Effect of hydrogen-peroxide-mediated oxidative stress on human dental pulp cells

Mitochondrial homeostasis in odontoblast: Physiology, pathogenesis and targeting strategies

Caries and pulpitis remain a major global disease burden and affect the quality of life of patients. Odontoblasts are key players in the progression of caries and pulpitis, not only secreting and mineralizing to form dentin, but also acting as a wall of defense to initiate immune defenses. Mitochondrion is an information processor for numerous cellular activities, and dysregulation of mitochondrion homeostasis not only affects cellular metabolism but also triggers a wide range of diseases. Elucidating mitochondrial homeostasis in odontoblasts can help deepen scholars' understanding of odontoblast-associated diseases. Articles on mitochondrial homeostasis in odontoblasts were evaluated for information pertinent to include in this narrative review. This narrative review focused on understanding the complex interplay between mitochondrial homeostasis in odontoblasts under physiological and pathological conditions. Furthermore, mitochondria-centered therapeutic strategies (including mitochondrial base editing, targeting platforms, and mitochondrial transplantation) were emphasized by resolving key genes that regulate mitochondrial function. Mitochondria are involved in odontoblast differentiation and function, and act as mitochondrial danger-associated molecular patterns (mtDAMPs) to mediate odontoblast pathological progression. Novel mitochondria-centered therapeutic strategies are particularly attractive as emerging therapeutic approaches for the maintenance of mitochondrial homeostasis. It is expected to probe key events of odontoblast differentiation and advance the clinical resolution of dentin formation and mineralization disorders and odontoblast-related diseases.

TRPA1 up-regulation mediates oxidative stress in a pulpitis model in vitro

BACKGROUND AND PURPOSE

Pulpitis is associated with tooth hypersensitivity and results in pulpal damage. Thermosensitive transient receptor potential (TRP) ion channels expressed in the dental pulp may be key transducers of inflammation and nociception. We aimed at investigating the expression and role of thermo-TRPs in primary human dental pulp cells (hDPCs) in normal and inflammatory conditions.

EXPERIMENTAL APPROACH

Inflammatory conditions were induced in hDPC cultures by applying polyinosinic:polycytidylic acid (poly(I:C)). Gene expression and pro-inflammatory cytokine release were measured by RT-qPCR and ELISA. Functions of TRPA1 channels were investigated by monitoring changes in intracellular Ca2+ concentration. Mitochondrial superoxide production was measured using a fluorescent substrate. Cellular viability was assessed by measuring the activity of mitochondrial dehydrogenases and cytoplasmic esterases. TRPA1 activity was modified by agonists, antagonists, and gene silencing.

KEY RESULTS

Transcripts of TRPV1, TRPV2, TRPV4, TRPC5, and TRPA1 were highly expressed in control hDPCs, whereas TRPV3, TRPM2, and TRPM3 expressions were much lower, and TRPM8 was not detected. Poly(I:C) markedly up-regulated TRPA1 but not other thermo-TRPs. TRPA1 agonist-induced Ca2+ signals were highly potentiated in inflammatory conditions. Poly(I:C)-treated cells displayed increased Ca2+ responses to H2O2, which was abolished by TRPA1 antagonists. Inflammatory conditions induced oxidative stress, stimulated mitochondrial superoxide production, resulted in mitochondrial damage, and decreased cellular viability of hDPCs. This inflammatory cellular damage was partly prevented by the co-application of TRPA1 antagonist or TRPA1 silencing.

CONCLUSION AND IMPLICATIONS

Pharmacological blockade of TRPA1 channels may be a promising therapeutic approach to alleviate pulpitis and inflammation-associated pulpal damage.

Clinical comparison of whitening efficacy and tooth sensitivity of different concentrations of hydrogen peroxide photoactivated with violet or blue LEDs

This study evaluated the photoactivation of hydrogen peroxide gels at different concentrations using blue or violet LED in terms of whitening efficacy and tooth sensitivity. Forty patients were randomly divided into 4 groups: HP6V (violet LED and 6% hydrogen peroxide), HP6B (blue LED and 6% hydrogen peroxide), HP35V (violet LED and 35% hydrogen peroxide), and HP35B (blue LED and 35% hydrogen peroxide). The L*, a* and b* values were measured before, 1 week and 3 months after treatment, and the ΔE and ΔWID values were calculated. Tooth sensitivity was measured using a visual analogue scale (VAS) before, immediately after, and 24 h after bleaching. The ΔE, ΔWID and bleaching sensitivity values were subjected to the ANOVA test and Bonferroni post-test. HP35V and HP35B showed higher whitening efficacy than HP6VL, while HP6V did not show statistical differences compared to the other groups. Regarding bleaching-related sensitivity, the HP6V and HP6B groups presented the lowest values when compared to HP35V and HP35B. HP6V showed whitening efficacy comparable to HP35V and HP35B but with reduced tooth sensitivity. TRIAL REGISTRATION NUMBER: NCT06165458; registration date: 12/09/2023.

