Hydrogen Peroxide Induces Heme Oxygenase–1 and Dentin Sialophosphoprotein mRNA in Human Pulp Cells

Hydrogen-Rich Water to Enhance Exercise Performance: A Review of Effects and Mechanisms

Background: Hydrogen-rich water (HRW) has garnered significant interest within the sports and exercise science community due to its selective antioxidant properties. Despite its potential benefits, comprehensive reviews specifically addressing its effects on athletic performance are limited. This review aims to assess the impact of HRW on sports performance and explore the underlying molecular biological mechanisms, with the goal of elucidating how HRW might enhance athletic performance. Methods: This review synthesizes research on HRW by examining articles published between 1980 and April 2024 in databases such as PubMed, the Cochrane Library, Embase, Scopus, and Web of Science. Results: It highlights HRW's effects on various aspects of athletic performance, including endurance, strength, sprint times, lunge movements, countermovement jump height, and time to exhaustion. While the precise mechanisms by which HRW affects athletic performance remain unclear, this review investigates its general molecular biological mechanisms beyond the specific context of sports. This provides a theoretical foundation for future research aimed at understanding how HRW can enhance athletic performance. HRW targets the harmful reactive oxygen and nitrogen species produced during intense exercise, thereby reducing oxidative stress-a critical factor in muscle fatigue, inflammation, and diminished athletic performance. HRW helps to scavenge hydroxyl radicals and peroxynitrite, regulate antioxidant enzymes, mitigate lipid peroxidation, reduce inflammation, protect against mitochondrial dysfunction, and modulate cellular signaling pathways. Conclusions: In summary, while a few studies have indicated that HRW may not produce significant beneficial effects, the majority of research supports the conclusion that HRW may enhance athletic performance across various sports. The potential mechanisms underlying these benefits are thought to involve HRW's role as a selective antioxidant, its impact on oxidative stress, and its regulation of redox homeostasis. However, the specific molecular biological mechanisms through which HRW improves athletic performance remain to be fully elucidated.

Fracture strength and bonding interface morphology of CAD/CAM-fabricated ceramic laminate veneers on bleached enamel treated with two different antioxidants

This study aimed to investigate the effects of two antioxidants and their application time on the fracture strength of computer-aided design and computer-aided manufacturing (CAD/CAM)-fabricated ceramic laminate veneers to bleached enamel, as well as their effects on the bonding interface micromorphology. Eight groups were set: Group NC (without bleaching and antioxidant treatment); Group NA (bleaching without antioxidant treatment); Group SA30, SA60, SA120 and Group PAC30, PAC60, PAC120 (bleaching and treating with sodium ascorbate or proanthocyanidins for 30, 60, and 120 min, respectively). After cementation of veneers, fracture strength values and failure modes were analyzed. The bonding interface morphology was observed by confocal laser scanning microscopy. The fracture strength was impaired when cementation procedure was performed immediately after bleaching. This reduction in fracture strength was reestablished with antioxidant treatment, and an extended treatment time contributed to better improvement. The resin tags at the bonding interfaces of the bleached enamel were impaired. Antioxidant treatments were able to reverse this unfavorable trend.

Morphine-induced modulation of Nrf2-antioxidant response element signaling pathway in primary human brain microvascular endothelial cells

Morphine is one of the most potent opioid analgesic used for pain treatment. Morphine action in the central nervous system requires crossing the blood-brain barrier. Due to the controversial relationship between morphine and oxidative stress, the potential pro- or antioxidant effects of morphine in the blood-brain barrier is important to be understood, as oxidative stress could cause its disruption and predispose to neurodegenerative diseases. However, investigation is scarce in human brain endothelial cells. Therefore, the present study evaluated the impact of morphine exposure at three different concentrations (1, 10 and 100 µM) for 24 h and 48 h on primary human brain microvascular endothelial cells. A quantitative data-independent acquisition mass spectrometry strategy was used to analyze proteome modulations. Almost 3000 proteins were quantified of which 217 were reported to be significantly regulated in at least one condition versus untreated control. Pathway enrichment analysis unveiled dysregulation of the Nrf2 pathway involved in oxidative stress response. Seahorse assay underlined mitochondria dysfunctions, which were supported by significant expression modulations of relevant mitochondrial proteins. In conclusion, our study revealed the dysregulation of the Nrf2 pathway and mitochondria dysfunctions after morphine exposure, highlighting a potential redox imbalance in human brain endothelial cells.

Compromised dental cells viability following teeth-whitening exposure

This study aimed to assess the viability of dental cells following time-dependent carbamide peroxide teeth-whitening treatments using an in-vitro dentin perfusion assay model. 30 teeth were exposed to 5% or 16% CP gel (4 h daily) for 2-weeks. The enamel organic content was measured with thermogravimetry. The time-dependent viability of human dental pulp stem cells (HDPSCs) and gingival fibroblast cells (HGFCs) following either indirect exposure to 3 commercially available concentrations of CP gel using an in-vitro dentin perfusion assay or direct exposure to 5% H₂O₂ were investigated by evaluating change in cell morphology and by hemocytometry. The 5% and 16% CP produced a significantly lower (p < 0.001) enamel protein content (by weight) when compared to the control. The organic content in enamel varied accordingly to the CP treatment: for the 16% and 5% CP treatment groups, a variation of 4.0% and 5.4%, respectively, was observed with no significant difference. The cell viability of HDPSCs decreased exponentially over time for all groups. Within the limitation of this in-vitro study, we conclude that even low concentrations of H₂O₂ and CP result in a deleterious change in enamel protein content and compromise the viability of HGFCs and HDPSCs. These effects should be observed in-vivo.

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.

Effectiveness of Whitening Strips Use Compared With Supervised Dental Bleaching: A Systematic Review and Meta-analysis

CLINICAL RELEVANCE

Bleaching performed at home while under the supervision of a dentist provides greater color alteration compared with whitening strips when evaluated with a spectrophotometer, although the color alteration was undetectable by unaided human eyes.

SUMMARY

Objective: A systematic review and meta-analysis were performed to answer the following research question: Does the use of whitening strips (WS) lead to an equivalent color change compared with supervised dental bleaching in patients with permanent dentition?Methods: A search was performed on August 10, 2017 (updated on March 22, 2019), in PubMed, the Brazilian Library in Dentistry, Latin American and Caribbean Health Sciences Literature database, Cochrane Library, Scopus, Web of Science, and SIGLE, without restrictions regarding date or language. Abstracts from the International Association for Dental Research, unpublished and ongoing trial registries, dissertations, and theses were also searched. Only randomized clinical trials (parallel or split mouth) in patients with permanent dentition that compared WS with dentist-supervised dental bleaching performed at home (AH) or in office (IO) were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. A meta-analysis with subgroup analysis (low and high peroxide concentration) was conducted for color change ΔE* (spectrophotometer) and ΔSGU (shade guide units), risk and intensity of tooth sensitivity (TS), gingival irritation (GI), and patient satisfaction using a random effects model. Heterogeneity was assessed with the Cochrane Q test and I2 statistics. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) was used to assess the quality of the evidence.Results: After the removal of duplicates, followed by title and abstract screening, 20 studies remained. Only two studies were considered to have a low RoB; 11 had a high RoB, and seven had an unclear RoB. For WS versus IO, data were not available for the meta-analysis. For WS versus AH bleaching, a significant difference in ΔE* favoring the AH group was observed (standardized mean difference [SMD] = -0.50, 95% confidence interval [CI] -0.79 to 0.21), but the risk (risk ratio = 0.78, 95% CI 0.65 to 0.93) and intensity of TS (SMD = -0.30, 95% CI -0.56 to -0.04) were lower in the WS group. Color change in ΔSGU, risk and intensity of GI, and patient satisfaction were not significantly different between groups (p>0.20). The quality of evidence for ΔE*, risk and intensity of TS, and intensity of GI were graded as moderate.Conclusion: Although the risk and intensity of TS were lower in the WS group, dentist-supervised at-home bleaching led to a better color change when measured with a spectrophotometer, although the color alteration was undetectable by unaided human eyes.

