Predominant cultivable microflora of plaque on removable dentures in patients with denture-induced stomatitis

Unraveling the Antibiofilm Activity of a New Nanogold Resin for Dentures and Epithesis

Dentures and epitheses are mostly made from poly(methyl methacrylate) (PMMA), which does not show antimicrobial properties. They present reservoirs of microorganisms grown in biofilms. The aim of this study is to prepare a PMMA enriched with gold nanoparticles (AuNPs)-PMMA/AuNPs and the examination of its physical, mechanical and antimicrobial properties. The AuNPS were synthetized from HAuCl₄ using the ultrasonic spray pyrolysis method with lyophilization. The PMMA/AuNP samples were compared to PMMA samples. Density was measured by pycnometer. Microhardness was evaluated using the Vickers hardness test. Monomicrobial biofilm formation (Streptococcus mitis, Candida albicans, Staphylococcus aureus and Escherichia coli) was measured by colony-forming units (CFUs) and MTT test and visualized by SEM. AuNP release was measured indirectly (the CFUs of the medium around the sample). The density and microhardness of the PMMA/AuNPs were similar to those of the PMMA. CFU and MTT values for the biofilms formed on the PMMA for each of the tested species were higher than those of the biofilms formed on the PMMA/AuNPs. The CFUs of the medium around the sample were similar for both materials. PMMA/AuNPs showed a significant reduction in the monomicrobial biofilms of all tested species. AuNPs are not released from PMMA/AuNPs. Density, indirect measurement of residual monomer and dentures weight were similar between PMMA and PMMA/AuNPs. Microhardness, as a measure of the wear resistance, was also similar between tested discs.

The denture microbiome in health and disease: an exploration of a unique community

The United Nations suggests the global population of denture wearers (an artificial device that acts as a replacement for teeth) is likely to rise significantly by the year 2050. Dentures become colonized by microbial biofilms, the composition of which is influenced by complex factors such as patient’s age and health, and the nature of the denture material. Since colonization (and subsequent biofilm formation) by some micro‐organisms can significantly impact the health of the denture wearer, the study of denture microbiology has long been of interest to researchers. The specific local and systemic health risks of denture plaque are different from those of dental plaque, particularly with respect to the presence of the opportunist pathogen Candida albicans and various other nonoral opportunists. Here, we reflect on advancements in our understanding of the relationship between micro‐organisms, dentures, and the host, and highlight how our growing knowledge of the microbiome, biofilms, and novel antimicrobial technologies may better inform diagnosis, treatment, and prevention of denture‐associated infections, thereby enhancing the quality and longevity of denture wearers.

In situ Multispecies Colonization of An Acrylic Resin: Comparison to Oral Microbiome and Potential for Inflammatory Response

Background:

Conventional acrylic resin is prone to microbial colonization and may cause inflammatory and allergic response.

Aims:

This study aims to research the initial microbial adhesion in situ and tissue response to an acrylic resin used in prosthodontics.

Materials and Methods:

Disks of a commercial acrylic resin were prepared and included on the surface of individual intraoral splints fabricated for 50 participants. The splints were used for 4 h, under clinical conditions. Beforehand, each participant was swabbed to provide a control for microbiological comparison. A cytological control sample was also taken from the palate. After the time elapsed, each splint was removed and growth of anaerobes, aerobes, Pseudomonas, oral streptococci, staphylococci, yeasts, and Streptococcus mutans was determined by plate counts and compared to the oral microbiome. A cytological sample was taken from the contact zone, stained using the Papanicolaou technique, analyzed in light microscopy, and classified accordingly. Means and standard deviations were calculated, and a nonparametric Wilcoxon test was employed to compare experimental groups. The significance level was set at 0.05 (95% confidence interval, and statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 20.0.

Results:

Nuclear-cytoplasm ratio increase was found in 84% of the smears retrieved from the contact zone. Over 60% showed nuclear alterations. With exception to yeasts and Pseudomonas, all microbial groups colonized the resin. No statistically significant differences were found between the oral microbiome and the acrylic resin's colonization except regarding yeasts (P > 0.05).

Conclusions:

Cellular alterations were found but a diagnosis of inflammation is inconclusive. Microbial adhesion to the acrylic resin was substantial, with multiple species adhering.

The subgingival periodontal microbiota of the aging mouth

Different mechanisms have been hypothesized to explain the increase in prevalence and severity of periodontitis in older adults, including shifts in the periodontal microbiota. However, the actual impact of aging on the composition of subgingival biofilms remains unclear. In the present article, we provide an overview of the composition of the subgingival biofilm in older adults and the potential effects of age on the oral microbiome. In particular, this review covers the following topics: (i) the oral microbiota of an aging mouth; (ii) the effects of age and time on the human oral microbiome; (iii) the potential impact of inflammaging and immunosenescence in the host-oral microbiota interactions; and (iv) the relationship of the aging oral microbiota and Alzheimer's disease. Finally, we present analyses of data compiled from large clinical studies that evaluated the subgingival microbiota of periodontally healthy subjects and patients with periodontitis from a wide age spectrum (20-83 years of age).

