Effect of an antifungal denture liner on the saliva yeast count in patients with denture stomatitis: a pilot study

Comparative effectiveness of interventions for the treatment of denture stomatitis: A systematic review with network meta-analysis

STATEMENT OF PROBLEM

Symptomatic denture stomatitis (DS) is a painful oral mucosal disorder that can impair quality of life in denture wearers. A complete cure of DS is difficult to achieve, and the most efficacious regimen to treat DS has not yet been conclusively established.

PURPOSE

The purpose of this network meta-analysis was to assess the comparative efficacy of interventions used for the treatment of DS.

MATERIAL AND METHODS

A search was conducted for trials published in Medline, Scopus, PubMed, and Cochrane Central Register of Controlled Trials from inception until February 2022 (PROSPERO Reg no: CRD42021271366). Network meta-analysis was performed on data from randomized controlled trials that assessed the comparative efficacy of any form of intervention for the treatment of DS in denture wearers. Agents were ranked according to their effectiveness in the treatment of DS based on outcomes using surface under the cumulative ranking (SUCRA).

RESULTS

A total of 25 articles were included in the quantitative analysis. Topical antifungal agents (risk ratio [RR]=4.37[95% confidence interval [CI]: 2.15,8.90), topical antimicrobial agents used along with systemic antifungal agents (RR=4.25[95% CI: 1.79,10.33]), systemic antifungal agents (RR=4.25[95% CI: 1.79,10.10]), photodynamic therapy (RR=4.25[95% CI: 1.75,8.98]), and topical plant products (RR=3.40[95% CI: 1.59,7.26]) were found to effectively improve DS. Microwave disinfection concurrently administered with topical antifungal agents (RR=7.38(95% CI: 2.75,19.81), microwave disinfection 7.38[95% CI: 2.75,19.81]), topical antifungal agents (RR=4.88[95% CI: 1.92,12.42]), topical plant products (RR=4.49[95% CI: 1.70,11.82]), systemic antifungal agents together with topical antimicrobial agents (RR=3.85[95% CI: 1.33,11.10]), topical antimicrobial agents (RR=3.39[95% CI: 1.17,9.81]), systemic antifungal agents (RR=3.37[95% CI: 1.21,9.34]), and photodynamic therapy or photochemotherapy (PDT) (RR=2.93[95% CI: 1.01,8.47]) were found to effectively resolve mycological DS. Topical antifungals ranked highest in the SUCRA ranking for clinical improvement, whereas microwave disinfection concurrently administered with topical antifungal agents ranked highest for mycological resolution. None of the agents demonstrated significant side effects except for topical antimicrobial agents which demonstrated altered taste and staining of oral structures.

CONCLUSIONS

Available evidence suggests that topical antifungals, microwave, and systemic antifungals are effective in the treatment of DS, but confidence in these findings is low because of the limited number of studies and a high risk of bias. Additional clinical trials are needed on photodynamic therapy, topical plant products, and topical antimicrobials.

Cross-kingdom interaction between Candida albicans and oral bacteria

Candida albicans is a symbiotic fungus that commonly colonizes on oral mucosal surfaces and mainly affects immuno-compromised individuals. Polymicrobial interactions between C. albicans and oral microbes influence the cellular and biochemical composition of the biofilm, contributing to change clinically relevant outcomes of biofilm-related oral diseases, such as pathogenesis, virulence, and drug-resistance. Notably, the symbiotic relationships between C. albicans and oral bacteria have been well-documented in dental caries, oral mucositis, endodontic and periodontal diseases, implant-related infections, and oral cancer. C. albicans interacts with co-existing oral bacteria through physical attachment, extracellular signals, and metabolic cross-feeding. This review discusses the bacterial-fungal interactions between C. albicans and different oral bacteria, with a particular focus on the underlying mechanism and its relevance to the development and clinical management of oral diseases.

Resilient liner modified by antimicrobials for denture stomatitis treatment: A randomized controlled trial

OBJECTIVES

This randomized clinical trial evaluated the effectiveness of an interim denture resilient liner (Trusoft) modified with minimum inhibitory concentrations (MICs) of antimicrobial agents for Candida albicans biofilm in the denture stomatitis (DS) treatment.

METHODS

Forty participants with DS and maxillary complete denture (MCD) wearers were randomly assigned to one of the treatments for 14 days (n=10): nystatin oral suspension (Control-100,000IU/mL; 4 × /day), MCD relined with Trusoft either without (Tru) or with nystatin (Ny) or chlorhexidine diacetate (Chx) at MICs. Cytological smears and mycological quantitative cultures were taken from the palate and denture before treatment (baseline), at the end of treatment (day 14), and at follow-up (days 30, 45, and 60). Photographs of the palate were made at each visit. Data were analyzed by the Cochran and χ² tests, ANOVA and the Tukey test or the Friedman and Kruskal-Wallis tests (α=0.05).

