Candida-associated denture stomatitis. Aetiology and management: a review. Part 1. Factors influencing distribution of Candida species in the oral cavity

Cryptocarya moschata fractions decrease planktonic cells and biofilms of Candida albicans and Streptococcus mutans

Extracts of Cryptocarya species have been shown to reduce biofilms, demonstrating their antimicrobial effects. The extracts can be fractionated to optimize their potential. In this study, we evaluated the antimicrobial activity of Cryptocarya moschata fractions against planktonic cells and biofilms of Candida albicans and Streptococcus mutans. Four fractions were prepared: 100% hexane, acetate/hexane 1:1, 100% ethyl acetate, and water. The effect of the fractions on planktonic cells was assessed by counting the colony-forming units per milliliter (CFU/mL). Biofilm tests included CFU/mL, cell metabolic activity, and qualitative analysis using confocal laser scanning microscopy (CLSM). Results were analyzed by the Mann-Whitney U test (α = 0.05). The fractions contained lipophilic constituents, styrylpyrones, glycosylated flavonoids, and alkaloids. Acetate/hexane (1:1) and 100% ethyl acetate fractions reduced the CFU/mL of planktonic C. albicans. C. moschata fractions did not affect planktonic S. mutans. For biofilms, the fractions reduced the CFU/mL (from 2-5 logs) and cell metabolic activity (approximately 80% reduction in a single-species biofilm). CLSM showed the fractions reduced microorganism viability and damaged the extracellular matrix of biofilms. We conclude that the acetate/hexane 1:1 and 100% ethyl acetate C. moschata fractions exhibit antimicrobial effects against biofilms.

Reduction of Multispecies Biofilms on an Acrylic Denture Base Model by Antimicrobial Photodynamic Therapy Mediated by Natural Photosensitizers

OBJECTIVES

The aim of this study is to investigate the antimicrobial efficacy of antimicrobial photodynamic therapy (PDT) using natural photosensitizers (curcumin, riboflavin, and phycocyanin) and light-emitting diode (LED) irradiation against multispecies biofilms in an acrylic denture base model.

MATERIALS AND METHODS

Forty-five acrylic specimens were fabricated using heat-curing acrylic resin. The specimens were then infected with a mixed culture of bacterial and fungal species (including Streptococcus mutans, Streptococcus sanguinis, Candida albicans, and Candida glabrata) for 4 days. The acrylic discs were divided into nine groups, with each group containing five discs: control, 0.2% chlorhexidine, 5.25% sodium hypochlorite, curcumin, riboflavin, phycocyanin alone or along with LED. After treatment, the number of colony-forming units (CFUs) per milliliter was counted. In addition, the extent of biofilm degradation was assessed using the crystal violet staining method and scanning electron microscopy.

RESULTS

All experimental groups exhibited a significant reduction in colony numbers for both bacterial and fungal species compared to the control (p < 0.001). The PDT groups exhibited a statistically significant reduction in colony counts for both bacteria and fungi compared to the photosensitizer-only groups.

CONCLUSIONS

The results of this in vitro study show that PDT with natural photosensitizers and LED devices can effectively reduce the viability and eradicate the biofilm of microorganisms responsible for causing denture infections.

Effectiveness of Lemon Verbena (Cymbopogon citratus) in Oral Candidiasis: A Systematic Review

The rise of phytotherapy has enabled the utilization of various plant species for medicinal purposes, such as Cymbopogon citratus (C. citratus), providing solutions for oral pathologies, such as oral candidiasis. The PubMed, Web of Science, Scopus, and SciELO databases were searched. In vivo and in vitro studies on the action of C. citratus against oral candidiasis were included, and ROBINS-I was used to determine study quality and risk of bias. The search yielded 1922 articles, of which 10 met the inclusion criteria. Limited scientific evidence exists regarding the use of C. citratus for oral candidiasis. However, studies have indicated its potent antifungal effects. Further studies, preferably clinical trials, are necessary to confirm this effect and to enable its clinical use as a therapeutic option.

Evaluation of adherence of Candida albicans to differently manufactured acrylic resin denture base materials

STATEMENT OF PROBLEM

Though computer-aided design and computer-aided manufactured (CAD-CAM) denture bases have become popular, evidence on the ability of C. albicans cells to adhere to these denture bases is lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the adherence of Candida albicans to differently manufactured acrylic resin denture bases.

MATERIAL AND METHODS

Acrylic resin disks were fabricated using a total of 6 different fabrication methods (compression molding, injection molding, CAD-CAM milling, and rapid prototyping on 3 different printers with 3 different resins). Each material was evaluated for adherence of C. albicans using 2 different experimental methods - suspension in inoculated tryptic soy broth (TSB) or placed onto a uniform lawn of C. albicans on tryptone soya agar (TSA) with 5% sheep's blood. Attached cells were quantified by spiral plating and then used to re-inoculate sterile plates. Logarithmic transformation was completed to normalize data. For the broth suspension, the Kruskal-Wallis test was used to identify any differences between the 6 specimen types in terms of recovery, and the Dunn test was used for post hoc analysis. For the microbial lawn experiment, 1-way analysis of variance (ANOVA) and then the Tukey Honestly Significant Difference (HSD) post hoc test were used.

RESULTS

Statistically significant differences were found between the numbers of adherent cells based on manufacturing method and between experimental designs (P<.05). All resins demonstrated growth with re-inoculation.

CONCLUSIONS

Though statistical significance was noted, neither experimental technique demonstrated what is likely a clinically significant preferential binding to any particular resin surface. Attached Candida cells are effective carriers of pathogens to uninfected surfaces. Further studies are indicated for potential virulence factors and differences in printed resins.

Dental and ENT Evaluation Before Liver Transplantation

The assessment of dental and ear, nose and throat (ENT) conditions holds significant importance in the pre-transplantation evaluation for individuals undergoing liver transplantation. This evaluation aims to address concerns related to dental and ENT issues both before and after liver transplantation. These concerns include the risk of sepsis, the impact of post-transplantation immunosuppression, the detection of existing malignancies, including oral potentially malignant disorders (OPMDs), and identifying any contraindications to the transplantation procedure. However, it is worth noting that there exists a notable absence of clear guidelines and protocols in the existing literature regarding this practice. Moreover, recent studies have presented conflicting results, and concerns have arisen regarding the cost-effectiveness of these evaluations. It is crucial to perform these investigations judiciously to avoid unnecessary testing burdens and delays in placing patients on waiting lists, particularly when considering live donor liver transplantation (LDLT) evaluations. A comprehensive examination of the oral and ENT regions, in conjunction with relevant laboratory tests, can play a pivotal role in identifying and managing oral and ENT diseases before the liver transplantation procedure. Timely recognition and treatment of potential issues are essential for minimizing perioperative morbidity and mortality. There is an evident need for prospective trials and studies to further explore and establish guidelines in the critical area of dental and ENT evaluation in liver transplantation recipients. Such research efforts would contribute significantly to enhancing our understanding and management of oral and ENT conditions in the pre-transplantation setting, ultimately improving patient care and outcomes.

The flexural strength of orthodontic acrylic resin containing resveratrol nanoparticles as antimicrobial agent: An in vitro study

OBJECTIVE

This study aimed to evaluate how the addition of resveratrol nanoparticles (RNPs), which act as an antimicrobial agent, affects the strength of acrylic resin used in orthodontics.

METHODS

According to ISO 20795-1-2013, 76 cold cure acrylic resin samples (65×10×3.3mm) were prepared. The samples were divided into four groups (19 samples in each group) based on RN concentrations added to 1mL acrylic monomer (0 for control, 256, 512, and 1024μg/mL). Flexural strength was assessed in megapascal (MPa) using a universal testing machine. Data analysis involved nonparametric Kruskal-Wallis analysis of variance and pairwise post-hoc Dunn's test.

RESULTS

The flexural strength decreased as the concentration of RNPs increased, with the lowest value observed at 1024μg/mL (63.06±5.33MPa). The control group exhibited the highest mean of flexural strength (88.43±4.41MPa), followed by the groups with RNPs at the concentrations of 256μg/mL (82.69±4.41MPa) and 512μg/mL (76.02±4.59MPa).

