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Han HS, Yum H, Cho YD, Kim S. Improvement of halitosis by probiotic bacterium Weissella cibaria CMU: A randomized controlled trial. Front Microbiol 2023; 14:1108762. [PMID: 36733919 PMCID: PMC9886871 DOI: 10.3389/fmicb.2023.1108762] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
Several in vitro and in vivo studies have evaluated the effect of probiotics on oral health; however, human clinical studies are still limited. Therefore, this study aimed to examine the effects of Weissella cibaria Chonnam Medical University (CMU)-containing tablets on halitosis. This randomized, double-blinded, placebo-controlled study included 100 adults with halitosis (age, 20-70 years). The participants were randomly assigned to the test group (n = 50) and control group (n = 50). One tablet [1 × 108 colony forming units (CFU)/tablet] was to be taken each day over 8 weeks. The concentrations of volatile sulfur compounds (VSCs), bad breath improvement scores, and oral colonization of W. cibaria were measured. Psychosocial indicators including depression, self-esteem, oral health-related quality of life, and subjective oral health status were evaluated. Most variables were assessed at baseline, 4, and 8 weeks, and W. cibaria number and safety variables were assessed at baseline and 8 weeks. Intergroup comparisons were carried out using Student's t-test, Chi-square test, or Fisher's exact test on per-protocol analysis. Intragroup differences before and after intake were analyzed using the linear mixed-effect model (LMM). Per-protocol analysis was carried out in the test group (n = 45) and control group (n = 46). Total VSC was significantly lower in the probiotics group than in the placebo group at baseline (week 0, p = 0.046) and at 8 weeks (p = 0.017). The sum of hydrogen sulfide and methyl mercaptan did not differ significantly between the groups at baseline; however, it was significantly lower in the probiotics group than in the placebo group at week 8 (p = 0.012). Bad breath improvement (BBI) scores were significantly reduced at week 8 (p = 0.006) in the probiotics group. Statistically significant intergroup differences were observed for changes in the level of W. cibaria at week 8 (p < 0.001). Psychological indicators significantly improved from baseline to week 8 in the probiotics group. No safety issues were observed in either group. The levels of W. cibaria was higher in patients with halitosis using W. cibaria CMU-containing tablets. The subjective degree of bad breath and psychological indicators were improved in patients with halitosis using W. cibaria CMU-containing tablets.
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Tamura T, Zhai R, Takemura T, Ouhara K, Taniguchi Y, Hamamoto Y, Fujimori R, Kajiya M, Matsuda S, Munenaga S, Fujita T, Mizuno N. Anti-Inflammatory Effects of Geniposidic Acid on Porphyromonas gingivalis-Induced Periodontitis in Mice. Biomedicines 2022; 10:biomedicines10123096. [PMID: 36551860 PMCID: PMC9775215 DOI: 10.3390/biomedicines10123096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
Periodontal disease is predominantly caused by the pathogenic bacterium Porphyromonas gingivalis that produces inflammation-inducing factors in the host. Eucommia ulmoides is a plant native to China that has been reported to reduce blood pressure, promote weight loss, and exhibit anti-inflammatory effects. Geniposidic acid (GPA) is the major component of E. ulmoides. Herein, we investigated the effects of GPA on P. gingivalis-induced periodontitis by measuring the inflammatory responses in human gingival epithelial cells (HGECs) after P. gingivalis stimulation and GPA addition in a P. gingivalis-induced periodontitis mouse model. We found that GPA addition suppressed interleukin (IL)-6 mRNA induction (33.8% suppression), IL-6 production (69.2% suppression), toll-like receptor (TLR) 2 induction, and mitogen-activated protein kinase (MAPK) phosphorylation in HGECs stimulated by P. gingivalis. Inoculation of mice with GPA inhibited P. gingivalis-induced alveolar bone resorption (25.6% suppression) by suppressing IL-6 and TLR2 production in the serum and gingiva. GPA suppressed osteoclast differentiation of bone marrow cells induced by M-CSF and sRANKL in mice (56.7% suppression). GPA also suppressed the mRNA expression of OSCAR, NFATc1, c-Fos, cathepsin K, and DC-STAMP. In summary, GPA exerts an anti-inflammatory effect on periodontal tissue and may be effective in preventing periodontal disease.
