In vivo biofilm formation on stainless steel bonded retainers during different oral health-care regimens

The oral microbiota and periodontal health in orthodontic patients

The oral microbiota develops within the first 2 years of childhood and becomes distinct from the parents by 4 years-of-age. The oral microbiota plays an important role in the overall health/symbiosis of the individual. Deviations from the state of symbiosis leads to dysbiosis and an increased risk of pathogenicity. Deviations can occur not only from daily life activities but also from orthodontic interventions. Orthodontic appliances are formed from a variety of biomaterials. Once inserted, they serve as a breeding ground for microbial attachment, not only from new surface areas and crevices but also from material physicochemical interactions different than in the symbiotic state. Individuals undergoing orthodontic treatment show, compared with untreated people, qualitative and quantitative differences in activity within the oral microbiota, induced by increased retention of supra- and subgingival microbial plaque throughout the treatment period. These changes are at the root of the main undesirable effects, such as gingivitis, white spot lesions (WSL), and more severe caries lesions. Notably, the oral microbiota profile in the first weeks of orthodontic intervention might be a valuable indicator to predict and identify higher-risk individuals with respect to periodontal health and caries risk within an otherwise healthy population. Antimicrobial coatings have been used to dissuade microbes from adhering to the biomaterial; however, they disrupt the host microbiota, and several bacterial strains have become resistant. Smart biomaterials that can reduce the antimicrobial load preventing microbial adhesion to orthodontic appliances have shown promising results, but their complexity has kept many solutions from reaching the clinic. 3D printing technology provides opportunities for complex chemical syntheses to be performed uniformly, reducing the cost of producing smart biomaterials giving hope that they may reach the clinic in the near future. The purpose of this review is to emphasize the importance of the oral microbiota during orthodontic therapy and to use innovative technologies to better maintain its healthy balance during surgical procedures.

Antimicrobial efficacy of antiplaque agents of common toothpastes against Porphyromonas gingivalis and Streptococcus oralis: An in vitro study

Background

This study was designed to evaluate the antimicrobial activity of common gum protection and antiplaque toothpastes against Porphyromonas gingivalis (P. gingivalis) and Streptococcus oralis (S. oralis) as important periodontal pathogens.

Materials and Methods

This experimental study investigated the antimicrobial activity of 15 commonly used toothpastes from different companies on the two common types of periopathogens, S. oralis and P. gingivalis . The antimicrobial activity of toothpaste was evaluated at three concentrations of 100%, 50%, and 25% and analyzed by agar well diffusion plate method and zone of inhibition. The obtained data were compared and statistically analyzed by SPSS software using one-way ANOVA and the least significant difference post hoc tests (α = 0.05).

Results

One-way ANOVA showed that the mean diameter of the two-bacterial zone of inhibition was significantly different at 100%, 50%, and 25% concentrations of toothpastes (P < 0.001). In general, the mean diameter of the zone of inhibition was greater at 100% concentration than the other two concentrations in all toothpastes. The highest zone of inhibition of the S. oralis was in the toothpastes containing tin. Further, the highest zone of inhibition of P. gingivalis was found in the triclosan-containing toothpastes.

Conclusion

Toothpastes containing triclosan had the most antimicrobial activity against P. gingivalis . Moreover, toothpastes containing tin compounds had the most antimicrobial effect against S. oralis .

Triclosan: A Small Molecule with Controversial Roles

Triclosan (TCS), a broad-spectrum antimicrobial agent, has been widely used in personal care products, medical products, plastic cutting boards, and food storage containers. Colgate Total® toothpaste, containing 10 mM TCS, is effective in controlling biofilm formation and maintaining gingival health. Given its broad usage, TCS is present ubiquitously in the environment. Given its strong lipophilicity and accumulation ability in organisms, it is potentially harmful to biohealth. Several reports suggest the toxicity of this compound, which is inserted in the class of endocrine disrupting chemicals (EDCs). In September 2016, TCS was banned by the U.S. Food and Drug Administration (FDA) and the European Union in soap products. Despite these problems, its application in personal care products within certain limits is still allowed. Today, it is still unclear whether TCS is truly toxic to mammals and the adverse effects of continuous, long-term, and low concentration exposure remain unknown. Indeed, some recent reports suggest the use of TCS as a repositioned drug for cancer treatment and cutaneous leishmaniasis. In this scenario it is necessary to investigate the advantages and disadvantages of TCS, to understand whether its use is advisable or not. This review intends to highlight the pros and cons that are associated with the use of TCS in humans.

