatment due to the high level of antifungal drug resistance displayed by sessile cells within these microbial communities. Thus, the treatment of fungal infections associated with a biofilm etiology represents a formidable and unmet clinical challenge. The increasing importance and awareness of fungal biofilms is reflected by the fact that this is now an area of very active research. Studies in the last decade have provided important insights into fungal biofilm biology, physiology, and pathology, as well as into the molecular basis of biofilm resistance. Here we discuss how this accumulated knowledge may inform the development of new antibiofilm strategies and therapeutics that are urgently needed.

Natural Sources as Innovative Solutions Against Fungal Biofilms

Fungal cells are capable of adhering to biotic and abiotic surfaces and form biofilms containing one or more microbial species that are microbial reservoirs. These biofilms may cause chronic and acute infections. Fungal biofilms related to medical devices are particularly responsible for serious infections such as candidemia. Nowadays, only a few therapeutic agents have demonstrated activities against fungal biofilms in vitro and/or in vivo. So the discovery of new anti-biofilm molecules is definitely needed. In this context, biodiversity is a large source of original active compounds including some that have already proven effective in therapies such as antimicrobial compounds (antibacterial or antifungal agents). Bioactive metabolites from natural sources, useful for developing new anti-biofilm drugs, are of interest. In this chapter, the role of molecules isolated from plants, lichens, algae, microorganisms, or from animal or human origin in inhibition and/or dispersion of fungal biofilms (especially Candida and Aspergillus biofilms) is discussed. Some essential oils, phenolic compounds, saponins, peptides and proteins and alkaloids could be of particular interest in fighting fungal biofilms.

Histatin 5 inhibits adhesion of C. albicans to Reconstructed Human Oral Epithelium

Candida albicans is the most pathogenic fungal species, commonly colonizing on human mucosal surfaces. As a polymorphic species, C. albicans is capable of switching between yeast and hyphal forms, causing an array of mucosal and disseminated infections with high mortality. While the yeast form is most commonly associated with systemic disease, the hyphae are more adept at adhering to and penetrating host tissue and are therefore frequently observed in mucosal fungal infections, most commonly oral candidiasis. The formation of a saliva-derived protein pellicle on the mucosa surface can provide protection against C. albicans on oral epithelial cells, and narrow information is available on the mucosal pellicle composition. Histatins are one of the most abundant salivary proteins and presents antifungal and antibacterial activities against many species of the oral microbiota, however, its presence has never been studied in oral mucosa pellicle. The objective of this study was to evaluate the potential of histatin 5 to protect the Human Oral Epithelium against C. albicans adhesion. Human Oral Epithelial Tissues (HOET) were incubated with PBS containing histatin 5 for 2 h, followed by incubation with C. albicans for 1 h at 37°C. The tissues were then washed several times in PBS, transferred to fresh RPMI and incubated for 16 h at 37°C at 5% CO₂. HOET were then prepared for histopathological analysis using light microscopy. In addition, the TUNEL assay was employed to evaluate the apoptosis of epithelial cells using fluorescent microscopy. HOET pre-incubated with histatin 5 showed a lower rate of C. albicans growth and cell apoptosis when compared to the control groups (HOET alone and HOET incubated with C. albicans). The data suggest that the coating with histatin 5 is able to reduce C. albicans colonization on epithelial cell surfaces and also protect the basal cell layers from undergoing apoptosis.

Trichosporon inkin biofilms produce extracellular proteases and exhibit resistance to antifungals

The aim of this study was to determine experimental conditions for in vitro biofilm formation of clinical isolates of Trichosporon inkin, an important opportunistic pathogen in immunocompromised patients. Biofilms were formed in microtitre plates in three different media (RPMI, Sabouraud and CLED), with inocula of 104, 105 or 106 cells ml- 1, at pH 5.5 and 7.0, and at 35 and 28 °C, under static and shaking conditions for 72 h. Growth kinetics of biofilms were evaluated at 6, 24, 48 and 72 h. Biofilm milieu analysis were assessed by counting viable cells and quantification of nucleic acids released into biofilm supernatants. Biofilms were also analysed for proteolytic activity and antifungal resistance against amphotericin B, caspofungin, fluconazole, itraconazole and voriconazole. Finally, ultrastructural characterization of biofilms formed in microtitre plates and catheter disks was performed by scanning electron microscopy. Greater biofilm formation was observed with a starter inoculum of 106 cells ml- 1, at pH 7.0 at 35 °C and 80 r.p.m., in both RPMI and Sabouraud media. Growth kinetics showed an increase in both viable cells and biomass with increasing incubation time, with maximum production at 48 h. Biofilms were able to disperse viable cells and nucleic acids into the supernatant throughout the developmental cycle. T. inkin biofilms produced more protease than planktonic cells and showed high tolerance to amphotericin B, caspofungin and azole derivatives. Mature biofilms were formed by different morphotypes, such as blastoconidia, arthroconidia and hyphae, in a strain-specific manner. The present article details the multicellular lifestyle of T. inkin and provides perspectives for further research.