CONCLUSION

In conclusion, the addition of RNs to orthodontic acrylic resin had a dose-dependent impact on its flexural strength. Based on the findings, we recommend incorporating RNs at a concentration of 256μg/mL as an antimicrobial agent in orthodontic acrylic resin. However, further research is necessary to assess the long-term effects and clinical applications of this approach.

Mechanophysical and Anti-Adhesive Properties of a Nanoclay-Containing PMMA Denture Resin

Poly(methyl methacrylate) (PMMA) is commonly used for dental dentures, but it has the drawback of promoting oral health risks due to oral bacterial adhesion. Recently, various nanoparticles have been incorporated into PMMA to tackle these issues. This study aims to investigate the mechanophysical and antimicrobial adhesive properties of a denture resin by incorporating of nanoclay into PMMA. Specimens were prepared by adding 0, 1, 2, and 4 wt % surface-modified nanoclay (Sigma) to self-polymerizing PMMA denture resin. These specimens were then evaluated using FTIR, TGA/DTG, and FE-SEM with EDS. Various mechanical and surface physical properties, including nanoindentation, were measured and compared with those of pure PMMA. Antiadhesion experiments were conducted by applying a Candida albicans (ATCC 11006) suspension to the surface of the specimens. The antiadhesion activity of C. albicans was confirmed through a yeast-wall component (mannan) and mRNA-seq analysis. The bulk mechanical properties of nanoclay-PMMA composites were decreased compared to those of pure PMMA, while the flexural strength and modulus met the ISO 20795-1 requirement. However, there were no significant differences in the nanoindentation hardness and elastic modulus. The surface energy revealed a significant decrease at 4 wt % nanoclay-PMMA. The antiadhesion effect of Candida albicans was evident along with nanoclay content in the nanocomposites and confirmed by the reduced attachment of mannan on nanoclay-PMMA composites. mRNA-seq analysis supported overall transcriptome changes in altering attachment and metabolism behaviors on the surface. The nanoclay-PMMA materials showed a lower surface energy as the content increased, leading to an antiadhesion effect against Candida albicans. These findings indicate that incorporating nanoclay into PMMA surfaces could be a valuable strategy for preventing the fungal biofilm formation of denture base materials.

Development of novel antimicrobial acrylic denture modified with copper nanoparticles

PURPOSE

This study aimed to synthesize heat-cured poly(methyl methacrylate) (PMMA) acrylic formulated with copper nanoparticles (nCu) for producing dentures with antimicrobial properties and ability to prevent denture stomatitis (DS).

METHODS

nCu/PMMA nanocomposites were prepared through in situ formation of nCu into methyl methacrylate (MMA). The fabricated material was characterized using scanning electron microscopy, spectroscopy (energy-dispersive X-ray, attenuated total reflectance-Fourier-transform infrared, and X-ray photoelectron spectroscopy), X-ray diffraction analysis, and mechanical flexural tests (ISO 20795-1:2008). Antimicrobial activity against Candida albicans and oral bacteria was determined. MTS assay (ISO 10993-5:2009) and copper release experiments were conducted to assess cytotoxicity. In the clinical trial, participants wearing nCu/PMMA (n=25) and PMMA (n=25) dentures were compared; specifically, DS incidence and severity and Candida species proliferation were assessed for 12 months. Data were analyzed using analysis of variance with Tukey's post hoc test (α=0.05).

RESULTS

nCu/PMMA nanocomposite loaded with 0.045% nCu exhibited the maximum antimicrobial activity against C. albicans and other oral bacteria without producing cytotoxicity in the wearer. nCu/PMMA dentures retained their mechanical and aesthetic properties as well as inhibited the growth of Candida species on both denture surface and patient palate. DS incidence and severity were lower in the nCu/PMMA denture group than in the PMMA denture group.

CONCLUSIONS

PMMA acrylic produced with copper nanotechnology is antimicrobial, biocompatible, and aesthetic and can reduce DS incidence. Thus, this material may act as a novel preventive alternative for oral infections associated with denture use.

Current Drug Delivery Strategies for Buccal Cavity Ailments using Mouth Dissolving Wafer Technology: A Comprehensive Review on the Present State of the Art

BACKGROUND

Mouth-dissolving wafer is polymer-based matrice that incorporates various pharmaceutical agents for oral drug delivery. This polymeric wafer is ingenious in the way that it needs not be administered with water, like in conventional tablet dosage form. It has better compliance among the pediatric and geriatric groups owing to its ease of administration.

OBJECTIVE

The polymeric wafer dissolves quickly in the oral cavity and is highly effective for a targeted local effect in buccal-specific ailments. It is a safe, effective, and versatile drug delivery carrier for a range of drugs used to treat a plethora of oral cavity-specific ailments that inflict common people, like thrush, canker sores, periodontal disease, benign oral cavity tumors, buccal neoplasm, and malignancies. This review paper focuses thoroughly on the present state of the art in mouth-dissolving wafer technology for buccal drug delivery and targeting. Moreover, we have also addressed present-time limitations associated with wafer technology to aid researchers in future developments in the arena of buccal drug delivery.

CONCLUSION

This dynamic novel formulation has tremendous future implications for designing drug delivery systems to target pernicious ailments and diseases specific to the buccal mucosa. In a nutshell, this review paper aims to summarize the present state of the art in buccal targeted drug delivery.

Comparison of the main pathogenic microorganisms of various common oral diseases in children and adults

The microorganisms in the human body gradually change and maintain a dynamic balance with the development of physiology and pathology. Oral microbiota is one of the most important microbiota in human body. It is not only closely related to the occurrence and development of oral diseases, but also plays an important role in the overall health. In childhood, the population of oral microorganisms is relatively small, but with the growth of age and tooth development, the species and quantity of oral microorganisms are gradually increasing. Different oral diseases also have their corresponding main microorganisms, and these dominant microorganisms change at different stages of the disease. In this review, we summarized and compared the main pathogenic microorganisms of several common oral diseases in children and adults. In addition, the possible association and difference between adults and children of the main pathogenic microorganisms in different stages of the same or different diseases are also discussed in order to provide research data for the development and diagnosis of common oral diseases in children and adults.

Highlights on Drug and Ion Release and Recharge Capacity of Antimicrobial Removable Prostheses

This article aimed to review the ion and drug release, recharge abilities, and antimicrobial properties of drug/ion-releasing removable prostheses, and to assess their capability in preventing and inhibiting denture stomatitis as well preventing caries and reversing carious lesions. Data was collected from published scientific papers listed in PubMed database from January 1975 to December 2021. English full-text articles, involving clinical or in vitro studies, focusing on removable prostheses and are concerned with drug/ion release and rechargeability as a way to prevent or inhibit denture stomatitis or dental caries were included. The relevant articles reported that ion- or drug-modified polymethylmethacrylate acts as a reservoir for these ions and drugs and is capable of releasing significant amounts with sustained release effect. Recharging of modified resin resulted in greater sustainability of ion and drug release, thus improving the long-term effects of protection against demineralization and reducing the adhesion of Streptococcus mutans and Candida albicans. Modifications of removable prostheses with rechargeable ions and drugs enhance remineralization, hinder demineralization, and reduce microbial adhesion in difficult-to-access areas. Selection of denture base for clinical use will consider its ability to act as an ion/drug reservoir that is capable of release and recharge.

Anti-multispecies microbial biofilms and anti-inflammatory effects of antimicrobial photo-sonodynamic therapy based on acrylic resin containing nano-resveratrol

BACKGROUND

Polymethylmethacrylate (PMMA)-based removable orthodontic appliances are susceptible to microbial colonization due to the surface porosity, and accumulating the biofilms causes denture stomatitis. the present study evaluated the anti-biofilm and antiinflammatory effects of antimicrobial photo-sonodynamic therapy (aPSDT) against multispecies microbial biofilms (Candida albicans, Staphylococcus aureus, Streptococcus sobrinus, and Actinomyces naeslundii) formed on acrylic resin modified with nanoresveratrol (NR).

MATERIALS AND METHODS

Following the determination of the minimum biofilm inhibitory concentration (MBIC) of NR, in vitro anti-biofilm activity of NR was evaluated. The antibiofilm efficacy against multispecies microbial biofilm including C. albicans, S. aureus, S. sobrinus, and A. naeslundii, were assessed by biofilm inhibition test and the results were measured. To reveal the anti-inflammatory effects of aPSDT on human gingival fibroblast (HGF) cells, the gene expression levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were evaluated via quantitative real-time polymerase chain reaction (qRT-PCR).