Photodynamic inactivation of a multispecies biofilm using curcumin and LED light

This study evaluated the potential of curcumin-mediated antimicrobial photodynamic inactivation (API) on multispecies biofilms of Candida albicans, Candida glabrata, and Streptococcus mutans of different ages. Acrylic samples (n = 480) were made with standardized rough surfaces and incubated with bacteria and yeast for 24 or 48 h. API was performed with curcumin (80, 100, 120 μM) and LED light. Additional acrylic samples were treated with curcumin or LED light only. Positive control samples received neither light nor curcumin. After API, colony counts were quantified (CFU/mL), cell metabolism was determined by means of XTT assay, and the total biofilm biomass was evaluated using Crystal Violet (CV) staining assay and images were obtained by confocal laser scanning microscopy (CLSM). The data were analyzed by nonparametric two-way ANOVA and post hoc Tukey tests (α < 0.05). For 24-h biofilm, API resulted in statistically significant difference (ρ < 0.001) of viability of C. albicans compared with control (P-L-) for all Cur concentrations. For 48-h biofilm, API resulted in statistically significant difference (ρ < 0.001) compared with control only when Cur at 120 μM was used. API promoted statistically significant difference (ρ ≤ 0.001) in the viability of S. mutans and C. glabrata for all Cur concentrations in the two biofilm ages. In addition, API produced a statistically significant difference (ρ < 0.001) of metabolic activity and of total biomass (ρ < 0.001) of multispecies biofilms compared with control for all Cur concentrations. It can be concluded that both 24- and 48-h biofilms were susceptible to API mediated by Cur; however, 24-h biofilm was more sensitive than the 48-h biofilm.

In Vitro Effects of Plantago Major Extract, Aucubin, and Baicalein on Candida albicans Biofilm Formation, Metabolic Activity, and Cell Surface Hydrophobicity

PURPOSE

To determine the in vitro effectiveness of Plantago major extract, along with two of its active components, aucubin and baicalein, on the inhibition of Candida albicans growth, biofilm formation, metabolic activity, and cell surface hydrophobicity.

MATERIALS AND METHODS

Twofold dilutions of P. major, aucubin, and baicalein were used to determine the minimum inhibitory concentration (MIC), minimum fungicidal concentration (MFC), and the minimum biofilm inhibitory concentration (MBIC) of each solution. Separately, twofold dilutions of P. major, aucubin, and baicalein were used to determine the metabolic activity of established C. albicans biofilm using a 2,3-bis (2- methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-carboxanilide reduction assay. Twofold dilutions of P. major, aucubin, and baicalein were used to determine the cell surface hydrophobicity of treated C. albicans biofilm by a two-phase assay using hexadecane. The hydrophobicity percentage of the cell surface was then calculated. A mixed-model ANOVA test was used for intergroup comparisons.

RESULTS

The MICs of P. major extract (diluted 1:2 to 1:8), aucubin (61 to 244 μg/ml), and baicalein (0.0063 to 100 μg/ml) on the total growth of C. albicans were noticeable at their highest concentrations, and the inhibition was dose dependent. The MFC was evaluated after 48 hours of incubation, and aucubin (244 μg/ml) exhibited a strong fungicidal activity at its highest concentration against C. albicans growth. The MBIC indicated no growth or reduced growth of C. albicans biofilm at the highest concentrations of aucubin (61 to 244 μg/ml) and baicalein (25 to 100 μg/ml). Similarly, the effects of these reagents on C. albicans biofilm metabolic activity and hydrophobicity demonstrated high effectiveness at their highest concentrations.

CONCLUSION

P. major extract, aucubin, and baicalein caused a dose-dependent reduction on the total growth, biofilm formation, metabolic activity, and cell surface hydrophobicity of C. albicans. This demonstrates their effectiveness as antifungals and suggests their promising potential use as solutions for C. albicans biofilm-related infections.

Photodynamic inactivation of a multispecies biofilm using Photodithazine(®) and LED light after one and three successive applications

In this investigation, the effectiveness of successive applications of antimicrobial photodynamic inactivation (API) mediated by Photodithazine(®) (PDZ) and LED light was evaluated against a multispecies biofilm formed by Candida albicans, Candida glabrata, and Streptococcus mutans on denture base acrylic resin. Standard cell suspensions (bacteria and yeast) were inoculated on acrylic resin samples, and the biofilm was grown for 48 h (37 °C/75 rpm). API was performed by the administration of PDZ (175 and 200 mg/L) and exposure to 37.5 J/cm(2) of LED light (660 nm). Additional samples were treated with PDZ or LED light only. Untreated control samples were not submitted to light or PDZ. The conditions described were applied once or in three consecutive applications for all groups. Cell viability was determined by colony counts (CFU/mL), metabolic activity, total biomass, and confocal laser scanning microscopy (CLSM). Data were analyzed by a nonparametric two-way ANOVA and Tukey tests (α = 0.05). The results obtained demonstrated a significant effect (p < 0.05) of number of applications and treatment groups for CFU/mL, and S. mutans showed the highest susceptibility to API. The metabolic activity of the multispecies biofilm was significantly reduced (p < 0.05) after API for both numbers of applications, which were also significantly different (p < 0.05) between them. The total biomass of the biofilm was significantly different (p < 0.05) only between groups submitted to one and three API applications. CLSM showed a visual increase of dead cells after API. API-mediated PDZ was effective in reducing the cell viability of multispecies biofilm. Three consecutive applications of API were more effective for reducing the cell viability and the total biomass of multispecies biofilm.

