Developments in dental plaque pH modelling

Fluid-based wearable sensors: a turning point in personalized healthcare

Nowadays, it has become very popular to develop wearable devices that can monitor biomarkers to analyze the health status of the human body more comprehensively and accurately. Wearable sensors, specially designed for home care services, show great promise with their ease of use, especially during pandemic periods. Scientists have conducted many innovative studies on new wearable sensors that can noninvasively and simultaneously monitor biochemical indicators in body fluids for disease prediction, diagnosis, and management. Using noninvasive electrochemical sensors, biomarkers can be detected in tears, saliva, perspiration, and skin interstitial fluid (ISF). In this review, biofluids used for noninvasive wearable sensor detection under four main headings, saliva, sweat, tears, and ISF-based wearable sensors, were examined in detail. This report analyzes nearly 50 recent articles from 2017 to 2023. Based on current research, this review also discusses the evolution of wearable sensors, potential implementation challenges, and future prospects.

O-pH: Optical pH Monitor to Measure Oral Biofilm Acidity and Assist in Enamel Health Monitoring

OBJECTIVE

Bacteria in the oral biofilm produce acid after consumption of carbohydrates which if left unmonitored leads to caries formation. We present O-pH, a device that ca measure oral biofilm acidity and provide quantitative feedback to assist in oral health monitoring.

METHOD

O-pH utilizes a ratiometric pH sensing method by capturing fluorescence of Sodium Fluorescein, an FDA approved chemical dye. The device was calibrated to a lab pH meter using buffered fluorescein solution with a correlation coefficient of 0.97. The calibration was further verified in vitro on additional buffered solution, artificial, and extracted teeth. An in vivo study on 30 pediatric subjects was performed to measure pH before (rest pH) and after a sugar rinse (drop pH), and the resultant difference in pH (diff pH) was calculated. The study enrolled subjects with low (Post-Cleaning) and heavy (Pre-Cleaning) biofilm load, having both unhealthy/healthy surfaces. Further, we modified point-based O-pH to an image-based device using a multimode-scanning fiber endoscope (mm-SFE) and tested in vivo on one subject.

RESULTS AND CONCLUSION

We found significant difference between Post-Cleaning and Pre-Cleaning group using drop pH and diff pH. Additionally, in Pre-Cleaning group, the rest and drop pH is lower at the caries surfaces compared to healthy surfaces. Similar trend was not noticed in the Post-Cleaning group. mm-SFE pH scope recorded image-based pH heatmap of a subject with an average average diff pH of 1.5.

SIGNIFICANCE

This work builds an optical pH prototype and presents a pioneering study for non-invasively measuring pH of oral biofilm clinically.

Ratiometric imaging of extracellular pH in Streptococcus mutans biofilms exposed to different flow velocities and saliva film thicknesses

Introduction: Fluid flow has a prominent influence on the metabolism of surface-attached biofilms. Dental biofilms are covered by a thin saliva film that flows at different rates in different locations under stimulated and unstimulated conditions. Methods:The present study employed pH ratiometry to study the impact of different flow velocities, saliva film thicknesses and saliva concentrations on microscale pH developments in Streptococcus mutans biofilms of different age. Results:While saliva flow at a velocity of 0.8 mm/min (unstimulated flow) had little impact on biofilm pH, stimulated flow (8 mm/min; 80 mm/min) affected vertical pH gradients in the biofilms and raised the average pH in 48-h biofilms, but not in 72-h and 168-h biofilms. The saliva film thickness had a strong impact on biofilm pH under both static and dynamic conditions. pH drops were significantly higher in biofilms exposed to a thin saliva film (≤ 50 µm) than a thick saliva film (> 50 µm). pH drops in the biofilms were also strongly dependent on the saliva concentration and thus the buffer capacity of the salivary medium. For 48-h and 72-h biofilms, but not for 168-h biofilms, pH drops in distinct microenvironments were more pronounced when the local biofilm thickness was high.

Synthesis of chitosan-based polymeric dyes as colorimetric pH-sensing materials: Potential for food and biomedical applications

pH-sensitive polymeric dyes were fabricated by grafting phenol red (PR) and rosolic acid (RA) onto chitosan (CS) by a facile method. Successful grafting was confirmed by ¹H NMR, FT-IR, UV-vis, XRD, and elemental analysis. The polymeric dyes exhibited no cell toxicity. The colorimetric pH-sensing films were fabricated by blending the polymeric dyes with CS to establish their pH-dependent color properties. The film color changed in the pH range 4-10, which may indicate food spoilage or wound status. Covalently grafting of polymeric dyes in the films led to excellent color stability, leaching resistance, and reversibility. Hence, the synthesized polymeric dyes had potential as pH-indicative colorants for food and biomedical fields.