RESULTS

According to the results, the MBIC dose of NR against multispecies microbial biofilm was considered 512 µg/mL. The highest biofilm reduction activity was observed in MBIC treated with aPSDT and 2 × MBIC exposed to light emitting diode (LED) and ultrasound waves (UW). The expression level of TNF-α and IL-6 genes were significantly increased when HGF cells were exposed to multispecies microbial biofilms (P<0.05), while after treatment with aPSDT, the expression levels of genes were significantly downregulated in all groups (P<0.05).

CONCLUSION

Overall, NR-mediated aPSDT reduced the growth of the multispecies microbial biofilm and downregulated the expression of TNF-α and IL-6 genes. Therefore, modified PMMA with NR can be serving as a promising new orthodontic acrylic resin against multispecies microbial biofilms and the effect of this new material is amplified when exposed to LED and UW.

Evaluation of the effectiveness of bioactive glass fillers against Candida albicans adhesion to PMMA denture base materials: An in vitro study

Background

Dentures with antimicrobial properties are desirable for preventing Candida albicans adhesion. This study was to assess the effectiveness of bioactive glass (BAG) on C. albicans adhesion, surface roughness, and hardness of denture base materials.

Methods

Heat-polymerized (HP) and autopolymerized (AP) acrylic resins were used to fabricate 240 disk specimens (120/material, 60/C. albicans, 60/surface roughness and hardness). Specimens were divided into five groups (n = 10) based on the BAG concentration: 0.5, 1.5, 3, 5, and 7.5 wt% of the acrylic powder, with a control group comprised of unmodified specimens. Direct culture method was used to assess C. albicans adhesion. A profilometer and Vickers hardness test were used to measure surface roughness and hardness respectively. Analysis of variance (ANOVA) and post hoc Tukey's test were used for data analysis (α = 0.05).

Results

BAG addition significantly decreased the C. albicans count when compared with the control group (P < 0.001) for both HP and AP. Regarding surface roughness, there was no change in the HP acrylic resins (P > 0.05), while the AP acrylic resins exhibited significantly higher surface roughness with BAG addition (P < 0.001). The hardness of the HP and AP acrylic resins were significantly higher with the addition of BAG (P < 0.001).

Conclusions

The addition of BAG to HP and AP acrylic resins effectively decreases C. albicans adhesion. The roughness of AP acrylic resins increases with the addition of BAG, while the hardness of both HP and AP acrylic resins increase with the addition of BAG.

Efficacy of antimicrobial photodynamic therapy in disinfection of Candida biofilms on acrylic dentures: A systematic review

BACKGROUND

The aim of this systematic review was to critically analyze and summarize the currently available scientific evidence concerning antifungal efficacy of aPDT against Candida on acrylic surface.

METHODS

The focused question was: '"Is aPDT effective in minimizing the counts of Candida on acrylic dentures". A literature search was conducted interpedently on the following electronic research databases: PubMED/MEDLINE, Cochrane, Google Scholar and Embase. The MeSH terms used were: ((antimicrobial photodynamic therapy) OR (light) OR (laser) OR (photodynamic)) AND ((Candida) OR (denture stomatitis)) AND ((denture) OR (acrylic) OR (polymethylmethacrylate) OR (dental prosthesis)). Data was extracted from the studies and quality assessment was carried out using a modified version of the CONSORT checklist.

RESULTS

Eighteen in-vitro anti-microbial studies and 5 clinical studies were included. Twenty-two studies suggested that aPDT was effective in reducing the Candida count on acrylic dentures and one study did not have a significant effect. 19 out of 23 studies were graded as having 'medium' quality and 4 studies were graded as 'high'. Several photosensitizers, including methylene blue, porphyrin derivatives, toluidine blue-O and others were used. LED was the most popular light source used for photo-activation of the photosensitizers.

CONCLUSION

Within the limitations of this review, aPDT is effective in reducing Candida growth on acrylic dentures and may prove to be clinical effective in preventing or treating denture stomatitis. However, more long-term clinical research is required before its clinical efficacy can be determined.

Overview of common oral lesions

This article summarises common oral lesions that clinicians may face in everyday practice by categorising them by clinical presentation: ulcerated lesions, white or mixed white-red lesions, lumps and bumps, and pigmented lesions. The pathologies covered include recurrent aphthous stomatitis, herpes simplex virus, oral squamous cell carcinoma, geographic tongue, oral candidosis, oral lichen planus, pre-malignant disorders, pyogenic granuloma, mucocele and squamous cell papilloma, oral melanoma, hairy tongue and amalgam tattoo. The objective of this review is to improve clinician knowledge and confidence in assessing and managing common oral lesions presenting in the primary care setting.

Characterization of Cervus timorensis Velvet Antler and its Effect on Biofilm Formation of Candida Species

Oral biofilms comprise extracellular polysaccharides and polymicrobial microorganisms. The objectives of the study were to characterize the deer velvet antler (DVA) compounds and their effect on Candida species biofilm formation with the hypothesis that DVA inhibits the biofilm of Candida spp. Liquid Chromatography-Quadrupole Time of Flight-Mass Spectrometry (LC-QTOF-MS) was conducted to characterize the DVA compounds. To study the effect of DVA on biofilm, Candida albicans ATCC MYA-4901 (ALT5), AIDS isolate (ALC2), oral cancer isolate (ALC3), C. dubliniensis ATCC MYA-2975, C. glabrata ATCC 90030, C. krusei 14 243, C. lusitaniae ATCC 34449, C. parapsilosis ATCC 22019, and C. tropicalis ATCC 13803 were inoculated with DVA in separate wells of a 96-well plate containing RPMI-1640 followed by 72 h incubation. A total of 45 compounds were detected in the DVA extract. C. lusitaniae exhibited a higher percentage of biofilm biomass reduction when treated with DVA extract (66.10% ± 5.33), followed by ALC3 (44.12% ± 6.24). However, C. glabrata, C. krusei, and C. parapsilosis showed no reduction in biofilm biomass after being treated with DVA extract. Most Candida strains also exhibited decreased total cell count when treated with DVA extract, except for ALC3 and C. krusei. ALT5 had the lowest total cell count (0.17 × 105 cells/mL) when cultured with DVA extract. In conclusion, DVA extract inhibits Candida spp. biofilm formation except for C. glabrata, C. krusei, and C. parapsilosis.

Host's Immunity and Candida Species Associated with Denture Stomatitis: A Narrative Review

Denture-related Candida stomatitis, which has been described clinically in the literature, is either localized or generalized inflammation of the oral mucosa in connection with a removable prosthesis. During this inflammatory process, the mycobacterial biofilm and the host’s immune response play an essential role. Among microorganisms of this mixed biofilm, the Candida species proliferates easily and changes from a commensal to an opportunistic pathogen. In this situation, the relationship between the Candida spp. and the host is influenced by the presence of the denture and conditioned both by the immune response and the oral microbiota. Specifically, this fungus is able to hijack the innate immune system of its host to cause infection. Additionally, older edentulous wearers of dentures may experience an imbalanced and decreased oral microbiome diversity. Under these conditions, the immune deficiency of these aging patients often promotes the spread of commensals and pathogens. The present narrative review aimed to analyze the innate and adaptive immune responses of patients with denture stomatitis and more particularly the involvement of Candida albicans sp. associated with this pathology.

Antimicrobial efficacy and biocompatibility of extracts from Cryptocarya species

This study evaluated the efficacy of Cryptocarya spp extracts on biofilm of Candida albicans and its biocompatibility. Mature biofilm of C. albicans was formed on denture base acrylic resin samples and the fungicidal effect of the extracts was evaluated by Alamar Blue® assay, counting colony-forming units (CFU/mL) and confocal laser scanning microscopy (CLSM). Cytotoxicity of extracts from Cryptocarya species was evaluated by AlamarBlue® assay, using normal oral keratinocytes (NOK) cells. In additional, Analysis of plant extracts by ultra-high-performance liquid chromatography-diode array detector-tandem mass spectrometry (UPLC-DAD-MS) was performed. The results showed significant reduction in the cellular metabolism and in the number of CFU/mL of C. albicans (p<0.05). The concentration of 0.045 g/mL completely inhibited the number of CFU/mL. Regarding cytotoxicity, all extracts decreased cell viability compared to the control group. CLSM analysis showed predominance of live cells, but with a great difference between the groups. Antimicrobial activity of extracts from Cryptocarya on C. albicans biofilm was confirmed. However, all extracts showed toxicity on NOK cells.