Effectiveness of Chemical and Microwave Disinfection on Denture Biofilm Fungi and the Influence of Disinfection on Denture Base Adaptation

The aims of this study were to evaluate the effectiveness of six disinfection methods and the influence of these methods on the adaptation of maxillary dentures. Acrylic resin specimens contaminated with fungi were exposed to the following disinfection treatments: 1. microwave oven (900 W) at full power for 5 min (with soaking the specimen in 250 ml water), 2. microwave oven at medium power for 5 min (with soaking the specimen in 250 ml water), 3. sodium hypochlorite 5.25 % for 5 min, 4. diluted sodium hypochlorite 1:420 for 5 h, 5. Chlorhexidine gluconate for 5 h, 6. effervescent tablets for 15 min, 7. soaking in 250 ml tap water for 15 min. Colony forming units (CFUs) of remaining cells were counted and compared with t test (p ≤ 0.05). Dimensional stability was evaluated using aluminum die simulating the maxillary edentulous arch. Posterior palatal gaps were measured. Data were analyzed using one-way ANOVA test and t test (p ≤ 0.05). Microwave irradiation (at full or medium power) and sodium hypochlorite 5.25 % for 5 min were able to reduce the CFUs of fungi by more than 4 log10 whereas diluted sodium hypochlorite, chlorhexidine gluconate, and effervescent tablets did not achieve a reduction of >2.8, 2.68 and 1.66, respectively. For dimensional stability test, t test revealed significant difference between control group and the microwave at full power group (p = 0.000). Within the limits of this study, microwave oven at medium power and sodium hypochlorite (5.25 %) are effective and safe methods of disinfecting removable dentures.

Dodonaea viscosa var. angustifolia Inhibits Germ Tube and Biofilm Formation by C. albicans

The virulence factors of Candida albicans are germ tube and biofilm formation, adherence to host tissues, and production of hydrolytic enzymes. This study investigated the effect of Dodonaea viscosa var. angustifolia extract on the germ tube and biofilm formation of C. albicans. Serum containing the three subinhibitory concentrations of leaf extract was inoculated with C. albicans, incubated, and viewed under a light microscope. Number of cells with germ tube was recorded and the results were analysed using Scheffe test for pairwise comparison. Biofilms were grown on coverslips in the presence of plant extracts and processed for scanning electron microscopy (SEM). Planktonic cells were grown in the presence of plant extract for 6 h and processed for electron microscopy (TEM). The crude plant extract significantly (P < 0.01) reduced the germ tube formation of C. albicans at 3.125 (85.36%), 1.56 (61.91%), and 0.78 mg/mL (26.27%) showing a concentration dependent effect. SEM results showed concentration dependent reduction in biofilm and hyphae formation. TEM results showed that the plant extract caused damage to the cell wall and cell membrane. DVA extract has ability to reduce virulence of C. albicans by inhibiting germ tube and biofilm formation through damage to the cell wall. Therefore, it has therapeutic potential.

Effectiveness of photodynamic therapy for the inactivation of Candida spp. on dentures: in vitro study

OBJECTIVE

This in vitro study evaluated the effectiveness of photodynamic therapy (PDT) for the inactivation of different species of Candida on maxillary complete dentures.

BACKGROUND DATA

The treatment of denture stomatitis requires the inactivation of Candida spp. on dentures. PDT has been reported as an effective method for Candida inactivation.

METHODS

Reference strains of C. albicans, C. glabrata, C. tropicalis, C. dubliniensis and C. krusei were tested. Thirty-four dentures were fabricated in a standardized procedure and subjected to ethylene oxide sterilization. The dentures were individually inoculated with one of the strains and incubated at 37°C for 24 h. Dentures submitted to PDT (P+L+) were individually sprayed with 50 mg/L of Photogem(®) (PS) and, after 30 min, illuminated by LED light for 26 min (37.5 J/cm(2)). Additional dentures were treated only with PS (P+L-) or light (P-L+) or neither (P-L-). Samples of serial dilutions were spread on Sabouraud dextrose agar and incubated at 37°C for 48 h. The colonies were counted and the values of log (cfu/mL) were analyzed by Kruskall-Wallis and Dunn tests (p<0.05).

RESULTS

For all species of Candida, PDT resulted in significant reduction (p<0.05) of cfu/mL values from dentures when compared with P-L- (reductions from 1.73 to 3.99 log(10)). Significant differences (p<0.05), but lower reductions, were also observed for P+L- and P-L+when compared with P-L- for some species of Candida.

CONCLUSIONS

PDT was an effective method for reducing Candida spp. on dentures.

Denture stomatitis treated with photodynamic therapy: five cases

OBJECTIVE

Photodynamic therapy (PDT) is an effective method for Candida spp. inactivation in vitro and in vivo, but as yet, no clinical trial has been conducted. This report describes 5 cases of denture stomatitis (DS) treated with PDT.

STUDY DESIGN

Five subjects with clinical and microbiologic diagnosis of DS were submitted to 6 sessions of PDT 3 times a week for 15 days. In each session, patients' dentures and palates were sprayed with 500 mg/L Photogem, and, after 30 minutes of incubation, irradiated by light-emitting diode light source at 455 nm (37.5 and 122 J/cm(2), respectively). Cultures of Candida spp. from dentures and palates and standard photographs of the palates were taken at baseline (day 0), at the end of the treatment (day 15), and at follow-up time intervals (days 30 and 60).