Catalysis-based approaches with biopolymers and violet LED to improve in-office dental bleaching

This in vitro experimental investigation aimed to evaluate the impact of the combined application of a nanofiber scaffold (NS), a polymeric catalyst primer (PCP) containing 10 mg/mL of heme peroxidase enzyme, and violet LED (LEDv) on the esthetic efficacy (EE), trans-amelodentinal cytotoxicity (TC), and procedural duration of conventional in-office bleaching therapy. To achieve this, 96 standardized enamel/dentin discs were individually placed in artificial pulp chambers. A 35% hydrogen peroxide (H2O2) bleaching gel was administered for 45, 30, or 15 min to the enamel, either previously coated with NS + PCP or left uncoated, followed by irradiation with LEDv for 15 min or no irradiation. The established groups were as follows: G1, negative control (no treatment); G2, 35% H2O2/45 min; G3, NS + PCP + LEDv; G4, NS + PCP + 35%H2O2/45 min + LEDv; G5, NS + PCP + 35%H2O2/30 min + LEDv; and G6, NS + PCP + 35%H2O2/15 min + LEDv. Extracts (culture medium + gel components diffused through the discs) were collected and applied to odontoblast-like MDPC-23 cells. EE (ΔE00 and ΔWI) and TC were assessed using ANOVA/Tukey analysis (p < 0.05). The EE analysis revealed no statistical differences between G6 and G2 (p > 0.05). Cells in G6 exhibited higher viability and lower oxidative stress compared to other bleached groups (p < 0.05). In conclusion, employing NS + PCP + LEDv to catalyze a 35%H2O2 bleaching gel applied for 15 min to the enamel resulted in successful esthetic improvements and reduced the cytotoxicity commonly linked with traditional in-office bleaching procedures.

Evaluation of oxidative stress cycle in healthy and inflamed dental pulp tissue: a laboratory investigation

OBJECTIVES

The purpose of this study was to investigate the oxidative stress cycle consisting of reactive oxygen molecules (ROS), glutathione (GSH) and glutathione S-transferase (GST) in caries-related pulp inflammation.

METHODOLOGY

Fifty-four pulp tissue samples were collected from healthy donors with the diagnosis of reversible pulpitis, symptomatic irreversible pulpitis, and healthy pulp. Twelve pulp samples from each group were homogenized and total protein, ROS, GSH, and GST were measured by spectrophotometer. The remaining 6 samples from each group were prepared for paraffin block and used for the histopathologic and immunohistochemical evaluation of oxidative stress parameters and TUNEL labeling. Data were analyzed statistically.

RESULTS

The results revealed that total protein levels significantly decreased; however, ROS levels increased in both reversible and irreversible pulpitis compared to the healthy pulp (p < 0.01). Also, as inflammation increases, GST enzyme levels decrease while GSH levels increase significantly (p < 0.05). It was found that the number of TUNEL (+) cells was increased in irreversible pulpitis samples compared to healthy and reversible pulpitis groups (p < 0.05). GSTP1 and GSH immunoreactivity were also observed in irreversible pulpitis samples.

CONCLUSIONS

It has been revealed that caries-related inflammation alters the oxidative stress cycle in dental pulp tissue. The increase in GSH levels in the inflamed dental pulp due to the increase in ROS levels may improve the defensive ability of the dental pulp.

CLINICAL RELEVANCE

There is a relationship between oxidative stress and inflammation. Control of excessive oxidative stress in pulpitis can stimulate reparative and regenerative processes. The present findings may provide an overview of the management of oxidative stress in cases with pulpitis during regenerative treatments.

Lipopolysaccharides and hydrogen peroxide induce contrasting pathological conditions in dental pulpal cells

AIM

To determine the effects of lipopolysaccharides (LPS), hydrogen peroxide (H₂ O₂ ), and both combined on cell proliferation/differentiation, inflammation, mitochondrial dynamics as indicated by mitochondrial fission/fusion, antioxidants as indicated by superoxide dismutase 2 (SOD2), and apoptosis of human dental pulpal cells (HDPCs).

METHODOLOGY

Pulpal tissues from eight healthy subjects (n = 8) were collected from Faculty of Dentistry, Chiang Mai University. Isolated HDPCs from healthy donors were divided into four experimental groups: vehicle, 20 μg/ml LPS, 400 μM H₂ O₂ , and the two combined. All experimental groups were investigated to assess cell proliferation, mineralization, differentiation, inflammation, mitochondrial dynamics, antioxidants, and apoptosis.

RESULTS

H₂ O₂ and combined agents decreased cell proliferation of HDPCs equally. LPS, H₂ O_2, and both combined decreased mineralization and differentiation with an increase in tumour necrosis factor-alpha (TNF-α) levels. Surprisingly, LPS and combined agents increased SOD2 expression and caused an imbalance in mitochondrial dynamics. A significant increase in apoptosis was observed in the case of H₂ O₂ and combined agents.

CONCLUSIONS

These findings suggest that LPS induced inflammation, imbalanced mitochondrial dynamics, and reduced cell differentiation without altering apoptosis and cell proliferation. However, H₂ O₂ decreased cell proliferation, and differentiation, and increased inflammation, and apoptosis without interfering with mitochondrial dynamics. Based on our findings, combining LPS and H₂ O₂ could be potentially used as the inducers in in vitro study to mimic the clinical pulpitis.

The influence of hydrogen peroxide concentration on the chemical kinetics of photo-accelerated tooth whitening

BACKGROUND

The bleaching procedure consists of chemical principles of free radical release that react with chromophores, which results in an amount of energy released in this process. However, the evaluation of the electrical potential generated in these protocols has not yet been thoroughly investigated in the literature. Thus, this study aimed to examine variations in pH, mV, and temperature of different concentrations of hydrogen peroxide in the presence or absence of an intermittent LED/LASER photo acceleration system.

METHODS

The study was divided into six groups (n = 9) according to the concentration of hydrogen peroxide (6%, 15%, and 35%), associated or not with the photo acceleration system LED/LASER. We followed the variation of pH, mV, and temperature at 1, 5, 10, 15, and 30 min after gel manipulation. Data were evaluated by two-way ANOVA of repeated measures (α =0.05).

RESULTS

pH, mV, and temperature of the groups showed statistical differences both in the light and bleach and in the interaction between the two factors (p < 0.0001), where pH and mV were more influenced by the bleach and light factor, while the temperature was influenced by the bleach factor associated with light. HP15 presented the most significant change in pH, mV, and temperature.