Novel in-office peroxide-free tooth-whitening gels: bleaching effectiveness, enamel surface alterations, and cell viability

To evaluate the bleaching ability, the effect on enamel surface and cytotoxicity of novel tooth-whitening formulations containing papain, ficin, or bromelain. Forty bovine dental discs (6 cm ×4 cm) were pigmentated and randomly allocated into the following groups (n = 10): Group 1, 20 wt% carbamide peroxide (control); group 2, 1% papain-based whitening; group 3, 1% ficin-based whitening; and group 4, 1% bromelain-based whitening. The whitening gels were prepared and applied on the enamel three times per day once a week, for 4 weeks. Color measurement was obtained by CIEDE2000. Enamel Knoop microhardness and roughness were evaluated. The WST-1 assay was used to evaluate the cell viability of mouse fibroblast cells (L929). Data were statistically analyzed by one-way analysis of variance (ANOVA) and Student Newman Keuls's post hoc test at α = 0.05 significance level. Bromelain, ficin-based, and carbamide peroxide bleaching gels showed a similar color change (p < 0.001). Higher enamel hardness decrease and higher enamel roughness were caused by the carbamide peroxide (p < 0.05). The experimental whitening gels did not affect cell viability. Tooth bleaching gels containing bromelain, papain, or ficin have substantial clinical potential to be used in the development of peroxide-free tooth whitening gels.

In vivo analysis of the presence of heme oxygenase-1, transcription factor Jun-D and CD90+/CD73+/CD105+/CD45- cells in the pulp of bleached teeth

AIM

To investigate hydrogen peroxide (H₂ O₂ )-induced responsiveness in pulp cells using heme oxygenase-1 (HO-1) immunolabelling, Jun-D immunolabelling to study the effects of H₂ O₂ on odontoblastic differentiation and CD90+/CD73+/CD105+/CD45- cell counting for in vivo identification of mesenchymal stem cells in the pulp.

METHODOLOGY

The maxillary molars of 50 rats were treated with a bleaching gel (35% H₂ O₂ , 1 × 30 min) or placebo gel (control groups). At 2, 3, 7, 15 and 30 days after the treatment (n = 10), inflammation in pulp tissue was analysed by haematoxylin-eosin staining, HO-1- and Jun-D-immunolabelled cells were counted in each third of the pulp chamber, and the number of CD90+/CD73+/CD105+/CD45- cells was quantified by immunofluorescence. The results were assessed using the Paired t-test or Wilcoxon signed-rank test (P < 0.05).

RESULTS

Significant H₂ O₂ -induced inflammation was noted at 2 and 3 days (P < 0.05), with tertiary dentine formation occurring from 7 days. The bleached specimens had greater HO-1 immunolabelling in the middle and cervical thirds of the coronal pulp at 2 and 3 days, in all thirds at 7 days, and in the occlusal third at 15 days (P < 0.05), and significant nuclear Jun-D immunolabelling in the cervical third at 2 and 3 days and in the occlusal and middle thirds at 7 days (P < 0.05). Bleached and control groups had low numbers of CD90+/CD73+/CD105+/CD45- cells in the pulp at all periods (P > 0.05).

CONCLUSIONS

Pulp cells responded to oxidative stress by expressing HO-1 during the post-bleaching inflammation phase until the beginning of the repair phase. Jun-D expression occurred during the reduction of inflammation and the beginning of tertiary dentine production. The presence of oxidative stress did not influence the number of CD90+/CD73+/CD105+/CD45- cells identified in vivo in the dental pulp.

Comparison of diffusion, cytotoxicity and tissue inflammatory reactions of four commercial bleaching products against human dental pulp stem cells

Multiple side effects related to bleaching were found to occur in the dental pulp tissue, including decreased cell metabolism and viability. In this work we evaluated the in vitro diffusion capacity, cytotoxicity and biocompatibility of four commercial bleaching products on stem cells from human dental pulp (hDPSCs). Two commercial bleaching gels hydrogen peroxide-based (HP), Norblanc Office 37.5% (Nor-HP) and Opalescence Boost 40% (Opal-HP) were applied for 30 min to enamel/dentine discs. Another two gels from the same manufacturers, 16% carbamide peroxide-based (CP), Norblanc Home (Nor-CP) and Opalescence CP 16% (Opal-CP), were applied for 90 min. The diffusion of HP was analysed by fluorometry. Cytotoxicity was determined using the MTT assays, the determination of apoptosis, immunofluorescence assays and intracellular reactive oxygen species (ROS) level. Tissue inflammatory reactions were evaluated histopathologically in rats. Statistical differences were performed by one-way ANOVA and Bonferroni post-test (α < 0.05). Normon products showed lower cytotoxicity and diffusion capacity than the Ultradent products. A high intracellular ROS level was measured in hDPSCs after exposure to Opal-HP. Finally, a severe necrosis of both coronal and radicular pulp was observed with Opal-HP. Similar concentrations of hydrogen peroxide and carbamide peroxide in a variety of bleaching products exhibited different responses in cells and dental pulp tissue, suggesting that bleaching products contain unknown agents that could influence their toxicity.

MS-5, a Naphthalene Derivative, Induces the Apoptosis of an Ovarian Cancer Cell CAOV-3 by Interfering with the Reactive Oxygen Species Generation

Reactive oxygen species (ROS) are widely generated in biological processes such as normal metabolism and response to xenobiotic exposure. While ROS can be beneficial or harmful to cells and tissues, generation of ROS by diverse anti-cancer drugs or phytochemicals plays an important role in the induction of apoptosis. We recently identified a derivative of naphthalene, MS-5, that induces apoptosis of an ovarian cell, CAOV-3. Interestingly, MS-5 induced apoptosis by down-regulating the ROS. Cell viability was evaluated by water-soluble tetrazolium salt (WST-1) assay. Apoptosis was evaluated by flow cytometry analysis. Intracellular ROS (H₂O₂), mitochondrial superoxide, mitochondrial membrane potential (MMP) and effect on cycle were determined by flow cytometry. Protein expression was assessed by western blotting. The level of ATP was measured using ATP Colorimetric/Fluorometric Assay kit. MS-5 inhibited growth of ovarian cancer cell lines, CAOV-3, in a concentration- and time-dependent manner. MS-5 also induced G1 cell cycle arrest in CAOV-3 cells, while MS-5 decreased intracellular ROS generation. In addition, cells treated with MS-5 showed the decrease in MMP and ATP production. In this study, we found that treatment with MS-5 in CAOV-3 cells induced apoptosis but decreased ROS level. We suspect that MS-5 might interfere with the minimum requirements of ROS for survival. These perturbations appear to be concentration-dependent, suggesting that MS-5 may induce apoptosis by interfering with ROS generation. We propose that MS-5 may be a potent therapeutic agent for inducing apoptosis in ovarian cancer cell through regulation of ROS.

