Antiplaque biocides and bacterial resistance: a review

Antimicrobial and Cytotoxic Potential of Eucalyptus Essential Oil-Based Nanoemulsions for Mouthwashes Application

Objective: An eucalyptus essential oil-based nanoemulsion was produced and evaluated for its antimicrobial properties against Streptococcus mutans and its cytotoxicity in the surface mucous cells of rabbits. Methods: The essential oil-based nanoemulsion was synthesized with two species of eucalyptus-Eucalyptus citriodora and Eucalyptus globulus-followed by physicochemical characterization and the determination of antimicrobial activity and cell viability. Subsequently, the mouthwash formulations (fluoride and fluoride-free) were functionalized with the nanoemulsion, and their in vitro antimicrobial actions were evaluated against S. mutans. Results: The nanoemulsion presented an average particle size of around 100 nm, a polydispersity index close to 0.3, a zeta potential between -19 and -30 mV, a pH close to 7, a spherical shape, and a cell viability above 50%. The antimicrobial activity analysis showed that the nanoemulsion was effective in the control of S. mutans. The mouthwashes functionalized with the nanoemulsion also presented bacteriostatic and bactericidal properties. Conclusions: The bio-based material produced with eucalyptus essential oil presented adequate physicochemical characteristics, with the potential to be used as an innovative material in preventive dentistry, contributing to the maintenance of oral and systemic health.

Choline and geranate ionic liquid for subgingival biofilm control

Periodontitis is a chronic inflammatory disease that causes destruction of the periodontium and eventual tooth loss. The priority in the periodontal treatment is to remove the subgingival biofilm. Chemical removal of biofilms using antimicrobial agents has been applied in clinical practice. However, their clinical effect is still limited because the agents must overcome biofilm's significant drug tolerance, which is primarily caused by the extracellular matrix, a physical barrier that attenuates drug diffusion. This study aimed to study the use of ionic liquids (ILs), a new class of biocompatible materials, for controlling subgingival biofilms because of their excellent permeability. Choline and geranate (CAGE) IL was tested for its highly potent antiseptic behavior and permeability. Antibacterial tests revealed that the significant efficacy of CAGE against periodontopathic microorganisms was derived from their ability to destroy cell membrane, as demonstrated by membrane permeability assay and transmission electron microscopy imaging. Antibiofilm tests using two pathogenic biofilm models revealed that CAGE exerted efficacy against the biofilm-embedded bacteria, conspicuously neutralized the biofilms, and eventually destroyed the biofilm structure. Furthermore, the penetration of CAGE into the biofilm was visually confirmed using confocal laser scanning microscopy. This study highlighted the potential of CAGE as a powerful antibiofilm therapeutic.

Supra and subgingival application of antiseptics or antibiotics during periodontal therapy

Periodontal diseases (gingivitis and periodontitis) are characterized by inflammatory processes which arise as a result of disruption of the balance in the oral ecosystem. According to the current S3 level clinical practice guidelines, therapy of patients with periodontitis involves a stepwise approach that includes the control of the patient's risk factors and the debridement of supra and subgingival biofilm. This debridement can be performed with or without the use of some adjuvant therapies, including physical or chemical agents, host modulating agents, subgingivally locally delivered antimicrobials, or systemic antimicrobials. Therefore, the main aim of this article is to review in a narrative manner the existing literature regarding the adjuvant application of local agents, either subgingivally delivered antibiotics and antiseptics or supragingivally applied rinses and dentifrices, during the different steps in periodontal therapy performed in Europe.

Screening of heat-killed lactic acid bacteria based on inhibitory activity against oral bacteria and effects of oral administration of heat-killed Ligilactobacillus salivarius CP3365 on periodontal health in healthy participants: a double-blinded, randomized, placebo-controlled trial

Objectives

The aims of this study were to select heat-killed lactic acid bacteria (HKL) with antibiotic activity and investigate the efficacy of this bacteria in maintaining periodontal parameters in healthy participants.

Materials and methods

An in vitro evaluation was conducted to assess the inhibitory efficacy of lactic acid bacteria against Porphyromonas gingivalis and Fusobacterium nucleatum subsp. nucleatum. The effects of HKL administration on various parameters (plaque control record, bleeding on probing, and probing pocket depth) were assessed in a randomized, placebo-controlled trial. Participants in the test and placebo groups (n = 32) consumed oral tablets containing placebo or HKL daily for 8 weeks. Oral bacteria in supra-plaque and saliva were identified using 16S rRNA gene community profiling analysis.

Results

Heat-killed Ligilactobacillus salivarius CP3365 significantly (p < 0.05) decreased the viability of oral bacteria and was selected for clinical trials. Administration of HKL CP3365 significantly (p < 0.05) inhibited increases in each parameter. No changes in the relative abundance of P. gingivalis or F. nucleatum subsp. nucleatum were detected by HKL CP3365, but the relative abundance of oral bacteria (genera Porphyromonas, Fusobacterium, and Haemophilus) was significantly (p < 0.05) decreased.

Conclusion

HKL CP3365 effectively inhibited oral bacteria growth and was useful for maintaining periodontal health.

Clinical Trial Registration

[https://www.umin.ac.jp/ctr/index.htm], identifier [UMIN000045656].

Bacterial resistance to antiseptics used in dentistry: A systematic scoping review of randomized clinical trials

OBJECTIVES

To evaluate the prevalence and proportions of bacteria resistant to antiseptics used in dentistry.

METHODS

A review of randomized clinical trials (RCTs) was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews involving different databases. MeSH terms and keywords were provided to examine only RCTs with antiseptic-resistant results.

RESULTS

Five RCTs were included. These investigations analysed 442 patients. Concerning the prevalence and proportion of species resistant to antiseptics, it was found that the chlorhexidine group showed a statistically significant increase in Streptococcus mutans and Lactobacillus acidophilus counts indicating bacterial resistance (p < 0.001). Moreover, Veillonella species showed resistance to triclosan at the commencement and during the RCTs, and a slight increase in the proportion of resistant strains was observed. Porphyromonas gingivalis, Staphylococcus aureus, and Pseudomonas aeruginosa did not show resistance to cetylpyridinium chloride. Similarly, it was no observed resistance to medicinal herbal plant formulations.