CONCLUSION

The use of LED/laser increased the temperature of the gels and altered the pH and mV kinetics of HP6 and HP15, which did not occur in HP35, possibly due to the high ionic potential linked to the concentration.

Oxidative stress impairs the calcification ability of human dental pulp cells

Background

The relationship between internal root resorption and oxidative stress has not yet been reported. This study aimed to add molecular insight into internal root resorption. The present study was conducted to investigate the effect of hydrogen peroxide (H₂O₂) as an inducer of oxidative stress on the calcification ability of human dental pulp cells (hDPCs) and the involvement of inositol 1, 4, 5-trisphosphate (IP3).

Material and methods

hDPCs (Lonza, Basel, Switzerland) were exposed to H₂O₂. Cell viability and reactive oxygen species (ROS) production were then evaluated. To investigate the effect of H₂O₂ on the calcification ability of hDPCs, real-time PCR for alkaline phosphatase (ALP) mRNA expression, ALP staining, and Alizarin red staining were performed. Data were compared with those of hDPCs pretreated with 2-aminoethyldiphenylborate (2-APB), which is an IP3 receptor inhibitor.

Results

H₂O₂ at concentrations above 250 µM significantly reduced cell viability (P < 0.01). More ROS production occurred in 100 µM H₂O₂-treated hDPCs than in control cells (P < 0.01). 2-APB significantly decreased the production (P < 0.05). H₂O₂-treated hDPCs showed significant reductions in ALP mRNA expression (P < 0.01), ALP activity (P < 0.01), and mineralized nodule deposition compared with negative control cells (P < 0.01). 2-APB significantly inhibited these reductions (P < 0.01, P < 0.05 and P < 0.01, respectively). Data are representative of three independent experiments with three replicates for each treatment and values are expressed as means ± SD.

Conclusion

To the best of our knowledge, this is the first study documenting the involvement of IP₃ signaling in the calcification ability of human dental pulp cells impaired by H₂O₂.

Assessment of Biochemical Parameters of the Oral Fluid before and after Using Office Teeth Whitening Systems

One of the most important functions of the oral fluid is to maintain oral homeostasis. In-office teeth whitening systems are able to change the mineral metabolism and the activity of a number of enzymes in the oral fluid, but there are conflicting data in publications about this. The aim of this study was to compare the effect of Opalescense Boost, ZOOM Advance POWER, and ZOOM Phillips White Speed, which contain different percentages of hydrogen peroxide, on the performance of oral fluid. After the procedure of whitening teeth with the studied in-office systems, the concentration of calcium in the oral fluid increased, and the activity of alkaline phosphatase decreased. Calcium levels returned to baseline values after 30 days, and alkaline phosphatase activity returned after 14 days. There was no significant difference in the changes in calcium concentration and alkaline phosphatase activity between different tooth whitening systems. Chemical teeth whitening with the Opalescense Boost system caused the largest change in the activity of superoxide dismutase in the oral fluid compared to the ZOOM Advance POWER and ZOOM Phillips White Speed photocatalytic teeth whitening systems. An increase in the activity of superoxide dismutase by +75.5% was shown immediately after the procedure of teeth whitening with the Opalescense Boost system, which indicated an increase in the power of antioxidant defense mechanisms. To assess the effectiveness and safety of using various whitening systems, it is possible to study the dynamics of the activity of superoxide dismutase, which reflects the processes of antioxidant protection of the oral cavity.

Manganese oxide increases bleaching efficacy and reduces the cytotoxicity of a 10% hydrogen peroxide bleaching gel

OBJECTIVE

The study aims to assess the effects of a 10% H₂O₂ bleaching gel with different MnO₂ concentrations on the bleaching efficacy (BE), degradation kinetics (DK) of H₂O₂, and trans-amelodentinal cytotoxicity (TC).

MATERIALS AND METHODS

Standardized bovine enamel/dentin disks (n = 96) were placed in artificial pulp chambers, and the bleaching gels were applied for 45 min. Thus, the following groups were established: (G1) no treatment (negative control/NC); (G2) 35% H₂O₂ (positive control/PC); (G3) 10% H₂O₂; (G4) 10% H₂O₂ + 2 mg/mL MnO₂; (G5) 10% H₂O₂ + 6 mg/mL MnO₂; and (G6) 10% H₂O₂ + 10 mg/mL MnO₂. After analyzing bleaching efficacy (ΔE₀₀ and ΔWI), the degradation kinetics of H₂O₂ and trans-amelodentinal cytotoxicity were determined (n = 8, ANOVA/Tukey; p < 0.05).

RESULTS

G6 presented BE (ΔE₀₀ and ΔWI) statistically similar to G2, which represented conventional in-office bleaching (p = 0.6795; p > 0.9999). A significant reduction in the diffusion of H₂O₂ occurred in G3, G4, G5, and G6 compared to G2 (p < 0.0001). The highest DK of H₂O₂ occurred in G6 (p < 0.0001), which had the lowest TC in comparison with all other bleached groups (p ≤ 0.0186).

CONCLUSION

The addition of 10 mg/mL of MnO₂ in a 10% H₂O₂ bleaching gel potentiates the degradation of this reactive molecule, which increases the BE of the product and decreases TC.

CLINICAL SIGNIFICANCE

Replacing a 35% H₂O₂ gel commonly used for conventional in-office dental bleaching by a 10% H₂O₂ gel containing 10 mg/mL of MnO₂ reduces the cytotoxicity of this professional therapy, maintaining its excellent esthetic efficacy.

Influence of Manganese Oxide on the Esthetic Efficacy and Toxicity Caused by Conventional In-office Tooth Bleaching Therapy

OBJECTIVE

This study aimed to evaluate the esthetic efficacy, cytotoxicity, and kinetics of decomposition of hydrogen peroxide (H2O2) present in a commercial bleaching gel with 35% H2O2 (BG35%) chemically activated with manganese oxide (MnO2).