Evaluation of biochemical changes in dental tissues after different office bleaching methods

The color of the teeth is an important topic for many people and can be influenced by intrinsic and extrinsic stains. There is an increasing demand for whitening of the teeth year by year. The most popular way of whitening is "bleaching," which is the result of the breakdown of pigments located in the enamel and/or the dentin, caused by reactive oxygen species (ROS) released from bleaching agents. These bleaching agents could increase matrix metalloproteinase (MMP)-mediated collagen degradation in dentin. The aim of this study was to compare biochemical changes and oxidative stress levels of the human premolar dentin-pulp complex after three different bleaching methods containing hydrogen peroxide (H₂O₂) bleaching agents. Individuals, whose first four premolars were extracted for orthodontic purposes, included into the study. Group 1-Laser: bleaching gel containing 46% H₂O₂ (LaserWhite20 whitening gel, Biolase Technology Inc., San Clemente, CA, USA) and a diode laser activation (Ezlase 940 nm system). Group 2: 35% H₂O₂ containing whitening gel (Whiteness HP Maxx, FGM) and halogen light source activation (Optilux 501, Kerr, Orange, CA, USA). Group 3: 35% H₂O₂ containing whitening gel (Whiteness HP Maxx, FGM). Group 4-Control: No whitening treatment. According to the test results, there were no significant differences among groups in the values of cathepsin B and MMP proteolytic activities ( p > 0.05). The total ROS values released from the dentin tissue were higher than those obtained from the pulp tissue ( p < 0.05). There were significant differences among the bleaching groups in the ROS values released from the dentin tissue.

Mineral Trioxide Aggregate Mixed with 5-Aminolevulinic Acid for the Photodynamic Antimicrobial Strategy in Hard Tissue Regeneration

Aminolevulinic acid (ALA) based photodynamic antimicrobial strategy can provide good antimicrobial effects and be used for medical applications. The aim of this study was to apply this strategy to Mineral Trioxide Aggregate (MTA), which is commonly used as a filling material for root endings and by doing so, to increase the bactericidal capability of MTA, as well as to investigate its characterization, cytocompatibility, and odontogenic differentiation potential. MTA is known to be a derivative of calcium silicate (CS). In this study, MTA specimens with or without ALA and light treatment were prepared. Diametral tensile strength values (DTS), setting durations, X-ray diffraction (XRD) spectra, apatite-mineralization, and antimicrobial abilities of the MTA, were also analyzed. Human dental pulp cells (hDPCs) can proliferate into the newly formed matrix and differentiate into odontoblasts to reinforce and strengthen the root. Levels of hDPCs proliferation and its odontogenic capabilities when cultured on MTA with ALA and light treatment, and the percentages of cells existing in the various cell cycle stages, were further evaluated in this study. The results indicated that MTA added ALA with light treatment had greater antibacterial ability and cytocompatibility, compared to MTA alone. A higher percentage S phase of the cells cultured on MTA added ALA with light treatment was observed. Furthermore, hDPCs cultured on MTA added ALA with light treatment had the highest expression levels of the odontoblastic differentiation markers. ALA has great antimicrobial efficiency and is a potential material for future medical applications. ALA-based photodynamic antibacterial strategy applied in the MTA has great antibacterial ability, cytocompatibility, and odontoblastic differentiation potential, and can facilitate the development of root canal treatment.

Effects of Epigallocatechin Gallate, an Antibacterial Cross-linking Agent, on Proliferation and Differentiation of Human Dental Pulp Cells Cultured in Collagen Scaffolds

INTRODUCTION

This study aimed to evaluate the efficacy of epigallocatechin gallate (EGCG), an antibacterial cross-linking agent, on the proliferation and differentiation of human dental pulp cells (hDPCs) cultured in hydrogel collagen scaffolds.

METHODS

The odontogenic differentiation induced by EGCG was evaluated by alkaline phosphatase (ALP) activity and odontogenic-related gene expression using real-time polymerase chain reaction. The antibacterial effect of EGCG was investigated by a disc diffusion assay in comparison with glutaraldehyde. Proliferation was analyzed by cell number counting under both optical and confocal laser scanning microscopes. To assess the mechanical properties of collagen treated with EGCG, the setting time, surface roughness, and compressive strength were measured.

RESULTS

EGCG itself did not up-regulate the odontogenic-related markers (P > .05) although ALP activity was slightly increased. The proliferation and differentiation of hDPCs cultured in collagen increased significantly in the presence of EGCG (P < .05). The antibacterial activity of EGCG was similar to that of glutaraldehyde. The setting time of collagen was significantly shortened when it was treated with EGCG (P < .05). The surface roughness and compressive strength of the cross-linked collagen were higher than those of collagen without EGCG (P < .05).

CONCLUSIONS

Our results showed that EGCG, the antibacterial cross-linking agent, promoted the proliferation and differentiation of hDPCs cultured in collagen scaffolds. Furthermore, the enhanced mechanical properties of collagen scaffolds induced by EGCG may play important roles in cell behavior. Consequently, the application of EGCG to collagen scaffolds might be beneficial for regenerative endodontic therapy.

The Protective Effect of Indole-3-Acetic Acid (IAA) on H2O2-Damaged Human Dental Pulp Stem Cells Is Mediated by the AKT Pathway and Involves Increased Expression of the Transcription Factor Nuclear Factor-Erythroid 2-Related Factor 2 (Nrf2) and Its Downstream Target Heme Oxygenase 1 (HO-1)

Indole-3-acetic acid (IAA) is the most common plant hormone of the auxin class and is known to have many effects including cell proliferation enhancement and antioxidant property. However, no study has revealed its defensive effects against oxidative toxicity in human dental pulp stem cells (hDPSCs). In this study, we investigated the effects of IAA on hydrogen peroxide- (H₂O₂-) induced oxidative toxicity in hDPSCs. H₂O₂-induced cytotoxicity was attenuated after IAA treatment. Cell cycle analysis using FACS showed that the damaged cell cycle and increased number of apoptotic cells by H₂O₂ treatment were recovered after the treatment of IAA. The H₂O₂-mediated increased expression of the proapoptotic genes, BAX and p53, was attenuated by IAA treatment, while IAA treatment increased antiapoptotic genes, BCL-2 and ATF5 expression. The increases of cleaved caspase-3 and ROS by H₂O₂ were also decreased after treatment of IAA. To further investigate the mechanism of IAA, Nrf2-related antioxidant pathway was examined and the results showed that the level of Nrf2 and HO-1 expressions, stimulated by H₂O_2, decreased after treatment of IAA. Moreover, IAA treatment protected hDPSCs against H₂O₂-induced oxidative stress via increased expression of Nrf2 and HO-1, mediated by the AKT pathway.

