Antibacterial and Remineralization Efficacy of Casein Phosphopeptide, Glycomacropeptide Nanocomplex, and Probiotics in Experimental Toothpastes: An In Vitro Comparative Study

Biomimetic and protective effects of bioactive toothpastes on eroded enamel surfaces

This study aimed to evaluate the effectiveness of bioactive toothpastes in remineralizing eroded enamel surfaces in vitro. Bovine enamel blocks (n = 48) were obtained and classified into untreated, demineralized, and treated areas. Specimens were randomly classified into six groups (n = 8 each): fluoride-free toothpaste (NCT), Colgate Total 12 (PCT), Sensodyne Repair and Protect (SRP), Sensodyne Pronamel (SPE), Regenerador + Sensitive (RGS), and RGS/calcium booster (RCB). The specimens were subjected to erosive pH cycling for 5 days for 4 times/day (90 s) and treated with toothpaste slurries (1:3) for 1 min. The Vickers hardness (50 g/10 s) and percentage surface hardness recovery (%SMHR) were calculated. Furthermore, the topography and roughness (Ra) of the enamel surface were evaluated using a 3D non-contact optical profilometer, along with the tooth surface loss (TSL). Data were statistically analyzed using analysis of variance or Tukey's test (significance: 5%). The %SMHR of the SRP and NCT groups were significantly lower than those of the other groups (p < 0.05). Ra was higher when the eroded area was treated with SRP and SPE (p < 0.05). Treatment with RGS, PCT, and SPE favored the recovery of the enamel surface compared with the NCT group (p < 0.05). The best TSL results were obtained with treatment with RGS, followed by PCT and SPE (p < 0.05). The RCB group showed statistically equivalent results for surface hardness recovery and TSL (p > 0.05). Conclusively, PCT and RGS toothpastes were more effective in remineralizing the enamel surface.

Laboratory evaluation of anti-plaque and remineralization efficacy of sugarless probiotic jelly candy supplemented with natural nano prebiotic additive

We evaluated the anti-cariogenic effect of an experimental synbiotic compound containing probiotic Lacticaseibacillus rhamnosus (NRRL B-442)-based jelly candy supplemented with natural prebiotic grape seed extract (GSE) in a nanoemulsion formula on the colonization and establishment of Streptococcus mutans (ATCC 25175) and Actinomyces viscosus (ATTCC 19246) biofilms through counting colony forming units, scanning electron microscopy (SEM), and transmission electron microscopy (TEM). We were then analysing the remineralizing effect of synbiotic jelly candy on human enamel surface lesions using Vickers microhardness testers, atomic force microscopy (AFM), SEM, energy-dispersive X-ray spectroscopy (EDAX), and confocal laser scanning microscopy (CLSM) at three stages (sound, after demineralization, and after pH cycling). We found after 21 days of treatment of the pH-cycled enamel discs with jelly candy for 10 min twice daily, a 68% decrease in S. mutans colony formation, reducing biofilm development, trapping S. mutans visualized in jelly candy under SEM examination, and significantly altering the morphological structure of these bacteria under TEM analysis. For remineralization measurements, statistically significant differences in microhardness integrated mineral loss, and lesion depth through CLSM between demineralization and treatment stages. These findings provide an effective anti-cariogenic synbiotic compound of grape seed extract and probiotic jelly candy with potential remineralizing activity.

New Technological Approaches for Dental Caries Treatment: From Liquid Crystalline Systems to Nanocarriers

Dental caries is the most common oral disease, with high prevalence rates in adolescents and low-income and lower-middle-income countries. This disease originates from acid production by bacteria, leading to demineralization of the dental enamel and the formation of cavities. The treatment of caries remains a global challenge and the development of effective drug delivery systems is a potential strategy. In this context, different drug delivery systems have been investigated to remove oral biofilms and remineralize dental enamel. For a successful application of these systems, it is necessary that they remain adhered to the surfaces of the teeth to allow enough time for the removal of biofilms and enamel remineralization, thus, the use of mucoadhesive systems is highly encouraged. Among the systems used for this purpose, liquid crystalline systems, polymer-based nanoparticles, lipid-based nanoparticles, and inorganic nanoparticles have demonstrated great potential for preventing and treating dental caries through their own antimicrobial and remineralization properties or through delivering drugs. Therefore, the present review addresses the main drug delivery systems investigated in the treatment and prevention of dental caries.