METHODS AND MATERIALS

After incorporating 2 mg/mL, 6 mg/mL, and 10 mg/mL of MnO2 into BG35%, the stability of pH and temperature of the products were analyzed. To assess the esthetic efficacy (ΔE and ΔWI), the BG35%s with MnO2 were applied for 45 minutes on enamel/dentin discs (DiE/D). BG35% or no treatment were used as positive (PC) and negative (NC) controls, respectively. To analyze the cell viability (CV) and oxidative stress (OXS), the same bleaching protocols were performed on DiE/D adapted to artificial pulp chambers. The extracts (culture medium + gel components that diffused through the discs) were applied to pulp cells and submitted to H2O2 quantification. BG35% with MnO2 that showed the best results was evaluated relative to kinetic decomposition of H2O2, with consequent generation of free radicals (FR) and hydroxyl radicals (OH•). The data were submitted to the one-way analysis of variance complemented by Tukey post-test (α=0.05). Data on kinetics of H2O2 decomposition were submitted to the Student's-t test (α=0.05).

RESULTS

All the BG35%s with MnO2 showed stability of pH and temperature, and the gel with 10 mg/mL of this activator had an esthetic efficacy 31% higher than that of the PC (p<0.05). Reduction in OXS and trans-amelodentinal diffusion of H2O2 occurred when all the BG35%s with MnO2 were used. The addition of 6 and 10 mg/mL of MnO2 to BG35% increased the CV in comparison with PC, confirmed by the cell morphology analysis. An increase in FR and OH• formation was observed when 10 mg/mL of MnO2 was added to BG35%.

CONCLUSION

Catalysis of BG35% with MnO2 minimized the trans-amelodentinal diffusion of H2O2 and toxicity of the product to pulp cells. BG35% containing 10 mg/mL of MnO2 potentiated the decomposition of H2O2, enhancing the generation of FR and OH•, as well as the efficacy of the in-office tooth therapy.

Strategy for reducing cytotoxicity and obtaining esthetic efficacy with 15 min of in-office dental bleaching

OBJECTIVES

Evaluate in vitro the esthetic efficacy and cytotoxicity of a bleaching gel containing 35% hydrogen peroxide (BG-35%H₂O₂), applied for different time intervals, on enamel coated or not with polymeric biomaterials.

MATERIALS AND METHODS

Nanofiber scaffolds (NSc) and a primer catalyst (PrCa) were used to coat the bovine enamel/dentin discs before the application of BG-35%H₂O₂, according to the following groups: G1-negative control (NC, without treatment); G2, G3, and G4-BG-35%H₂O₂ applied for 3 × 15, 2 × 15, and 15 min; G5, G6, and G7-BG-35%H₂O₂ applied on enamel coated with NSc and PrCa for 3 × 15; 2 × 15, and 15 min, respectively. The culture medium with components of gel diffused through the discs was applied on MDPC-23 cells, which were evaluated regarding to viability (VB), integrity of the membrane (IM), and oxidative stress (OxS). The quantity of H₂O₂ diffused and esthetic efficacy (ΔE/ΔWI) of the dental tissues were also analyzed (ANOVA/Tukey; p < 0.05).

RESULTS

Only G7 was similar to G1 regarding VB (p > 0.05). The lowest value of H₂O₂ diffusion occurred in G4 and G7, where the cells exhibited the lowest OxS than G2 (p < 0.05). Despite G5 showing the greatest ΔE regarding other groups (p < 0.05), the esthetic efficacy observed in G7 was similar to G2 (p > 0.05). ΔWI indicated a greater bleaching effect for groups G5, G6, and G7 (p < 0.05).

CONCLUSION

Coating the dental enamel with polymeric biomaterials reduced the time and the cytotoxicity of BG-35%H₂O₂.

CLINICAL SIGNIFICANCE

Coating the dental enamel with polymeric biomaterials allows safer and faster BG-35%H₂O₂ application.

Effect of bleaching gel volume on color change and postoperative sensitivity: a randomized clinical study

OBJECTIVES

Although bleaching therapy is considered a dose-dependent treatment, the effect of the volume of product used is yet to be studied. This study thus aimed to evaluate the influence of bleaching gel volume on chromatic alteration and postoperative sensitivity.

METHODOLOGY

Thirty patients were selected and allocated into three groups; the lower canines were analyzed according to the volume of gel used: GI-0.025 mL, GII-0.05 mL, and GIII-0.10 mL. Chromatic alteration analysis was performed using a portable digital spectrophotometer by calculating the ΔE, ΔE00, ΔL*, Δa*, and Δb* values and the whiteness index (W_ID). Spontaneous sensitivity was assessed using a questionnaire, and sensitivity was stimulated by thermo-sensory analysis. Analyses were conducted in five stages: baseline, after 1st, 2nd, and 3rd bleaching sessions, and 14 days after the end. Data were analyzed using the two-way ANOVA test with repeated measures and Tukey's post hoc test (p < 0.05).

RESULTS

It was observed that ΔE, ΔE00, and ΔL* were similar between groups at the end of the bleaching therapy; and the values of Δa*, Δb*, and WID were higher in the GIII group. For sensitivity, it was found that the GI was the one with the lowest values; o GII intermediate values; while the GIII group presents the highest values of spontaneous and stimulated sensitivity.

CONCLUSION

Gel volume influenced the response to bleaching and significantly influenced the spontaneous sensitivity and cold stimulus.

CLINICAL RELEVANCE

The amount of bleaching gel used during therapy is key to both the response to color change and postoperative sensitivity.