Flexible potentiometric pH sensors for wearable systems

There is a growing demand for developing wearable sensors that can non-invasively detect the signs of chronic diseases early on to possibly enable self-health management. Among these the flexible and stretchable electrochemical pH sensors are particularly important as the pH levels influence most chemical and biological reactions in materials, life and environmental sciences. In this review, we discuss the most recent developments in wearable electrochemical potentiometric pH sensors, covering the key topics such as (i) suitability of potentiometric pH sensors in wearable systems; (ii) designs of flexible potentiometric pH sensors, which may vary with target applications; (iii) materials for various components of the sensor such as substrates, reference and sensitive electrode; (iv) applications of flexible potentiometric pH sensors, and (v) the challenges relating to flexible potentiometric pH sensors.

pH-Responsive polymeric nanocarriers for efficient killing of cariogenic bacteria in biofilms

Traditional antibacterial treatments, such as chlorhexidine (CHX), destroy cariogenic biofilms. However, they exert negative effects in clinical applications, for example, teeth staining, taste disturbance and harm to oral tissue after a long-term exposure. Therefore, biocompatible strategies for efficient antibacterial drug delivery are in high demand. In this study, aimed at dental caries therapy enhancement, we designed a pH-responsive nanocarrier system, capable of releasing CHX in an acidic environment within cariogenic biofilms. Cationic poly(ethylene glycol)-block-poly(2-(((2-aminoethyl)carbamoyl)oxy)ethyl methacrylate) (PEG-b-PAECOEMA) was synthesized first. Modification of PAECOEMA by citraconic anhydride (CA) forms negatively charged PEG-b-PAECOEMA/CA, which could assemble into core-shell polyionic complex micelles (PICMs) when mixed with cationic CHX via electrostatic interactions. PICMs are stable in healthy neutral oral microenvironments with CHX encapsulated in the core and PEG shell exposed. Once in acidic milieu within caries-producing biofilms, they rapidly disassemble and release CHX cargo owing to degradation of citraconic amide groups. Molecular structures of the above copolymers were confirmed using 1H NMR and gel permeation chromatography (GPC) analysis. The pH-dependent degradation rates of citraconic amide in PEG-b-PAECOEMA/CA copolymer were measured by fluorescamine method. Atomic force microscopy (AFM) studies confirmed successful assembly of well-defined spherical PICMs in aqueous solution. The disassembly of PICMs in acidic microenvironment was observed using dynamic light scattering (DLS). PICMs showed an obvious pH-dependent drug release profile when the pH changed from 7.4 to 5.5. More importantly, the micellar system could reduce drug toxicity of CHX and exhibited outstanding antibacterial capability in the biofilm of Streptococcus mutans. Micelles constructed from pH-sensitive PEG-b-PAECOEMA/CA are highly promising for dental caries therapy and provide guidelines for drug-delivery system design in other acidic pathologic systems.

[Construction of a low-pH-sensing system in Streptococcus mutans]

OBJECTIVE

To construct a low-pH-sensing system in Streptococcus mutans (S. mutans) and to visually detect the pH in situ.

METHODS

Promoter of ureaseⅠ(PureⅠ) and green fluorescence protein (gfp) DNA fragments were amplified by polymerase chain reaction (PCR) from the genome of Streptococcus salivarius 57.I and S. mutans containing the gfp fragment. The two amplified DNA fragments were ligated together and further integrated into pDL278 to construct the recombinant plasmid pDL278-pureⅠ-gfp. This recombinant plasmid was then transformed into S. mutans UA159 cells. Subsequently, the intensity of the optical density per unit area of the low-pH-sensing system was measured and compared under different pH conditions and different processing times.

RESULTS

PureⅠ and gfp DNA fragments were amplified successfully with the correct molecule sizes (450 and 717 bp, respectively). The recombinant plasmid pDL278-pureⅠ-gfp was constructed and further verified by PCR and sequencing. The intensity of the optical density per unit area of the low-pH-sensing system increased with decreasing pH and increasing processing time.