CONCLUSIONS

Resistance of S. mutans and L. acidophilus to chlorhexidine was observed, this resistance increased during the follow-up period. Similarly, although in a slight proportion, an increase in the resistance of Veillonella spp. to triclosan during the study period was also described. No microorganisms resistance was observed to any of the other antiseptics studied.

Antibacterial Properties In Vitro of Magnesium Oxide Nanoparticles for Dental Applications

(1) Dental caries, periodontitis, or peri-implantitis are commensal infections related to oral biofilm former bacteria. Likewise, magnesium oxide nanoparticles (MgO-NPs) were studied to introduce them to the antibacterial properties of a few microorganisms. Considering this, the purpose of the present investigation was to determine the antibacterial properties of MgO-NPs on representative oral strains. (2) Methods: MgO-NPs with a cubic crystal structure were obtained by magnesium hydroxide mechanical activation. After synthesis, the MgO-NPs product was annealed at 800 °C (2 h). The MgO-NPs obtained were tested against ten oral ATCC strains at ten serial concentrations (1:1 20.0-0.039 mg/mL per triplicate) using the micro-broth dilution method to determine the minimal inhibitory concentration (MIC) or minimal bactericidal concentration (MIB). Measures of OD595 were compared against each positive control with a Student's t-test. Viability was corroborated by colony-forming units. (3) Results: The polycrystalline structure had an average size of 21 nm as determined by X-ray diffraction and transmission electron microscopy (high resolution). Antimicrobial sensitivity was observed in Capnocytophaga gingivalis (MIB/MIC 10-5 mg/mL), Eikenella corrodens (MIB 10 mg/mL), and Streptococcus sanguinis (MIB 20 mg/mL) at high concentrations of the MgO-NPs and at lower concentrations of the MgO-NPs in Actinomyces israelii (MIB 0.039 mg/mL), Fusobacterium nucleatum subsp. nucleatum (MIB/MIC 5-2.5 mg/mL), Porphyromonas gingivalis (MIB 20 mg/mL/MIC 2.5 mg/mL), Prevotella intermedia (MIB 0.625 mg/mL), Staphylococcus aureus (MIC 2.5 mg/mL), Streptococcus mutans (MIB 20 mg/mL/MIC 0.321 mg/mL), and Streptococcus sobrinus (MIB/MIC 5-2.5 mg/mL). (4) Conclusions: The MgO-NPs' reported antibacterial properties in all oral biofilm strains were evaluated for potential use in dental applications.

Flavonoid Baicalein Suppresses Oral Biofilms and Protects Enamel Hardness to Combat Dental Caries

The objectives of this study were to investigate the effects of a novel method using flavonoids to inhibit Streptococcus mutans (S. mutans), Candida albicans (C. albicans) and dual-species biofilms and to protect enamel hardness in a biofilm-based caries model for the first time. Several flavonoids, including baicalein, naringenin and catechin, were tested. Gold-standard chlorhexidine (CHX) and untreated (UC) groups served as controls. Optimal concentrations were determined by cytotoxicity assay. Biofilm MTT, colony-forming-units (CFUs), biofilm biomass, lactic acid and polysaccharide production were evaluated. Real-time-polymerase-chain reaction (qRT-PCR) was used to determine gene expressions in biofilms. Demineralization of human enamel was induced via S. mutans-C. albicans biofilms, and enamel hardness was measured. Compared to CHX and UC groups, the baicalein group achieved the greatest reduction in S. mutans, C. albicans and S. mutans-C. albicans biofilms, yielding the least metabolic activity, polysaccharide synthesis and lactic acid production (p < 0.05). The biofilm CFU was decreased in baicalein group by 5 logs, 4 logs, 5 logs, for S. mutans, C. albicans and S. mutans-C. albicans biofilms, respectively, compared to UC group. When tested in a S. mutans-C. albicans in vitro caries model, the baicalein group substantially reduced enamel demineralization under biofilms, yielding an enamel hardness that was 2.75 times greater than that of UC group. Hence, the novel baicalein method is promising to inhibit dental caries by reducing biofilm formation and protecting enamel hardness.

Harnessing the Antibacterial Properties of Fluoridated Chitosan Polymers against Oral Biofilms

Dental caries are a worldwide endemic chronic disease affecting people of all ages. Due to the limitations of daily used oral hygiene products, there is an unmet need for new, effective, safe, and economic oral products. We have recently demonstrated that N-(2(2,6-diaminohexanamide)-chitosan (CS3H Lys) has enhanced antibacterial properties against Streptococcus mutans, the main cariogenic bacterium, and here we investigated the effect of fluoridation of this polymer (CS3H Lys F) on its antibacterial properties and the ability to protect teeth from acid demineralization. We further formulated this polymer into mouthwash preparations and studied their cytocompatibility and physicochemical stability over 6 months. CS3H Lys F was 1.6-fold more effective than the highest tested oral NaF dose in preventing acid demineralization. CS3H Lys F has a 3- to 5-fold lower minimum inhibitory concentration value against S. mutants than the values reported for chitosan polymers and showed negligible cell toxicity. The mouthwashes were stable at both 25 and 40 °C. Further work is under way towards other CS3H Lys F oral hygiene products such as a toothpaste.

Effect of TrisEDTA and Chlorhexidine 0.12% on an In Vitro-Defined Biofilm Representing the Subgingival Plaque Biofilm of the Dog

This study was designed to investigate the effects of chlorhexidine 0.12%, TrisEDTA (tromethamine ethylenediamintetraacetic acid), and a combination of chlorhexidine 0.12% and TrisEDTA on an in vitro plaque biofilm model comprised of three bacterial species commonly found in canine subgingival plaque. Porphyromonas gulae, Actinomyces canis, and Neisseria canis were grown in a biofilm on polished hydroxyapatite coated titanium alloy pucks for 72 h prior to exposure to one of four test solutions: TrisEDTA, chlorhexidine 0.12%, a combination of TrisEDTA and chlorhexidine 0.12%, or sterile deionized water as a control. Following exposure to the test solution, a sample was collected of the biofilm either immediately or following 24 h of additional incubation in a broth medium. Lower numbers of CFU/mL of Porphyromonas gulae resulted when the biofilm was treated with a solution of chlorhexidine 0.12% and TrisEDTA compared to with chlorhexidine 0.12% alone, TrisEDTA alone, or the control and so this solution can be said to be synergistic against Porphyromonas gulae in this controlled in vitro model. Greater reductions in the numbers of CFU/mL of Actinomyces canis and Neisseria canis resulted from treatment with chlorhexidine 0.12% alone than if treated with the combination of TrisEDTA and chlorhexidine 0.12%. When treated biofilm samples were allowed 24 h of additional growth in fresh media, greater variance resulted and this variance highlights the complex dynamics involved in bacterial growth within a biofilm.