RESULTS

Four patients showed clinical resolution of DS (no inflammation) after PDT sessions, and only 1 subject demonstrated reduction in palatal inflammation. Recurrence of DS was observed in 2 patients during the follow-up period.

CONCLUSIONS

PDT appears to be an alternative treatment for DS.

Should patients with hip joint prosthesis receive antibiotic prophylaxis before dental treatment?

The safety committee of the American Academy of Orthopedic Surgeons (AAOS) recommended in 2009 that clinicians should consider antibiotic prophylaxis for all patients with total joint replacement before any invasive procedure that may cause bacteremia. This has aroused confusion and anger among dentists asking for the evidence. The present review deals with different aspects of the rationale for this recommendation giving attention to views both in favor of and against it.

Ageing exacerbates damage of systemic and salivary neutrophils from patients presenting Candida-related denture stomatitis

Background

Ageing leads to a decline in the function of the immune system, increasing the body's susceptibility to infections through the impairment of T-cells, macrophages, neutrophils and dendritic cells Denture stomatitis is a primary oral disease affecting elderly denture wearers. The major etiologic factor involved in this pathology is the infection by Candida albicans, an opportunistic pathogen that causes local and disseminated diseases in immunosuppressed humans. Neutrophils play a critical role in the immune response against C. albicans and are continually present in the salivary fluid and in the blood. The aim of this study was to determine ageing-related changes in salivary and blood neutrophils and their potential implications in Candida-related denture stomatitis.

Results

Our results showed a lower number of neutrophils in the saliva from patients presenting Candida-related denture stomatitis in comparison to their matched controls. Furthermore, fewer neutrophils were isolated from the saliva of aged control individuals in comparison to matched younger subjects. CXCR1, CD62L and CD11b expression were significantly greater on systemic neutrophils from younger control individuals. Elderly individuals showed more apoptotic salivary neutrophils and lower GM-CSF levels than younger ones, regardless of the occurrence of Candida infection. On the other hand, CXCL-8 concentrations were higher in the saliva from elderly individuals. Besides, TNF-α was detected at elevated levels in the saliva from infected elderly subjects. Salivary neutrophils from elderly and young patients presented impaired phagocytic activity against C. albicans. However, just systemic neutrophils from elderly showed decreased phagocytosis when compared to the younger ones, regardless of the occurrence of infection. In addition, neutrophils from aged individuals and young patients presented low fungicidal activity.

Conclusion

The data suggests that the Candida related-denture stomatitis is associated to neutrophils function deficiency, and ageing drastically appears to alter important characteristics of such cells, facilitating the establishment of this infection.

Inhibition of biofilms associated with dentures and toothbrushes by tetrasodium EDTA

AIMS

We examined the efficacy of tetrasodium EDTA in eradicating biofilms derived from salivary inocula or pure cultures of Candida albicans on discs of polymethyl methacrylate (PMMA) denture base or on toothbrushes that had been used normally for 4-8 weeks. Its efficiency in virus neutralization was also determined.

METHODS AND RESULTS

Overnight (16 h) treatment with 4% (w/v) tetrasodium EDTA solution reduced salivary and C. albicans biofilm viable counts by > or =99%. Biofilm removal was confirmed using confocal laser scanning microscopy. Presence/absence of sucrose during biofilm formation had no effect on killing efficacy. Prolonged treatment of PMMA with tetrasodium EDTA did not influence subsequent formation of C. albicans biofilms or affect surface roughness of the PMMA, but it reduced subsequent biofilm formation from a salivary inoculum. Infectivities of herpes simplex virus and polio virus suspensions were reduced by >99.99% by treatment for 1 and 2 h, respectively.

CONCLUSIONS

Tetrasodium EDTA solution efficiently disinfected toothbrushes and PMMA discs, with the detachment of biofilms, and rapidly neutralized both nonenveloped and enveloped viruses.

SIGNIFICANCE AND IMPACT OF THE STUDY

Dentures and toothbrushes become contaminated by bacterial biofilms and by viruses. There is a need for disinfection methods that are rapidly effective, cost-effective, nontoxic and easily implemented. These studies indicate that tetrasodium EDTA solution has disinfection applications in the oral care field.

Denture-related stomatitis: identification of aetiological and predisposing factors - a large cohort

The aim of this study was to identify and characterize aetiological and predisposing factors in denture-related stomatitis (DRS), by means of a case-control, transversal study, in a large cohort of 140 persons wearing removable maxillary polymethylamethacrylate prostheses. Data were obtained by (1) a questionnaire that included the identification of the subject, demographic and social data, medical history and behaviour; (2) intra-oral examination; (3) evaluation of the prosthesis; (4) microbiological examination; (5) yeast identification and analyses using Epi-info and the chi-square test. Results showed significant associations between DRS and yeasts, gender, age and alcohol consumption. We also found a significant relationship between the presence of yeasts and hyposalivation and decreased salivary pH. We found a highly significant difference between groups with and without DRS concerning the presence or absence of yeasts, regardless of the sample origin. Most cases of DRS showed the presence of Candida albicans. The results confirm a highly significant difference between groups with and without DRS concerning the presence or absence of yeasts.