CLEANING OF REMOVABLE DENTAL PROSTHESES - A SYSTEMATIC REVIEW

Objectives The aim of this systematic review was to provide an overview of the scientific evidence available from prospective clinical studies regarding denture hygiene interventions. Therefore, investigations addressing the efficacy of removing microorganisms and biofilms formed on the surface of removable dental prostheses (RDPs) and denture base materials in situ and their impact on the properties of denture base materials, such as color stability, surface roughness, and dimensional stability, were included. Methods A systematic literature search was conducted from June 1975-May 2020 and included articles published in English that have been indexed in the digital archives of PubMed and Cochrane (including PubMed, Embase, ICTRP, CT.gov). A complementary manual search of the initially retrieved studies was conducted. Inclusion criteria comprised prospective clinical trials with a minimum of ten participants investigating (1) approaches and methods to remove biofilms formed on the surface of RDPs and denture base materials in situ and/or (2) the influence of these biofilms on denture base materials. A total of forty-four studies were included in this systematic review, which was registered in the PROSPERO database (CRD42020189649). Results and Conclusions Data gathered from the systematic review indicate that the combined use of chemical and mechanical denture hygiene interventions is significantly more effective than single cleaning approaches. Only limited evidence is available from clinical studies regarding the effect of denture hygiene interventions on the properties of denture base materials.

Ozone ultrafine bubble water inhibits the early formation of Candida albicans biofilms

This study aimed to investigate the effect of ozone ultrafine bubble water (OUFBW) on the formation and growth of Candida albicans (C. albicans) biofilms and surface properties of denture base resins. OUFBWs were prepared under concentrations of 6 (OUFBW6), 9 (OUFBW9), and 11 ppm (OUFBW11). Phosphate buffered saline and ozone-free electrolyte aqueous solutions (OFEAS) were used as controls. Acrylic resin discs were made according to manufacturer instructions, and C. albicans was initially cultured on the discs for 1.5 h. A colony forming unit (CFU) assay was performed by soaking the discs in OUFBW for 5 min after forming a 24-h C. albicans biofilm. The discs after initial attachment for 1.5 h were immersed in OUFBW and then cultured for 0, 3, and 5 h. CFUs were subsequently evaluated at each time point. Moreover, a viability assay, scanning electron microscopy (SEM), Alamar Blue assay, and quantitative real-time polymerase chain reaction (qRT-PCR) test were performed. To investigate the long-term effects of OUFBW on acrylic resin surface properties, Vickers hardness (VH) and surface roughness (Ra) were measured. We found that OUFBW9 and OUFBW11 significantly degraded the formed 24-h biofilm. The time point CFU assay showed that C. albicans biofilm formation was significantly inhibited due to OUFBW11 exposure. Interestingly, fluorescence microscopy revealed that almost living cells were observed in all groups. In SEM images, the OUFBW group had lesser number of fungi and the amount of non-three-dimensional biofilm than the control group. In the Alamar Blue assay, OUFBW11 was found to suppress Candida metabolic function. The qRT-PCR test showed that OUFBW down-regulated ALS1 and ALS3 expression regarding cell-cell, cell-material adhesion, and biofilm formation. Additionally, VH and Ra were not significantly different between the two groups. Overall, our data suggest that OUFBW suppressed C. albicans growth and biofilm formation on polymethyl methacrylate without impairing surface properties.

Antifungal Effect of Piezoelectric Charges on PMMA Dentures

Candida-associated denture stomatitis is a recurring disease affecting up to 67% of denture wearers. Poly(methyl methacrylate) (PMMA) remains the main material employed in the fabrication of dentures due to its desirable physical, mechanical, and aesthetic properties. However, the improvement of its antimicrobial properties remains a challenge. To address this need, we developed PMMA composite filled with piezoelectric nanoparticles of barium titanate (BaTiO₃) for therapeutic effects. Candida albicans biofilms were cultivated on the surface of the composites under continuous cyclic mechanical loading to activate the piezoelectric charges and to resemble mastication patterns. The interactions between biofilms and biomaterials were evaluated by measuring the biofilm biomass, metabolic activity, and the number of viable cells. To explore the antifungal mechanisms, changes in the expression of genes encoding adhesins and superoxide dismutase were assessed using reverse transcription-polymerase chain reaction. With the addition of piezoelectric nanoparticles, we observed a significant reduction in the biofilm formation and interference in the yeast-to-hyphae transition compared to the standard PMMA. Moreover, we observed that the cyclic deformation of biomaterial surfaces without antifungal agents produced increased biomass, metabolic activity, and a number of viable cells compared to the static/no-deformed surfaces. Cyclic deformation appears to be a novel mechanobiological signal that enables pathogenicity and virulence of C. albicans cells with increased expression of the yeast-to-hyphae transition genes. The outcome of this study opens new opportunities for the design of antifungal dentures for improved clinical service and reduced need for cleaning methods.

Microbicidal effect of 405-nm blue LED light on Candida albicans and Streptococcus mutans dual-species biofilms on denture base resin

This study investigated: (1) the microbicidal effect of 405-nm blue LED light irradiation on biofilm formed by Candida albicans hyphae and Streptococcus mutans under dual-species condition on denture base resin, (2) the generation of intracellular reactive oxygen species (ROS) induced by irradiation, and (3) the existence of intracellular porphyrins, which act as a photosensitizer. Denture base resin specimens were prepared and C. albicans and S. mutans dual-species biofilms were allowed to form on the specimens. The biofilms were irradiated with 405-nm blue LED light and analyzed using the colony-forming unit assay, fluorescence microscopy, and scanning electron microscopy (SEM). Single-species biofilms of C. albicans and S. mutans formed on the specimens were irradiated with 405-nm blue LED light. After the irradiation, the intracellular ROS levels in C. albicans and S. mutans cells were measured. In addition, the level of intracellular porphyrins in C. albicans and S. mutans were measured. Irradiation for more than 30 min significantly inhibited the colony formation ability of C. albicans and S. mutans. Fluorescence microscopy revealed that almost all C. albicans and S. mutans cells were killed by irradiation. SEM images showed various cell damage patterns. Irradiation led to the generation of intracellular ROS and porphyrins were present in both C. albicans and S. mutans cells. In conclusion, irradiation with 405-nm blue light-emitting diode light for 40 min effectively disinfect C. albicans hyphae and S. mutans dual-species biofilms and possibly react with intracellular porphyrins resulting in generation of ROS in each microorganism.

Retentive efficacy, antimicrobial and cytotoxicity comparisons between different types of commercial and experimental denture adhesives with antifungal action

The effect of the addition of nystatin and an alternative antifungal derived from pyrazoles in different commercial denture adhesives on their retentive efficacy, cytotoxicity and antimicrobial activity against Candida albicans was evaluated. Commercial denture adhesives were prepared with the inclusion of nystatin and 3,5-diaryl-4,5-dihydro-1H-pyrazole-1-carboximidamide (pyrazole) in three concentrations: 23.78 %w/w, 3.02 %w/w, and 0.31 %w/w (0.015 g, 0.0015 g, and 0.00015 g, respectively). The retentive efficacy was tested observing the influence of the medium, type of commercial denture type and the test condition (dipping). The antifungal action through disk diffusion and direct contact tests at 1, 4, 8 and 12 h and cytotoxic activity was evaluated in mouse fibroblasts (NIH/3T3) by the MTT reduction colorimetric assay. The addition of pyrazole and nystatin in commercial denture adhesives did not affect retentive efficacy rates and enhanced antifungal actions against Candida albicans. Results show a possibility of using denture adhesives as a delivery system for commercial antifungals (Nystatin) or pyrazole, with the second concentration (1,560 µg-3.02 %w/w) as the most efficient.

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.