RESULTS

Palatal smears of the Ny and Chx groups exhibited no mycelial Candida (0%) on day 14, and, at the 60-day follow-up, it was observed for only 1 participant from Chx group. MCD smears showed reduction in mycelial forms for all groups on day 14 (P<0.05), but this difference was maintained at follow-up only for the relined dentures (P<0.05). Unlike Tru and the control groups, Ny and Chx groups evidenced a significant reduction in CFU/mL values and DS severity throughout the trial (P<0.05).

CONCLUSIONS

The addition of nystatin and chlorhexidine at MICs to an interim resilient liner is a promising treatment for DS, with better results than those for conventional therapy with nystatin suspension, including the follow-ups.

CLINICAL SIGNIFICANCE

Compared with conventional topical antifungal therapy, modifying a denture reline material with antimicrobials provided a therapeutic option for denture stomatitis. This non-invasive, straightforward therapeutic approach can be easily adopted by dentists and has the advantage of not requiring patient compliance while maintaining therapeutic concentrations on the denture base.

Tissue Conditioner Incorporating a Nano-Sized Surface Pre-Reacted Glass-Ionomer (S-PRG) Filler

We aimed to evaluate the properties of a novel tissue conditioner containing a surface pre-reacted glass-ionomer (S-PRG) nanofiller. Tissue conditioners containing 0 (control), 2.5, 5, 10, 20, or 30 wt% S-PRG nanofiller or 10 or 20 wt% S-PRG microfiller were prepared. The S-PRG nanofillers and microfillers were observed using scanning electron microscopy. The ion release, acid buffering capacity, detail reproduction, consistency, Shore A0 hardness, surface roughness, and Candida albicans adhesion of the tissue conditioners were examined. The results indicated that the nanofiller particles were smaller and more homogeneous in size than the microfiller particles. In addition, Al, B, F, and Sr ions eluted from S-PRG were generally found to decrease after 1 day. Acid neutralization was confirmed in a concentration-dependent manner. The mechanical properties of tissue conditioners containing S-PRG nanofiller were clinically acceptable according to ISO standard 10139-1:2018, although the surface roughness increased with increasing filler content. Conditioners with 5-30 wt% nanofiller had a sublethal effect on C. albicans and reduced fungal adhesion in vitro. In summary, tissue conditioner containing at least 5 wt% S-PRG nanofiller can reduce C. albicans adhesion and has potential as an alternative soft lining material.

Drug Delivery (Nano)Platforms for Oral and Dental Applications: Tissue Regeneration, Infection Control, and Cancer Management

The oral cavity and oropharynx are complex environments that are susceptible to physical, chemical, and microbiological insults. They are also common sites for pathological and cancerous changes. The effectiveness of conventional locally-administered medications against diseases affecting these oral milieus may be compromised by constant salivary flow. For systemically-administered medications, drug resistance and adverse side-effects are issues that need to be resolved. New strategies for drug delivery have been investigated over the last decade to overcome these obstacles. Synthesis of nanoparticle-containing agents that promote healing represents a quantum leap in ensuring safe, efficient drug delivery to the affected tissues. Micro/nanoencapsulants with unique structures and properties function as more favorable drug-release platforms than conventional treatment approaches. The present review provides an overview of newly-developed nanocarriers and discusses their potential applications and limitations in various fields of dentistry and oral medicine.

Therapeutic Role of Nystatin Added to Tissue Conditioners for Treating Denture-Induced Stomatitis: A Systematic Review

Denture-induced stomatitis (DIS) represents a pathological condition caused by ill-fitting dentures trauma, manifested as inflammation of the palatal tissue beneath the denture. The fungal infections are the principal contributory factors to DIS. Although the aetiology of DIS is multifactorial, the Candida albicans fungal infection remains the main cause. The objective of the present systematic review was to evaluate the latest literature on the addition of nystatin into the tissue conditioners (TCs) in the management of DIS. To search the published literature about “the addition of nystatin in TCs for treating DIS”, electronic databases (PubMed (National library of medicine) and Cochrane Library (Wiley)) were searched (from 1975 until December 2020) using different keywords. Various studies described the effectiveness and efficacy of incorporating nystatin into several TCs. The present systematic review reported that the addition of nystatin is beneficial, with slight or no consequences on both the mechanical and physical features of TCs. Adding nystatin to various TCs for treating DIS can be suggested.