Heme oxygenase-1 protects spinal cord neurons from hydrogen peroxide-induced apoptosis via suppression of Cdc42/MLK3/MKK7/JNK3 signaling

The mechanisms by which oxidative stress induces spinal cord neuron death has not been completely understood. Investigation on the molecular signal pathways involved in oxidative stress-mediated neuronal death is important for development of new therapeutics for oxidative stress-associated spinal cord disorders. In current study we examined the role of heme oxygenase-1 (HO-1) in the modulation of MLK3/MKK7/JNK3 signaling, which is a pro-apoptotic pathway, after treating primary spinal cord neurons with H2O2. We found that MLK3/MKK7/JNK3 signaling was substantially activated by H2O2 in a time-dependent manner, demonstrated by increase of activating phosphorylation of MLK3, MKK7 and JNK3. H2O2 also induced expression of HO-1. Transduction of neurons with HO-1-expressing adeno-associated virus before H2O2 treatment introduced expression of exogenous HO-1 in neurons. Exogenous HO-1 reduced phosphorylation of MLK3, MKK7 and JNK3. Consistent with its inhibitory effect on MLK3/MKK7/JNK3 signaling, exogenous HO-1 decreased H2O2-induced neuronal apoptosis and necrosis. Furthermore, we found that exogenous HO-1 inhibited expression of Cdc42, which is crucial for MLK3 activation. In addition, HO-1-induced down-regulation of MLK3/MKK7/JNK3 signaling might be related to up-regulation of microRNA-137 (mir-137). A mir-137 inhibitor alleviated the inhibitory effect of HO-1 on JNK3 activation. This inhibitor also increased neuronal death even when exogenous HO-1 was expressed. Therefore, our study suggests a novel mechanism by which HO-1 exerted its neuroprotective efficacy on oxidative stress.

Influence of enamel/dentin thickness on the toxic and esthetic effects of experimental in-office bleaching protocols

OBJECTIVES

This paper aims to assess the whitening effectiveness and toxicity of tooth-bleaching protocols applied to enamel/dentin disks simulating mandibular incisors (ICs) and premolars (PMs).

MATERIALS AND METHODS

A 10% hydrogen peroxide (H₂O₂) gel was applied for 3 × 15, 1 × 15, or 1 × 5 min to enamel/dentin disks simulating mandibular ICs and PMs, and the trans-enamel and trans-dentinal diffusion products were applied to human dental pulp cells (1 h). Professional therapy (35% H₂O₂-3 × 15 min) was used as positive control, and non-bleached samples were used as negative control. Cell viability and morphology, oxidative stress generation, and odontoblastic marker expression were assessed. The H₂O₂ diffusion and enamel color change (ΔE) were also analyzed.

RESULTS

The 10% H₂O₂ gel induced significant cell viability reduction only when applied 3 × 15 min, with the intensity of oxidative stress and down-regulation of odontoblastic markers being higher in the IC group. The other experimental bleaching protocols caused slight alterations regarding the cell parameters evaluated, with intensity being related to enamel/dentin thickness. These effects were also correlated with higher H₂O₂ diffusion in the IC group. ΔE values similar as positive control were found for the 10% 3 × 15 and 1 × 15 protocols on IC group, after 4 and 6 sessions.

CONCLUSION

Application of a 10% H₂O₂ bleaching gel for 15 or 45 min to thin dental substrate significantly minimizes cell toxicity in comparison with highly concentrated gels associated with similar esthetic outcomes by increasing the number of bleaching sessions.

CLINICAL RELEVANCE

Bleaching gels with 10% H₂O₂ applied in small teeth for short periods may be an interesting alternative to obtain whitening effectiveness without causing toxicity to pulp cells, which may be able to reduce the tooth hypersensitivity claimed by patients.

The impact of antimicrobial photodynamic therapy on peri-implant disease: What mechanisms are involved in this novel treatment?

According to the American Academy of Implant Dentistry, 3 million Americans have dental implants, and this number is growing by 500,000 each year. Proportionally, the number of biological complications is also increasing. Among them, peri-implant disease is considered the most common cause of implant loss after osseointegration. In this context, microorganisms residing on the surfaces of implants and their prosthetic components are considered to be the primary etiologic factor for peri-implantitis. Some research groups have proposed combining surgical and non-surgical therapies with systemic antibiotics. The major problem associated with the use of antibiotics to treat peri-implantitis is that microorganisms replicate very quickly. Moreover, inappropriate prescription of antibiotics is not only associated with potential resistance but also and most importantly with the development of superinfections that are difficult to eradicate. Although antimicrobial photodynamic therapy (aPDT) was discovered several years ago, aPDT has only recently emerged as a possible alternative therapy against different oral pathogens causing peri-implantitis. The mechanism of action of aPDT is based on a combination of a photosensitizer drug and light of a specific wavelength in the presence of oxygen. The reaction between light and oxygen produces toxic forms of oxygen species that can kill microbial cells. This mechanism is crucial to the efficacy of aPDT. To help us understand conflicting data, it is necessary to know all the particularities of the etiology of peri-implantitis and the aPDT compounds. We believe that this review will draw attention to new insights regarding the impact of aPDT on peri-implant disease.

Co-Cr dental alloys induces cytotoxicity and inflammatory responses via activation of Nrf2/antioxidant signaling pathways in human gingival fibroblasts and osteoblasts

OBJECTIVE

Although cobalt-chromium (Co-Cr) dental alloys are routinely used in prosthodontics, the biocompatibility of Co-Cr alloys is controversial. The aims of the present study were to investigate the effects of Co-Cr alloys on human gingival fibroblasts (HGF) and osteoblasts in an in vitro model as well as their potential molecular mechanisms, focusing on NF-E2-related factor 2 (Nrf2) pathways.

METHODS

Cells were directly seeded on prepared Co-Cr alloy discs (15.0mm diameter, 1.0mm thickness) or indirectly treated with Co-Cr alloy located at the bottom of an insert well and incubated for 3 days. Cytotoxicity and reactive oxygen species (ROS) production was evaluated by MTS assay and flow cytometry, respectively. Protein and mRNA levels were determined by Western blotting and RT-PCR analysis, respectively.

RESULTS

Cell viability and flow cytometric assay demonstrated that the Co-Cr alloy was cytotoxic to HGFs and osteoblasts, and significantly increased ROS production. In addition, the Co-Cr alloys upregulated pro-inflamamtory cytokines (TNF-α, IL-1β, IL-6, and IL-8) and increased levels of various inflammatory mediators (iNOS derived nitrite oxide, and COX-2-derived PGE2) in both cells. A mechanistic study showed that Co-Cr alloys activates the NRF2 pathway and up-regulate antioxidant enzymes including heme oxygenase-1 (HO-1). Co-Cr alloys activated JAK2/STAT3, p38/ERK/JNK MAPKs and NF-κB signaling pathways. Furthermore, antioxidants (resveratrol and NAC) and HO-1 inhibitor (SnPP) significantly inhibited the production of ROS and inflammatory mediators, as well as the activation of NF-κB signaling in Co-Cr alloy stimulated HGFs and osteoblasts.