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Affiliation(s)
- Tetsuya Tamura
- Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Ruoqi Zhai
- Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Tasuku Takemura
- Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Kazuhisa Ouhara
- Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
- Correspondence: ; Tel.: +81-82-257-5663; Fax: +81-82-257-5664
| | - Yuri Taniguchi
- Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Yuta Hamamoto
- Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Ryousuke Fujimori
- Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Mikihito Kajiya
- Department of Innovation and Precision Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Shinji Matsuda
- Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Syuichi Munenaga
- Department of General Dentistry, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Tsuyoshi Fujita
- Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Noriyoshi Mizuno
- Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
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Hamamoto Y, Ouhara K, Munenaga S, Shoji M, Ozawa T, Hisatsune J, Kado I, Kajiya M, Matsuda S, Kawai T, Mizuno N, Fujita T, Hirata S, Tanimoto K, Nakayama K, Kishi H, Sugiyama E, Kurihara H. Effect of Porphyromonas gingivalis infection on gut dysbiosis and resultant arthritis exacerbation in mouse model. Arthritis Res Ther 2020; 22:249. [PMID: 33076980 PMCID: PMC7574451 DOI: 10.1186/s13075-020-02348-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 10/07/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Porphyromonas gingivalis (Pg) infection causes periodontal disease and exacerbates rheumatoid arthritis (RA). It is reported that inoculation of periodontopathogenic bacteria (i.e., Pg) can alter gut microbiota composition in the animal models. Gut microbiota dysbiosis in human has shown strong associations with systemic diseases, including RA, diabetes mellitus, and inflammatory bowel disease. Therefore, this study investigated dysbiosis-mediated arthritis by Pg oral inoculation in an experimental arthritis model mouse. METHODS Pg inoculation in the oral cavity twice a week for 6 weeks was performed to induce periodontitis in SKG mice. Concomitantly, a single intraperitoneal (i.p.) injection of laminarin (LA) was administered to induce experimental arthritis (Pg-LA mouse). Citrullinated protein (CP) and IL-6 levels in serum as well as periodontal, intestinal, and joint tissues were measured by ELISA. Gut microbiota composition was determined by pyrosequencing the 16 s ribosomal RNA genes after DNA purification of mouse feces. Fecal microbiota transplantation (FMT) was performed by transferring Pg-LA-derived feces to normal SKG mice. The effects of Pg peptidylarginine deiminase (PgPAD) on the level of citrullinated proteins and arthritis progression were determined using a PgPAD knockout mutant. RESULTS Periodontal alveolar bone loss and IL-6 in gingival tissue were induced by Pg oral infection, as well as severe joint destruction, increased arthritis scores (AS), and both IL-6 and CP productions in serum, joint, and intestinal tissues. Distribution of Deferribacteres and S24-7 was decreased, while CP was significantly increased in gingiva, joint, and intestinal tissues of Pg-inoculated experimental arthritis mice compared to experimental arthritis mice without Pg inoculation. Further, FMT from Pg-inoculated experimental arthritis mice reproduced donor gut microbiota and resulted in severe joint destruction with increased IL-6 and CP production in joint and intestinal tissues. The average AS of FMT from Pg-inoculated experimental arthritis was much higher than that of donor mouse. However, inoculation of the PgPAD knockout mutant inhibited the elevation of arthritis scores and ACPA level in serum and reduced CP amount in gingival, joint, and intestinal tissues compared to Pg wild-type inoculation. CONCLUSION Pg oral infection affected gut microbiota dysbiosis and joint destruction via increased CP generation.