Effect of zinc oxide nanoparticles incorporated into tissue conditioner on antifungal, physical, and mechanical properties

This study evaluated the antifungal, physical, and mechanical properties of tissue conditioner incorporated with different amounts of zinc oxide nanoparticles (ZnOnps) at different storage times (0, 7, and 14 days). Specimens of 0, 5, 10, 15 wt% ZnOnps, or 15 wt% nystatin incorporated into tissue conditioner were fabricated (control, 5Zn, 10Zn, 15Zn, and Nys). The direct contact test (n=6) was performed to evaluate the antifungal effect against C. albicans suspension. The penetration depth (n=6) and tensile bond strength (n=8) were evaluated following ISO 13139. The 15Zn significantly reduced C. albicans cell number compared with control at all storage times (p<0.001). The penetration depths and tensile bond strengths of the 5Zn, 10Zn, 15Zn, and Nys were not significantly different compared with control at all storage times (p>0.05). In conclusion, the 15Zn provides antifungal effect up to 14 days without adverse effects on penetration depth and tensile bond strength.

To study the effect of Cocos nucifera oil when incorporated into tissue conditioner on its tensile strength and antifungal activity: An in vitro study

Aim:

This study aims to test the tensile strength and growth of Candida albicans on Viscogel tissue conditioner when incorporated with coconut oil (CCO) and to compare its efficacy with other antifungal agents.

Settings and Design:

Evaluative - In-vitro study design.

Materials and Methods:

Fifty dumbbell-shaped samples (n = 10) of Viscogel tissue conditioner were fabricated according to ASTM standard and were classified into 5 groups (10% CCO, 30% w/w tea tree oil, 5% w/w fluconazole, 0.03% w/w silver nanoparticles, and plain tissue conditioner). These samples were compared and evaluated for their tensile strength. Further to test the antifungal activity, a total of 60 samples (n = 15) were fabricated, each group (n = 15) was further divided into three subgroups (n = 5), namely 24-h, 3-day, and 5-day period, which were inoculated in sabouraud dextrose agar plate to test for the growth of C. albicans.

Statistical Analysis Used:

Oneway ANOVA and post hoc Tukey honestly significant difference test.

Results:

10% w/w CCO yielded a mean tensile strength of 20.06 as compared to the plain tissue conditioner which showed a mean tensile strength of 17.81. Similarly, 10% w/w CCO incorporated into Viscogel tissue conditioner showed a significant reduction in the colonization of C. albicans on the 5^th day.

Conclusions:

10% w/w of CCO when mixed with Viscogel tissue conditioner showed a significant reduction in the growth of C. albicans, and addition of the same increased the tensile strength of the tissue conditioner.

Promising Alternative Therapeutics for Oral Candidiasis

:

Candida is the main human fungal pathogen causing infections (candidiasis), mostly in the elderly and immunocompromised hosts. Even though Candida spp. is a member of the oral microbiota in symbiosis, in some circumstances, it can cause microbial imbalance leading to dysbiosis, resulting in oral diseases. Alternative therapies are urgently needed to treat oral candidiasis (usually associated to biofilms), as several antifungal drugs’ activity has been compromised. This has occurred especially due to an increasing occurrence of drugresistant in Candida spp. strains. The overuse of antifungal medications, systemic toxicity, cross-reactivity with other drugs and a presently low number of drug molecules with antifungal activity, have contributed to important clinical limitations.

:

We undertook a structured search of bibliographic databases (PubMed Central, Elsevier’s ScienceDirect, SCOPUS and Springer’s SpringerLink) for peer-reviewed research literature using a focused review in the areas of alternatives to manage oral candidiasis. The keywords used were “candidiasis”, “oral candidiasis”, “biofilm + candida”, “alternative treatment”, “combination therapy + candida” and the reports from the last 10 to 15 years were considered for this review.

:

This review identified several promising new approaches in the treatment of oral candidiasis: combination anti-Candida therapies, denture cleansers, mouth rinses as alternatives for disrupting candidal biofilms, natural compounds (e.g. honey, probiotics, plant extracts and essential oils) and photodynamic therapy.

:

The findings of this review confirm the importance and the urgency of the development of efficacious therapies for oral candidal infections.

Antifungal activity and Shore A hardness of a tissue conditioner incorporated with terpinen-4-ol and cinnamaldehyde

PURPOSE

This study investigated the anti-Candida activity and the Shore A hardness of a tissue conditioner (Softone™) modified by incorporation of terpinen-4-ol and cinnamaldehyde.