SIGNIFICANCE

This study is the first to show that Co-Cr alloys exert cytotoxic and inflammatory effects via activation of Nrf2/ARE signaling and up-regulation of downstream HO-1, which could represent candidate targets for the regulation of inflammatory responses to Co-Cr alloys.

Behaviour of human dental pulp cells cultured in a collagen hydrogel scaffold cross-linked with cinnamaldehyde

AIM

To investigate the effects of the cross-linking agent cinnamaldehyde (CA) on differentiation of human dental pulp cells (hDPCs) cultured in a collagen hydrogel, which may be useful as a scaffold for regenerative endodontic therapy.

METHODOLOGY

The odontogenic potential of hDPCs exposed to CA was examined using alkaline phosphatase (ALP) activity, Alizarin red S staining and real-time polymerase chain reaction for odontogenic gene expression. The morphological features of hDPCs cultured in CA-treated collagen were evaluated by scanning electron microscopy. Determination of cell numbers for evaluating proliferation was assessed by optical and fluorescence microscopy. To assess the mechanical properties of collagen treated with CA, setting time, compressive strength and surface roughness were measured. Statistical analysis was performed using Student's t-test compared with control (P = 0.05).

RESULTS

CA per se did not increase ALP activity, calcium nodule formation and expression of odontogenic-related markers (P > 0.05). On the contrary, the proliferation and odontogenic differentiation of hDPCs cultured in a collagen scaffold was promoted in the presence of CA (P < 0.05). The setting time was significantly shortened, and the compressive strength and surface roughness were increased by treatment with CA (P < 0.05).

CONCLUSIONS

Cross-linking of collagen scaffolds by CA had beneficial effects with respect to attachment, proliferation and differentiation of hDPCs. Consequently, the application of cross-linking agents such as CA may represent a new strategy for dentine-pulp complex regeneration.

Hydrogen peroxide induces apoptosis in human dental pulp cells via caspase-9 dependent pathway

INTRODUCTION

Reactive oxygen species are a group of metabolic intermediates produced during oxidative metabolism in eukaryotic cells. They include superoxide anion (O2(-)), hydrogen peroxide (H2O2), hydroxyl radical (·OH), and (1)O2. Of these intermediates, H2O2 is the most stable. Dental pulp cells can be invaded by tooth bleaching, laser radiation, and dental materials. This can influence the intracellular level of reactive oxygen species. Apoptosis, which is the best-known form of programmed cell death, is pivotal to tissue development and regeneration. Little information is available regarding the relationship between H2O2 and apoptosis of human dental pulp cells (hDPCs). The purpose of this study was to investigate whether H2O2 can induce apoptosis in hDPCs and its signaling way.

METHODS

HDPCs were obtained by using a modified tissue explant technique in vitro and cultured at 37°C, 20% O2 (5% CO2, 95% air) in Dulbecco modified Eagle medium. Cell viability was investigated by methyl-thiazol-tetrazolium assay. Cell apoptosis was detected by using the annexin V-fluorescein isothiocyanate/propidium iodide apoptosis assay and flow cytometry. Expression of activated caspase-3, cleaved caspase-9, and β-actin was analyzed by using Western blot.

RESULTS

Cell viability of hDPCs decreased more in treated groups than in the control group from days 1 to 7. The relative number of apoptotic cells and the expression of activated caspase-3 and cleaved caspase-9 were much higher in groups exposed to 20 and 50 μmol/L H2O2.

CONCLUSIONS

These results imply that low concentrations of H2O2 are cytotoxic to hDPCs and induce apoptosis in hDPCs in a caspase-9-dependent way.

Effect of the Acidic Dental Resin Monomer 10-methacryloyloxydecyl Dihydrogen Phosphate on Odontoblastic Differentiation of Human Dental Pulp Cells

Although 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) is frequently used as an acidic resin monomer in dental adhesives, its effect on dental pulp cells (DPCs) has been rarely reported. The purpose of this study was to examine the effects of 10-MDP on the inflammatory response and odontoblastic differentiation of DPCs at minimally toxic concentrations. We found that 10-MDP caused the release of inflammatory cytokines including NO, PGE2, iNOS, COX-2, TNF-α, IL-1β, IL-6 and IL-8 in a concentration-dependent manner. In addition, 10-MDP reduced alkaline phosphatase activity, mineralization nodule formation and mRNA expression of odontoblastic differentiation markers such as dentin sialophosphoprotein, dentin matrix protein-1, osterix and Runx2 in a concentration-dependent manner with low toxicity. In addition, 10-MDP induced activation of nuclear factor-E2-related factor 2 (Nrf2) and its target gene, haeme oxygenase-1 (HO-1). We evaluated whether the effect of 10-MDP was related to the induction of HO-1 and found that treatment with a selective inhibitor of HO-1 reversed the production of 10-MDP-mediated pro-inflammatory cytokines and the inhibition of differentiation markers. Pre-treatment with either a GSH synthesis inhibitor or antioxidants blocked 10-MDP-induced mitogen-activated protein kinases (MAPKs), Nrf2 and NF-κB pathways. Taken together, the results of this study showed that minimally toxic concentrations of 10-MDP promoted an inflammatory response and suppressed odontoblastic differentiation of DPCs by activating Nrf2-mediated HO-1 induction through MAPK and NF-κB signalling.

Indirect cytocompatibility of a low-concentration hydrogen peroxide bleaching gel to odontoblast-like cells

AIM

To assess the initial cytotoxicity and the late phenotype marker expression of odontoblast-like cells (MDPC-23) subjected to less aggressive in-office bleaching therapies.

METHODOLOGY

A 17.5% hydrogen peroxide (H2O2) gel was applied for 45, 15 or 5 min to enamel/dentine discs adapted to trans-wells positioned over cultured MDPC-23 cells. No treatment was performed on the negative control. Immediately after bleaching, the cell viability, gene expression of inflammatory mediators and quantification of H2O2 diffusion were evaluated. The ALP activity, DSPP and DMP-1 gene expression and mineralized nodule deposition (MND) were assessed at 7, 14 or 21 days post-bleaching and analysed statistically with Mann-Whitney U-tests (α = 5%).

RESULTS

H2O2 diffusion, proportional to treatment time, was observed in all bleached groups. Reductions of approximately 31%, 21% and 13% in cell viability were observed for the 45-, 15- and 5-min groups, respectively. This reduction was significant (P < 0.05) for the 45- and 15-min groups, which also presented significant (P < 0.05) over-expression of inflammatory mediators. The 45-min group was associated with significant (P < 0.05) reductions in DMP-1/DSPP expression at all periods, relative to control. The ALP activity and MND were reduced only in initial periods. The 15-min group had less intense reduction of all markers, with no difference to control at 21 days.

CONCLUSIONS

The 17.5% H2O2 applied to tooth specimens for 5 min caused no alteration in the odontoblast-like cells. When this gel was applied for 45 or 15 min, a slight cytotoxicity, associated with alterations in phenotypic markers, was observed. However, cells were able to recover their functions up to 21 days post-bleaching.

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

OBJECTIVES

To evaluate the effect of the oxidative stress on human dental pulp cells (HDPCs) promoted by toxic concentrations of hydrogen peroxide (H2O2) on its odontoblastic differentiation capability through time.