Antifungal activity of propolis against Candida species isolated from cases of chronic periodontitis

This research evaluated the fungistatic and fungicidal activities of red propolis alcoholic extract (RPAE) against different Candida species isolated from chronic periodontitis cases, and compared with chlorhexidine (CHX). Nineteen samples of Candida species (C. albicans [n = 12], C. tropicalis [n = 5] and C. glabrata [n = 2]) isolated from chronic periodontitis cases were analyzed. The fungistatic and fungicidal activity of both RPAE and CHX were evaluated using fluconazole and C. parapsilosis (ATCC 6258) as a control. Fungistatic activity was analyzed based on the Clinical and Laboratory Standards Institute (CLSI) reference procedure to determine the minimum inhibitory concentrations. Fungicidal activity was established according to the absence of fungal growth on Sabouraud Dextrose Agar medium. The fungistatic and fungicidal activities of RPAE were observed, respectively, at 32-64 μg/mL and 64-512 μg/mL for C. albicans, 64 μg/mL and 64-256 μg/mL for C. glabrata, and 32-64 μg/mL and 64 µg/mL for C. tropicalis. CHX fungistatic activity was observed at concentrations of 0.003-1.92 µg/mL for C. albicans, 1.92 µg/mL for C. glabrata, and 0.03-1.92 µg/mL for C. tropicalis. Fluconazole fungistatic activity ranged between 1-64 μg/mL, and fungicidal activity occurred at 8-64 μg/mL, for the three Candida species analyzed. All the Candida species were susceptible to RPAE antifungal activity, but five samples of C. albicans, one of C. tropicalis and one of C. glabrata were resistant to fluconazole antifungal activity. CHX showed fungistatic activity against all the Candida species analyzed. The antifungal potential of these substances suggests that they can be applied as an alternative treatment for diseases affected by these species.

Nylon-3 polymers active against drug-resistant Candida albicans biofilms

Candida albicans is the most common fungal pathogen in humans, and most diseases produced by C. albicans are associated with biofilms. We previously developed nylon-3 polymers with potent activity against planktonic C. albicans and excellent C. albicans versus mammalian cell selectivity. Here we show that these nylon-3 polymers have strong and selective activity against drug-resistant C. albicans in biofilms, as manifested by inhibition of biofilm formation and by killing of C. albicans in mature biofilms. The best nylon-3 polymer (poly-βNM) is superior to the antifungal drug fluconazole for all three strains examined. This polymer is slightly less effective than amphotericin B (AmpB) for two strains, but the polymer is superior against an AmpB-resistant strain.

Resins-based denture soft lining materials modified by chlorhexidine salt incorporation: an in vitro analysis of antifungal activity, drug release and hardness

OBJECTIVES

To evaluate the in vitro growth inhibition of Candida albicans, the rate of chlorhexidine release and shore A hardness from resins-based denture soft lining materials modified by chlorhexidine diacetate (CDA) or chlorhexidine hydrochloride (CHC) incorporation.

METHODS

Resin discs were prepared from soft denture liners based on poly (methyl methacrylate) (PMMA) or poly (ethyl methacrylate) (PEMA) containing 0.5, 1.0 and 2.0 wt.% of CDA or CHC. For antifungal activity resin discs were placed on agar plates inoculated with C. albicans, after 48 h at 37°C the diameters of inhibition zones were measured. For the chlorhexidine release, discs were immersed into distilled water at 37°C, and spectral measurements were made after 48 h. Shore A hardness was evaluated at the baseline, 2 and 7 days, using 6mm thick rectangular specimens also immersed into distilled water at 37°C. Data were statistically processed by SigmaStat software using ANOVA and all pairwise multiple comparison procedures was done using the Holm-Sidak method, with α=0.05 (p<0.001).

RESULTS

CDA added to PMMA soft liner and PEMA soft liner had a dose-related inhibitory effect on C. albicans and on chlorhexidine release rate (p<0.001). The PMMA and PEMA hardness increased statistically by time but not for the different CDA concentrations. CHC had no inhibitory effect on C. albicans.

SIGNIFICANCE

Chlorhexidine diacetate released from resins-based soft lining materials can be convenient to reduce the biofilm development on the material surface and treat denture stomatitis, without depending on patient compliance.