MATERIAL AND METHODS

Agar diffusion, microdilution, and mechanism of action methods were performed to determine to evaluate the antifungal activity of phytoconstituents. Then, phytoconstituents in varying concentrations were incorporated into the tissue conditioner. The anti-Candida effect of the modified conditioner was evaluated through agar punch well and biofilm formation methods. Shore A hardness of the experimental liners was evaluated after baseline, 24 h, 48 h, 4 days, and 7 days immersion on artificial saliva.

RESULTS

The phytoconstituents incorporated into Softone showed completely inhibited fungal growth in concentrations of 20-40% and did not present significant antifungal activity until their concentrations where higher than 5%. There were differences between non-modified Softone and M5, M10, C10, and T10% (p < 0.05). The groups containing 10-40% of cinnamaldehyde incorporated into Softone were able to completely inhibit the biofilm. Concentrations below 40% of terpinen-4-ol showed unsatisfactory biofilm inhibition. The T40% and C40% groups presented the lowest Shore A hardness values. Hardness values from groups T40% at 7 days (p = 0.476); C40% at 4 days (p = 0.058); and T20% (p = 0.058), C20% (p = 0.205), T30% (p = 0.154), and C30% (p = 0.874) after 48 h did not differ from the control group.

CONCLUSIONS

Cinnamaldehyde incorporated into Softone inhibited Candida biofilm formation at concentrations of 10-40%, being more effective than terpinen-4-ol modification despite of halo inhibition observed by both products.

CLINICAL RELEVANCE

All modifications showed a very similar pattern of hardness being useful for clinical practice.

In vivo biocompatibility of an interim denture resilient liner containing antifungal drugs

STATEMENT OF PROBLEM

Antifungal agents incorporated into interim denture resilient liners have been suggested as an adjunct treatment for denture stomatitis (DS). However, before applying this protocol to humans, biocompatibility analysis of such drugs in animal models is required.

PURPOSE

The purpose of this animal study was to evaluate the in vivo biocompatibility of an interim resilient liner modified with minimum inhibitory concentrations (MICs) of antifungal drugs for Candida albicans biofilm.

MATERIAL AND METHODS

Sixty Wistar rats were divided into 6 groups (n=5): PC=positive control/no protocol; IOD (intraoral device)=rats using an acrylic resin palatal device (PD); Tru=rats using a PD relined with Trusoft; and Ny (nystatin), Chx (chlorhexidine diacetate), and Ke (ketoconazole) groups=rats using a PD relined with Trusoft + drug MICs. The rats were sacrificed at 7 or 14 days of trial. Histopathological qualitative analysis was performed by comparing photomicrographs of histological sections of the intermolar region. Morphological changes in the epithelium and keratin were quantitatively analyzed by computerized planimetry, and data were analyzed by using 2-way ANOVA and the Tukey HSD test (α=.05).

RESULTS

Quantitative analysis showed that only PD containing Ke significantly decreased the thickness and area of the keratin compared with the other groups (P<.001), which showed no differences between each other (P>.05). These results agreed with those of qualitative analysis.

CONCLUSIONS

Incorporation of MICs of Ny and Chx in Trusoft did not induce histopathological changes in the rat palatal mucosa, suggesting the in vivo biocompatibility of this DS treatment.

Antimicrobial efficacy and mechanical properties of BAC-modified hard and soft denture liners

This study investigated the antimicrobial efficacy and mechanical strength of hard and soft denture liners modified with benzalkonium chloride (BAC). The specimens (1 mm thickness, 8 mm diameter) were prepared by mixing 0.5, 1, 2 and 5 wt% BAC with soft (Sofreliner Medium, Tokuyama) and hard (Rebase II, Tokuyama) denture liners (n = 5/group). BAC was not added to the controls. Candida albicans ATCC 28366 (A ₅₅₀ = 0.5) and Streptococcus mutans Ingbritt suspensions (A ₅₅₀ = 0.35) were pipetted onto the specimens, and incubated for 4 h. The viable cells were collected, and determined by plate-culturing (CFU). The tests were repeated after the specimens were soaked in distilled water for 7 days. The mechanical strengths were evaluated by tear and 4-point flexural strength tests for soft and hard liners, respectively. The data were analyzed with ANOVA and Tukey's HSD tests at p = 0.05. C. albicans viability was lost in all groups of BAC-modified soft liners (p < 0.001), and S. mutans viability was reduced (p < 0.01), except of soaked BAC 0.5 wt% group (p > 0.05). For the hard liner, BAC 5 wt% killed the C. albicans and S. mutans cells both before and after soaked in water (p < 0.001). BAC 2 wt% showed comparable tear strength with the soft liner control (p > 0.05). BAC did not reduce the flexural strength of the hard liner (p > 0.05), except of BAC 5 wt% group (p < 0.01). BAC can be a promising agent reducing the C. albicans and S. mutans viability on the soft and hard denture liner surfaces.