Considerations for the Prosthetic Dental Treatment of Geriatric Patients in Germany

Demographic changes in the industrialized countries require that dentists adapt to the growing and heterogeneous group of elderly patients and develop concepts for the dental care of fit, frail, and dependent old and very old people. In general, dental care for old and very old people should be based on their individual everyday life. As a result of demographic changes, improved oral hygiene at home, and the establishment of professional teeth and denture cleaning, tooth loss occurs increasingly in higher ages, which implies that first extensive prosthetic rehabilitation with fixed or/and removable dental prostheses is shifting to a higher average age than ever before. This phenomenon requires that the individual diseases, potential multimorbidity and polypharmacy, and associated limitations are taken into consideration. Against this background, the current survey aims to summarize epidemiological trends associated with tooth loss, using Germany as a highly representative country for demographic changes as an example. Furthermore, the current narrative summary outlines general principles that should be followed in dental care, treatment of geriatric patients, and outlines current therapeutic options in prosthetic dentistry.

Detection of Helicobacter pylori in oral yeasts from students of a Chilean university

INTRODUCTION

Nearly 73% of the Chilean population is infected with Helicobacter pylori (H. pylori), a factor predisposing for gastric cancer. Recent studies have demonstrated the presence of this pathogen within yeasts, suggesting that this fact can directly influence the failure of a treatment, transmission, and reinfection.

AIM

To detect the presence of H. pylori inside oral yeasts isolated from students of the University of Concepción (Chile).

METHODS

72 samples, obtained from the oral cavity using cotton swabs were incubated in YPD broth for 48h at 37°C and posteriorly seeded in Sabouraud Dextrose agar plus chloramphenicol at the same temperature and for the same time. Yeasts isolated were observed microscopically (wet mounting and Gram-stained) and identified using microbiological techniques. Intracellular H. pylori detection was performed by the amplification of 16S rDNA by PCR.

RESULTS

Oral yeasts were detected in 24 samples (33.3%), being C. albicans (79.2%) the most frequent species, followed by C. dubliniensis (12.4%), C. krusei (4.2%), and C. tropicalis (4.2%). When analyzed by PCR, 15 of the 24 oral yeasts 62.5 % were positive for H. pylori 16S rDNA. From the 15 individuals positive for yeast harboring H. pylori, 81% of them reported stomach discomfort, and the presence of the bacteria was diagnosed at some moment in 20% of them.

CONCLUSION

The intracellular presence of the H. pylori in oral yeasts suggests an endosymbiotic relationship of these microorganisms, which could favor H. pylori transmission and reinfection in the gastrointestinal tract.

Antagonistic effect of isolated and commercially available probiotics on the growth of Candida albicans on acrylic resin denture surfaces

STATEMENT OF PROBLEM

Biofilms can be retained on dental prostheses leading to the development of infections. The indiscriminate use of antifungal drugs can result in the development of microorganisms that are resistant to these antimicrobial agents. Whether probiotics are a suitable alternative for reducing the prevalence of oral candidiasis is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the influence of 6 different live strains of probiotics and 2 commercially available probiotic supplements used for inhibiting the growth of Candida albicans biofilm in heat-polymerized acrylic resin denture base material and to determine whether biofilm byproducts modify the surface of specimens.

MATERIAL AND METHODS

Biofilms of C. albicans were formed on acrylic resin specimens in the presence of probiotics and quantified by colony-forming units (CFUs), and the surface roughness (Ra) of the specimens was assessed before and after the formation of biofilms. The CFU and roughness data were analyzed by analysis of variance and the Tukey HSD test (α=.05).

RESULTS

A significant decrease in the number (CFU/mL) of C. albicans cells was found when they were cultured with 4 probiotics: B. lactis (P=.045), B. longum (P<.001), L. casei (P<.001), and L. helveticus (P<.001) and with the commercially available probiotic Prolive (P=.05). The Ra of specimens decreased after exposure to different microbial biofilms (P≤.05) except in 3 experimental groups.

CONCLUSIONS

In general, the tested probiotics had an antagonistic effect on the growth of C. albicans, and the surface of acrylic resin was altered after exposure to biofilm byproducts.

Biological and Mechanical Properties of Denture Base Material as a Vehicle for Novel Hydroxyapatite Nanoparticles Loaded with Drug

Purpose: This study aimed to evaluate the biological and mechanical properties of the poly(methyl methacrylate) (PMMA) denture base material as a vehicle incorporating novel hydroxyapatite nanoparticles (HA-NP) loaded with metronidazole (MZ) drug.

Methods: HA-NP was prepared via wet-chemical-method, characterized by XRD, SEM/EDX, TEM, Fourier-transform infrared spectroscopy (FTIR), as well as the measurement of surface area and pore-size distribution. Four drug delivery formulas were prepared in the form of discs (10 x 2 mm) as follows: F1 (MZ/ HA-NP/PMMA), F2 (HA-NP/ PMMA), F3 (control-PMMA) and F4 (MZ/PMMA). Characterization of all formulas was performed using differential scanning calorimetry (DSC) and FTIR. MZ release rate, antimicrobial properties against three oral pathogens, cytotoxicity (MTT assay) and surface micro-hardness were also assessed. Statistical analysis of data was performed using one-way ANOVA test (P < 0.05).

Results: DSC thermograms showed compatibility among MZ, HA-NP and PMMA along with physical stability over 6 months storage period at room temperature. FTIR spectroscopy proved the absence of any possible chemical interaction with MZ. MZ-HA-NP/PMMA formula showed relatively better drug release compared to MZ-PMMA. Both formulas showed statistically significant antimicrobial potentials against two microbial strains. MTT demonstrated reduction in cell cytotoxicity after 96 hours with the least value for HA-NP. Surface micro-hardness revealed non-significant reduction compared with the control PMMA.

Conclusion: A novel biocompatible drug nanocarrier (HA-NP) was developed and incorporated in PMMA denture base material as a vehicle to allow prolonged sustained drug release to manage oral infections.

Association between Vitamin D and Candida-Associated Denture Stomatitis

Candida-associated denture stomatitis (CADS) is a fungal infection affecting 60–65% of denture wearers. Its etiology is complex and multifactorial and often associated with host immunodeficiency. Evidence exists that vitamin D has potential immunomodulatory and anti-inflammatory effects. The aim of this case–control study was to assess the association between vitamin D levels and CADS. The study included 32 complete denture wearers with CADS and 32 sex- and age-matched complete denture wearers without CADS. The patients were clinically examined, and the severity of denture stomatitis was assessed according to Newton’s classification scale. The serum vitamin D level was determined via the use of an electrochemiluminescence assay. The vitamin D level in the CADS group and control group was 54.68 ± 17.07 and 56.82 ± 17.75 nmol/L, respectively. There was no significant difference between the groups (p = 0.622). Univariate logistic regression analysis showed that the presence of CADS was not associated with hypovitaminosis D (odds ratio (OR) = 1.44; 95% confidence interval (CI) = 0.37–5.54). It can be concluded that vitamin D is not associated with CADS and does not play a significant role in host susceptibility to CADS. This finding suggests that vitamin D screening is not indicated routinely in patients with Candida-associated denture stomatitis.

Surface Characterization, Antimicrobial Activity, and Biocompatibility of Autopolymerizing Acrylic Resins Coated with Reynoutria elliptica Extract

We conducted surface characterization to assess the biocompatibility and investigate the antimicrobial activity against oral pathogens in autopolymerizing acrylic resins, coated with light-curable coating resin, containing various concentrations of Reynoutria elliptica extract (0, 200, 400, and 600 µg/mL). The R. elliptica extract powder was prepared using a freeze-drying technique. Further, a goniometer and microhardness tester were used to determine the water contact angle, and Vickers hardness, respectively; color measurements were performed on the uncoated and coated acrylic resin disks. The polyphenol content of the extracts from the coated acrylic resin disk was analyzed using UV-VIS spectroscopy. The antimicrobial activity of the coated acrylic resin disk against Streptococcus mutans and Candida albicans was observed for 24 and 48 h by measuring the optical density using spectrophotometry. In addition, biocompatibility was confirmed by testing the cell viability according to ISO 10993-5. The water contact angle, Vickers hardness, and color change values of the coated acrylic resin disks were not significantly different from the control. Polyphenol was detected in all experimental groups, with no significant differences between the experimental groups. The experimental groups exhibited significant antimicrobial activity against S. mutans and C. albicans compared to the control group, after 48 h of incubation. The cell viability between the control and experimental groups was not significantly different. The proposed coating resin containing R. elliptica extract is applicable on dental acrylic resins, due to their antimicrobial properties and excellent biocompatibility, with no deterioration of surface characteristics.