Topical treatment of periodontitis using an iongel

Almost 50 % of the U.S. population suffers from oral infections such as periodontitis. Current treatment options for periodontitis include mechanical cleaning procedures, which are performed often under local anesthesia and are time-consuming. Alternate option includes systemic antibiotics which increase the risk of antimicrobial resistance and are not recommended for prolonged usage. Topical treatments of gingiva-based antimicrobial agents have shown limited efficacy due to poor penetration of the therapeutic into deep gingiva where the infection resides. Herein, we report an Iongel of a Deep Eutectic Antimicrobial (IDEA), which simultaneously exhibits deep tissue penetration and antimicrobial activity against P. gingivalis. In vivo studies confirmed that IDEA successfully penetrated into the gingiva and the gingival sulcus, where the pathogens primarily exist, within a short time. In vitro studies confirmed that the dose delivered was adequate to inactivate P. gingivalis biofilm. In vivo studies in a periodontal rat model confirmed that a topical treatment of IDEA eliminated pathogenic bacteria, and the disease progression was significantly suppressed. Safety studies confirmed excellent tolerance to IDEA. Altogether, IDEA offers a promising topical agent against periodontitis.

Cytotoxicity and effects of curcumin and cinnamaldehyde hybrids on biofilms of oral pathogens

The objective of the study was to evaluate the cytotoxicity and effect of curcumin-cinnamaldehyde hybrids (CCHs) on the biofilm of oral pathogens. Of the 18 hybrids tested, nine had an inhibitory effect on at least one of the bacterial species tested, with minimal inhibitory and bactericidal concentrations ranging from 9 to 625 μg ml^-1. CCH 7 promoted a potent inhibitory effect against all the bacterial species tested and better compatibility than chlorhexidine (CHX). CCH 7 also presented a similar or improved effect over that of CHX, causing a reduction in bacterial metabolism and viability in single and dual-species biofilms. CCH 7 reduced by 86% and 34% the viability of multispecies biofilms formed by collection and clinical strains. It can be concluded that CCH 7 was cytocompatible at the minimal inhibitory concentration, presented anti-biofilm action against oral pathogens, and could act as an antimicrobial agent for application in endodontics.

Antimicrobial Effects of Essential Oils on Oral Microbiota Biofilms: The Toothbrush In Vitro Model

The present investigation intended to evaluate the bacteriostatic and bactericidal abilities of clove, oregano and thyme essential oils against oral bacteria in planktonic and biofilm states. Furthermore, aiming to mimic everyday conditions, a toothbrush in vitro model was developed. Determination of the minimum inhibitory concentration, minimum bactericidal concentration, minimum biofilm inhibitory concentration and minimum biofilm eradication concentration were achieved using the microdilution procedure. To simulate the toothbrush environment, nylon fibers were inoculated with oral bacteria, which, after incubation to allow biofilm development, were submitted to contact with the essential oils under study. Thyme and oregano essential oils revealed promising antimicrobial effects, both in growth inhibition and the destruction of cells in planktonic and biofilm states, while clove essential oil showed a weaker potential. Regarding the toothbrush in vitro model, observation of the nylon fibers under a magnifying glass proved the essential oil anti-biofilm properties. Considering the effects observed using the in vitro toothbrush model, a realistic approximation to oral biofilm establishment in an everyday use object, a putative application of essential oils as toothbrush sanitizers to help prevent the establishment of bacterial biofilm can be verified.

Site-Selective N-Methylation of 5,15-Diazaporphyrins: Reactive Cationic Porphyrinoids that Provide Isoporphyrin Analogues

N-Alkylation significantly changes the electronic and optical properties, as well as the reactivity of nitrogen-containing π-conjugated molecules. In this study, it is found that treating 5,15-diazaporphyrins with methyl triflate selectively affords the corresponding N-methyl-5,15-diazaporphyrinium cations in good yield. N-Methylation substantially alters the electronic properties and reactivity of diazaporphyrins. The electron-accepting properties of the N-methyl-5,15-diazaporphyrinium cations are enhanced due to their lowered LUMO level. Stabilization of the LUMO energy enables regio- and stereoselective Diels-Alder reactions of the cationic diazaporphyrin with cyclopentadiene. N-Methylation also enhances the acidity of the inner NH protons, and thus, allows facile deprotonation to provide nitrogen-substituted isoporphyrin analogues with only one NH group in the central cavity.

Effects of a sub-minimum inhibitory concentration of chlorhexidine gluconate on the development of in vitro multi-species biofilms

Following antimicrobial administrations in oral environments, bacteria become exposed to a sub-minimum inhibitory concentration (sub-MIC), which can induce in vitro single-species biofilms. This study explored the effects of chlorhexidine gluconate (CHG) at a sub-MIC on in vitro multi-species biofilms comprising Streptococcus mutans, Streptococcus oralis and Actinomyces naeslundii. CHG at a sub-MIC was found to induce in vitro biofilm growth, although the bacterial growth was not significantly different from that in the control. The gene transcription related to S. mutans multi-species biofilm formation with CHG at a sub-MIC was significantly higher than that of the control, but this was not found in S. mutans single-species biofilms. The bio-volume of extracellular polysaccharides with CHG at a sub-MIC was significantly higher than that of the control. This suggests that CHG at a sub-MIC may promote the development of multi-species biofilms by affecting the gene transcription related to S. mutans biofilm formation.

Evidence-based strategy for dental biofilms: Current evidence of mouthwashes on dental biofilm and gingivitis

Therapeutic mouthwash (MW) is an adjunctive tool along with a regular oral hygiene routine of daily tooth brushing and daily flossing. Previous systematic reviews have demonstrated that it is effective against dental biofilm and gingival inflammation, for prevention of dental caries, and for managing one's bad breath condition according to the active ingredients. MWs prevent the microorganisms from bacterial adhesion that corresponds to the initial step in biofilm formation. This review summarized the current state of evidence such as anti-biofilm, anti-gingivitis and cariostatic properties of MWs by evaluating systematic reviews from the past six years. The anti-biofilm property has been proven to be effective, with strong evidence of three main clinical efficacies. The most commonly studied active agent was chlorhexidine gluconate (CHX), followed by essential oil (EO) and cetylpyridinium chloride. All the systematic reviews are in complete agreement that CHX and EO provide statistically significant improvements in terms of plaque and gingival indices. These effects have held up over the years as the number of studies has increased. While the use of fluoride MW is proven to be effective in improving the oral health of both children and adults, the quality of evidence is still regarded as low.