"Nature cures:" An alternative herbal formulation as a denture cleanser

BACKGROUND

Candida albicans is one of the microorganisms which harbor the oral cavity, especially in elderly. However, the incidence of existence of this increases in patients using removable dental prosthesis. There is therefore a need to test the anticandidal efficacy of these cost-effective, easily available products to be used as routine denture cleansers.

AIM AND OBJECTIVES

(1) To evaluate antifungal properties of triphala churna on the heat cure denture base material. (2) To evaluate the antifungal effect of chlorhexidine gluconate on the heat cure denture base material. (3) To compare the antifungal effect of triphala churna and chlorhexidine gluconate with a control. (4) To evaluate which among triphala churna and chlorhexidine gluconate has a better antifungal property on the heat cure denture base material.

MATERIALS AND METHODS

Study population consisted of sixty dentures wearers from those attending the Outpatient Department of Prosthodontics of the School of Dentistry, Krishna Institute of Medical Sciences Deemed University, Karad. Swabs were collected from the dentures before and after the use of triphala and chlorhexidine. The swabs were cultured on Sabouraud dextrose agar and the total Candida counts were determined.

CONCLUSION

Triphala as an antifungal is shown to have more efficacy than the conventional chlorhexidine mouthwash. Résumé Arrière-plan: Candida albicans est l'un des micro-organismes qui abritent la cavité buccale surtout chez les personnes âgées. Cependant, l'incidence de l'existence de cette augmentation chez les patients utilisant des prothèses dentaires amovibles. Il est donc nécessaire de tester l'efficacité anticancédique de ces produits rentables et faciles à utiliser pour être utilisés comme nettoyants de routine pour prothèses dentaires. Buts et Objectifs: (1) Évaluer les propriétés antifongiques de Triphala churna sur le matériau de base de la prothèse thermo-durcissable. (2) Évaluer l'effet antifongique du gluconate de chlorhexidine sur le matériau de base de la prothèse thermo-durcissable. (3) Comparer l'effet antifongique de Triphala churna et du gluconate de chlorhexidine avec un témoin. (4) Évaluer lequel parmi Triphala churna et le gluconate de chlorhexidine a une meilleure propriété antifongique sur le matériel de base de la prothèse de durcissement à chaud. Matériaux et Méthode: La population de l'étude était constituée de soixante porteurs de prothèses dentaires de ceux qui fréquentaient le Département de Prosthodontie de l'École des Sciences Dentaires de l'Institut Krishna des Sciences Médicales de l'Université de Karad. Des prélèvements ont été effectués sur les prothèses avant et après l'utilisation de Triphala et de chlorhexidine. On a cultivé les écouvillons sur de l'agar Sabouraud dextrose et on a déterminé le nombre total de candida.

CONCLUSION

Triphala comme un anti fongique est démontré pour avoir plus d'efficacité que le lavage de la bouche classique chlorhexidine.

Role of antifungal medicaments added to tissue conditioners: A systematic review

PURPOSE

The aim of this review is to investigate the current state of knowledge on the incorporation of antifungal agents into the tissue conditioners for the treatment of denture induced stomatitis.

STUDY SELECTION

Studies reporting the incorporation of antifungal/antimicrobial agents in to tissue conditioners were included in the review. In order to search the studies on the topic "incorporation of antifungal agents in tissue conditioners for the treatment of denture induced stomatitis" ISI web of science, PubMed/MEDLINE, and Google-Scholar databases were searched from 1970 up to and including July 2015 using various keywords such as antifungal agents, tissue conditioners, Candida albicans, denture stomatitis, etc.

RESULTS

Various studies reported the efficacy and effectiveness of adding conventional organic antifungal medicines (nystatin, azole group derivatives and chlorhexidine, antimicrobials/antifungals other than organic (silver zeolite, silver nano-particles, photo-catalysts and metallic oxides) and natural and herbal antimicrobials (tea tree oil, lemongrass essential oil and origanum oil) into various tissue conditioners. The review literature reported that incorporation of antifungal agents into tissue conditioners is effective with minimal or no effects on physical and mechanical properties of tissue conditioners.