Preparation of Nano-Apatite Grafted Glass-Fiber-Reinforced Composites for Orthodontic Application: Mechanical and In Vitro Biofilm Analysis

This study aimed to fabricate nano-hydroxyapatite (nHA) grafted/non-grafted E-glass-fiber-based (nHA/EG) and E-glass fiber (EG) orthodontic retainers and to compare their properties with commercially available retainers. Stainless-steel (SS) retainers and everStick Ortho (EST) were used as control groups. The retainers were evaluated with Raman spectroscopy and bonded to bovine teeth. The samples were fatigued under cyclic loading (120,000 cycles) followed by static load testing. The failure behavior was evaluated under an optical microscope and scanning electron microscope. The strain growth on the orthodontic retainers was assessed (48h and 168h) by an adhesion test using Staphylococcus aureus and Candida albicans. The characteristic peaks of resin and glass fibers were observed, and the debonding force results showed a significant difference among all of the groups. SS retainers showed the highest bonding force, whereas nHA/EG retainers showed a non-significant difference from EG and EST retainers. SS retainers’ failure mode occurred mainly at the retainer–composite interface, while breakage occurred in glass-fiber-based retainers. The strains’ adhesion to EST and EG was reduced with time. However, it was increased with nHA/EG. Fabrication of nHA/EG retainers was successfully achieved and showed better debonding force compared to other glass-fiber-based groups, whereas non-linear behavior was observed for the strains’ adhesion.

Recent Development of Active Ingredients in Mouthwashes and Toothpastes for Periodontal Diseases

Periodontal diseases like gingivitis and periodontitis are primarily caused by dental plaque. Several antiplaque and anti-microbial agents have been successfully incorporated into toothpastes and mouthwashes to control plaque biofilms and to prevent and treat gingivitis and periodontitis. The aim of this article was to review recent developments in the antiplaque, anti-gingivitis, and anti-periodontitis properties of some common compounds in toothpastes and mouthwashes by evaluating basic and clinical studies, especially the ones published in the past five years. The common active ingredients in toothpastes and mouthwashes included in this review are chlorhexidine, cetylpyridinium chloride, sodium fluoride, stannous fluoride, stannous chloride, zinc oxide, zinc chloride, and two herbs—licorice and curcumin. We believe this comprehensive review will provide useful up-to-date information for dental care professionals and the general public regarding the major oral care products on the market that are in daily use.

Contribution of Essential Oils to the Fight against Microbial Biofilms—A Review

The increasing clinical use of artificial medical devices raises the issue of microbial contamination, which is a risk factor for the occurrence of biofilm-associated infections. A huge amount of scientific data highlights the promising potential of essential oils (EOs) to be used for the development of novel antibiofilm strategies. We aimed to review the relevant literature indexed in PubMed and Embase and to identify the recent directions in the field of EOs, as a new modality to eradicate microbial biofilms. We paid special attention to studies that explain the mechanisms of the microbicidal and antibiofilm activity of EOs, as well as their synergism with other antimicrobials. The EOs are difficult to test for their antimicrobial activity due to lipophilicity and volatility, so we have presented recent methods that facilitate these tests. There are presented the applications of EOs in chronic wounds and biofilm-mediated infection treatment, in the food industry and as air disinfectants. This analysis concludes that EOs are a source of antimicrobial agents that should not be neglected and that will probably provide new anti-infective therapeutic agents.

Comparative evaluation of periodontal effects and survival rates of Memotain and five-stranded bonded retainers : A prospective short-term study

PURPOSE

To prospectively compare the short-term periodontal effects and survival rates of mandibular lingual canine-to-canine Memotain (CA-Digital, Mettmann, Germany) and five-stranded bonded retainers.