Development of antiseptic adaptation and cross-adapatation in selected oral pathogens in vitro

There is evidence that pathogenic bacteria can adapt to antiseptics upon repeated exposure. More alarming is the concomitant increase in antibiotic resistance that has been described for some pathogens. Unfortunately, effects of adaptation and cross-adaptation are hardly known for oral pathogens, which are very frequently exposed to antiseptics. Therefore, this study aimed to determine the in vitro increase in minimum inhibitory concentrations (MICs) in oral pathogens after repeated exposure to chlorhexidine or cetylpyridinium chloride, to examine if (cross-)adaptation to antiseptics/antibiotics occurs, if (cross-)adaptation is reversible and what the potential underlying mechanisms are. When the pathogens were exposed to antiseptics, their MICs significantly increased. This increase was in general at least partially conserved after regrowth without antiseptics. Some of the adapted species also showed cross-adaptation, as shown by increased MICs of antibiotics and the other antiseptic. In most antiseptic-adapted bacteria, cell-surface hydrophobicity was increased and mass-spectrometry analysis revealed changes in expression of proteins involved in a wide range of functional domains. These in vitro data shows the adaptation and cross-adaptation of oral pathogens to antiseptics and antibiotics. This was related to changes in cell surface hydrophobicity and in expression of proteins involved in membrane transport, virulence, oxidative stress protection and metabolism.

Chemical Composition of East Asian Invasive Knotweeds, their Cytotoxicity and Antimicrobial Efficacy Against Cariogenic Pathogens: An In-Vitro Study

BACKGROUND Giant knotweeds originating from East Asia, such as Reynoutria japonica, and Reynoutria sachalinensis, and their hybrid such as Reynoutria x bohemica, are invasive plants in Europe and North America. However, R. japonica is also a traditional East Asian drug (Polygoni cuspidati rhizoma) used in Korean folk medicine to improve oral hygiene. The aim of this study was to evaluate the antibacterial activity of acetone extracts of Reynoutria species against dominant caries pathogen such as Streptococcus mutans and alternative pathogens, as well as characterize the phytochemical composition of extracts and examine their cytotoxicity. MATERIAL AND METHODS Ultrasonic extraction was used to obtain polyphenol-rich extracts. The extracts were characterized by HPLC-DAD-ESI-MS. To test bacterial viability, the minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) against S. mutans, S. salivarius, S. sanguinis, and S. pyogenes were determined. The cytotoxicity of the extracts to human fibroblasts derived from gingiva was evaluated using the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. RESULTS The R. japonica extract had the highest bacteriostatic and bactericidal activity against pathogens causing caries, mainly dominant caries pathogen S. mutans (mean MIC 1000 μg/mL and MBC 2000 μg/mL), which was most likely associated with a higher content of stilbene aglycons and anthraquinone aglycons in the extract. Moreover, the R. japonica extract demonstrated the lowest cytotoxic effect on human fibroblasts and exhibited cytotoxic activity only at the concentration causing the death of all S. mutans. CONCLUSIONS The results indicate that the R. japonica acetone extract can be considered as a natural, antimicrobial agent for caries control.

Resistance Toward Chlorhexidine in Oral Bacteria - Is There Cause for Concern?

The threat of antibiotic resistance has attracted strong interest during the last two decades, thus stimulating stewardship programs and research on alternative antimicrobial therapies. Conversely, much less attention has been given to the directly related problem of resistance toward antiseptics and biocides. While bacterial resistances toward triclosan or quaternary ammonium compounds have been considered in this context, the bis-biguanide chlorhexidine (CHX) has been put into focus only very recently when its use was associated with emergence of stable resistance to the last-resort antibiotic colistin. The antimicrobial effect of CHX is based on damaging the bacterial cytoplasmic membrane and subsequent leakage of cytoplasmic material. Consequently, mechanisms conferring resistance toward CHX include multidrug efflux pumps and cell membrane changes. For instance, in staphylococci it has been shown that plasmid-borne qac ("quaternary ammonium compound") genes encode Qac efflux proteins that recognize cationic antiseptics as substrates. In Pseudomonas stutzeri, changes in the outer membrane protein and lipopolysaccharide profiles have been implicated in CHX resistance. However, little is known about the risk of resistance toward CHX in oral bacteria and potential mechanisms conferring this resistance or even cross-resistances toward antibiotics. Interestingly, there is also little awareness about the risk of CHX resistance in the dental community even though CHX has been widely used in dental practice as the gold-standard antiseptic for more than 40 years and is also included in a wide range of oral care consumer products. This review provides an overview of general resistance mechanisms toward CHX and the evidence for CHX resistance in oral bacteria. Furthermore, this work aims to raise awareness among the dental community about the risk of resistance toward CHX and accompanying cross-resistance to antibiotics. We propose new research directions related to the effects of CHX on bacteria in oral biofilms.

Effectiveness of erythrosine-mediated photodynamic antimicrobial chemotherapy on dental plaque aerobic microorganisms: A randomized controlled trial

Background:

Dental plaque is one of the predominant causes of major oral diseases. Although mechanical and chemical methods are extensively followed to control the development of plaque, plaque-related diseases still persist. Therefore, this necessitates for alternative measures of plaque control, one such alternative is photodynamic antimicrobial chemotherapy (PACT).

Materials and Methods:

Split mouth randomized clinical trial (CTRI/2017/03/008239) was conducted on 30 participants who reported to the hospital. Participants were asked to rinse their mouth for 1 min using 10 ml of 25 μM erythrosine solutions. Same tooth on both quadrants of the same jaw are selected as the test and control. Intervention used was halogen-based composite curing light with wavelength of 500–590 nm. Plaque sample from the control tooth and test tooth was collected before and after exposure, respectively, and sent to microbiological laboratory for colony count.