Application of Functional and Edible Coatings and Films as Promising Strategies for Developing Dairy Functional Products—A Review on Yoghurt Case

Edible coatings and films appear to be a very promising strategy for delivering bioactive compounds and probiotics in food systems when direct incorporation/inoculation is not an option. The production of dairy products has undergone radical modifications thanks to nanotechnology. Despite being a relatively new occurrence in the dairy sector, nanotechnology has quickly become a popular means of increasing the bioavailability and favorable health effects of a variety of bioactive components. The present review describes, in detail, the various processes being practiced worldwide for yoghurt preparation, microencapsulation, and nanotechnology-based approaches for preserving and/or enriching yoghurt with biologically, and its effect on health and in treating various diseases. In the case of yoghurt, as a perfect medium for functional ingredients supplementation, different gums (e.g., alginate, xanthan gum, and gum arabic), alone or in combination with maltodextrin, seem to be excellent coatings materials to encapsulate functional ingredients. Edible coatings and films are ideal carriers of bioactive compounds, such as antioxidants, antimicrobials, flavors, and probiotics, to improve the quality of dairy food products. Yoghurt is regarded as a functional superfood with a variety of health benefits, especially with a high importance for women’s health, as a probiotic. Consumption of yoghurt with certain types of probiotic strains which contain γ-linolenic acid or PUFA can help solve healthy problems or alleviate different symptoms, and this review will be shed light on the latest studies that have focused on the impact of functional yoghurt on women’s health. Recently, it has been discovered that fermented milk products effectively prevent influenza and COVID-19 viruses. Bioactive molecules from yoghurt are quite effective in treating various inflammations, including so-called “cytokine storms” (hypercytokinaemia) caused by COVID-19.

Effect of postbiotic-toothpaste on salivary levels of IgA in 6- to 12-year-old children: Study protocol for a randomized triple-blind placebo-controlled trial

BACKGROUND

Children in mixed dentition are highly at risk for dental caries, which is a major health issue worldwide. Despite their effect in controlling dental caries, using probiotics can be challenging. Therefore, it has been advised to use their inanimate forms, called postbiotics. We hypothesize that postbiotics can enhance the oral immunity.

METHODS

The aim of this triple-blind, randomized, placebo-controlled trial is to investigate the effect of postbiotic-toothpaste (Bifidobacterium animalis subsp. animalis) on salivary levels of Immunoglobulin A (IgA) and pH in children. Using comparing two means formula to calculate the sample size, for this trial 80 healthy 6- to 12-year-old children during mixed dentition with no cavitated dental caries will be selected by convenience sampling method and randomly allocated to two groups, postbiotic-toothpaste or placebo-toothpaste. Saliva samples will be gathered at baseline and four weeks after the intervention. The level of salivary IgA will be determined by ELISA and salivary pH will be measured using a pH meter. Data will be compared within and between groups using independent t-test and paired t-test, in case of normality, with a p < 0.05 as statistically significant.

DISCUSSION

If postbiotics-toothpaste prove to be effective in improving the oral immunity, they can be used to prevent dental caries and other oral diseases. The result of this study can help researchers who are working on the immunomodulatory effects of postbiotics in children.

TRIAL REGISTRATION NUMBER

Iranian Registry of Clinical Trials (IRCT), IRCT20191016045128N2. Registered on 7 March 2022.

Sol-gel synthesis of amorphous calcium phosphate nanoparticles in brown rice substrate and assessment of their cytotoxicity and antimicrobial activities

OBJECTIVE

This study intended to perform a synthesizing procedure for amorphous calcium phosphate (ACP) through a green template by the usage of brown rice (BR).

MATERIALS AND METHODS

ACP nanoparticles were obtained by application of a sol-gel method and comprehensively characterized using X-ray powder diffraction (XRD), zeta potential, fourier-transform infrared spectroscopy (FTIR), field emission scanning electron microscope (FESEM), and atomic force microscopy (AFM). Cytotoxic activity of ACP was evaluated in human epithelial type 2 (HEp-2) cell lines. The antibacterial effects of nanoparticles were appraised against Gram-positive Streptococcus mutans and Enterococcus faecalis.