Malodour in denture wearers: an ill-defined problem

Denture plaque has not been studied to the same extent as dental plaque, and although there are many similarities in microbial composition, there are some significant differences. Denture-induced stomatitis is associated with poor denture hygiene, a more acidogenic plaque and the presence of Candida albicans. Obligate Gram-negative anaerobic micro-organisms, although present in denture plaque, have rarely been specifically investigated. Opportunist pathogens including coliforms and staphylococci have been isolated from dentures. Teeth adjacent to partial dentures are more susceptible to caries and periodontal diseases, perhaps due to an increased plaque buildup at the prosthesis/tooth interface. Little work has been published on malodour associated with dentures. The inert material provides a substratum for the plaque biofilm, which encompasses a range of odour-producing species. The microbiology of the tongue in denture wearers has not been specifically studied. Thus the nature, origin and extent of malodour in denture wearers is ill-defined, but many species capable of producing malodorous compounds are present. The wide age and health range presented by denture wearers further confounds investigation. There is a need for further work in the area, both for cosmetic- and health-associated reasons in the increasing elderly population.

Effects of polishing techniques on the surface roughness of acrylic denture base resins

STATEMENT OF PROBLEM

Rough surfaces of denture bases promote adhesion of microorganisms and plaque formation. It is therefore important to know how different polishing systems affect surface roughness of denture base acrylic resins.

PURPOSE

The objective of this study was to compare the effects of 4 chairside polishing kits and 2 conventional laboratory techniques used for polishing 3 different acrylic denture base resins.

MATERIAL AND METHODS

Using contact profilometric measurement, the surface texture of 54 specimens (15x30x3 mm) per acrylic material (autopolymerized ProBase Cold, heat-polymerized ProBase Hot, and injection heat-polymerized SR Ivocap plus) was studied before and after cutting with a tungsten carbide bur, and during and after chairside polishing with 4 polishing kits (Exa Technique, Acrylic Polisher HP blue, AcryPoint, Becht Polishing Cream), and after conventional polishing with 2 polishing systems (Universal Polishing Paste for Resins and Metals, Lesk Polishing Liquid). There were 9 specimens for each acrylic resin material and polishing method combination. Conventional lathe polishing with polishing paste served as the control. Mean average surface roughness (Ra) values of each specimen group were analyzed using a 2-way analysis of variance, the Scheffé post-hoc test, and paired t test (alpha=.05) with the Bonferroni adjustment. After testing the polished acrylic resin surfaces were evaluated under a scanning electron microscope.

RESULTS

The highest mean average surface roughness (Ra=2.86+/-0.8 microm to 3.99+/-1.31 microm) was measured for surfaces finished with a tungsten carbide bur. The lowest surface roughness values (Ra=0.02+/-0.01 microm) were determined for acrylic resin specimens polished with a lathe and polishing paste. The Ra values of resin specimens after polishing with chairside silicone polishing kits ranged from 0.05+/-0.0 microm to 0.35+/-0.05 microm. Mean average Ra values of specimens polished with a polishing cream alone (Ra=1.01+/-0.17 microm to 1.68+/-0.47 microm) were significantly higher (P<.05) than those obtained with other polishing systems tested, which was confirmed by scanning electron microscope images of acrylic resin surfaces. Significant differences in mean average surface roughness were found between autopolymerizing and injected heat-polymerizing resin specimens. In addition, scanning electron microscopy revealed increased porosity of autopolymerizing resin specimens.

CONCLUSIONS

Conventional laboratory polishing was found to produce the smoothest surface of denture base acrylic resin. Chairside silicone polishing kits produced a significantly smoother surface of acrylic resin than specimens polished with a tungsten carbide bur. The presence of large pores was characteristic for the autopolymerizing resin material.

Candida albicans and Streptococcus salivarius modulate IL-6, IL-8, and TNF-alpha expression and secretion by engineered human oral mucosa cells

We investigated the involvement of oral epithelial cells via two cytokines (IL-6 and TNF-alpha) and one chemokine (IL-8) in local defences against live yeast (Candida albicans) and bacteria (Streptococcus salivarius) using an engineered human oral mucosa model. We report that the yeast changed from the blastospore to the hyphal form and induced significant tissue disorganization at later contact periods (24 and 48 h) compared to the bacteria. However, this effect did not reduce the viability or total number of epithelial cells. Gene activation analyses revealed that IL-6, IL-8 and TNF-alpha mRNA levels rose in tissues in contact with live C. albicans or S. salivarius. Gene activation was followed by an upregulation of protein secretion. IL-6 levels were higher after contact with C. albicans than with S. salivarius. IL-8 levels after contact with S. salivarius were higher than with C. albicans. Our study suggests that S. salivarius is more efficient at inducing proinflammatory mediator release than C. albicans. These results provide additional evidence for the contribution of oral epithelial cells to the inflammatory response against fungi and bacteria.

Internalization of Staphylococcus aureus by human keratinocytes

Staphylococcus aureus is among the most important human pathogens and causes various superficial and systemic infections. The ability of S. aureus to be internalized by, and survive within, host cells, such as keratinocytes, may contribute to the development of persistent or chronic infections and may finally lead to deeper tissue infections or dissemination. To examine the mechanisms of internalization of S. aureus by keratinocytes, isogenic mutants lacking fibronectin-binding proteins (FnBPs), a recombinant protein consisting of the fibronectin-binding domain of S. aureus FnBPs, and an anti-alpha5beta1 antibody were used in cocultures with immortalized keratinocytes and primary keratinocytes. We found that internalization of S. aureus by immortalized keratinocytes requires bacterial FnBPs and is mediated by the major fibronectin-binding integrin alpha5beta1. In contrast to internalization by immortalized keratinocytes, internalization of S. aureus by primary keratinocytes could occur through FnBP-dependent and -independent pathways. S. aureus clumping factor B (ClfB), which was recently determined to bind to epithelial cells, was not involved in the uptake of this bacterium by keratinocytes. The identification of an alternate uptake pathway, which is independent of S. aureus FnBPs and host cell alpha5beta1, has important implications for the design of therapies targeted to bacterial uptake by host cells.