H2O2 gel bleaching induces cytotoxicity and pain conduction in dental pulp stem cells via intracellular reactive oxygen species on enamel/dentin disc

Background

Bleaching is widely accepted for improving the appearance of discolored teeth; however, patient compliance is affected by bleaching-related complications, especially bleaching sensitivity. This study aimed to investigate the role of reactive oxygen species (ROS) in cytotoxicity and pain conduction activated by experimental tooth bleaching.

Methods

Dental pulp stem cells with or without N-acetyl-L-cysteine (NAC), an ROS scavenger, were cultured on the dentin side of the enamel/dentin disc. Subsequently, 15% (90 min) and 40% (30 min) bleaching gels were painted on the enamel surface. Cell viability, intracellular ROS, Ca²⁺, adenosine triphosphate (ATP), and extracellular ATP levels were evaluated using the Cell Counting Kit-8 assay, 2’,7’-dichlorodihydrofluorescein diacetate, CellROX, fura-3AM fluorescence assay, and ATP measurement kit. The rat incisor model was used to evaluate in vivo effects after 0, 1, 3, 7, and 30 days of bleaching. Changes in gene and protein expression of interleukin 6 (IL-6), tumor necrosis factor-alpha (TNFα), transient receptor potential ankyrin 1 (TRPA1), and Pannexin1 (PANX1) in dental pulp stem cells and pulp tissue were detected through RT-PCR, western blotting, and immunofluorescence.

Results

The bleaching gel suppressed dental pulp stem cell viability and extracellular ATP levels and increased intracellular ROS, Ca²⁺, and intracellular ATP levels. The mRNA and protein expression of IL-6, TNFα, TRPA1, and PANX1 were up-regulated in vitro and in vivo. Furthermore, the 40% gel had a stronger effect than the 15% gel, and NAC ameliorated the gel effects.

Conclusions

Our findings suggest that bleaching gels induce cytotoxicity and pain conduction in dental pulp stem cells via intracellular ROS, which may provide a potential therapeutic target for alleviating tooth bleaching nociception.

LED/laser photoactivation enhances the whitening efficacy of low concentration hydrogen peroxide without microstructural enamel changes

BACKGROUND

The association of low concentration hydrogen peroxide (HP) and a light source has been widely used to achieve efficient bleaching. We investigated the colorimetric and microstructural changes of bovine enamel bleached with 6% HP associated or not with a hybrid light source system of violet light and laser (LED/laser).

METHODS

Twenty bovine crowns were used to obtain specimens of 7 × 7 × 2 mm. Then, they were randomized in two groups (n=10): 6% HP and 6% HP + LED/laser. After staining with dark tea solution, three bleaching sessions were performed. Colorimetric evaluation (∆L*, ∆a*, ∆b*, ∆E₀₀ [CIEDE2000] and WI_D) after 24 hours of each session and 7 days after the final bleaching session was performed. Enamel Vickers microhardness at baseline, 24 hours and 7 days after the last bleaching session were also evaluated. Two-way repeated measures ANOVA and Bonferroni post-test was used at a significance level of 5%.

RESULTS

6% HP and 6% + HP LED/laser showed satisfactory bleaching results. The group photoactivated showed higher WI_D values (p<0.05). Differences between groups were observed for ∆E₀₀, ∆L* and ∆a* (p<0.05), except for ∆b* (p>0.05). Intra-group differences were also found (p<0.05). Regarding microhardness, no inter or intra-group differences were observed (p>0.05).

CONCLUSIONS

The photoactivation with LED/laser enhanced the whitening efficacy of 6% HP compared to the group without photoactivation. Thus, the LED/laser activation appears to be a good option when using low concentration HP-based agents. In addition, both bleaching protocols did not cause changes on enamel microhardness.

TRPA1 triggers hyperalgesia and inflammation after tooth bleaching

Hyperalgesia has become a major problem restricting the clinical application of tooth bleaching. We hypothesized that transient receptor potential ankyrin 1 (TRPA1), a pain conduction tunnel, plays a role in tooth hyperalgesia and inflammation after bleaching. Dental pulp stem cells were seeded on the dentin side of the disc, which was cut from the premolar buccal tissue, with 15% (90 min) or 40% (3 × 15 min) bleaching gel applied on the enamel side, and treated with or without a TRPA1 inhibitor. The bleaching gel stimulated intracellular reactive oxygen species, Ca²⁺, ATP, and extracellular ATP in a dose-dependent manner, and increased the mRNA and protein levels of hyperalgesia (TRPA1 and PANX1) and inflammation (TNFα and IL6) factors. This increment was adversely affected by TRPA1 inhibitor. In animal study, the protein levels of TRPA1 (P = 0.0006), PANX1 (P < 0.0001), and proliferation factors [PCNA (P < 0.0001) and Caspase 3 (P = 0.0066)] increased significantly after treated rat incisors with 15% and 40% bleaching gels as detected by immunohistochemistry. These results show that TRPA1 plays a critical role in sensitivity and inflammation after tooth bleaching, providing a solid foundation for further research on reducing the complications of tooth bleaching.

Influence of Hydrogen Peroxide on Mineralization in Dental Pulp Cells: A Systematic Review

Background: Dental bleaching agents show the ability to permeate through dental hard tissues, which may lead to pulp tissue changes. This systematic review (PROSPERO register: CRD42020213767) is aimed at understanding the effects of bleaching agents on the process of mineralization of the pulp tissue.

Methods: Only in vitro studies evaluating the influence of hydrogen peroxide (HP) on mineralization in dental pulp cells were included. Studies without a non-bleached control group or cells after co-treatment with a bleaching agent other than HP and/or carbamide peroxide were excluded. The primary outcomes evaluated were alkaline phosphatase (ALP) activity and mineralized nodule deposition. The mineralization markers analysis in dental pulp cells and the cell viability were considered secondary outcomes. Two independent authors conducted a systematic search (PubMed/MEDLINE, Scopus, Embase, Cochrane Library, and OpenGrey until January 2021) with no language restrictions and performed data extraction. The quality assessment was appraised according to a modified Joanna Briggs Institute critical appraisal checklist.