The influence of Azadirachta indica, Melaleuca alternifolia, and Cocos nucifera on Candida albicans strain in tissue conditioner at varying time intervals

Aim:

The search for alternative therapies for oral candidiasis is a necessity and the use of medicinal plants seems to be one such promising solutions. Incorporation of phytotherapeutic agents, Azadirachta indica (neem oil), Melaleuca alternifolia oil (tea tree oil), and Cocos nucifera oil (coconut oil), were tested for their efficacy as antifungal agents against Candida albicans. Next, the efficacy of these three antifungal agents when incorporated in a soft relining material at minimum inhibitory concentration (MIC) was evaluated.

Settings and Design:

Evaluative - In-vitro study design.

Materials and Methods:

The MIC against C. albicans ATCC 24433 was calculated for M. alternifolia oil, A. indica oil, and C. nucifera oil using the broth microdilution method. Based on the preliminary screening results for MIC, tissue conditioner samples were prepared to evaluate the zone of inhibition (ZOI) and MIC. Antifungal activity of the MIC of the three oils was assessed and compared by measuring the mean ZOI. Antifungal activity of the three oils was assessed using one-way analysis of variance (ANOVA) and post hoc test.

Statistical Analysis Used:

Oneway ANOVA and post hoc Tukey honestly significant difference test.

Results:

Inhibition against C. albicans was exhibited when 20% v/v, 25% v/v, and 15% v/v of C. nucifera oil, M. alternifolia oil, and A. indica oil were used, respectively. The results of ANOVA and post hoc test at the end of 48 h and 7 days suggested that all three oils were significantly different from each other (P = 0.000) and A. indica/neem oil with 15% concentration had the best antifungal activity at the end of 48 h and 7 days.

Conclusion:

The antimycotic activity of M. alternifolia, C. nucifera, and A. indica mixed with the Visco-gel tissue conditioner can be used as an alternative therapy for denture stomatitis.

In vitro adherence of Candida albicans to zirconia surfaces

OBJECTIVES

This study aimed to characterize surface properties such as roughness (Ra) and surface-free energy (SFE) of glazed and polished yttria-stabilized zirconia and to evaluate in vitro adherence of fungus Candida albicans and salivary bacteria, Staphylococcus epidermidis, mixed with C. albicans to these substrata. Additionally, the influence of salivary proteins (albumin, mucin and α-amylase) on yeast adhesion was studied.

MATERIAL AND METHODS

Ra and SFE of glazed and polished zirconia discs were measured. Specimens were wetted with saliva and salivary proteins prior to incubation with C. albicans and mixed suspension of C. albicans and S. epidermidis for 24 hr, respectively. Microbial adhesion was quantified by counting colony-forming units (CFU). Differences in physicochemical properties were proved by t test. "Linear mixed model" with the factors "type of surface" and "wetting media" was applied to analyse the effects on fungal adhesion (p < .05).

RESULTS

SFE and Ra of glazed specimens were significantly higher than corresponding values of polished ones. The wetting media significantly changed the fungal binding (p = .0016). Significantly higher quantities of adhering fungi were found after mucin incubation compared to saliva (p = .004). For the factor "surface" as well as the interaction between "surface" and "wetting media," no statistically significant differences have been found. In mixed suspension, the growth of Candida was completely prevented.

CONCLUSIONS

Glazed and polished zirconia differs in terms of physicochemical surface properties. These differences appear to be modulated by pellicle coating affecting the biomass of adhered Candida. Mucin seems to be good binding sites for adhesion of C. albicans.

Relationship between oral hygiene and fungal growth in patients: users of an acrylic denture without signs of inflammatory process

Objectives

To answer to the following questions: is there any relationship between oral hygiene and the growth of yeast in patients without mucosal inflammation; and is there a need for mycological examination patients without mucosal inflammation?

Background

Patients with candidiasis may report varied symptoms, but such infections are most often asymptomatic. In addition to its high incidence in denture users (60%-100%), there is a concern that Candida species from the oral cavity may colonize the upper gastrointestinal tract and lead to septicemia, which has a 40%-79% mortality rate and can require a prolonged hospital stay. It is thus important for all physicians to be aware of the risk factors, diagnosis, and treatment of oral candidiasis in older patients.

Methods

A retrospective study was carried out on a group of patients who had undergone mycological examination and assessment of the intensity of yeast growth, and oral hygiene.

Results

Ninety-one denture wearers who lacked signs of clinical inflammation were included in the study. The growth of Candida albicans was as follows: 14 patients had up to 20 colonies; 19 patients had over 20 colonies. Ten percent of patients with good oral hygiene proved to have more than 20 yeast colonies. 5% of patients with bad oral hygiene had more than 20 colonies.

Conclusions

There was no relationship found between hygiene and the growth rate of fungal microorganisms. In patients without clinical symptoms of stomatitis, mycological examination should be considered.

Efficacy of removing Candida albicans from orthodontic acrylic bases: an in vitro study

Background

This study evaluated the efficacy of four methods in removing Candida albicans from the acrylic base material used to fabricate removable orthodontic appliances.

Methods

Heat-processed bars of orthodontic acrylic were incubated in a suspension of C. albicans for 2 h at 37 °C. Samples were allocated into five groups (five bars per group) according to the cleaning method: (1) manual brushing using a toothbrush; (2) soaking in a commercial denture cleaning solution; (3) soaking in a commercial mouthwash solution; (4) using an ultrasonic cleaner; and (5) soaking in distilled water as a negative control. Yeast remaining attached to the bars after cleaning were removed by vortexing in growth medium and plated on Sabouraud dextrose agar. The reduction in yeast colony count after cleaning was calculated and expressed as the number of colony forming units per acrylic bar (CFU/bar). The experiment was carried out three times.

Results

All four cleaning methods resulted in a significant decrease in viable yeast cells associated with the acrylic bars compared to the control group. The mean percentage reduction in viable yeast cells affected by the cleaning methods was: brushing 89.9%; chlorhexidine 95.8%; ultrasonic cleaning 99.9%; and denture tablet 100%.

Conclusions

All four methods evaluated in this study were effective, to some extent, in removing C. albicans from orthodontic acrylic samples. The most effective, and readily available, cleaning method was the use of commercial denture sterilizing tablets.

In vitro assessment of the antifungal effects of neem powder added to polymethyl methacrylate denture base material

Background

Denture with antimicrobial activities is desirable to prevent Candida albican adhesion subsequently decreasing the susceptibility of denture stomatitis incidence. Azadirachta Indica, commonly known as Neem powder has antimicrobial effect but the effect of its addition to acrylic denture base on C. albicans adhesion has not been investigated. The aim of this study was determine whether adding neem powder to acrylic denture base materials could reduce Candida albicansadhesion.

Material and Methods

One hundred and twenty acrylic resin denture specimens were fabricated and divided into heat-polymerized (n=60) and auto-polymerized (n=60) groups. Each group was further divided into 6 groups (n=10) based on the neem concentration: 0, 0.5, 1, 1.5, 2 and 2.5 wt% of the polymer. After polymerization, the specimens were polished, stored in distilled water, sonicated, sterilized, submerged in artificial saliva containing C. albicans, and finally, placed in an incubator at 37°C. Slide counting and direct culture methods were used to assess the antifungal effects of the neem addition. An analysis of variance and post hoc Tukey’s test were performed for the data analysis (p≤0.05 was statistically significant).

Results

Based on the results, the neem addition significantly decreased the C. albicans count when compared to the control group (p≤0.05). Moreover, the count decreased as the neem concentration increased (lowest count with 2.5 wt%).

Conclusions

The results suggest that adding neem powder to acrylic resin denture base materials reduces the adhesion of C. albicans; therefore, the incorporation of neem could be a possible denture stomatitis prevention method.

Key words:Denture stomatitis, Candida albicans, Azadirachta indica, neem powder, denture base.

Kinetics of antifungal activity of home-generated ozonated water on Candida albicans

Background and Purpose:

Candida-associated denture stomatitis is one of the most common forms of oral candidiasis among denture wearers. Regarding this, the aim of the present study was to evaluate the antifungal effects of home-generated ozonated water on the adhesion of the C. albicans attached to the surface of the denture base acrylic resins.