Results:

Logarithmic mean and standard deviation of control group with 10² dilutions of aerobic microbial count were found to be 5.34 ± 0.94, and for experimental group, it was 4.47 ± 1.37. The statistical difference between mean CFU values between aerobic bacterial counts was significant (P = 0.006).

Conclusions:

Erythrosine-mediated PACT reduces the extent of dental plaque microbial count and has a potential preventive and therapeutic use in day-to-day life and dental clinics.

Comparative Evaluation of Antimicrobial Efficacy of Silver Nanoparticles and 2% Chlorhexidine Gluconate When Used Alone and in Combination Assessed Using Agar Diffusion Method: An In vitro Study

Context:

Silver nanoparticle (AgNP) is a potent antimicrobial that is widely used in several fields of medicine. Chlorhexidine (CHX) gluconate is a well-known agent used in dentistry to eliminate oral microbial flora.

Aims:

The aim of this study is to evaluate the efficacy of AgNPs, 2% CHX gluconate, and the combination of two solutions against endodontic pathogens such as Enterococcus faecalis, Klebsiella pneumoniae, and Candida albicans. These organisms are frequently found in the root canal space and their persistence may lead to endodontic failure. The synergistic effect of the two solutions has been evaluated in this study. The antibiotic gentamycin was taken as the control group.

Settings and Design:

Agar well diffusion method was used and minimum inhibitory concentration of AgNP was found to be 15 μg/mL. AgNPs were synthesized from the aqueous plant extract of Cassia roxburghii. The combination of CHX-AgNP solution was stirred together by a glass rod. The values were tabulated and subjected to statistical analysis using the SPSS software version 20. One-way ANOVA test was used to compare within the groups and between groups. The level of significance was set at 5%.

Results:

CHX-AgNP combined solution exhibited the highest efficacy in comparison to these solutions used alone. They showed the highest efficacy against C. albicans among the three organisms tested.

Conclusion:

The present study demonstrates the antimicrobial efficacy of a novel mixture of CHX-AgNP solution, and it may be developed as a promising antimicrobial agent against endodontic flora.

Pyridinium salts: from synthesis to reactivity and applications

This review highlights the pyridinium salts in terms of their natural occurrence, synthesis, reactivity, biological properties, and diverse applications.

Cymbopogon citratus essential oil: effect on polymicrobial caries-related biofilm with low cytotoxicity

The objective of this study was to evaluate the effects of Cymbopogon citratus essential oil and its main compound (citral) against primary dental colonizers and caries-related species. Chemical characterization of the essential oil was performed by gas chromatography/mass spectroscopy (GC/MS), and the main compound was determined. Antimicrobial activity was tested against Actinomyces naeslundii, Lactobacillus acidophilus, S. gordonii, S. mitis, S. mutans, S. sanguinis and S. sobrinus. Minimum inhibitory and bactericide concentrations were determined by broth microdilution assay for streptococci and lactobacilli reference, and for clinical strains. The effect of the essential oil on bacterial adhesion and biofilm formation/disruption was investigated. Negative (without treatment) and positive controls (chlorhexidine) were used. The effect of citral on preformed biofilm was also tested using the same methodology. Monospecies and microcosm biofilms were tested. ANOVA or Kruskal-Wallis tests were used (α=0.05). Cytotoxicity of the essential oil to human keratinocytes was performed by MTT assay. GC/MS demonstrated one major component (citral). The essential oil showed an inhibitory effect on all tested bacterial species, including S. mutans and L. acidophilus. Essential oil of C. citratus (10X MIC) reduced the number of viable cells of lactobacilli and streptococci biofilms (p < 0.05). The essential oil inhibited adhesion of caries-related polymicrobial biofilm to dental enamel (p < 0.01). Citral significantly reduced the number of viable cells of streptococci biofilm (p < 0.001). The essential oil showed low cytotoxicity to human keratinocytes. Based on these findings, this study can contribute to the development of new formulations for products like mouthwash, against dental biofilms.

Comparing the effect of 0.06% -, 0.12% and 0.2% Chlorhexidine on plaque, bleeding and side effects in an experimental gingivitis model: a parallel group, double masked randomized clinical trial

BACKGROUND

Chlorhexidine is the gold standard of dental plaque prevention. The aim of the present study was to compare the plaque and gingivitis inhibiting effect of commercial products containing 0.2%, 0.12% and 0.06% chlorhexidine in a modified experimental gingivitis model.

METHODS

In three groups of healthy volunteers, experimental gingivitis was induced and monitored over 21 days and simultaneously treated with the commercial solutions containing 0.2%, 0.12% and 0.06% chlorhexidine. The maxillary right quadrant of each individual received mouthwash only, whereas the maxillary left quadrant was subject to both rinsing and mechanical oral hygiene. Compliance and side effects were monitored at days 7, 14, and 21. Plaque and gingivitis scores were obtained at baseline and day 21.

RESULTS

The commercial mouthwash containing 0.2% chlorhexidine resulted in statistically significantly lower plaque scores than the 0.12 and 0.06% mouthwashes after 21 days use, whereas no statistically significant difference was found between the effects of the two latter.

CONCLUSION

A commercially available mouthwash containing 0.2% chlorhexidine had statistically significant better effect in preventing dental plaque than the 0.12% and 0.06% solutions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02911766 . Registration date: September 9th 2016.

Development of antimicrobial coating by layer-by-layer [corrected] dip coating of chlorhexidine-loaded micelles

Layer-by-layer (LbL) dip coating, accompanying with the use of micelle structure, allows hydrophobic molecules to be coated on medical devices' surface via hydrogen bonding interaction. In addition, micelle structure also allows control release of encapsulated compound. In this research, we investigated methods to coat and maximize the amount of chlorhexidine (CHX) on silicone surface through LbL dip coating method utilizing hydrogen bonding interaction between PEG on micelle corona and PAA. The number of coated cycles was varied in the process and 90 coating cycles provided the maximum amount of CHX loaded onto the surface. In addition, pre-coating the surface with PAA enhanced the amount of coated CHX by 20%. Scanning electron microscope (SEM) and Fourier Transform Infrared Spectroscopy (FTIR) were used to validate and characterize the coating. For control release aspect, the coated film tended to disrupt at physiological condition; hence chemical crosslinking was performed to minimize the disruption and maximize the release time. Chemical crosslinking at pH 2.5 and 4.5 were performed in the process. It was found that chemical crosslinking could help extend the release period up to 18 days. This was significantly longer when compared to the non-crosslinking silicone tube that could only prolong the release for 5 days. In addition, chemical crosslinking at pH 2.5 gave higher and better initial burst release, release period and antimicrobial properties than that of pH 4.5 or the normal used pH for chemical crosslinking process.