Results: The search resulted in 473 studies, and 11 were considered eligible. Overall, a reduction in the process of mineralization was observed among pulp cells after bleaching. A reduction in the ALP activity was reported in the mostly bleached groups using different protocols and analysis periods of nine studies. Regarding mineralized nodule deposition, 6 studies reported a significant reduction from 7 to 21 days among bleached groups. Of those three studies that investigated other mineralization markers, two found a reduction in the expression of dentin matrix acidic phosphoprotein (DMP)-1, dentin sialophosphoprotein (DSPP), and matrix extracellular phosphoglycoprotein (MEPE) among some bleaching gel concentrations. In contrast, one study showed a greater expression of osteopontin (OPN) and osteocalcin (OCN) in 100 μmol/L HP after 5 or 10 min of exposure, and another study showed significant induction of DSPP in concentrations of up to 0.5 mmol/L HP.

Conclusion: Especially, high concentrations of bleaching gel reduce the potential of mineralization in pulp cells in in vitro studies; however, different HP concentrations, bleaching protocols, and analysis periods can influence this outcome.

Polymeric biomaterials maintained the esthetic efficacy and reduced the cytotoxicity of in-office dental bleaching

Evaluate the kinetics of hydrogen peroxide (H₂ O₂ ) degradation, esthetic efficacy and cytotoxicity of a bleaching gel with 35%H₂ O₂ applied on enamel previously covered or not with polymeric nanofibrillar scaffold (SNan), polymeric primer catalyst (PPol), and both. Standardized enamel/dentin discs (n = 128) obtained from bovine teeth were adapted to pulp chambers. After covering enamel with the polymeric products, the bleaching gel was applied for 45 min, establishing the following groups: G1: no treatment (negative control); G2: 35%H₂ O₂ (positive control); G3: SNan; G4: PPol; G5: SNan + PPol; G6: SNan + 35%H₂ O₂ ; G7: PPol + 35%H₂ O₂ ; G8: SNan + PPol + 35%H₂ O₂ . The kinetics of H₂ O₂ degradation (n = 8), bleaching efficacy (ΔE/ΔWI; n = 8), trans-amelodentinal cytotoxicity (n = 8), and cell morphology (n = 4) were assessed (ANOVA/Tukey test; p < 0.05). Greater H₂ O₂ degradation occurred in G7 and G8. Bleaching efficacy (ΔE) was higher in G6, G7, and G8 in comparison with G2 (p < 0.05). However, no difference was observed for ΔWI (p > 0.05). G8 presented the lower level of trans-amelodentinal diffusion of H₂ O₂ , oxidative stress, and toxicity to the MDPC-23 cells (p < 0.05). Polymeric biomaterials increased the kinetics of H₂ O₂ decomposition, as well as maintained the esthetic efficacy and minimized the cytotoxicity caused by a bleaching gel with 35%H₂ O₂ . CLINICAL SIGNIFICANCE: Application of a bleaching gel with 35%H₂ O₂ on enamel previously covered by polymeric biomaterials maintains the esthetic efficacy and reduces the cytotoxicity caused by a single session of in-office dental bleaching.

Bleaching and microstructural effects of low concentration hydrogen peroxide photoactivated with LED/laser system on bovine enamel

BACKGROUND

Tooth whitening protocols with low concentration hydrogen peroxide (HP) appear to minimize the microstructural effect on teeth. In addition, light sources have been used to enhance bleaching efficiency. This study evaluated the color change and microhardness of a protocol with 6% HP photoactivated by LED/laser in comparison with 35% HP.

METHODS

Twenty bovine incisors were randomized in two groups: 6% HP + LED/laser and 35% HP (n=10). Teeth were submitted to staining using dark tea. Three whitening sessions were carried out according to the manufacturer's instructions. Enamel microhardness (VHN) and color change evaluation (∆L*, ∆a*, ∆b*, ∆E₀₀ [CIEDE2000], and WI_D) before 24 hours and 7 days after the last whitening session were performed. Two-way repeated ANOVA and Bonferroni post-test was used (α = 0.05).

RESULTS

Both groups showed perceptible color changes, being more pronounce for 35% HP. Differences were observed for ∆a*, ∆b* and ∆E₀₀ (p≤0.027), except for ∆L* (p>0.05). Differences were also found in the comparison among the evaluation times within the same group (p≤0.027), except for ∆a* results (p>0.05). WI_D showed that 35% HP exhibited high whiteness values. Regarding microhardness, the groups did not show significant differences (p>0.05). However, 35% HP showed decreased values after 7 days of the last whitening session compared to the baseline (p≤0.027).

CONCLUSIONS

6% HP + LED/laser promoted perceptible color change, but not comparable with 35% HP. No differences on enamel microhardness were observed between the whitening protocols. However, 35% HP showed decreased hardness after 7 days of whitening compared to baseline.