CONCLUSIONS

Incorporation of different antifungal medicaments to commercially available tissue conditioners can be recommended for the management of denture induced stomatitis.

Peel bond strength of soft lining materials with antifungal to a denture base acrylic resin

The effect of the addition of nystatin, miconazole, ketoconazole, chlorhexidine, and itraconazole into the soft lining materials Softone and Trusoft on their peel bond strength to a denture base acrylic resin was evaluated. Specimens of soft lining materials (n=7) were made without (control) or with the incorporation of antifungals at their minimum inhibitory concentrations to the biofilm of C. albicans and bonded to the acrylic resin. Peel testing was performed after immersion in distilled water at 37ºC for 24 h, 7 and 14 days. Data (MPa) were analyzed by 3-way ANOVA/Tukey-Kramer test (α=0.05) and the failure modes were classified. The addition of nystatin and ketoconazole did not affect the peel bond strength for up to 14 days. Most failures were predominantly cohesive within soft lining materials. With the exception of itraconazole, incorporating the antifungals into the soft lining materials did not result in values below those recommended for peel bond strength after 7 and 14 days of analysis.

Harnessing the multifunctionality in nature: a bioactive agent release system with self-antimicrobial and immunomodulatory properties

Major problems with biomedical devices in particular implants located in nonsterile environments concern: (i) excessive immune response to the implant, (ii) development of bacterial biofilms, and (iii) yeast and fungi infections. An original multifunctional coating that addresses all these issues concomitantly is developed. A new exponentially growing polyelectrolyte multilayer film based on polyarginine (PAR) and hyaluronic acid (HA) is designed. The films have a strong inhibitory effect on the production of inflammatory cytokines released by human primary macrophage subpopulations. This could reduce potential chronic inflammatory reaction following implantation. Next, it is shown that PAR, due to its positive charges, has an antimicrobial activity in film format against Staphylococcus aureus for 24 h. In order to have a long-term antimicrobial activity, a precursor nanoscale silver coating is deposited on the surface before adding the PAR/HA films. Moreover, the PAR/HA films can be easily further functionalized by embedding antimicrobial peptides, like catestatin (CAT), a natural host defense peptide. This PAR/HA+CAT film proves to be effective as an antimicrobial coating against yeast and fungi and its cytocompatibility is also assessed. Finally, this all-in-one system constitutes an original strategy to limit inflammation and prevents bacteria, yeast, and fungi infections.

The comparative study of antifungal activity of Syzygium aromaticum, Punica granatum and nystatin on Candida albicans; an in vitro study

AIM

Candida species are opportunistic fungi, among which, Candida albicans is the most important species responsible for infections in immunocompromised patients with invasive fungal disease. Resistance of Candida species to antifungal drugs has led scientists to pay more attention to traditional medicine herbs. Due to the limitations in the treatment of fungal diseases such as shortages, high prices, antifungal side effects and drug resistance or reduced susceptibility to fungal drugs we decided to study the antifungal effects of herbal extracts of Syzygium aromaticum and Punica granatum.

METHODS

Twenty-one isolates of oral C. albicans in patients with denture stomatitis referred to prosthesis department, Dental faculty of Tehran University of Medical Sciences were prepared and cultured. Plant extracts were prepared from the herbs market. Tests on patient samples and standard strains 5027ATCC (PTCC10231) yeast C. albicans were performed via well diffusion method. In addition, nystatin and methanol were used as positive and negative control, respectively. Finally, the antifungal effect of extracts using Statistical Repeated measurement ANOVA test was investigated.

RESULTS

Both S. aromaticum and P. granatum showed noticeable antifungal activity in well method. Syzygium aromaticum showed better anti candida activity than nystatin (P<0.001).

CONCLUSION

Due to increasing problems with fungal diseases, these findings suggest that the plant extracts of S. aromaticum and P. granatum showed good antifungal effects (P-value<0.001). S. aromaticum (inhibition zone diameter: 29.62) showed better antifungal effects than nystatin (inhibition zone diameter: 28.48).

Effect of the addition of antimicrobial agents on Shore A hardness and roughness of soft lining materials

PURPOSE

While the incorporation of antimicrobial agents into soft denture liners has been suggested as a reliable alternative treatment for denture stomatitis, it may affect the liner's properties. The effect of addition of antimicrobial agents for the treatment of denture stomatitis on the surface roughness and Shore A hardness of soft lining materials was evaluated.