METHODS

In all, 52 patients requiring retention after orthodontic treatment were assigned to 2 study groups (n = 26 in each group). Retention was provided by Memotain retainers which were fabricated digitally using CAD-CAM (computer-aided design and computer-aided manufacturing) technology in the first group and by five-stranded retainers which were fabricated manually using a conventional bending method in the second group. The patients were examined at the following time points: 1 week, 1 month, 3 months and 6 months. Plaque index, gingival index, probing depth, marginal recession, bleeding on probing, failure rate per tooth, and survival rate of retainer wires were analyzed by Mann-Whitney U, Friedman, Wilcoxon signed-rank, and χ² tests.

RESULTS

The differences between the groups were nonsignificant for plaque index, gingival index, probing depth, marginal recession, bleeding on probing, failure rate per tooth and survival rate of retainer wires. Significant differences were observed within the groups throughout the follow-up period for plaque index and probing depth. The survival rates of retainer wires were 77% for the Memotain retainers and 73% for the five-stranded retainers for the 6‑month follow-up period.

CONCLUSIONS

Periodontal outcomes and survival rates of Memotain and five-stranded mandibular lingual bonded retainers were similar. Furthermore, periodontal health was maintained and considerably high survival rates were achieved with both retainer types.

Comparison of new formulas of stannous fluoride toothpastes with other commercially available fluoridated toothpastes: A systematic review and meta-analysis of randomised controlled trials

AIM

The aim of this study was to systematically review and analyse the difference in efficacy of stannous fluoride toothpaste formulations in comparison to other fluoridated toothpastes without stannous fluoride.

MATERIALS AND METHODS

A systematic search of the literature was performed according to PRISMA guidelines. A search strategy was developed to answer the study question and was performed in PubMed-Medline databases. Inclusion criteria were randomised controlled clinical trials comparing stannous fluoride toothpaste formulations with other fluoridated toothpastes not containing stannous fluoride.

RESULTS

The search in PubMed-Medline databases resulted in 384 articles; 23 articles were downloaded for review, 16 articles were included in the report and six could be used for meta-analysis. All studies were randomised controlled clinical trials that compared clinical outcomes between toothpastes with stannous fluoride combinations and toothpastes with only fluoride. The overall results of the 16 studies favoured the stannous fluoride formulations. However, in a meta-analysis of the randomised controlled clinical trials, it was demonstrated that stannous fluoride toothpaste formulations provided significantly better outcomes based on the Gingival Index (SMD -0.14, 95% CI -0.20, -0.07, P = 0.0001), but not the Modified Gingival Index (SMD -0.30, 95% CI -0.7, 0.09, P = 0.13).

PRACTICAL IMPLICATIONS

The antibacterial properties of stannous seem to provide favourable results when formulated with a fluoridated toothpaste. This systematic review highlights the lack of homogenous research available to rigorously compare stannous fluoride toothpaste formulations with other fluoridated toothpastes without stannous fluoride.

Antimicrobial and Antibiofilm Effect of Cranberry Extract on Streptococcus mutans and Lactobacillus acidophilus: An In Vitro Study

Background

Nature has been a source of medicinal treatments since millennia and plant-based systems continue to play an essential role.

Aim

To study the antimicrobial and antibiofilm effect of cranberry on Streptococcus mutans and Lactobacillus acidophilus.

Materials and methods

The ethanolic extract of cranberry was tested against standard MTCC strains of S. mutans (MTCC 25175) and L. acidophilus (MTCC 8129) for minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). The time kill assay was performed to check the time-dependent bactericidal effect of the cranberry extract on microorganisms. Percentage of cell adhesion and biofilm inhibition of the dental microorganism at various doses of cranberry extract was measured by a spectrophotometer and biofilm morphology characteristics were observed under scanning electron microscopy. All the tests were carried out in triplicates. Data were computed in the SPSS software and mean/SD was determined. The results are presented in a descriptive manner; Kruskal–Wallis analysis of variance (ANOVA) and the Friedman's test were applied for comparative evaluation of the groups. p value <0.05 was considered statistically significant.