Evaluation of the aesthetic effect, enamel microhardness and trans-amelodentinal cytotoxicity of a new bleaching agent for professional use containing trimetaphosphate and fluoride

This study evaluated the effects of calcium gluconate (CaGlu), sodium fluoride (NaF), sodium trimetaphosphate (TMP), and NaF/TMP when added to a 35% hydrogen peroxide (H₂O₂) bleaching gel on the color change, enamel hardness, penetration and cytotoxicity trans-amelodentinal. Bovine enamel/dentin disks (n = 288) were divided according to the bleaching gel: 35% H₂O₂; 35% H₂O₂ + 0.05% NaF; 35% H₂O₂ + 0.25% TMP; 35% H₂O₂ + 0.05% NaF + 0.25% TMP; 35% H₂O₂ + 0.1% NaF + 1% TMP and 35% H₂O₂ + 2% CaGlu. The bleaching gels were applied thrice (40 min/session) at 7-day intervals between each application. Then, the color change, percentage of surface hardness loss (%SH), cross-sectional hardness (ΔKHN), trans-amelodentinal penetration of H₂O₂, cell viability and morphology (MDPC-23 odontoblast-like cells), alkaline phosphatase activity (ALP) and deposition of mineralization nodules were determined. The data were submitted to ANOVA, followed by the Student-Newman-Keuls test (p < 0.05). All bleaching gels showed significant color changes after treatment (p < 0.001). Mineral loss (%SH and ΔKHN) and H₂O₂ penetration were lower for 35% H₂O₂/0.1% NaF/1% TMP; 35% H₂O₂/2% CaGlu, meanwhile, showed higher values, compared to the other groups (p < 0.001). Cell viability was around 9%, except for the bleaching gel containing 35% H₂O₂/0.1% NaF/1% TMP with 12.8% (p < 0.05). ALP was higher for groups containing TMP compared to other whitening gels (p < 0.05). The formation of mineralization nodules was greater for gels containing NaF/TMP or CaGlu (p < 0.05). The alterations of cell morphology were intense for all bleaching gels. It was concluded that the addition of NaF/TMP in-office bleaching did not interfere in bleaching efficacy, reduced enamel demineralization, H₂O₂ penetration and cytotoxicity.

Exploring the molecular disorder and dysfunction mechanism of human dental pulp cells under hypoxia by comprehensive multivariate analysis

Dental pulp cells (DPCs) are multipotent cells, which can differentiate into various tissues and have the potential to treat many diseases. However, little is known about the molecular disorder mechanism. To explore the mechanism of molecular disorders and dysfunction of DPCs under hypoxia, we investigated the molecular effects of two hypoxic time lengths on DPCs. Differential analysis, protein interaction network (PPI), enrichment analysis and coupling analysis were further synthesized to identify human dental pulp cell dysfunction modules under hypoxic conditions. Based on the module aggregation of 579 genes, 13 dental pulp cell dysfunction modules were obtained. Importantly, we found that up to 12 modules were significantly involved in positive regulation of neurogenesis, positive regulation of nervous system development. Based on the predictive analysis of regulators, we identified a series of ncRNAs (including CRNDE, MALAT1, microRNA-140-5p, microRNA-300 and microRNA-30a-5p) and transcription factors (including E2F1). Based on the comprehensive functional module analysis, we identified the dysfunction module of human dental pulp cells (HDPCs) under hypoxia. The results suggest that nerve regulation plays an important role in regulating the dysfunction module of DPCs. These prominent pivotal regulators in the module were used as an important part of the molecular disorders of DPCs, may be an important part of the subnetwork of the manipulation module and affect the molecular dysregulation mechanism of DPCs. This study provides new directions and potential targets for further research.

Sclerostin promotes human dental pulp cells senescence

Background

Senescence-related impairment of proliferation and differentiation limits the use of dental pulp cells for tissue regeneration. Deletion of sclerostin improves the dentinogenesis regeneration, while its role in dental pulp senescence is unclear. We investigated the role of sclerostin in subculture-induced senescence of human dental pulp cells (HDPCs) and in the senescence-related decline of proliferation and odontoblastic differentiation.

Methods

Immunohistochemical staining and qRT-PCR analyses were performed to examine the expression pattern of sclerostin in young (20–30-year-old) and senescent (45–80-year-old) dental pulps. HDPCs were serially subcultured until senescence, and the expression of sclerostin was examined by qRT-PCR analysis. HDPCs with sclerostin overexpression and knockdown were constructed to investigate the role of sclerostin in HDPCs senescence and senescence-related impairment of odontoblastic differentiation potential.

Results

By immunohistochemistry and qRT-PCR, we found a significantly increased expression level of sclerostin in senescent human dental pulp compared with that of young human dental pulp. Additionally, elevated sclerostin expression was found in subculture-induced senescent HDPCs in vitro. By sclerostin overexpression and knockdown, we found that sclerostin promoted HDPCs senescence-related decline of proliferation and odontoblastic differentiation potential with increased expression of p16, p53 and p21 and downregulation of the Wnt signaling pathway.

Discussion

The increased expression of sclerostin is responsible for the decline of proliferation and odontoblastic differentiation potential of HDPCs during cellular senescence. Anti-sclerostin treatment may be beneficial for the maintenance of the proliferation and odontoblastic differentiation potentials of HDPCs.

Alginate/Hydroxyapatite-Based Nanocomposite Scaffolds for Bone Tissue Engineering Improve Dental Pulp Biomineralization and Differentiation

Tissue engineering is widely recognized as a promising approach for bone repair and reconstruction. Several attempts have been made to achieve materials that must be compatible, osteoconductive, and osteointegrative and have mechanical strength to provide a structural support. Composite scaffolds consisting in biodegradable natural polymers are very promising constructs. Hydroxyapatite (HAp) can support alginate as inorganic reinforcement and osteoconductive component of alginate/HAp composite scaffolds. Therefore, HAp-strengthened polymer biocomposites offer a solid system to engineer synthetic bone substitutes. In the present work, HAp was incorporated into an alginate solution and internal gelling was induced by addition of slowly acid-hydrolyzing D-gluconic acid delta-lactone for the direct release of calcium ions from HAp. It has been previously demonstrated that alginate-based composites efficiently support adhesion of cancer bone cell lines. Human dental pulp stem cells (DPSCs) identified in human dental pulp are clonogenic cells capable of differentiating in multiple lineage. Thus, this study is aimed at verifying the mineralization and differentiation potential of human DPSCs seeded onto scaffolds based on alginate and nano-hydroxyapatite. For this purpose, gene expression profile of early and late mineralization-related markers, extracellular matrix components, viability parameters, and oxidative stress occurrence were evaluated and analyzed. In summary, our data show that DPSCs express osteogenic differentiation-related markers and promote calcium deposition and biomineralization when growing onto Alg/HAp scaffolds. These findings confirm the use of Alg/HAp scaffolds as feasible composite materials in tissue engineering, being capable of promoting a specific and successful tissue regeneration as well as mineralized matrix deposition and sustaining natural bone regeneration.