Materials and Methods:

For the purpose of the study, different concentrations of C. albicans were added to the tubes containing acrylic resin blocks, and then incubated for 2 h at 35°C. The samples were assigned into three groups, each of which contained 42 samples, including normal saline (NS) solution as the negative control, nystatin (N) solution as the positive control, and ozonated water as the test group. The samples were washed and placed in an ultrasonic bath. Subsequently, the saline solution was cultured on Sabouraud dextrose agar. The concentrations of Candida were evaluated during the contact times.

Results:

The test group (i.e., ozonated water) with 114 colony-forming units (CFU) showed a significant reduction of Candida colonies, compared to the NS group with 2,172 CFU. The 120- and 1-minute incubation with ozonated water showed the highest and lowest effects on the viability of Candida adhered to the acrylic resin, respectively.

Conclusion:

Based on the findings, home-generated ozonated water can be applied to remove the Candida attached to the surface of the denture plates.

Cytokine gene polymorphism in denture stomatitis patients: A clinical study

OBJECTIVE

This clinical study investigated the association between cytokine gene polymorphism and Candida growth in denture stomatitis (DS) patients.

SUBJECTS AND METHODS

Saliva and blood samples of 160 complete denture wearers (80 healthy controls and 80 with DS) were collected for mycological and gene polymorphism testing, respectively. Salivary Candida growth and TNF-α, TGF-β, IL-6, and IL-10 genotypes were investigated. Data were analyzed using Student's t test, Mann-Whitney U test, chi-square analysis, and continuity (yates) correction tests (p < .05).

RESULTS

Candida albicans colony counts in saliva were significantly higher in the DS group and in the TNF-α GG genotype (p < .05). TGF-β TC GG and TGF-β CC GG haplotypes were significantly higher in DS and control groups, respectively (p < .05). C. albicans colony counts were significantly higher in control group in the TGF-β TC GG haplotype (p < .05). Candida glabrata colony counts were significantly higher in the DS group than the control group in IL-6 GG genotype (p < .05). The difference between DS types in IL-6 genotypes was significant with lower expression level in DS type 3 than DS type 1 and also type 2 (p ≤ .01).

CONCLUSION

The significant differences in some genotypes of the TNF-α, TGF-β, and IL-6 in DS patients are promising in understanding the host defense in DS.

Properties of an acrylic resin after immersion in antiseptic soaps: Low-cost, easy-access procedure for the prevention of denture stomatitis

Denture stomatitis triggered by Candida species requires better preventive measures. This study evaluated the physical and biological properties of a denture base acrylic resin after immersion in antiseptic soaps. Acrylic resin specimens were prepared and stored in distinct solutions for 0, 7, 14, 21, and 28 days. The solutions were as follows: DW: distilled water at 37°C (control group); DS: cycles of daily immersion in Dettol soap for 8 hours at room temperature, followed by immersion in distilled water for 16 hours at 37°C; PS: cycles of daily immersion in Protex soap, as described for the previous group; LS: cycles of daily immersion in Lifebuoy soap, as described for the DS group. The parameters evaluated at each time point were the following: biofilm formation capacity by Candida albicans and reduction of preformed fungal biofilms, cytotoxicity, surface roughness, hardness, and color change. For the fungal adhesion phase, the type of soap had a statistically significant effect (p = 0.0292), but after 24 hours, no differences were found between solutions or between storage times. Regarding the efficacy of biofilm reduction, there was a significant difference when the groups were compared to each other (p = 0.014). Dettol and Lifebuoy eliminated the preformed biofilm on the specimens. Moreover, all the soaps were classified as non-cytotoxic (on HaCaT cell line) because there was no difference in cell viability between the different groups, except after 21 days, when a decrease in cell viability occurred, regardless of the type of soap. Regarding the roughness, there was no statistically significant difference (p > 0.05) between the groups. Lifebuoy decreased resin hardness regardless of storage time (p = 0.003). After 21 and 28 days of storage, there was an increase in hardness value, regardless of the type of soap. The specimens’ color, according to the National Bureau of Standards values, ranged from 0.27 to 0.58 (i.e., imperceptible or mild color changes). In general, the disinfectant soaps were not able to prevent biofilm formation, but all the soaps were effective in reducing the preformed biofilm. In addition, all soaps were non-cytotoxic and did not change surface roughness, hardness (except Lifebuoy), and color (except Lifebuoy). Therefore, immersion in two antiseptic soaps (Protex and Dettol) may be a cheap and easy procedure for preventing denture stomatitis.

Antifungal effect of tissue conditioners containing poly(acryloyloxyethyltrimethyl ammonium chloride)-grafted chitosan on Candida albicans growth in vitro

Background/purpose

Denture stomatitis is a pathological condition affecting the mucosa underneath ill-fitting dentures, and Candida albicans is considered its main etiologic factor. Tissue conditioners are temporary lining materials often applied to dentures to treat inflamed tissues. However, tissue conditioners do not exert antifungal activity, and the soft surface texture harbors C. albicans easily. The aim of this study was to examine the antifungal activity of tissue conditioners modified with chitosan (CS) or a quaternized chitosan (QCS), which was synthesized by grafting 2-[(acryloyloxy)ethyl] trimethyl ammonium chloride onto CS.

Materials and methods

Tissue conditioners containing varying weight percentages of CS or QCS were prepared as experimental discs 10 mm in diameter and 1 mm in thickness. Samples were co-cultured with C. albicans and the number of colony forming units was recorded. Other evaluations included cell toxicity and tensile bond strength to the resin denture base.

Results

It was found significantly fewer fungal colonies in tissue conditioners modified with CS or QCS, and none when the weight percentage of QCS exceeded 5%. CS and QCS did not affect the viability of human gingival epithelium cells or fibroblasts, and tensile bond strength did not differ between control and modified tissue conditioners.

Conclusion

This study provides a foundation for the development of QCS as a novel and safe antifungal agent applied to tissue conditioners in clinical practice.

Rosemary, Castor Oils, and Propolis Extract: Activity Against Candida Albicans and Alterations on Properties of Dental Acrylic Resins

PURPOSE

To evaluate the in vitro activity of 8% rosemary, 2% castor oils, and 12% propolis glycolic extract against Candida albicans, as well as the physical changes of properties in colorless and pink acrylic resins after immersion in these liquids.

MATERIALS AND METHODS

Colorimetric, roughness, and Knoop microhardness assays were evaluated in 25 specimens distributed into five groups (3 test groups and 2 control groups - distilled water and hypochlorite 1%), totaling five specimens per group for each acrylic resin (colorless and pink). The specimens were individually immersed for 30 minutes in 10 mL of these liquids, washed, and dried once a week. They were maintained in distilled water at 37°C between processes during all experiments. The analyses were performed before immersion and in the 4th and/or 12th month. In vitro, 18 acrylic resins were exposed to C. albicans and, after a process of 30 minutes in immersion in the five groups cited and oil vehicle control of vesicle (liquid Vaseline), the specimens were washed and incubated for 24 hours in 37°C. The growth was determined by colony counting. For comparisons between the groups in each trial and the disinfection test, paired Student's t-tests and ANOVA with post hoc Tukey were performed by the SPSS program, considering α = 0.05.

RESULTS

None of the liquids altered the microhardness, but all the natural compounds and 1% sodium hypochlorite (control) altered color and roughness after the 12th month of immersion in these agents. In the colorless specimens, 8% rosemary oil caused a color change similar to water, and less color and roughness alterations when compared to 2% castor oil and 1% sodium hypochlorite, respectively. There was no growth of yeast colonies after immersion in rosemary oil, propolis glycolic extract, and 1% sodium hypochlorite.

CONCLUSION

Eight percent rosemary oil has the potential to be used as an acrylic resin disinfectant.

Functional denture soft liner with antimicrobial and antibiofilm properties

Background/purpose

Denture soft liners, especially used for elders who have poor disinfection habits, provide a favourable environment for accumulation and colonization of microorganisms. This in vitro study is aimed to investigate the effectiveness of natural carvacrol incorporation into soft lining material on the inhibition of oral pathogens.