Results

The results showed that MICs of cranberry extract against S. mutans and L. acidophilus are 12.5 mg/dL and 6.125 mg/dL, respectively, and MBCs are 25 mg/dL and 12.5 mg/dL, respectively. A significant decrease in the biofilm formation and cell adhesion of microorganisms at MIC (50%) and MBC (70%) was observed as compared to control as observed under a spectrophotometer and a scanning electron microscope.

Conclusion

This study has identified bactericidal, bacteriostatic, and antibiofilm effects of cranberry extract against S. mutans and L. acidophilus in a time-dependent and dose-dependent manner.

How to cite this article

Singhal R, Patil P, Siddibhavi M, et al. Antimicrobial and Antibiofilm Effect of Cranberry Extract on Streptococcus mutans and Lactobacillus acidophilus: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(1):11–15.

Development of a clinical practice guideline for orthodontic retention

OBJECTIVES

To develop a clinical practice guideline (CPG) for orthodontic retention (OR).

MATERIALS AND METHODS

The CPG was developed according to the AGREE II instrument and EBRO (Dutch methodology for evidence-based guideline development). Reporting was done according the RIGHT statement. A Task Force developed clinical questions regarding OR. To answer these questions, a systematic literature search in PubMed and EMBASE was performed. Two independent researchers identified and selected studies, assessed risk of bias using Cochrane RoB tool and rated quality of evidence using GRADE. The Task Force formulated considerations and recommendations after discussing the evidence. The concept CPG was sent for commentary to all relevant stakeholders.

RESULT

One systematic review-with 15 studies-met the inclusion criteria. In case of low evidence and lack of outcome measures, expert-based considerations were developed. Over four meetings, the Task Force reached consensus on considerations and recommendations, after which the concept CPG was ready for the commentary phase. After processing the comments, the CPG was presented to the Dutch Association of Orthodontists, whereafter authorization followed.

LIMITATIONS

The paucity of evidence-based studies concerning OR and the reporting of measurable patient outcomes.

CONCLUSION

This CPG offers practitioner recommendations for best practice regarding OR, may reduce variation between practices and assists with patient aftercare. A carefully chosen retention procedure for individual patients, combined with clear information and communication between orthodontist, dentist and patient will contribute to long-term maintenance of orthodontic treatment results.

Extracellular Polymeric Matrix Production and Relaxation under Fluid Shear and Mechanical Pressure in Staphylococcus aureus Biofilms

The viscoelasticity of a biofilm's EPS (extracellular polymeric substance) matrix conveys protection against mechanical challenges, but adaptive responses of biofilm inhabitants to produce EPS are not well known. Here, we compare the responses of a biofilm of an EPS-producing (ATCC 12600) and a non-EPS producing (5298) Staphylococcus aureus strain to fluid shear and mechanical challenge. Confocal laser scanning microscopy confirmed absence of calcofluor-white-stainable EPS in biofilms of S. aureus 5298. Attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy combined with tribometry indicated that polysaccharide production per bacterium in the initial adhering layer was higher during growth at high shear than at low shear and that this increased EPS production extended to entire biofilms, as indicated by tribometrically measured coefficients of friction (CoF). CoF of biofilms grown under high fluid shear were higher than those when grown under low shear, likely due to wash-off polysaccharides. Measurement of a biofilm's CoF implies application of mechanical pressure that yielded an immediate increase in the polysaccharide band area of S. aureus ATCC 12600 biofilms due to their compression. Compression decreased after relief of pressure to the level observed prior to mechanical pressure. For biofilms grown under high shear, this coincided with a higher percent whiteness in optical coherence tomography-images indicative of water outflow, returning back into the biofilm during stress relaxation. Biofilms grown under low shear, however, were stimulated during tribometry to produce EPS, also after relief of stress. Knowledge of factors that govern EPS production and water flow in biofilms will allow better control of biofilms under mechanical challenge and better understanding of the barrier properties of biofilms against antimicrobial penetration.IMPORTANCE Adaptive responses of biofilm inhabitants in nature to environmental challenges such as fluid shear and mechanical pressure often involve EPS production with the aim of protecting biofilm inhabitants. EPS can assist biofilm bacteria in remaining attached or can impede antimicrobial penetration. The TriboChemist is a recently introduced instrument, allowing the study of initially adhering bacteria to a germanium crystal using ATR-FTIR spectroscopy, while simultaneously allowing measurement of the coefficient of friction of a biofilm, which serves as an indicator of the EPS content of a biofilm. EPS production can be stimulated by both fluid shear during growth and mechanical pressure, while increased EPS production can continue after pressure relaxation of the biofilm. Since EPS is pivotal in the protection of biofilm inhabitants against mechanical and chemical challenges, knowledge of the factors that make biofilm inhabitants decide to produce EPS, as provided in this study, is important for the development of biofilm control measures.