METHODS

HDPCs were exposed to two different concentrations of H2O2 (0.1 and 0.3μg/ml) for 30min. Thereafter, cell viability (MTT assay) and oxidative stress generation (H2DCFDA fluorescence assay) were immediately evaluated. Data were compared with those for alkaline phosphatase (ALP) activity (thymolphthalein assay) and mineralized nodule deposition (alizarin red) by HDPCs cultured for 7 days in osteogenic medium.

RESULTS

A significant reduction in cell viability and oxidative stress generation occurred in the H2O2-treated cells when compared with negative controls (no treatment), in a concentration-dependent fashion. Seven days after H2O2 treatment, the cells showed significant reduction in ALP activity compared with negative control and no mineralized nodule deposition.

CONCLUSION

Both concentrations of H2O2 were toxic to the cells, causing intense cellular oxidative stress, which interfered with the odontogenic differentiation capability of the HDPCs.

CLINICAL SIGNIFICANCE

The intense oxidative stress on HDPCs mediated by H2O2 at toxic concentrations promotes intense reduction on odontoblastic differentiation capability in a 7-day evaluation period, which may alter the initial pulp healing capability in the in vivo situation.

Immediate and late analysis of dental pulp stem cells viability after indirect exposition to alternative in-office bleaching strategies

OBJECTIVES

To evaluate human dental pulp stem cell viability and capacity to recover from experimental dental bleaching techniques.

MATERIAL AND METHODS

Enamel/dentin disks adapted to trans-wells were positioned on previously cultivated dental pulp stem cells. Bleaching gels containing 35, 17.5, 10, and 8 % hydrogen peroxide (H2O2) were applied one or three times (each application lasting 15 min) on enamel. Cell viability (MTT assay) and morphology (SEM) were evaluated immediately (T1) or 72 h (T2) post-bleaching.

RESULTS

The 35 % H2O2 gel promoted intense reduction in viability (93-97 %) and morphological alterations of the cells at T1, irrespective of frequency of application, with absence or limited capacity for recovery being observed at T2. The other bleaching gels presented significant lower toxicity when compared with the 35 % H2O2 gel, in a time/concentration fashion. In T1, no significant difference was observed between the negative control (without bleaching) and the 8 and 10 % H2O2 gels applied on enamel for 15 min, in which the cells presented elevated viability and morphology similar to the negative control at T2.

CONCLUSIONS

Bleaching gels with 8 and 10 % H2O2 in their composition cause limited immediate toxic effect on pulp stem cells, which recover their viability 3 days after treatment.

CLINICAL RELEVANCE

This study presents proposals for in-office dental bleaching to be performed with limited aggressive effect on dental pulp stem cells. Therefore, we are able to offer interesting clinical alternatives for bleaching vital teeth, under professional supervision, maintaining the integrity and reparative capacity of pulp-dentin complex.

Effect of fluoride-treated enamel on indirect cytotoxicity of a 16% carbamide peroxide bleaching gel to pulp cells

The aim of this study was to evaluate the possibility of fluoride solutions applied to enamel to protect pulp cells against the trans-enamel and transdentinal cytotoxicity of a 16% carbamide peroxide (CP) bleaching gel. The CP gel was applied to enamel/dentin discs adapted to aicial pulp chambers (8 h/day) during 1, 7 or 14 days, followed by fluoride (0.05% or 0.2%) application for 1 min. The extracts (culture medium in contact with dentin) were applied to MDPC-23 cells for 1 h, and cell metabolism (MTT assay), alkaline phosphatase (ALP) activity and cell membrane damage (flow cytometry) were analyzed. Knoop microhardness of enamel was also evaluated. Data were analyzed statistically by ANOVA and Kruskal-Wallis tests (α=0.05). For the MTT assay and ALP activity, significant reductions between the control and the bleached groups were observed (p<0.05). No statistically significant difference occurred among bleached groups (p>0.05), regardless of fluoride application or treatment days. Flow cytometry analysis demonstrated 30% of cell membrane damage in all bleached groups. After 14 days of treatment, the fluoride-treated enamel presented significantly higher microhardness values than the bleached-only group (p<0.05). It was concluded that, regardless of the increase in enamel hardness due to the application of fluoride solutions, the treated enamel surface did not prevent the toxic effects caused by the 16% CP gel to odontoblast-like cells.

Urethane dimethacrylate induces cytotoxicity and regulates cyclooxygenase-2, hemeoxygenase and carboxylesterase expression in human dental pulp cells

The toxic effect of urethane dimethacrylate (UDMA), a major dental resin monomer, on human dental pulp is not fully clear. In this study, we investigated the influence of UDMA on the cytotoxicity, cell cycle distribution, apoptosis and related gene expression of dental pulp cells. The role of reactive oxygen species, hemeoxygenase-1 (HO-1) and carboxylesterase (CES) in UDMA cytotoxicity, was evaluated. UDMA induced morphological changes of pulp cells and decreased cell viability by 29-49% at concentrations of 0.1-0.35 mM. UDMA induced G0/G1, G2/M cell cycle arrest and apoptosis. The expression of cdc2, cyclinB1 and cdc25C was inhibited by UDMA. Moreover, UDMA stimulated COX-2, HO-1 and CES2 mRNA expression of pulp cells. The cytotoxicity of UDMA was attenuated by N-acetyl-l-cysteine, catalase and esterase, but was enhanced by Zn-protoporphyrin (HO-1 inhibitor), BNPP (CES inhibitor) and loperamide (CES2 inhibitor). Exposure of UDMA may potentially induce the inflammation and toxicity of dental pulp. These findings are important for understanding the clinical response of human pulp to resin monomers after operative restoration and pulp capping, and also provide clues for improvement of dental materials.

Recent advances in pulp capping materials: an overview

Emphasis has shifted from the "doomed" organ concept of an exposed pulp to one of hope and recovery. The era of vital-pulp therapy has been greatly enhanced with the introduction of various pulp capping materials. The aim of this article is to summarize and discuss about the various and newer pulp capping materials used for protection of the dentin-pulp complex.

The survival role of peroxisome proliferator-activated receptor gamma induces odontoblast differentiation against oxidative stress in human dental pulp cells

INTRODUCTION

Peroxisome proliferator-activated receptor gamma (PPARγ) has well-known anti-inflammatory action in human dental pulp cells (HDPCs). The purpose of this study was to investigate whether the anti-inflammatory action of PPARγ involves in cellular cytoprotection and supports odontoblast differentiation under oxidative stress in HDPCs.

METHODS

To simulate long-term oxidative stress, pulp cells were treated with 150 μmol hydrogen peroxide (H(2)O(2)) for 12 days. The replication deficiency adenovirus (adenovirus PPARγ) was introduced for PPARγ overexpression in pulp cells. The cellular cytotoxicity and reactive oxygen species formation by H(2)O(2) were determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and 2',7'-dichlorodihydrofluorescein diacetate with fluorescence-activated cell sorting assay. To determine the roles of PPARγ, several molecules of odontogenic/osteogenic and signal pathway were analyzed by reverse-transcription polymerase chain reaction and Western hybridization. Dentin mineralization was determined by alizarin red stain and alkaline phosphatase activity assay.