Biofilm formation in Haas palatal expanders with and without use of an antimicrobial agent: an in situ study

Orthodontic appliances causes specific alterations in oral environment, including reduction of pH, increase of dental biofilm and elevation of salivary microbial levels, causing an increased risk for dental caries. This study evaluated, using microbial culture and scanning electron microscopy (SEM), the in situ contamination by mutans streptococci (MS) of different surfaces of Haas palatal expanders with and without use of chlorhexidine gluconate mouthrinses (CHX). Thirty-four patients were randomly assigned to two groups (n = 17/group), using placebo (Group I) and 0.12% CHX (Group II-Periogard^® ) mouthrinses twice a week. After 4 months, appliances were submitted to microbiological processing and after fragments were analyzed by SEM. Mann-Whitney U test (α = 5%) was used to assess differences between groups on the appliances' different surfaces and to compare the contamination on the free and nonfree surfaces of these components. There was no difference (p = 0.999) between groups regarding the number of MS colonies/biofilms on the nonfree surfaces, which showed intense contamination. However, free surfaces of Group II presented less contamination (p < 0.001) than those of Group I in all appliances' components. Results of the microbial culture were confirmed by SEM. Use of 0.12% CHX was effective in reducing the formation of MS colonies/biofilms on free surfaces of Haas expanders, in situ.

Vizantin inhibits bacterial adhesion without affecting bacterial growth and causes Streptococcus mutans biofilm to detach by altering its internal architecture

An ideal antibiofilm strategy is to control both in the quality and quantity of biofilm while maintaining the benefits derived from resident microflora. Vizantin, a recently developed immunostimulating compound, has also been found to have antibiofilm property. This study evaluated the influence on biofilm formation of Streptococcus mutans in the presence of sulfated vizantin and biofilm development following bacterial adhesion on a hydroxyapatite disc coated with sulfated vizantin. Supplementation with sulfated vizantin up to 50 μM did not affect either bacterial growth or biofilm formation, whereas 50 μM sulfated vizantin caused the biofilm to readily detach from the surface. Sulfated vizantin at the concentration of 50 μM upregulated the expression of the gtfB and gtfC genes, but downregulated the expression of the gtfD gene, suggesting altered architecture in the biofilm. Biofilm development on the surface coated with sulfated vizantin was inhibited depending on the concentration, suggesting prevention from bacterial adhesion. Among eight genes related to bacterial adherence in S. mutans, expression of gtfB and gtfC was significantly upregulated, whereas the expression of gtfD, GbpA and GbpC was downregulated according to the concentration of vizantin, especially with 50 μM vizantin by 0.8-, 0.4-, and 0.4-fold, respectively. These findings suggest that sulfated vizantin may cause structural degradation as a result of changing gene regulation related to bacterial adhesion and glucan production of S. mutans.

Dental plaque bacteria with reduced susceptibility to chlorhexidine are multidrug resistant

BACKGROUND

Chlorhexidine (CHX) is used in oral care products to help control dental plaque. In this study dental plaque bacteria were grown on media containing 2 μg/ml chlorhexidine gluconate to screen for bacteria with reduced CHX susceptibility. The isolates were characterized by 16S rRNA gene sequencing and antibiotic resistance profiles were determined using the disc diffusion method.

RESULTS

The isolates were variably resistant to multiple drugs including ampicillin, kanamycin, gentamicin and tetracycline. Two species, Chryseobacterium culicis and Chryseobacterium indologenes were able to grow planktonically and form biofilms in the presence of 32 μg/ml CHX. In the CHX and multidrug resistant C. indologenes we demonstrated a 19-fold up-regulation of expression of the HlyD-like periplasmic adaptor protein of a tripartite efflux pump upon exposure to 16 μg/ml CHX suggesting that multidrug resistance may be mediated by this system. Exposure of biofilms of these resistant species to undiluted commercial CHX mouthwash for intervals from 5 to 60 s indicated that the mouthwash was unlikely to eliminate them from dental plaque in vivo.

CONCLUSIONS

The study highlights the requirement for increased vigilance of the presence of multidrug resistant bacteria in dental plaque and raises a potential risk of long-term use of oral care products containing antimicrobial agents for the control of dental plaque.

Efficacy of Four Fluoride Mouth Rinses on Streptococcus mutans in High Caries Risk Children - A Randomized Controlled Trial

INTRODUCTION

Dental caries has been traditionally described as a multifactorial disease that involves the interaction of various factors like host, agent, substrate and time. Landmark studies have established the fact that Mutans Streptococci are the primary etiologic agents of dental caries. The prevention of dental caries by fluoride supplements in various vehicles, such as water and toothpaste, constitutes one of the most successful prevention measures.

AIM

The aim of the present study was to compare the clinical efficacy of four fluoride mouth rinses on Streptococcus mutans in high caries risk children and also to check the efficacy of the ingredient Triclosan which is present in two of the four mouth rinses.

MATERIALS AND METHODS

The study is double blinded, consisting of 1000 children in age group 6-14yrs who were screened from residential schools. Of the total, 200 children were categorized as high caries risk group based on caries risk assessment tool form given by American Association of Pediatric Dentistry (AAPD) guidelines 2011. Prior to the study, salivary samples were collected and sent for microbial analysis to estimate Streptococcus mutans counts. Out of 200 salivary samples, 132 showed 106CFU of Streptococcus mutans and these children were included in the study. The 132 children from each group received the assigned mouth wash for 14 consecutive days. On 15th day the salivary samples were collected and sent for microbial analysis and the obtained results were subjected to statistical analysis.

RESULTS

All the mouth washes showed a significant reduction in Colony Forming Units (CFU) counts of Streptococcus mutans. Among the four groups Group D (S flo) showed greater percentage reduction of Streptococcus mutans followed by Group A (Act), B (Kidodent) and C (Zerocary). There was no stastically significance reduction of Streptococcus mutans among the Triclosan containing and non containing groups.