pH-Activated nanoparticles with targeting for the treatment of oral plaque biofilm

Oral plaque biofilms are highly resilient microbial assemblies that are challenging to eradicate. We described the pH-positive, doxycycline (DOX)-loaded nanocarriers to combat multidrug-resistant pathogenic biofilms.

Incorporating LsrK AI-2 quorum quenching capability in a functionalized biopolymer capsule

Antibacterial resistance is an issue of increasing severity as current antibiotics are losing their effectiveness and fewer antibiotics are being developed. New methods for combating bacterial virulence are required. Modulating molecular communication among bacteria can alter phenotype, including attachment to epithelia, biofilm formation, and even toxin production. Intercepting and modulating communication networks provide a means to attenuate virulence without directly interacting with the bacteria of interest. In this work, we target communication mediated by the quorum sensing (QS) bacterial autoinducer-2, AI-2. We have assembled a capsule of biological polymers alginate and chitosan, attached an AI-2 processing kinase, LsrK, and provided substrate, ATP, for enzymatic alteration of AI-2 in culture fluids. Correspondingly, AI-2 mediated QS activity is diminished. All components of this system are "biofabricated"-they are biologically derived and their assembly is accomplished using biological means. Initially, component quantities and kinetics were tested as assembled in microtiter plates. Subsequently, the identical components and assembly means were used to create the "artificial cell" capsules. The functionalized capsules, when introduced into populations of bacteria, alter the dynamics of the AI-2 bacterial communication, attenuating QS activated phenotypes. We envision the assembly of these and other capsules or similar materials, as means to alter QS activity in a biologically compatible manner and in many environments, including in humans.

Effect of LongZhang Gargle on Biofilm Formation and Acidogenicity of Streptococcus mutans In Vitro

Streptococcus mutans, with the ability of high-rate acid production and strong biofilm formation, is considered the predominant bacterial species in the pathogenesis of human dental caries. Natural products which may be bioactive against S. mutans have become a hot spot to researches to control dental caries. LongZhang Gargle, completely made from Chinese herbs, was investigated for its effects on acid production and biofilm formation by S. mutans in this study. The results showed an antimicrobial activity of LongZhang Gargle against S. mutans planktonic growth at the minimum inhibitory concentration (MIC) of 16% and minimum bactericidal concentration (MBC) of 32%. Acid production was significantly inhibited at sub-MIC concentrations. Biofilm formation was also significantly disrupted, and 8% was the minimum concentration that resulted in at least 50% inhibition of biofilm formation (MBIC50). A scanning electron microscopy (SEM) showed an effective disruption of LongZhang Gargle on S. mutans biofilm integrity. In addition, a confocal laser scanning microscopy (CLSM) suggested that the extracellular polysaccharides (EPS) synthesis could be inhibited by LongZhang Gargle at a relatively low concentration. These findings suggest that LongZhang Gargle may be a promising natural anticariogenic agent in that it suppresses planktonic growth, acid production, and biofilm formation against S. mutans.

Impact of Orthodontic Treatment on Periodontal Tissues: A Narrative Review of Multidisciplinary Literature

The aim of this review is to describe the most commonly observed changes in periodontium caused by orthodontic treatment in order to facilitate specialists' collaboration and communication. An electronic database search was carried out using PubMed abstract and citation database and bibliographic material was then used in order to find other appropriate sources. Soft and hard periodontal tissues changes during orthodontic treatment and maintenance of the patients are discussed in order to provide an exhaustive picture of the possible interactions between these two interwoven disciplines.