RESULTS

Pulp cells treated with long-term H(2)O(2) showed high reactive oxygen species formation, low cell viability, down-expression of antioxidant molecules (Cu/Zn and Mn superoxide dismutase), and odontogenic/osteogenic markers (eg, dentin sialophosphoprotein, dentin matrix protein-1, osteopontin, bone sialoprotein, Runx-2, and bone morphogenetic protein 2 and 7). In addition, pulp cells with oxidative stress underwent the activation of ERK1/2, activator protein-1, and nuclear factor-κB translocation to the nucleus. However, the PPARγ-overexpressed cells gave opposite results although under oxidative stress. Furthermore, PPARγ and its agonist rosiglitazone exhibited an induction of dentin mineralization under oxidative stress.

CONCLUSIONS

PPARγ in pulp cells increases cell viability, odontoblastic differentiation, and dentin mineralization under oxidative stress. These results offer new insights into the potential antioxidative activity of PPARγ and its agonist for therapeutic agents for pulp vitality in HDPCs.

Bleaching effectiveness, hydrogen peroxide diffusion, and cytotoxicity of a chemically activated bleaching gel

OBJECTIVES

The objective of this study was to evaluate the bleaching effectiveness, hydrogen peroxide diffusion (H2O2), and cytotoxicity of a bleaching gel with 35 % H2O2 either associated with ferrous sulfate (FeSO4) or not.

MATERIALS AND METHODS

Enamel/dentin discs adapted to artificial pulp chambers were placed in compartments containing a culture medium (Dulbecco's Modified Eagle's Medium (DMEM)) and distributed into the following groups: G1-no treatment (negative control), G2-10 % carbamide peroxide (one application for 4 h), G3-35 % H2O2 (three applications for 15 min), and G4-35 % H2O2 + 0.004 g FeSO4 (three applications for 15 min). After treatments, the extracts (DMEM + bleaching components that diffused across enamel and dentin) were applied on human dental pulp cells (HDPCs) and odontoblast-like cells (MDPC-23). Cell viability (MTT assay, Kruskal-Wallis and Mann-Whitney, α = 5 %), quantification of H2O2 diffusion, and color change of the enamel/dentin discs (Commission Internationale de I'Eclairage L*a*b* system) were assessed (analysis of variance and Tukey's tests, α = 5 %).

RESULTS

For both cells, a significant reduction in cell viability was observed for G3 and G4 compared with G1 and G2. No statistical difference was observed between G3 and G4. The rate of H2O2 diffusion was significantly higher in G3 compared with that in G2 and G4. The ΔE value for G4 was statistically higher than that of the other groups.

CONCLUSIONS

Chemical activation of H2O2 by FeSO4 improves the bleaching effectiveness. However, this metal ion has no significant protective effect against pulp cell cytotoxicity.

CLINICAL RELEVANCE

Although the chemical activation of H2O2 by adding FeSO4 to the bleaching agent improved the bleaching effectiveness, this metal ion has no significant protective effect against pulp cell cytotoxicity.

Deferoxamine promotes osteoblastic differentiation in human periodontal ligament cells via the nuclear factor erythroid 2-related factor-mediated antioxidant signaling pathway

BACKGROUND AND OBJECTIVE

Recently it was reported that deferoxamine (DFO), an iron chelator, stimulates bone formation from MG63 and mesenchymal stem cells, but inhibits differentiation in rat calvarial cells; however, the effect of DFO on osteoblastic differentiation in human periodontal ligament cells (hPDLCs) has not been reported. The aim of this study was to investigate the effects and the possible underlying mechanism of DFO on osteoblastic differentiation of hPDLCs.

MATERIAL AND METHODS

The effect of DFO on osteoblast differentiation was determined by the staining intensity of calcium deposits with Alizarin red and by RT-PCR analysis of the expression of osteoblastic markers. Signal transduction pathways were analyzed by western blotting.

RESULTS

DFO increased osteogenic differentiation in a concentration-dependent manner by expression of the mRNA for differentiation markers and calcium nodule formation. Exposure of hPDLCs to DFO resulted in increases in the production of reactive oxygen species and in the levels of nuclear factor erythroid 2-related factor (Nrf2) protein in nuclear extractions, as well as a dose-dependent increase in the expression of Nrf2 target genes, including glutathione (GSH), glutathione S-transferase, γ-glutamylcysteine lygase, glutathione reductase and glutathione peroxidase. Pretreatment with Nrf2 small interfering RNA, GSH depletion by buthionine sulfoximine and diethyl maleate, and with antioxidants by N-acetylcysteine and vitamin E, blocked DFO-stimulated osteoblastic differentiation. Furthermore, pretreatment with GSH depletion and antioxidants blocked DFO-induced p38 MAPK, ERK, JNK and nuclear factor-kappaB pathways.

CONCLUSION

These data indicate, for the first time, that nontoxic DFO promotes osteoblastic differentiation of hPDLCs via modulation of the Nrf2-mediated antioxidant pathway.

The number of bleaching sessions influences pulp tissue damage in rat teeth

INTRODUCTION

Hydrogen peroxide tooth bleaching is claimed to cause alterations in dental tissue structures. This study investigated the influence of the number of bleaching sessions on pulp tissue in rats.

METHODS

Male Wistar rats were studied in 5 groups (groups 1S-5S) of 10 each, which differed by the number (1-5) of bleaching sessions. In each session, the animals were anesthetized, and 35% hydrogen peroxide gel was applied to 3 upper right molars. Two days after the experimental period, the animals were killed, and their jaws were processed for light microscope evaluation. Pulp tissue reactions were scored as follows: 1, no or few inflammatory cells and no reaction; 2, <25 cells and a mild reaction; 3, between 25 and 125 cells and a moderate reaction; and 4, 125 or more cells and a severe reaction. Results from each experimental group were compared between groups and within groups to the corresponding unbleached upper left molars and analyzed for significant differences using the Kruskal-Wallis test (P < .05).

RESULTS

All tissue sections showed significant bleaching-induced changes in the dental pulp. After 1 bleaching session, necrotic tissue in the pulp horns and underlying inflammatory changes were observed. The extent and intensity of these changes increased with the number of bleaching sessions. After 5 sessions, the changes included necrotic areas in the pulp tissue involving the second third of the radicular pulp and intense inflammation in the apical third.

CONCLUSIONS

The number of bleaching sessions directly influenced the extent of pulp damage.

Effective tooth-bleaching protocols capable of reducing H(2)O(2) diffusion through enamel and dentine

OBJECTIVES

To evaluate the effects of experimental protocols on bleaching effectiveness and hydrogen peroxide (HP) diffusion through enamel and dentine.

METHODS

Enamel/dentine discs were subjected to six bleaching sessions, consisting of 1 or 3 applications of 17.5% or 35%-HP gel for 5/15min, or 37% carbamide peroxide (CP) gel for 10/20min. Discs undergoing the regular protocol (35%-HP; 3×15min) constituted the positive control group. Colour change (ΔE) was assessed (CIE L*a*b* system) after each session. HP diffusion was quantified (sessions 1, 3, and 6) in enamel/dentine discs adapted to artificial pulp chambers. Data were analysed by Pillai's Trace and Bonferroni test, or by one-way ANOVA and SNK/Tamhane's test (α=5%).