RESULTS

The procedures for the evaluation of the characterization outcomes, dispersion, and stability of our product were confirmed by observing the smooth and uniformed surfaces of ACP. The zeta potential value of the synthesized sample was -22 mV, which indicates its acceptable stable condition caused by electrostatic repulsion. The cytotoxicity of the ACP nanoparticles was investigated in HEp-2 cells, and results showed no cytotoxicity for the synthesized nanoparticles. Also, the obtained minimum inhibitory concentration (MIC) of ACP nanoparticles in opposition to S. mutans and E. faecalis was 15 and 20 µg/ml, respectively, indicating the resistance of E. faecalis in comparison to S. mutans and MBC for synthesized nanoparticles against S. mutans and E. faecalis strains was 20 and 25 µg/ml.

CONCLUSION

The present study showed that this compound has no toxicity on the examined cell line. Also, the antibacterial properties of the synthesized ACP were approved by the obtained data, which enables the application of this material for therapeutic purposes in the pharmaceutical industry.

Resistance against Erosive Challenge of Dental Enamel Treated with 1,450-PPM Fluoride Toothpastes Containing Different Biomimetic Compounds

OBJECTIVES

 This in vitro study aimed to characterize the superficial and subsurface morphology of dental enamel treated with fluoridated gels containing different biomimetic compounds after erosive challenge.

MATERIALS AND METHODS

Bovine incisor teeth were sectioned to obtain enamel blocks (4 mm × 4 mm × 6 mm; n = 5) that were demineralized to create an artificial caries lesion and treated by pH cycling interspersed with exposure to fluoridated toothpaste slurries under agitation. During pH cycling (demineralization and remineralization for 2 and 22 hours, respectively) for 6 days, the enamel blocks were exposed to toothpaste slurries under agitation with one of the dental gels: Regenerate Enamel Science (NR-5 technology), Daily Regenerator Dental Clean (REFIX technology), and Sensodyne Repair & Protect (Novamin technology). The enamel blocks were subjected to an erosive challenge, immersed in 50% citric acid for 2 minutes, and then washed with plenty of distilled water. The surface and cross-sectional micromorphology were assessed using scanning electron microscope (SEM). The elemental analyses (weight percentage) were determined with an energy-dispersive X-ray spectroscopy (EDS).

RESULTS

 Enamel treated with the product containing REFIX technology presented a smoother surface morphology compared to the other treatments. The higher resistance to the erosive challenge can be attributed to a silicon-enriched mineral layer formed on the enamel induced by the REFIX-based toothpaste. This was not observed in the specimens treated with the other technology-containing toothpastes.

CONCLUSION

 The REFIX technology seemed to be the most promising compared to the Novamin and NR-5 technologies. In addition to forming a surface mineralized layer, the enamel treated with REFIX technology associated with the pH cycling resisted a subsequent erosive challenge.

Biomimetic Mechanism of Action of Fluoridated Toothpaste Containing Proprietary REFIX Technology on the Remineralization and Repair of Demineralized Dental Tissues: An In Vitro Study

Objectives  This in vitro study aimed to characterize the mineral content and surface and cross-sectional morphology of enamel and dentin tissues treated with a 1450 ppm fluoride-containing toothpaste with REFIX technology.

Materials and Methods  Bovine enamel blocks ( n = 5) were obtained (4 × 4 × 6 mm), demineralized (artificial caries lesion), and treated (pH cycling and brushing with the toothpaste). During the pH cycling, which lasted for 7 days (demineralization and remineralization took 6 and 18 hours, respectively), the enamel was brushed for 5 minutes using an electric toothbrush before being immersed in a remineralizing solution. The dentin blocks were acid-etched for 2 minutes (0.05 M citric acid, pH 1.8) to expose the dentinal tubules ( n = 5). Morphological analysis of the dentin was performed immediately and after 7 days of brushing with the dentifrice, and compared with the control group. The specimens were then cross-sectioned. The surface and cross-sectional micromorphology were assessed using scanning electron microscopy (SEM). The elemental analyses (weight%) were determined with an energy-dispersive X-ray spectroscopy (EDS).

Results  The toothpaste with REFIX technology remineralized and repaired the surface enamel effectively. The elemental analysis also demonstrated that treating the enamel with the toothpaste formed a silicon-enriched mineral layer on the enamel surface. Elemental analysis of the enamel cross-sections showed that the toothpaste induced a mineral change. The results were also consistent in the dentin, where the dentinal tubules were progressively occluded until there was complete occlusion after 7 days.

Conclusions  We prove the biomimetic mechanism of action of fluoridated toothpaste containing proprietary REFIX technology for obtaining silicon-enriched, remineralized and repaired dental tissues.