Treatment of microbial biofilms in the post-antibiotic era: prophylactic and therapeutic use of antimicrobial peptides and their design by bioinformatics tools

The treatment for biofilm infections is particularly challenging because bacteria in these conditions become refractory to antibiotic drugs. The reduced effectiveness of current therapies spurs research for the identification of novel molecules endowed with antimicrobial activities and new mechanisms of antibiofilm action. Antimicrobial peptides (AMPs) have been receiving increasing attention as potential therapeutic agents, because they represent a novel class of antibiotics with a wide spectrum of activity and a low rate in inducing bacterial resistance. Over the past decades, a large number of naturally occurring AMPs have been identified or predicted from various organisms as effector molecules of the innate immune system playing a crucial role in the first line of defense. Recent studies have shown the ability of some AMPs to act against microbial biofilms, in particular during early phases of biofilm development. Here, we provide a review of the antimicrobial peptides tested on biofilms, highlighting their advantages and disadvantages for prophylactic and therapeutic applications. In addition, we describe the strategies and methods for de novo design of potentially active AMPs and discuss how informatics and computational tools may be exploited to improve antibiofilm effectiveness.

Nanoscale adhesion forces between enamel pellicle proteins and hydroxyapatite

The acquired enamel pellicle (AEP) is important for minimizing the abrasion caused by parafunctional conditions as they occur, for instance, during bruxism. It is a remarkable feature of the AEP that a protein/peptide film can provide enough protection in normofunction to prevent teeth from abrasion and wear. Despite its obvious critical role in the protection of tooth surfaces, the essential adhesion features of AEP proteins on the enamel surface are poorly characterized. The objective of this study was to measure the adhesion force between histatin 5, a primary AEP component, and hydroxyapatite (HA) surfaces. Both biotinylated histatin 5 and biotinylated human serum albumin were allowed to adsorb to streptavidin-coated silica microspheres attached to atomic force microscope (AFM) cantilevers. A multimode AFM with a Nanoscope IIIa controller was used to measure the adhesion force between protein-functionalized silica microspheres attached to cantilever tips and the HA surface. The imaging was performed in tapping mode with a Si3N4 AFM cantilever, while the adhesion forces were measured in AFM contact mode. A collection of force-distance curves (~3,000/replicate) was obtained to generate histograms from which the adhesion forces between histatin 5 or albumin and the HA surface were measured. We found that histatin 5 exhibited stronger adhesion forces (90% >1.830 nN) to the HA surface than did albumin (90% > 0.282 nN). This study presents an objective approach to adhesion force measurements between histatin 5 and HA, and provides the experimental basis for measuring the same parameters for other AEP constituents. Such knowledge will help in the design of synthetic proteins and peptides with preventive and therapeutic benefits for tooth enamel.

Antifungal therapy with an emphasis on biofilms

Fungal infections are on the rise as advances in modern medicine prolong the lives of severely ill patients. Fungi are eukaryotic organisms and there are a limited number of targets for antifungal drug development; as a result the antifungal arsenal is exceedingly limited. Azoles, polyenes and echinocandins constitute the mainstay of antifungal therapy for patients with life-threatening mycoses. One of the main factors complicating antifungal therapy is the formation of fungal biofilms, microbial communities displaying resistance to most antifungal agents. A better understanding of fungal biofilms provides for new opportunities for the development of urgently needed novel antifungal agents and strategies.

Candida albicans flu1-mediated efflux of salivary histatin 5 reduces its cytosolic concentration and fungicidal activity

Histatin 5 (Hst 5) is a salivary human antimicrobial peptide that is toxic to the opportunistic yeast Candida albicans. Fungicidal activity of Hst 5 requires intracellular translocation and accumulation to a threshold concentration for it to disrupt cellular processes. Previously, we observed that total cytosolic levels of Hst 5 were gradually reduced from intact cells, suggesting that C. albicans possesses a transport mechanism for efflux of Hst 5. Since we identified C. albicans polyamine transporters responsible for Hst 5 uptake, we hypothesized that one or more polyamine efflux transporters may be involved in the efflux of Hst 5. C. albicans FLU1 and TPO2 were found to be the closest homologs of Saccharomyces cerevisiae TPO1, which encodes a major spermidine efflux transporter, indicating that the products of these two genes may be involved in efflux of Hst 5. We found that flu1Δ/Δ cells, but not tpo2Δ/Δ cells, had significant reductions in their rates of Hst 5 efflux and had significantly higher cytoplasmic Hst 5 and Hst 5 susceptibilities than did the wild type. We also found that flu1Δ/Δ cells had reduced biofilm formation compared to wild-type cells in the presence of Hst 5. Transcriptional levels of FLU1 were not altered over the course of treatment with Hst 5; therefore, Hst 5 is not likely to induce FLU1 gene overexpression as a potential mechanism of resistance. Thus, Flu1, but not Tpo2, mediates efflux of Hst 5 and is responsible for reduction of its toxicity in C. albicans.