Staphylococcus aureus in the oral cavity: a three-year retrospective analysis of clinical laboratory data

OBJECTIVE

A retrospective analysis of laboratory data to investigate the isolation of Staphylococcus aureus from the oral cavity and facial area in specimens submitted to a regional diagnostic oral microbiology laboratory.

METHODS

A hand search of laboratory records for a three-year period (1998-2000) was performed for specimens submitted to the regional diagnostic oral microbiology laboratory based at Glasgow Dental Hospital and School. Data were collected from forms where S. aureus was isolated. These data included demographics, referral source, specimen type, methicillin susceptibility and clinical details.

RESULTS

For the period 1998-2000, there were 5,005 specimens submitted to the laboratory. S. aureus was isolated from 1,017 specimens, of which 967 (95%) were sensitive to methicillin (MSSA) and 50 (5%) were resistant to methicillin (MRSA). The 1,017 specimens were provided from 615 patients. MRSA was isolated from 37 (6%) of patients. There was an increasing incidence of S. aureus with age, particularly in the >70 years age group. The most common specimen from which MSSA was isolated was an oral rinse (38%) whilst for MRSA isolates this was a tongue swab (28%). The clinical condition most commonly reported for MSSA isolates was angular cheilitis (22%). Erythema, swelling, pain or burning of the oral mucosa was the clinical condition most commonly reported for MRSA isolates (16%). Patients from whom the MSSA isolates were recovered were most commonly (55%) seen in the oral medicine clinic at the dental hospital, whilst patients with MRSA were more commonly seen in primary care settings such as nursing homes, hospices and general dental practice (51%).

CONCLUSION

In line with more recent surveys, this retrospective study suggests that S. aureus may be a more frequent isolate from the oral cavity than hitherto suspected. A small proportion of the S. aureus isolates were MRSA. There were insufficient data available to determine whether the S. aureus isolates were colonising or infecting the oral cavity. However, the role of S. aureus in several diseases of the oral mucosa merits further investigation.

Reassessing the presence of Candida albicans in denture-related stomatitis

OBJECTIVE

The aim of this study was to reevaluate the link between Candida albicans and denture-related stomatitis according to a modified Newton classification, which reflects the classic types of inflammation as well as the extent to which the tissue is affected.

STUDY DESIGN

Two groups of denture wearers were evaluated for denture-related stomatitis. The presence and number of yeasts on the dentures, the identification of the Candida species present, and the amount of plaque coverage were determined. Putative risk factors were included in the study. Relations between these variables and stomatitis were analyzed statistically.

RESULTS

According to Newton's classification, the presence of yeast on the denture was not linked to whether subjects had stomatitis. But with our classification, higher prevalence of yeast carriers, yeast colony number, and plaque coverage were found on the dentures of individuals with the most extensive inflammation, regardless of Newton type. Among risk factors evaluated, wearing dentures at night and smoking were associated with the most extensive inflammation. We also demonstrated that the presence of C albicans as well as the cohabitation of different Candida species was more frequent in denture-related stomatitis. The differences were statistically significant.

CONCLUSIONS

Statistical analysis of microbiologic data from different denture-related stomatitis categories according to our modified classification showed that the presence of yeast on dentures was significantly associated with the extent of the inflammation, rather than with the Newton type. Our findings suggest that the inflammatory process of stomatitis favors the colonization of Candida. These results could have new implications for diagnosis and management of the condition.

Bronchopneumonia and oral health in hospitalized older patients. A pilot study

AIMS

To correlate microbial findings obtained by bronchoalveolar lavage in pneumonia patients with the clinical situation of the oral cavity.

METHOD

Quantitative aerobic and anaerobic cultures were carried out in 150 ml samples of bronchoalveolar lavage (BAL) obtained by means of an endoscope (Video Endoscope Pentax) inserted per os in the infected bronchus.

MATERIAL

Twenty consecutive patients with a tentative clinical diagnosis of bronchopneumonia in whom BAL was carried out for diagnostic purposes. A clinical evaluation of the oral health status (oral hygiene, caries, periodontal diseases) was subsequently carried out.

RESULTS

In seven edentulous subjects wearing complete dentures the culture of anaerobic microorganisms was negative or yielding less than 100 cfu/ml BAL. Two patients yielded high counts of S. aureus and one high counts of P. aeruginosa. In the 13 subjects with natural teeth left one showed high counts of Veillonella spp. (anaerobic) + P. aeruginosa, one high counts of Veillonella spp. + S. aureus, one high counts of P. aeruginosa + S. aureus and one high counts of E. coli. These four subjects showed poor oral hygiene, periodontal pockets and a BAL microflora consistent with periodontal pathology.

CONCLUSION

The results of this pilot study suggest that microorganisms of denture plaque or associated with periodontal diseases may give rise to aspiration pneumonia in susceptible individuals.