MATERIALS AND METHODS

The test groups comprised specimens (36 × 7 × 6 mm(3) ) of soft materials (Softone and Trusoft) without (control) or with incorporation of drugs (nystatin, miconazole, ketoconazole, chlorhexidine diacetate, and itraconazole). Hardness (Shore A) and roughness (Ra) were evaluated after immersion of specimens (n = 10) in distilled water at 37°C for 24 hours, 7 and 14 days. Data were analyzed by 3-way ANOVA/Tukey's test (α = 0.05).

RESULTS

After 14 days, an increase (p < 0.05) was observed in the hardness of soft materials with time for the modified specimens, except for itraconazole. Addition of drugs increased the Softone roughness only for the addition of miconazole and chlorhexidine (p < 0.05), and did not increase the roughness of Trusoft with time. Only chlorhexidine and itraconazole altered the roughness compared to the control for each material (p < 0.05).

CONCLUSIONS

The smallest changes of hardness and roughness with time in the modified groups compared to controls were observed for itraconazole groups for both materials.

Effect of antimicrobial agents incorporated into resilient denture relines on the Candida albicans biofilm

OBJECTIVE

The antimicrobial action of five drugs incorporated in temporary denture relines on the fungal biofilm was evaluated.

MATERIALS AND METHODS

A Candida albicans biofilm (SC5314) was formed on specimens (10 × 1 mm) of materials (Trusoft and Softone) modified or not (control) by the drugs (nystatin, miconazole, ketoconazole, itraconazole, and chlorhexidine diacetate). Cell viability was determined spectrophotometrically by the tetrazolium salt reduction assay (XTT) after 24 h, 48 h, and 7 and 14 days of incubation. The minimum inhibitory concentrations (MICs) were those which inhibited 90% or more of fungal growth. Fungal susceptibility was confirmed by confocal laser scanning microscopy analysis.

RESULTS

The MICs of drugs incorporated in the materials were 0.032, 0.256, 0.128, 0.256, and 0.064 g ml(-1) for nystatin, miconazole, ketoconazole, itraconazole, and chlorhexidine, respectively. Images from nystatin, chlorhexidine, and ketoconazole demonstrated no viable cells.

CONCLUSIONS

The antimicrobials incorporated in the resilient materials inhibited fungal growth during 14 days, with lower MICs for nystatin and chlorhexidine.

Prevention and treatment of Candida colonization on denture liners: a systematic review

STATEMENT OF PROBLEM

Denture liners are well known for their poor physical properties that favor the accumulation of plaque and colonization by Candida species, which can irritate the oral tissues and lead to denture stomatitis.

PURPOSE

A systematic review was conducted to determine the feasibility of a prevention protocol for Candida colonization in denture liners and an effective treatment after the fungi has colonized the material.

MATERIAL AND METHODS

Clinical and in vitro investigations that assessed the treatment and/or prevention of Candida colonization and biofilm formation in denture liners were selected according to the PRISMA statement. Seven electronic databases were searched from 1950 to April 2012 with the keywords "denture liner" OR "reline*" OR "tissue conditioner" AND "Candida" OR "denture stomatitis" OR "oral candidiasis" OR "antifungal agents" OR "denture clean*".

RESULTS

The incorporation of nystatin (in general, 500 000 units) into tissue conditioners to prevent the onset of the disease and immersion in sodium hypochlorite for disinfection were the methods most often described in this systematic review, and both methods were able to prevent or inhibit Candida colonization, depending on their concentrations. The 0.5% sodium hypochlorite concentration can disinfect tissue conditioners and denture liners. Microwave irradiation has also been described an alternative method of disinfection. Because of a lack of standardized results (especially with regard to the method used to perform microbial counts), a meta-analysis could not be performed.

CONCLUSIONS

The literature suggests that the use of 0.5% sodium hypochlorite can help disinfect denture liners and tissue conditioners. The incorporation of nystatin in those materials is also able to treat or prevent oral candidiasis. However, as most of the studies were in vitro, there is insufficient reliable evidence to truly provide recommendations regarding the ideal cleaning method or whether the addition of antifungal agents is worthwhile. Well-designed randomized controlled trials are needed to provide answers to these questions.

In vitro antifungal activity of two tissue conditioners combined with nystatin, miconazole and fluconazole against Candida albicans

AIM

To determine and compare antifungal activity of two tissue conditioners combined with nystatin, miconazole and fluconazole against Candida albicans.

MATERIALS AND METHODS

Two tissue conditioners Viscogel and GC Soft combined with nystatin, miconazole and fluconazole were tested against Candida albicans using agar core inhibition diameter assay. One-way analysis of variance followed by Tukey's post-hoc test was used to test the intergroup difference. p-value < 0.05 was considered statistically significant.