The effect of histatin 5, adsorbed on PMMA and hydroxyapatite, on Candida albicans colonization

The limited number of treatments for oral candidiasis resulted in the emergence of azole-resistant Candida albicans strains, thus enforcing the need for novel antifungal treatments. Although histatin 5 (H5) demonstrates antifungal activity, its inhibitory effect when adhered to hydroxyapatite and Polymetylmethacrylate (PMMA) surfaces, resembling conditions of the in vivo pellicle, remains unexplored. The objective of this in vitro study was to determine whether surface-adhered H5 inhibits the colonization of C. albicans on hydroxyapatite and/or PMMA. The C. albicans assay involved developing a mono-protein pellicle (either H5 or albumin) on hydroxyapatite and PMMA discs, introducing C. albicans and counting the number of adhered cells, throughout time, using scanning electron microscopy. A negative binomial statistical model and the Tukey-Kramer test were used for statistical analysis, with p < 0.01 indicating significance. H5-coated PMMA had significantly reduced number of cells compared to albumin-coated PMMA at 30, 90 and 1440 min (p < 0.0001), with the number of cells decreasing significantly in 90 and 1440 min (p < 0.0001). Similarly, H5-coated hydroxyapatite had significantly fewer cells compared to the albumin-coated surface at 90 and 1440 min (p < 0.0001), with the number of cells decreasing significantly at 30, 90 and 1440 min (p < 0.0001). In conclusion, C. albicans colonization was most inhibited by PMMA and hydroxyapatite-adhered H5 after 1440 min, illustrating the time-dependent effect of H5. In addition, yeast cells colonized albumin-coated PMMA, while dense hyphal networks formed on albumin-coated hydroxyapatite, suggesting that C. albicans morphology is influenced by the surface available for albumin adhesion.

Cytocompatible antifungal acrylic resin containing silver nanoparticles for dentures

Background

Inhibition of Candida albicans on denture resins could play a significant role in preventing the development of denture stomatitis. The safety of a new dental material with antifungal properties was analyzed in this work.

Methods

Poly(methyl methacrylate) [PMMA] discs and PMMA-silver nanoparticle discs were formulated, with the commercial acrylic resin, Nature-Cryl^TM, used as a control. Silver nanoparticles were synthesized and characterized by ultraviolet-visible spectroscopy, dispersive Raman spectroscopy, and transmission electron microscopy. The antifungal effect was assessed using a luminescent microbial cell viability assay. Biocompatibility tests were carried out using NIH-3T3 mouse embryonic fibroblasts and a Jurkat human lymphocyte cell line. Cells were cultured for 24 or 72 hours in the presence or absence of the polymer formulations and analyzed using three different tests, ie, cellular viability by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, and cell proliferation by enzyme-linked immunosorbent assay BrdU, and genomic DNA damage (Comet assay). Finally, the samples were evaluated mechanically, and the polymer-bearing silver nanoparticles were analyzed microscopically to evaluate dispersion of the nanoparticles.

Results

The results show that PMMA-silver nanoparticle discs significantly reduce adherence of C. albicans and do not affect metabolism or proliferation. They also appear not to cause genotoxic damage to cells.

Conclusion

The present work has developed a new biocompatible antifungal PMMA denture base material.

Antimicrobial peptide control of pathogenic microorganisms of the oral cavity: a review of the literature

Antimicrobial peptides, molecules produced in many different organisms, have high biocidal activity against several microorganisms. However, several questions about these molecules remain unclear. Therefore, this report details a systematic survey of the literature on the use of antimicrobial peptides against oral pathogens and indicates which peptides and microorganisms are most extensively studied. Articles were located using the PubMed and Science Direct databases with the following inclusion criteria: publication date between 2002 and 2011; keywords "biofilm OR biological film OR biological layer OR bacterial growth" AND "peptide" AND "oral cavity OR mouth OR buccal mucosa OR oral mucosa OR mouth mucosa"; and abstract in English. A total of 73 articles were selected after refinement of the data. An increase in publications focusing on the use of antimicrobial peptides against oral microorganisms was observed. In addition, the peptides produced by cells of the oral mucosa (defensins, LL-37 and histatins) as well as Streptococcus mutans (among cariogenic bacteria) and Porphyromonas gingivalis (among periodontal bacteria) were the most studied subjects. It was concluded that the use of antimicrobial peptides as a tool for microbial control is of increasing importance, likely due to its widespread use, mechanism of action, and low rates of bacterial resistance.