[Biofilm disclosing agents in complete denture: clinical and antimicrobial evaluation]

This study evaluated the disclosing ability, removal facility and antimicrobial effect of biofilm disclosing agents applied on complete dentures. Disclosing ability was evaluated by means of the visual method. The solutions were applied on the internal surface of dentures. After being photographed, the dentures were brushed with denture-specific brush and dentifrice and photographed again. The obtained slides were projected on paper (10 X amplification) and the total and stained surfaces were outlined with graphite, cut off and weighed, in order to assess removal facility. The evaluation of antimicrobial effects was carried out by means of the method of diffusion in agar, and the results were obtained by measuring the length of the halos and rings. In terms of disclosing ability, the best solutions were 0.05% methylene blue, 5% erythrosin, 1% sodic fluorescein, Replak and 1% neutral red. One percent eosin, 1% sodic fluorescein and 5% erythrosin were the most easily removed solutions. One percent eosin, 5% erythrosin, 1% sodic fluorescein, 0.3% proflavine, Replak and 1% neutral red presented no antimicrobial effect. The solutions which presented the greatest disclosing ability and removal facility as well as absence of antimicrobial effect - which are essential requirements in the assessment of hygiene methods and guidance on oral health - were 1% eosin, 1% neutral red and 5% erythrosin.

Oral mucous membrane flora in patients using saliva substitutes

Salivary substitutes are sometimes valuable for elderly people and radiotherapy patients, and may be used indefinitely. It is possible that this change in the ecology may effect the oral flora.

OBJECTIVE

To analyse the presence of micro-organisms on oral mucous membranes during use of saliva substitutes.

DESIGN

Cross-over single-blind study.

SETTING

Clinic for Maxillofacial Surgery, Malmö University Hospital and Department of Oral Microbiology, Malmö University.

SUBJECTS

19 patients with low salivary secretion who had been radiated for cancer in the head and neck region.

INTERVENTION

Two saliva substitutes: linseed extract and a carboxymethyl cellulose preparation (Salinum and MAS-84) were used for 3 week periods.

MEASUREMENTS

Microbial samples taken, processed and analysed.

RESULTS

No differences were observed when comparing baseline values with the results after the saliva substitutes and no significant differences between the use of different agents.

CONCLUSION

The study suggests that use of linseed extract and carboxymethyl cellulose preparation during periods of weeks does not influence flora commonly related to caries, periodontitis or infections in the oral mucous membranes.

Anti-adhesive and antibacterial properties of a proprietary denture cleanser

The antimicrobial efficacy and anti-adhesive attributes of a proprietary denture cleanser were evaluated. To determine cleanser antimicrobial efficacy, Streptococcus mutans was grown on denture acrylic strips which were then exposed to the cleanser. To evaluate anti-adhesive efficacy, the strips were treated with the cleanser and then placed in the Strep. mutans suspension. Following incubation, adhered bacteria were removed and enumerated by viable counting. Treated denture acrylic plates were also placed in a parallel-plate flow chamber and then exposed to Strep. oralis. Images of adhered bacteria were analysed to determine biofilm coverage. Biofilm removal force was quantified by increasing the flow rate between the acrylic plates. The cleanser exhibited a 100% kill against Strep. mutans adhered to the acrylic surface, and inhibited attachment of cells by 66%. The flow chamber study found that cleanser-treated denture acrylic allowed the formation of a multilayer biofilm which was easily removed by a slight increase in flow rate.

Insulin-dependent diabetes mellitus and oral soft tissue pathologies: II. Prevalence and characteristics of Candida and Candidal lesions

OBJECTIVE

To assess the prevalence of Candida albicans and oral infection with Candida in patients with insulin-dependent diabetes mellitus (IDDM).

STUDY DESIGN

This cross-sectional study compared the prevalence of candidiasis in 405 subjects with IDDM and 268 nondiabetic control subjects. Assessments included evidence of clinical manifestations of candidiasis and a quantitative measure of Candida pseudohyphae in a cytologic smear from the midline posterior dorsal tongue.

RESULTS

More subjects with IDDM than control subjects without IDDM (15.1% vs 3.0%) were found to have clinical manifestations of candidiasis, including median rhomboid glossitis, denture stomatitis, and angular cheilitis. IDDM subjects were also more likely to have any Candida pseudohyphae in their cytologic smears (23.0% vs 5.7%; P <.0001), as well as pseudohyphae counts of >10/cm(2) (7.1% vs 0.8%; P <.0001). Diabetic subjects with median rhomboid glossitis were more likely to have a longer duration of IDDM and complications of nephropathy and retinopathy. Denture stomatitis was associated with smoking, retinopathy, higher Candida counts, poor glycemic control, and longer duration of IDDM. A multivariate regression analysis found 3 factors to be significantly associated with the presence of Candida pseudohyphae in the subjects with IDDM: current use of cigarettes (odds ratio, 2:4), use of dentures (odds ratio, 2:3), and elevated levels of glycosylated hemoglobin (odds ratio, 1:9). The use of antimicrobials, immunosuppressants, or drugs with xerostomic side effects was not related to the presence of Candida.

CONCLUSIONS

Candida pseudohyphae and oral soft tissue manifestations of candidiasis were more prevalent in subjects with IDDM than in control subjects without diabetes. The presence of Candida pseudohyphae was significantly associated with cigarette smoking, use of dentures, and poor glycemic control.