CONCLUSIONS

A low-pH-sensing system was constructed successfully in S. mutans. Our research verified that pureⅠ of Streptococcus salivarius can function well in S. mutans as an acid induced promoter, and provided a new method of detecting the pH of plaque biofilms in situ.

Effect on oral pH changes and taste perception in 10-14-year-old children, after calcium fortification of a fruit juice

AIM

The aim was to determine the effect of calcium fortification of a commercially available mixed-fruit juice on oral pH changes and taste perception in a group of 10 to 14 year-old Indian children.

METHOD

A controlled, blinded, non-randomised clinical trial was adopted, consisting of a sample of 100 healthy children (DMFT <3; age 10-14 years), who were exposed to three test juices one by one [Group A: original fruit juice (control group); Group B: calcium-fortified fruit juice and Group C: calcium + vitamin D fortified fruit juice]. Oral pH, collection of saliva and plaque sampling was undertaken, before and after the juice exposure by each subject at 0, 1, 5, 15, 30 and 45 min. The respective pH was measured with a digital pH meter. For taste perception, a scoring system was used after exposure of the juices to the subjects in a blind manner. The statistical evaluation was done using one-way ANOVA for salivary and plaque pH and Kruskal-Wallis test for buffer capacity and taste perception.

RESULTS

There was a smaller drop in salivary and plaque pH (p < 0.5) and a significant reduction in perceived taste (p < 0.001) by the subjects after calcium modification of fruit juice.

CONCLUSION

The calcium-modified mixed fruit juices was less acidogenic compared with the unfortified juice, and hence will be less cariogenic and erosive towards teeth.

Sugar industry influence on the scientific agenda of the National Institute of Dental Research's 1971 National Caries Program: a historical analysis of internal documents

BACKGROUND

In 1966, the National Institute of Dental Research (NIDR) began planning a targeted research program to identify interventions for widespread application to eradicate dental caries (tooth decay) within a decade. In 1971, the NIDR launched the National Caries Program (NCP). The objective of this paper is to explore the sugar industry's interaction with the NIDR to alter the research priorities of the NIDR NCP.

METHODS AND FINDINGS

We used internal cane and beet sugar industry documents from 1959 to 1971 to analyze industry actions related to setting research priorities for the NCP. The sugar industry could not deny the role of sucrose in dental caries given the scientific evidence. They therefore adopted a strategy to deflect attention to public health interventions that would reduce the harms of sugar consumption rather than restricting intake. Industry tactics included the following: funding research in collaboration with allied food industries on enzymes to break up dental plaque and a vaccine against tooth decay with questionable potential for widespread application, cultivation of relationships with the NIDR leadership, consulting of members on an NIDR expert panel, and submission of a report to the NIDR that became the foundation of the first request for proposals issued for the NCP. Seventy-eight percent of the sugar industry submission was incorporated into the NIDR's call for research applications. Research that could have been harmful to sugar industry interests was omitted from priorities identified at the launch of the NCP. Limitations are that this analysis relies on one source of sugar industry documents and that we could not interview key actors.

CONCLUSIONS

The NCP was a missed opportunity to develop a scientific understanding of how to restrict sugar consumption to prevent tooth decay. A key factor was the alignment of research agendas between the NIDR and the sugar industry. This historical example illustrates how industry protects itself from potentially damaging research, which can inform policy makers today. Industry opposition to current policy proposals-including a World Health Organization guideline on sugars proposed in 2014 and changes to the nutrition facts panel on packaged food in the US proposed in 2014 by the US Food and Drug Administration-should be carefully scrutinized to ensure that industry interests do not supersede public health goals.

The Stephan Curve revisited

The Stephan Curve has played a dominant role in caries research over the past several decades. What is so remarkable about the Stephan Curve is the plethora of interactions it illustrates and yet acid production remains the dominant focus. Using sophisticated technology, it is possible to measure pH changes in plaque; however, these observations may carry a false sense of accuracy. Recent observations have shown that there may be multiple pH values within the plaque matrix, thus emphasizing the importance of the milieu within which acid is formed. Although acid production is indeed the immediate proximate cause of tooth dissolution, the influence of alkali production within plaque has received relative scant attention. Excessive reliance on Stephan Curve leads to describing foods as "safe" if they do not lower the pH below the so-called "critical pH" at which point it is postulated enamel dissolves. Acid production is just one of many biological processes that occur within plaque when exposed to sugar. Exploration of methods to enhance alkali production could produce rich research dividends.