Materials and methods

Antimicrobial susceptibility of carvacrol was primarily determined by disc diffusion method. Soft lining material was prepared as recommended by the manufacturer and 10 μL carvacrol was added aseptically to the soft liner discs. Inhibition zones for the control discs without carvacrol (C) and carvacrol-incorporated discs (CL) were determined by disc diffusion method. The biofilm inhibition percentages of carvacrol on soft liner was determined by MTT assay and also observed by Scanning Electron Microscopy (SEM).

Results

Carvacrol displayed great antimicrobial activity for yeast, Gram-negative and Gram-positive strains. The highest inhibition zone of carvacrol (41.33 ± 1.53 mm) was measured for Bacillus subtilis strain which is followed by Candida albicans and Streptococcus sanguis (34.00 ± 1.73 mm and 32.33 ± 0.58 mm, respectively). The inhibition zones were also similar for soft liner discs with carvacrol, with the highest inhibition zones against B. subtilis, Streptococcus mutans and C. albicans (43.67 ± 0.58 mm, 40.33 ± 0.58 mm and 38.33 ± 1.15 mm, respectively). Incorporation of carvacrol into the soft liner decreased (98.03 ± 0.2%) of the biofilm formation for C. albicans.

Conclusion

Carvacrol-incorporation obviously decreased the colonization and plaque formation of oral pathogens, especially C. albicans accumulation. Carvacrol may be useful as a promising agent for antibacterial and antifungal management for denture soft lining materials.

Isolation of Candida spp. from denture-related stomatitis in Pará, Brazil

The aim of this study was to isolate and identify Candida species from the oral cavity of denture wearers with denture-related stomatitis who were attended at the University Federal of Pará (Belém City, Pará State, Brazil). A total of 36 denture wearers with denture-related stomatitis were included, and type I (50%), type II (33%) and type III (17%) stomatitis were observed. Candida spp. were isolated from 89% of the cases and included five different Candida species. C. albicans was the most frequently recovered species (78% of the cases), followed by C. famata and C. tropicalis. We observed a significant association between Candida species isolation and unsatisfactory denture condition (p = 0.0017). Our results demonstrated the highly frequency of Candida species isolation in denture wearers with denture-related stomatitis and showed the relationship between these species and poor denture maintenance.

In Vitro Evaluation of the Inhibitory Activity of Thymoquinone in Combatting Candida albicans in Denture Stomatitis Prevention

Candida albicans adhesion and proliferation on denture bases may lead to denture stomatitis, which is a common and recurrent problem in denture wearers. The goal of this study was to assess the inhibitory effect of thymoquinone incorporated in the polymethyl methacrylate denture base material against Candida albicans. Eighty acrylic resin specimens were fabricated and divided into eight groups (n = 10) according to thymoquinone concentrations of 0.5%, 1%, 1.5%, 2%, 2.5%, 3%, and 5% of acrylic powder. Two methods were used to evaluate the effect of thymoquinone on Candida albicans: the slide count and the serial dilution test. A multivariate analysis of variance (MANOVA) and the post-hoc Tukey’s Honestly Significant Difference (HSD) test were performed to compare the difference of means between the observations taken at various intervals with baseline. The p value was statistically significant at ≤0.05. According to the slide count and the serial dilution test, the mean number of adhered Candida albicans in the control group was 5436.9 ± 266 and 4691.4 ± 176.8; however, this number dramatically decreased to 0 ± 0 and 32.4 ± 1.7 in group 8 (concentration 5%). These results suggest that the incorporation of thymoquinone into the acrylic resin denture base material might be effective in preventing Candida albicans adhesion.

Nicotine Upregulates Coaggregation of Candida albicans and Streptococcus mutans

PURPOSE

Denture stomatitis is a condition of painless inflammation of denture-bearing mucosa. Reports indicate that nicotine, the major psychoactive ingredient in tobacco, increases growth of Streptococcus mutans and Candida albicans in denture biofilm. The purpose of this study was to determine the in vitro effects of nicotine on coaggregation of C. albicans with S. mutans.

MATERIAL AND METHODS

C. albicans strain ATCC 10231, S. mutans strain UA159 (ATTC 700610), and nicotine dilutions (ranging from 0 to 32 mg/ml) were used for this study. Both microorganisms were grown for 24 hours in dilutions of nicotine (0 to 32 mg/ml) made in tryptic soy broth (TSB) or TSB supplemented with 1% sucrose (TSBS; S. mutans) or yeast peptone dextrose broth (YPD; C. albicans). Suspensions of the nicotine-treated cells were prepared, mixed together and incubated for up to 24 hours to determine if there was an increase in coaggregation of nicotine-treated cells compared to the no nicotine control cells. Qualitative analysis of coaggregation was performed using a visual aggregation assay and light microscopic observation. A spectrophotometric assay was used to provide a quantitative analysis of the coaggregation.

RESULTS

The visual aggregation assay indicated a significant increase in coaggregation between C. albicans and S. mutans with increasing incubation time (0 to 24 hours) and nicotine concentrations (0 to 4 mg/ml). Microbial growth in nicotine at 4 mg/ml demonstrated a significant increase in coaggregation after 24 hours of incubation. The numbers of coaggregated S. mutans/C. albicans cells exhibited a significant increase with incubation time and nicotine concentrations when the samples were examined microscopically. More coaggregation of S. mutans and C. albicans was observed with incubation time and increased nicotine compared to the 0 mg/ml nicotine group. There was a noticeable increase of coaggregation when cells were grown in TSBS compared to TSB. Absorbance of nicotine-treated cells (0.25 to 4 mg/ml) exhibited a decrease in values compared to 0 mg/ml at 0 hours of incubation, confirming increased coaggregation.

CONCLUSION

These results demonstrated the effect of nicotine in increasing the coaggregation of S. mutans with C. albicans. Coaggregation increased with incubation time and nicotine concentration. Coaggregation was increased with S. mutans grown in TSBS compared to TSB, suggesting that growth in sucrose media leads to an increase in receptors responsible for coaggregation.

An In vitro Comparative Evaluation of Disinfectants on Standard and Clinical Microbial Strains on Heat Cure Resins

INTRODUCTION

Oral cavity is colonised by numerous micro-organisms that form a biofilm on the acrylic resin. Hence, routine hygiene is essential to prevent oral mucosal inflammation and lesions. Knowledge of appropriate disinfecting agents for acrylic resins is crucial in this context.

AIM

To compare and evaluate the effectiveness of four commercially available disinfectants on heat cure acrylic resin specimens contaminated with standard and clinical strains of two micro-organisms commonly inhabiting the oral microflora.

MATERIALS AND METHODS

Two hundred acrylic resin specimens (n=200), 10 in each group were contaminated in vitro with 1x10⁶ cells/ml suspensions of standard and clinical strains of micro-organisms (Candida albicans and Streptococcus mutans) and were immersed in four disinfectants (1% sodium hypochlorite, 2% chlorhexidine digluconate, 2% glutaraldehyde and 3.8% sodium perborate) for 10 minutes. The control group was not subjected to any disinfection process. For collection of clinical strains, oral swab was passed over the buccal mucosa and grown on blood agar culture media. Organism confirmation was done by growing them on selective culture media. Final counts of micro-organisms per ml were performed by plating method for evaluation of microbial level reduction. Results obtained were subjected to ANOVA and Tukey's test.

RESULTS

Standard strains of Candida albicans (C) and Streptoccocus mutans (S) subjected to various disinfectants showed varied mean Colony Forming Units per ml (CFU/ml) from <10,000 to 25,000 and <10000 to <50,000 respectively. Clinical strains and of Candida albicans (C) and Streptococcus mutans (S) subjected to various disinfectants showed varied mean CFU/ml from <10,000 to 50,000 and from 10,000 to 50,000 respectively. Control groups showed maximum mean CFU/ml (>10⁵). All intergroup comparisons were highly significant (p<0.001; HS) and intragroup comparisons were significant (p<0.05; S) except the comparison of clinical strains of Streptococcusmutans subjected to 2% chlorhexidine digluconate and 2% glutaraldehyde which was found to be non significant (p>0.05; NS).

CONCLUSION

Almost 1% sodium hypochlorite was found to be the most effective disinfectant for both Candida albicans and Streptococcus mutans. The least effective disinfectant being: 3.8% sodium perborate.