RESULTS

Maximum inhibition was seen in the fluconazole groups followed by miconazole and the least inhibition was seen in case of nystatin group.

CONCLUSION

Tissue conditioners when mixed with antifungal agents showed satisfactory inhibition of Candida albicans.

CLINICAL SIGNIFICANCE

Incorporation of antifungal drugs into tissue conditioners shows good inhibition of C. albicans and can be recommended for clinical use.

Study of the elution of fluconazole from a self-polymerizing acrylic resin and its activity against resistant Candida albicans

The study aimed, firstly, to monitor the release of an antifungal drug, fluconazole, from a self-polymerizing poly(methyl methacrylate) (PMMA) denture base resin in artificial saliva and comparing it with the release in water; and secondly, to investigate the effect of the released drug on the growth of resistant and standard strains of Candida albicans. A high-performance liquid chromatography-ultra-violet (HPLC-UV) method was used in the analysis of the released eluates into distilled water from self-polymerized PMMA discs doped with the 10% fluconazole antifungal drug. The efficacy of the released drug against resistant and standard strains of C. albicans was monitored, using agar diffusion method. The results showed that fluconazole, can be successfully incorporated with the self-polymerized PMMA. The findings suggest that the drug leaches steadily out of the PMMA resin into artificial saliva and distilled water at mouth temperature and that sustained drug release continued throughout the 28 days test period. It was shown that the released drug demonstrated antifungal activity against both standard and resistant C. albicans. The findings of this investigation have a clinical value in terms of their significant contribution to the treatment of fungal infections of the oral cavity. The sustained release of antifungal drug from the PMMA resin clearly constitutes a new dosage form of the drug via the poly(methyl methacrylate) delivery system.

In vitro antimicrobial effect of the tissue conditioner containing silver nanoparticles

PURPOSE

The aim of this study was to identify in vitro antimicrobial activity of the tissue conditioner containing silver nanoparticles on microbial strains, Staphylococcus aureus, Streptococcus mutans and Candida albicans.

MATERIALS AND METHODS

Experimental disc samples (20.0×3.0 mm) of tissue conditioner (GC Soft-Liner, GC cooperation, Tokyo, Japan) containing 0.1 - 3.0% silver nanoparticles (0%: control) were fabricated. Samples were placed on separate culture plate dish and microbial suspensions (100 µL) of tested strains were inoculated then incubated at 37℃. Microbial growth was verified at 24 hrs and 72 hrs and the antimicrobial effects of samples were evaluated as a percentage of viable cells in withdrawn suspension (100 µL). Data were recorded as the mean of three colony forming unit (CFU) numerations and the borderline of the antimicrobial effect was determined at 0.1% viable cells.

RESULTS

A 0.1% silver nanoparticles combined to tissue conditioner displayed minimal bactericidal effect against Staphylococcus aureus and Streptococcus mutans strains, a 0.5% for fungal strain. Control group did not show any microbial inhibitory effect and there were no statistical difference between 24 hrs and extended 72 hrs incubation time (P > .05).

CONCLUSION

Within the limitation of this in vitro study, the results suggest that the tissue conditioner containing silver nanoparticles could be an antimicrobial dental material in denture plaque control. Further mechanical stability and toxicity studies are still required.

Use of antifungal agents for oral candidiasis: results of a national survey

BACKGROUND

Candida albicans is an opportunistic agent that colonizes the oral mucosa.

OBJECTIVES

To determine the attitude of Spanish dentists toward the oral treatment of candidiasis.

METHOD

Between May and November 2006, a questionnaire was circulated to a random selection of 1134 dentists obtained from the General Dental Council's main list. The survey consisted of a block of socio-demographic items followed by another block related to the diagnosis and treatment of oral candidiasis. Replies to the questionnaire were received from 840 (74%) dentists.

RESULTS

50.4% of respondents were men, and 48.1% were female with a mean age of 38 and 12.2 years of professional experience. Miconazole was the most popular choice of antifungal agent prescribed (59.3%), followed by nystatin (57.7%) for topical use. Systemic antifungal agents were used by 30.20% of dentists, with a strong association between their use and the number of years in practice, gender and professional qualifications (P < 0.005).

CONCLUSION

Most Spanish dentists make clinical diagnosis and treat oral infections by C. albicans themselves with topical drugs (miconazole and nystatin) as a first choice. Systemic treatments are more commonly chosen by male dentists with long professional experience, especially by stomatologists.