CONCLUSION

The mean pre rinse CFU was significantly higher than post rinse CFU for all the study groups, suggesting that all the four mouth rinses were effective in decreasing the levels of Streptococcus mutans in the saliva. Both the Triclosan containing and non Triclosan groups showed the same amount of CFU count reduction.

Antibacterial and antiplaque efficacy of a commercially available octenidine-containing mouthrinse

OBJECTIVES

The purpose of this clinical study was to determine the antibacterial and antiplaque efficacy of a recently introduced octenidine-containing mouthrinse (Octenidol®) in comparison with established antiseptic mouthrinses.

MATERIALS AND METHODS

In a 4-day plaque-regrowth study employing a four-replicate cross-over design, a 0.1 % octenidine mouthrinse (Octenidol®/OCT-MR) was compared with a 0.12 % chlorhexidine mouthrinse (Paroex®/CHX-MR), an essential oil mouthrinse (Listerine®/EO-MR), and a placebo mouthrinse/P-MR. Plaque regrowth was assessed with a modified Quigley-Hein plaque index. The antibacterial effect was assessed by taking bacterial counts from the tooth surface and oral mucosa after professional tooth cleaning and after first rinsing with the allocated mouthrinse on days 1 and 5. Sixteen volunteers suspended tooth cleaning and rinsed twice daily with the allocated mouthrinse for 4 days.

RESULTS

All tested antiseptic mouthrinses were significantly more effective than the placebo mouthrinse in inhibiting plaque, but no significant differences were observed between OCT-MR and CHX-MR, OCT-MR and EO-MR, and CHX-MR and EO-MR. After 4 days, comparable bacterial count levels were found on both the tooth surface and mucosa applying OCT-MR and CHX-MR, which were significantly lower than that of EO-MR and P-MR.

CONCLUSION

Octenidol® and Paroex® showed comparable antibacterial and antiplaque efficacy in the human oral cavity.

CLINICAL RELEVANCE

The recently introduced octenidine-containing mouthrinse Octenidol® may become a suitable alternative to 0.12 % chlorhexidine-containing mouthrinses such as Paroex®.

Microbial contamination and disinfection methods of pacifiers

OBJECTIVES

To evaluate the microbial contamination of pacifiers by Mutans Streptococci(MS) and the efficacy of different methods for their disinfection.

METHODS

Twenty-eight children were assigned to a 4-stage changeover system with a 1-week interval. In each stage, children received a new pacifier and the parents were instructed to maintain their normal habits for 1 week. After this time, the pacifiers were subjected to the following 4 disinfection methods: spraying with 0.12% chlorhexidine solution, Brushtox or sterile tap water, and immersion in boiling tap water for 15 minutes. Microbiological culture for MS and Scanning Electron Microscopy (SEM) were performed. The results were analyzed statistically by Friedman's non-parametric test (a=0.05).

RESULTS

The 0.12% chlorhexidine spray was statistically similar to the boiling water (p>0.05) and more effective than the Brushtox spray and control (p<0.05). The analysis of SEM showed the formation of a cariogenic biofilm in all groups with positive culture.

CONCLUSIONS

Pacifiers become contaminated by MS after their use by children and should be disinfected routinely. Spraying with a 0.12% chlorhexidine solution and immersion in boiling water promoted better disinfection of the pacifiers compared with a commercial antiseptic toothbrush cleanser (Brushtox).

Lethal effect of blue light-activated hydrogen peroxide, curcumin and erythrosine as potential oral photosensitizers on the viability of Porphyromonas gingivalis and Fusobacterium nucleatum

OBJECTIVES

Recently, photodynamic therapy (PDT) has been introduced as a new modality in oral bacterial decontamination. Current research aims to evaluate the effect of photodynamic killing of visible blue light in the presence of hydrogen peroxide, curcumin and erythrosine as potential oral photosensitizers on Porphyromonas gingivalis associated with periodontal bone loss and Fusobacterium nucleatum associated with soft tissue inflammation.

MATERIALS AND METHODS

Standard suspension of P. gingivalis and F. nucleatum were exposed to Light Emitting Diode (LED) (440-480 nm) in combination with erythrosine (22 µm), curcumin (60 µM) and hydrogen peroxide (0.3 mM) for 5 min. Bacterial samples from each treatment groups (radiation-only group, photosensitizer-only group and blue light-activated photosensitizer group) were subcultured onto the surface of agar plates. Survival of these bacteria was determined by counting the number of colony forming units (CFU) after incubation.

RESULTS

RESULTS for antibacterial assays on P. gingivalis confirmed that curcumin, Hydrogen peroxide and erythrosine alone exerted a moderate bactericidal effect which enhanced noticeably in conjugation with visible light. The survival rate of P. gingivalis reached zero present when the suspension exposed to blue light-activated curcumin and hydrogen peroxide for 2 min. Besides, curcumin exerted a remarkable antibacterial activity against F. nucleatum in comparison with erythrosine and hydrogen peroxide (P=0.00). Furthermore, the bactericidal effect of visible light alone on P. gingivalis as black-pigmented bacteria was significant.

CONCLUSION

Our result suggested that visible blue light in the presence of erythrosine, curcumin and hydrogen peroxide would be consider as a potential approach of PDT to kill the main gramnegative periodontal pathogens. From a clinical standpoint, this regimen could be established as an additional minimally invasive antibacterial treatment of plaque induced periodontal pathologies.

Effects of combined oleic acid and fluoride at sub-MIC levels on EPS formation and viability of Streptococcus mutans UA159 biofilms

Despite the widespread use of fluoride, dental caries, a biofilm-related disease, remains an important health problem. This study investigated whether oleic acid, a monounsaturated fatty acid, can enhance the effect of fluoride on extracellular polysaccharide (EPS) formation by Streptococcus mutans UA159 biofilms at sub-minimum inhibitory concentration levels, via microbiological and biochemical methods, confocal fluorescence microscopy, and real-time PCR. The combination of oleic acid with fluoride inhibited EPS formation more strongly than did fluoride or oleic acid alone. The superior inhibition of EPS formation was due to the combination of the inhibitory effects of oleic acid and fluoride against glucosyltransferases (GTFs) and GTF-related gene (gtfB, gtfC, and gtfD) expression, respectively. In addition, the combination of oleic acid with fluoride altered the bacterial biovolume of the biofilms without bactericidal activity. These results suggest that oleic acid may be useful for enhancing fluoride inhibition of EPS formation by S. mutans biofilms, without killing the bacterium.