RESULTS

All tooth-bleaching protocols significantly increased the ΔE values. A reduction in HP diffusion and no significant difference in ΔE compared with the positive control were observed for the following bleaching protocols: 17.5%-HP 3×15min, at the 4th session; and 35%-HP 1×15 and 3×5min, at the 5th session. HP diffusion in the 37%-CP 3×20min bleaching protocol was statistically similar to that in the positive control. The other experimental bleaching protocols significantly decreased HP diffusion through enamel/dentine discs, but the ΔE values were statistically lower than those observed in the positive control, in all sessions.

CONCLUSION

Shortening the contact time of a 35%-HP gel or reducing its concentration produces gradual tooth colour change and reduced HP diffusion through enamel and dentine.

CLINICAL SIGNIFICANCE

A reduction in HP concentration, from 35% to 17.5%, in a bleaching gel or shortening its application time on enamel provides a significant tooth-bleaching improvement associated with decreased HP diffusion across hard dental tissues. Therefore, these protocols may be an interesting alternative to be tested in the clinical situation.

Hemeoxygenase-1 mediates an adaptive response to spermidine-induced cell death in human endothelial cells

Spermidine (SPD) is a ubiquitous polycation that is commonly distributed in living organisms. Intracellular levels of SPD are tightly regulated, and SPD controls cell proliferation and death. However, SPD undergoes oxidation in the presence of serum, producing aldehydes, hydrogen peroxide, and ammonia, which exert cytotoxic effect on cells. Hemeoxygenase-1 (HO-1) is thought to have a protective effect against oxidative stress. Upregulation of HO-1 in endothelial cells is considered to be beneficial in the cardiovascular disease. In the present study, we demonstrate that the ubiquitous polyamine, SPD, induces HO-1 in human umbilical vein endothelial cells (HUVECs). SPD-induced HO-1 expression was examined by Western blot and reverse transcription-polymerase chain reaction (RT-PCR). Involvement of reactive oxygen species, serum amine oxidase, PI3K/Akt signaling pathway, and transcription factor Nrf2 in the induction of HO-1 by SPD was also investigated. Furthermore, small interfering RNA knockdown of Nrf2 or HO-1 and treatment with the specific HO-1 inhibitor ZnPP exhibited a noteworthy increase of death of SPD-stimulated HUVECs. In conclusion, these results suggest that SPD induces PI3K/Akt-Nrf2-mediated HO-1 expression in human endothelial cells, which may have a role in cytoprotection of the cells against oxidative stress-induced death.

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

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

Tooth bleaching increases dentinal protease activity

Hydrogen peroxide is an oxidative agent commonly used for dental bleaching procedures. The structural and biochemical responses of enamel, dentin, and pulp tissues to the in vivo bleaching of human (n = 20) premolars were investigated in this study. Atomic force microscopy (AFM) was used to observe enamel nanostructure. The chemical composition of enamel and dentin was analyzed by infrared spectroscopy (FTIR). The enzymatic activities of dental cathepsin B and matrix metalloproteinases (MMPs) were monitored with fluorogenic substrates. The amount of collagen in dentin was measured by emission of collagen autofluorescence with confocal fluorescence microscopy. The presence of Reactive Oxygen Species (ROS) in the pulp was evaluated with a fluorogenic 2',7'-dichlorodihydrofluorescein diacetate (DCFDA) probe. Vital bleaching of teeth significantly altered all tested parameters: AFM images revealed a corrosion of surface enamel nanostructure; FTIR analysis showed a loss of carbonate and proteins from enamel and dentin, along with an increase in the proteolytic activity of cathepsin-B and MMPs; and there was a reduction in the autofluorescence of collagen and an increase in both cathepsin-B activity and ROS in pulp tissues. Together, these results indicate that 35% hydrogen peroxide used in clinical bleaching protocols dramatically alters the structural and biochemical properties of dental hard and soft pulp tissue.

High-density lipoproteins inhibit vascular endothelial inflammation by increasing 3β-hydroxysteroid-Δ24 reductase expression and inducing heme oxygenase-1

RATIONALE

Lipid-free apolipoprotein (apo) A-I and discoidal reconstituted high-density lipoproteins (rHDL) containing apoA-I, (A-I)rHDL, inhibit vascular inflammation by increasing 3β-hydroxysteroid-Δ24 reductase (DHCR24) expression.

OBJECTIVE

To determine whether the lipid-free apoA-I-mediated and (A-I)rHDL-mediated increase in DHCR24 expression induces the cytoprotective and potentially cardioprotective enzyme, heme oxygenase-1 (HO-1).

METHODS AND RESULTS

In vivo: A single intravenous infusion of lipid-free apoA-I (8 mg/kg) administered 24 hours before inserting a nonocclusive periarterial carotid collar into New Zealand White rabbits decreased collar-induced endothelial vascular cell adhesion molecule-1 and intercellular adhesion molecule-1 expression, reduced intima/media neutrophil infiltration, and increased DHCR24 and HO-1 mRNA levels. Knockdown of vascular DHCR24 and HO-1 and systemic administration of tin-protoporphyrin-IX, an HO inhibitor, abolished these anti-inflammatory effects. In vitro: Preincubation of human coronary artery endothelial cells with (A-I)rHDL before activation with tumor necrosis factor-α increased DHCR24 and HO-1 mRNA levels and inhibited cytokine-induced vascular cell adhesion molecule-1 and intercellular adhesion molecule-1 expression. Transfection of the cells with DHCR24 and HO-1 small interfering RNA and tin-protoporphyrin-IX treatment abolished these effects. The (A-I)rHDL-mediated induction of HO-1 was reduced in human coronary artery endothelial cells transfected with DHCR24 small interfering RNA. Transfection of human coronary artery endothelial cells with HO-1 small interfering RNA and tin-protoporphyrin-IX treatment did not inhibit the (A-I)rHDL-mediated increase in DHCR24 expression. Inhibition of phosphatidylinositol 3-kinase/Akt reduced the (A-I)rHDL-mediated increase in HO-1, but not DHCR24 expression. The activation of phosphatidylinositol 3-kinase/Akt by (A-I)rHDL was decreased in human coronary artery endothelial cells that were transfected with DHCR24 small interfering RNA.

CONCLUSIONS

Lipid-free apoA-I and (A-I)rHDL inhibit inflammation by increasing DHCR24 expression, which, in turn, activates phosphatidylinositol 3-kinase/Akt and induces HO-1.

The heme oxygenase system and oral diseases

Oral Diseases (2011) 17, 252-257 Heme oxygenase (HO) system catabolizes heme into three products: carbon monoxide (CO), biliverdin/bilirubin and free iron, which consists of three forms identified to date: the oxidative stress-inducible protein HO-1 and the constitutive isozymes HO-2 and HO-3. HO has been involved in many physiological and pathophysiological processes, ranging from Alzheimer's disease to cancer. The interest in HO system by scientists and clinicians involved with the oral and maxillofacial region is fairly recent, and few papers currently cited on HO relate to diseases in this anatomical area. This review will focus on the current understanding of the physiological significance of HO-1 induction and its possible roles in the oral diseases studied to date. The implications for possible therapeutic manipulation of HO are also discussed.