Priming with FGF2 stimulates human dental pulp cells to promote axonal regeneration and locomotor function recovery after spinal cord injury

Human dental pulp cells (DPCs), adherent cells derived from dental pulp tissues, are potential tools for cell transplantation therapy. However, little work has been done to optimize such transplantation. In this study, DPCs were treated with fibroblast growth factor-2 (FGF2) for 5-6 consecutive serial passages and were transplanted into the injury site immediately after complete transection of the rat spinal cord. FGF2 priming facilitated the DPCs to promote axonal regeneration and to improve locomotor function in the rat with spinal cord injury (SCI). Additional analyses revealed that FGF2 priming protected cultured DPCs from hydrogen-peroxide-induced cell death and increased the number of DPCs in the SCI rat spinal cord even 7 weeks after transplantation. The production of major neurotrophic factors was equivalent in FGF2-treated and untreated DPCs. These observations suggest that FGF2 priming might protect DPCs from the post-trauma microenvironment in which DPCs infiltrate and resident immune cells generate cytotoxic reactive oxygen species. Surviving DPCs could increase the availability of neurotrophic factors in the lesion site, thereby promoting axonal regeneration and locomotor function recovery.

Quantitative Assessment of the Effects of Oxidants on Antigen-Antibody Binding In Vitro

Objective. We quantitatively assessed the influence of oxidants on antigen-antibody-binding activity. Methods. We used several immunological detection methods, including precipitation reactions, agglutination reactions, and enzyme immunoassays, to determine antibody activity. The oxidation-reduction potential was measured in order to determine total serum antioxidant capacity. Results. Certain concentrations of oxidants resulted in significant inhibition of antibody activity but had little influence on total serum antioxidant capacity. Conclusions. Oxidants had a significant influence on interactions between antigen and antibody, but minimal effect on the peptide of the antibody molecule.

Antioxidant therapy enhances pulpal healing in bleached teeth

Objectives

The purpose of this study was to evaluate the histopathological effects of an antioxidant therapy on the pulp tissue of rat teeth exposed to a bleaching gel with 35% hydrogen peroxide.

Materials and Methods

Forty rats were subjected to oral ingestion by gavage of distilled water (DW) or ascorbic acid (AA) 90 min before the bleaching therapy. For the bleaching treatment, the agent was applied twice for 5 min each to buccal surfaces of the first right mandibular molars. Then, the animals were sacrificed at 6 hr, 24 hr, 3 day, or 7 day post-bleaching, and the teeth were processed for microscopic evaluation of the pulp tissue.

Results

At 6 hr, the pulp tissue showed moderate inflammatory reactions in all teeth of both groups. In the DW and AA groups, 100% and 80% of teeth exhibited pulp tissue with significant necrosis and intense tissue disorganization, respectively. At 24 hr, the AA-treated group demonstrated a greater regenerative capability than the DW group, with less intense inflammatory reaction and new odontoblast layer formation in 60% of the teeth. For up to the 7 day period, the areas of pulpal necrosis were replaced by viable connective tissue, and the dentin was underlined by differentiated odontoblast-like cells in most teeth of both groups.

Conclusions

A slight reduction in initial pulpal damage during post-bleaching was promoted by AA therapy. However, the pulp tissue of AA-treated animals featured faster regenerative potential over time.

Remodeling of Afferent Arterioles From Mice With Oxidative Stress Does Not Account for Increased Contractility but Does Limit Excessive Wall Stress

Because superoxide dismutase (SOD) knockout enhances arteriolar remodeling and contractility, we hypothesized that remodeling enhances contractility. In the isolated and perfused renal afferent arterioles from SOD wild type (+/+) and gene-deleted mice, contractility was assessed from reductions in luminal diameter with perfusion pressure from 40 to 80 mm Hg (myogenic responses) or angiotensin II (10(-6) mol/L), remodeling from media:lumen area ratio, superoxide (O2 (·-)) and hydrogen peroxide (H2O2) from fluorescence microscopy, and wall stress from wall tension/wall thickness. Compared with +/+ strains, arterioles from SOD1-/-, SOD2+/-, and SOD3-/- mice developed significantly (P<0.05) more O2 (·-) with perfusion pressure and angiotensin II and significantly increased myogenic responses (SOD1-/-: -20.7±2.2% versus -12.7±1.6%; SOD2+/-: -7.4±1.3% versus -12.6±1.4%; and SOD3-/-: -9.1±1.9% versus -15.8±2.2%) and angiotensin II contractions and ≈2-fold increased media:lumen ratios. Media:lumen ratios correlated with myogenic responses (r(2) =0.23; P<0.01), angiotensin II contractions (r(2)=0.57; P<0.0001), and active wall tension (r(2) =0.19; P<0.01), but not with active wall stress (r(2)=0.08; NS). Differences in myogenic responses among SOD3 mice were abolished by bath addition of SOD and were increased 3 days after inducing SOD3 knockout (-26.9±1.7% versus -20.1±0.7%; P<0.05), despite unchanged media:lumen ratios (2.01±0.09 versus 2.02±0.03; NS). We conclude that cytosolic, mitochondrial, or extracellular O2 (·-) enhance afferent arteriolar contractility and remodeling. Although remodeling does not enhance contractility, it does prevent the potentially damaging effects of increased wall stress.