Casein glycomacropeptide is well tolerated in healthy adults and changes neither high-sensitive C-reactive protein, gut microbiota nor faecal butyrate: a restricted randomised trial

Casein glycomacropeptide (CGMP) is a bioactive milk-derived peptide with potential anti-inflammatory effects. Animal studies suggest that CGMP may work by altering gut microbiota composition and enhancing butyrate production. Its effects on intestinal homoeostasis, microbiota and metabolites in humans are unknown. The aim of the present study was to assess both the intestinal and systemic immunomodulatory effects of orally ingested CGMP. We hypothesised that daily oral CGMP intake would reduce high-sensitive C-reactive protein (hsCRP) in healthy adults. In a single-centre limited but randomised, double-blinded, reference-controlled study, we compared the effects of a 4-week intervention of either 25 g of oral powder-based chocolate-flavoured CGMP or a reference drink. We included twenty-four healthy adults who all completed the study. CGMP had no systemic or intestinal immunomodulatory effects compared with a reference drink, with regard to either hsCRP or faecal calprotectin level, faecal microbiota composition or faecal SCFA content. CGMP ingestion did not affect satiety or body weight, and it caused no severe adverse events. The palatability of CGMP was acceptable, and adherence was high. CGMP did not induce or change gastrointestinal symptoms. In conclusion, we found no immunomodulatory effects of CGMP in healthy adults. In a minor group of healthy adults, oral ingestion of 25 g of CGMP during 4 weeks was safe, well tolerated, had acceptable palatability and was without any effects on body weight.

Casein phosphopeptide combined with fluoride enhances the inhibitory effect on initial adhesion of Streptococcus mutans to the saliva-coated hydroxyapatite disc

Background

Recent preventive strategies for dental caries focus on targeting the mechanisms underlying biofilm formation, including the inhibition of bacterial adhesion. A promising approach to prevent bacterial adhesion is to modify the composition of acquired salivary pellicle. This in vitro study investigated the effect and possible underlying mechanism of pellicle modification by casein phosphopeptide (CPP) on Streptococcus mutans (S. mutans) initial adhesion, and the impact of fluoride on the efficacy of CPP.

Methods

The salivary pellicle-coated hydroxyapatite (s-HA) discs were treated with phosphate buffered saline (negative control), heat-inactivated 2.5% CPP (heat-inactivated CPP), 2.5% CPP (CPP) or 2.5% CPP supplemented with 900 ppm fluoride (CPP + F). After cultivation of S. mutans for 30 min and 2 h, the adherent bacteria were visualized by scanning electron microscopy (SEM) and quantitatively evaluated using the plate count method. Confocal laser scanning microscopy (CLSM) was used to evaluate the proportions of total and dead S. mutans. The concentrations of total, free, and bound calcium and fluoride in the CPP and fluoride-doped CPP solutions were determined. The water contact angle and zeta potential of s-HA with and without modification were measured. The data were statistically analyzed using one-way ANOVA followed by a Turkey post hoc multiple comparison test.

Results

Compared to the negative control group, the amount of adherent S. mutans significantly reduced in the CPP and CPP + F groups, and was lowest in the CPP + F group. CLSM analysis showed that there was no statistically significant difference in the proportion of dead S. mutans between the four groups. Water contact angle and zeta potential of s-HA surface significantly decreased in the CPP and CPP + F groups as compared to the negative control group, and both were lowest in the CPP + F group.

Conclusions

Pellicle modification by CPP inhibited S. mutans initial adhesion to s-HA, possibly by reducing hydrophobicity and negative charge of the s-HA surface, and incorporating fluoride into CPP further enhanced the anti-adhesion effect.

Effect of Casein Phosphopeptide-Amorphous Calcium Phosphate on Fracture Resistance of Reattached Tooth Fragments Using Conventional and Self-Adhesive Bioactive Flowable Composite

Objectives  The present study aimed to investigate the effect of casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) complex and the type of flowable composite (conventional or self-adhesive bioactive) on the fracture resistance of fractured incisors restored through reattachment technique.

Materials and Methods  In this experimental in vitro study, 60 extracted bovine central mandibular incisors were randomly divided into six groups ( n = 10) according to the reattachment technique. Their incisal edges were cut off to represent an enamel–dentin fracture. The fragment edges were reattached as follows: Group 1—selective etching and bonding followed by conventional flowable composite; Group 2—selective etching and bonding followed by bioactive flowable composite; Group 3 was like Group 2 but without applying bonding; Groups 4, 5, and 6 were similar to Groups 1, 2, and 3, respectively, but both tooth fragments were pretreated with CPP-ACP-containing paste for 3 minutes. Fracture resistance was assessed by a universal testing machine.