Denture plaque and adherence of Candida albicans to denture-base materials in vivo and in vitro

The aim of this paper is to review our understanding of the mechanisms and clinical significance of adhesion of C. albicans to denture-base materials in relation to denture plaque and denture-related stomatitis. Earlier reports in the literature of a 65% prevalence level of denture-related stomatitis seem to be exaggerated. More recent studies indicate that denture-related stomatitis is considerably less common, particularly in normal healthy subjects. The etiology of the condition is discussed in this review, and although much of the literature supports the view that the condition is strongly associated with C. albicans, this is not always so. In some subjects, the cause appears to be related to a non-specific plaque. This review also considers the role of denture plaque in the pathogenesis of denture-related stomatitis, the sequential development of denture plaque, and its colonization by Candida organisms. Designing controlled in vivo studies is difficult, and as a consequence, many investigators have had to resort to in vitro studies. The majority of these studies have attempted to investigate the hydrophobicity of C. albicans, relating the surface free-energy of denture-base materials, particularly acrylic resin, to that of the organism. Surprisingly little work has been directed at surface roughness and how it affects retention of organisms. Further, no attention has been paid to the properties and character of the surface, other than average surface roughness, as it affects adhesion. A comparison of results from in vitro studies on the effect on adhesion of pre-coating the surfaces of denture-base materials with saliva has produced equivocal conclusions. This is largely due to little standardization of experimental protocols between studies, particularly in the collection and handling of the saliva used. In conclusion, the review strongly supports the suggestion that adherence of C. albicans to denture-base materials in vitro is related to the hydrophobicity of the organism. The clinical significance of the observation and the mechanisms for the development and maturation of denture plaque are yet to be understood. There is a clear need for further investigation of other factors that may moderate the adhesion of organisms and subsequent colonization of denture-base materials.

Porphyromonas gingivalis in an edentulous proband. A case-report

In a previous study, an edentulous subject showed the presence of P. gingivalis, only in saliva. The present case report is a longitudinal follow-up on this proband (female, 63 years) and her spouse with periodontitis (67 years). Samples were taken from the proband and the spouse for microbiological analysis at several occasions during a 3-year period and a 1-year period respectively. In the edentulous proband, P. gingivalis was present in saliva only, at all times. In the spouse, P. gingivalis was present in the periodontal pocket and on the mucous membranes, but the saliva was culture-negative for this species at both sampling times. The restriction enzyme analysis (REA) patterns of isolates (n=7) of P. gingivalis from the proband recovered over 3 years showed no differences. This indicated that the same clonal type of P. gingivalis persisted for 3 years in the proband. The P. gingivalis isolates (n=13) from the spouse showed no differences when REA patterns were compared. Comparison of REA patterns from the proband and the spouse also showed no differences. Thus the same clonal type of P. gingivalis can persist over several years in an edentulous subject and at least for 1 year in a subject with periodontal disease.

Rigidly splinted implants in the resorbed maxilla to retain a hinging overdenture: a series of clinical reports for up to 4 years

STATEMENT OF PROBLEM

The results of the implant overdenture treatment in the maxilla remains inferior to those in the mandible. Different reasons have been alluded to, such as bone quality and quantity, number of implants, as well as the prosthesis design.

PURPOSE

To investigate the latter, a new design for the rehabilitation of the resorbed maxillae was set up.

MATERIAL AND METHODS

Thirteen patients were selected and provided with four endosseous maxillary implants, splinted with a rigid-cast bar.

RESULTS

After a mean loading time of 3 years, six implants were lost; three at abutment and another three shortly after abutment connection, resulting in a cumulative success rate of 88.6% at year 4. A mean marginal bone loss of 0.3 mm was observed within the first year. After the first year, the marginal bone level, the attachment level, and the Periotest scores hardly changed. The main prosthetic complication was the frequent need to renew or to activate the attachments. A strong improvement in patient satisfaction was observed when compared with the old conventional denture.

CONCLUSIONS

Within the limits of this study, the outcome confirmed that, on a medium-term base, implant-retained hinging overdentures on four implants were promising.

Adhesive interactions between medically important yeasts and bacteria

Yeasts are being increasingly identified as important organisms in human infections. Adhesive interactions between yeasts and bacteria may contribute to yeast retention at body sites. Methods for studying adhesive interactions between bacterial strains are well known, and range from simple macroscopic methods to flow chamber systems with complex image analysis capabilities. The adhesive interactions between bacteria and yeasts have been studied employing several of the methods originally developed for studying adhesive interactions between bacteria. However, in many of the methods employed the larger size of the yeasts as compared with bacteria results in strong sedimentation of the yeasts, often invalidating the method adapted. In addition, most methods are semi-quantitative and do not properly control mass transport. Consequently, adhesive interaction mechanisms between yeasts and bacteria identified hitherto, including lectin binding and protein-protein interactions, must be regarded with caution. Extensive physico-chemical characteristics of yeast cell surfaces are not available and a physico-chemical mechanism has not yet been put forth. A new method for quantifying adhesive interactions between yeasts and bacteria is proposed, based on the use of a parallel plate flow chamber, in which the influence of adhering bacteria upon the kinetics of yeast adhesion and aggregation of the adhering yeasts is quantitatively evaluated, under carefully controlled mass transport.