Prospects of oral disease control in the future - an opinion

The mouth supports a diverse microbiota which provides major benefits to the host. On occasions, this symbiotic relationship breaks down (dysbiosis), and disease can be a consequence. We argue that progress in the control of oral diseases will depend on a paradigm shift away from approaches that have proved successful in medicine for many diseases with a specific microbial aetiology. Factors that drive dysbiosis in the mouth should be identified and, where possible, negated, reduced or removed, while antimicrobial agents delivered by oral care products may function effectively, even at sub-lethal concentrations, by modulating the activity and growth of potentially pathogenic bacteria. In this way, the beneficial activities of the resident oral microbiota will be retained and the risk of dysbiosis occurring will be reduced.

Withania somnifera attenuates acid production, acid tolerance and extra-cellular polysaccharide formation of Streptococcus mutans biofilms

Withania somnifera (Ashwagandha) is a plant of the Solanaceae family. It has been widely used as a remedy for a variety of ailments in India and Nepal. The plant has also been used as a controlling agent for dental diseases. The aim of the present study was to evaluate the activity of the methanol extract of W. somnifera against the physiological ability of cariogenic biofilms and to identify the components of the extract. To determine the activity of the extract, assays for sucrose-dependent bacterial adherence, glycolytic acid production, acid tolerance, and extracellular polysaccharide formation were performed using Streptococcus mutans biofilms. The viability change of S. mutans biofilms cells was also determined. A phytochemical analysis of the extract was performed using TLC and LC/MS/MS. The extract showed inhibitory effects on sucrose-dependent bacterial adherence (≥ 100 μg/ml), glycolytic acid production (≥ 300 μg/ml), acid tolerance (≥ 300 μg/ml), and extracellular polysaccharide formation (≥ 300 μg/ml) of S. mutans biofilms. However, the extract did not alter the viability of S. mutans biofilms cells in all concentrations tested. Based on the phytochemical analysis, the activity of the extract may be related to the presence of alkaloids, anthrones, coumarines, anthraquinones, terpenoids, flavonoids, and steroid lactones (withanolide A, withaferin A, withanolide B, withanoside IV, and 12-deoxy withastramonolide). These data indicate that W. somnifera may be a potential agent for restraining the physiological ability of cariogenic biofilms.

Nanoparticle-encapsulated chlorhexidine against oral bacterial biofilms

BACKGROUND

Chlorhexidine (CHX) is a widely used antimicrobial agent in dentistry. Herein, we report the synthesis of a novel mesoporous silica nanoparticle-encapsulated pure CHX (Nano-CHX), and its mechanical profile and antimicrobial properties against oral biofilms.

METHODOLOGY/PRINCIPAL FINDINGS

The release of CHX from the Nano-CHX was characterized by UV/visible absorption spectroscopy. The antimicrobial properties of Nano-CHX were evaluated in both planktonic and biofilm modes of representative oral pathogenic bacteria. The Nano-CHX demonstrated potent antibacterial effects on planktonic bacteria and mono-species biofilms at the concentrations of 50-200 µg/mL against Streptococcus mutans, Streptococcus sobrinus, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans and Enterococccus faecalis. Moreover, Nano-CHX effectively suppressed multi-species biofilms such as S. mutans, F. nucleatum, A. actinomycetemcomitans and Porphyromonas gingivalis up to 72 h.

CONCLUSIONS/SIGNIFICANCE

This pioneering study demonstrates the potent antibacterial effects of the Nano-CHX on oral biofilms, and it may be developed as a novel and promising anti-biofilm agent for clinical use.

Long-term efficacy of a 0.07% cetylpyridinium chloride mouth rinse in relation to plaque and gingivitis: a 6-month randomized, vehicle-controlled clinical trial

OBJECTIVE

To evaluate the effectiveness of 0.07% cetylpyridinium chloride (CPC) mouth rinse for reduction of gingival inflammation and inhibition of plaque compared to a vehicle control (VC) mouth rinse over a 6-month period.

MATERIALS & METHODS

Participants (n = 62) used their randomly assigned product as adjunct to toothbrushing. Bleeding, plaque and staining scores were assessed at baseline, 3 and 6 months. Plaque and saliva samples were taken at each assessment monitoring possible shifts in the composition of the microbiota.

RESULTS

A significant difference (P = 0.002) in favour of the CPC mouth rinse, with respect to plaque scores, was found. Bleeding scores at 6 months were not significantly different (P = 0.089). However, when correcting for baseline values, a tendency towards a significant difference in bleeding scores at end trail was observed in favour of the CPC mouth rinse (P = 0.061). Regarding staining at 3 and 6 months, a small but significant difference (8.6% and 10.4%, respectively) (P < 0.0001) was observed with lower scores for the VC group. There was a significant reduction in total anaerobic count in the CPC group at 6 months (P < 0.05). The ratio of aerobes/anaerobes was markedly increased at 3 months, especially in the CPC group. No further differences were observed between groups at 6 months.

CONCLUSIONS

The use of 0.07% CPC mouth rinse was significantly more effective in reducing plaque scores than the vehicle control. Bleeding scores were not different at 6 months. The test product was well accepted and did not cause any serious clinical side effects or negatively affected the microbiota.

Evaluation of antimicrobial effects of commercial mouthwashes utilized in South Korea

Streptococcus mutans is frequently associated with dental caries. Bacterial fermentation of food debris generates an acidic environment on the tooth surface, ultimately resulting in tooth deterioration. Therefore, various mouthwashes have been used to reduce and prevent Streptococcus mutans. The aim of this study was to evaluate the antimicrobial activities of 4 commercial mouthwashes and those of 10% and 20% ethanol solutions (formula A, B, C, D, E and F) against Streptococcus mutans using biofilm and planktonic methods. The range of reduction in the viable cell count of Streptococcus mutans as estimated by the biofilm and planktonic methods was 0.05-5.51 log (P ≤ 0.01) and 1.23-7.51 log (P ≤ 0.001) compared with the negative control, respectively, indicating that the planktonic method had a stronger antibacterial effect against S. mutans. Among the tested formulations, formula A(Garglin regular^Ⓡ mouthwash) was the most effective against Streptococcus mutans (P ≤ 0.001). [BMB Reports 2015; 48(1): 42-47]