Statistical Analysis  Data were analyzed by SPSS—Statistical Package for the Social Sciences—software using one-way analysis of variance and Tukey post-hoc tests (α= 0.05).

Results  The highest and lowest fracture resistance was recorded in Groups 5 (15.96 MPa) and Group 6 (1.95 MPa), respectively, being significantly different from the other groups. The mean fracture resistance of Groups 3 and 6 was significantly lower than the other groups ( p < 0.05). However, Groups 1, 2, and 4 showed no difference in fracture resistance.

Conclusion  Bioactive composite was not superior to conventional composite for fragment reattachment, but using it in self-adhesive mode reduced the fracture strength significantly. Yet, pretreatment with CPP-ACP, followed by application of adhesive, improved the fracture resistance of bioactive composite.

Effects of 1450-ppm Fluoride-containing Toothpastes Associated with Boosters on the Enamel Remineralization and Surface Roughness after Cariogenic Challenge

OBJECTIVES

 This in vitro study investigated the remineralization potential of 1450 ppm, fluoride-containing toothpastes containing different active remineralization agents after cariogenic challenge with pH cycling. The enamel surface roughness after brushing and the chemical and physical characteristics of the toothpastes tested were also analyzed.

MATERIALS AND METHODS

 Fifty-six bovine enamel blocks were obtained (4 × 4 × 6 mm) and divided into three thirds: intact (untreated), demineralized (artificial caries lesion), and treated (caries lesion, pH cycling, and brushing with dentifrices). Seven commercially available fluoride toothpastes (1450 ppm F): three with anti-erosion claims (Candida Professional [CPP], Colgate Total 12 Daily Repair [CDR], Regenerate Enamel Science [RES]); three with desensitizing claims (Bianco Pro Clinical [BPP], Elmex Sensitive [ESS], and Regenerador Diário DentalClean [RDC]); and one standard regular-fluoride toothpaste Colgate Total 12 (CTT) were selected. During pH cycling (demineralization 6 h/remineralization 18 h) for 7 days, the treated third was brushed with the different dentifrices for 10 minutes in a brushing machine before immersion in a remineralizing solution. The Knoop hardness (25 g, 10 second of the surface, and longitudinal section were then evaluated at eight depths (10 to 330 μm). Mean and percentage of surface hardness recovery (% SHR) were calculated. Surface enamel roughness (Ra) was also evaluated. The pH, %weight of particles, zeta potential, and polydispersity index of toothpaste slurries were also evaluated.

STATISTICAL ANALYSIS

 Data were statistically analyzed (ANOVA/Tukey, 5%).

RESULTS

 The %SHR of CPP was significantly lower than the others (p < 0.05). The enamel subsurface was more effectively remineralized when treated with BPP, ESS, and RDC. The surface roughness was higher when the demineralized third was treated with CTT, RDC, and RES and after the cariogenic challenge (p < 0.05). For some of the products tested, there was no relationship between surface remineralization and subsurface remineralization. Although toothpastes CPP and RDC present the lowest %SHR means, both products effectively remineralize within the subsurface carious lesion. Regression analysis demonstrated no strong correlations of the enamel surface roughness with the chemical and physical parameters.

CONCLUSIONS

 Most but not all the fluoride toothpastes were able to remineralize the enamel surface. No specific chemical or physical parameter alone correlated with the surface roughness.

Nanoparticles as Anti-Microbial, Anti-Inflammatory, and Remineralizing Agents in Oral Care Cosmetics: A Review of the Current Situation

Many investigations have pointed out widespread use of medical nanosystems in various domains of dentistry such as prevention, prognosis, care, tissue regeneration, and restoration. The progress of oral medicine nanosystems for individual prophylaxis is significant for ensuring bacterial symbiosis and high-quality oral health. Nanomaterials in oral cosmetics are used in toothpaste and other mouthwash to improve oral healthcare performance. These processes cover nanoparticles and nanoparticle-based materials, especially domains of application related to biofilm management in cariology and periodontology. Likewise, nanoparticles have been integrated in diverse cosmetic produces for the care of enamel remineralization and dental hypersensitivity. This review summarizes the indications and applications of several widely employed nanoparticles in oral cosmetics, and describes the potential clinical implementation of nanoparticles as anti-microbial, anti-inflammatory, and remineralizing agents in the prevention of dental caries, hypersensitivity, and periodontitis.