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Affiliation(s)
- Yuta Hamamoto
- Department of Periodontal Medicine, Division of Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Kazuhisa Ouhara
- Department of Periodontal Medicine, Division of Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
| | - Syuichi Munenaga
- Department of Periodontal Medicine, Division of Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Mikio Shoji
- Department of Microbiology and Oral Infection, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Tatsuhiko Ozawa
- Department of Immunology, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Jyunzo Hisatsune
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases (NIID), Toyama 1-23-1, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Isamu Kado
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical & Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Mikihito Kajiya
- Department of Periodontal Medicine, Division of Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Shinji Matsuda
- Department of Periodontal Medicine, Division of Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Toshihisa Kawai
- Department of Periodontology, Nova Southeastern University College of Dental Medicine, 3200 South University Drive, Fort Lauderdale, FL, 33328, USA
| | - Noriyoshi Mizuno
- Department of Periodontal Medicine, Division of Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Tsuyoshi Fujita
- Department of Periodontal Medicine, Division of Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kotaro Tanimoto
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical & Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Koji Nakayama
- Department of Microbiology and Oral Infection, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Hiroyuki Kishi
- Department of Immunology, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Eiji Sugiyama
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hidemi Kurihara
- Department of Periodontal Medicine, Division of Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
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Roslund K, Lehto M, Pussinen P, Groop PH, Halonen L, Metsälä M. On-line profiling of volatile compounds produced in vitro by pathogenic oral bacteria. J Breath Res 2019; 14:016010. [PMID: 31698353 DOI: 10.1088/1752-7163/ab5559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Infections by oral pathogens are one of the most common health problems worldwide. Due to the intimate connection between exhaled breath and the oral cavity, breath analysis could potentially be used to diagnose these infections. However, little is known about the volatile emissions of important oral pathogens that are connected with gingivitis and periodontitis. In this study, we have performed in vitro headspace measurements on four important oral pathogens (P. gingivalis, T. forsythia, P. intermedia and P. nigrescens) using proton transfer reaction time-of-flight mass spectrometry (PTR-TOF-MS). Some of the most abundant compounds produced by the bacteria include hydrogen sulphide, methanethiol, acetone, dimethylsulphide, isoprene, cyclopentanone and indole as tentatively assigned from the mass spectra. Several other abundant mass signals were recorded but the assignment of these is less certain. Some of the bacterial species can be separated from each other by the emitted volatile fingerprints. The results of this study can be used in potential development of a diagnostic breath test for oral infections. In addition, as several of the measured compounds are known to be toxic, the results point to an intriguing possibility of studying the connection between the bacterial virulence and the emitted volatile compounds.
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Affiliation(s)
- Kajsa Roslund
- Department of Chemistry, University of Helsinki, Helsinki, Finland
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Romero SDS, Schalch TO, do Vale KL, Ando ES, Mayer MPA, Feniar JPG, Fernandes KPS, Bussadori SK, Motta LJ, Negreiros RM, Tempestini Horliana ACR. Evaluation of halitosis in adult patients after treatment with photodynamic therapy associated with periodontal treatment: Protocol for a randomized, controlled, single-blinded trial with 3-month follow up. Medicine (Baltimore) 2019; 98:e16976. [PMID: 31574796 PMCID: PMC6775352 DOI: 10.1097/md.0000000000016976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/06/2019] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Halitosis is an unpleasant odor that emanates from the mouth. Studies show halitosis returns in a week, after treatment with PDT. Probably, bacteria living in the periodontal sulcus could recolonize the dorsum of the tongue. Until nowadays, there are no study in adult population that associates halitosis and periodontal treatment with follow-up evaluation. The aim of this randomized, controlled, single-blinded clinical trial is to treat oral halitosis in healthy adults with photodynamic therapy (PDT), associated with periodontal treatment and follow them up for 3 months. PATIENT CONCERNS:: the concerns assessments will be done over the study using anamnesis interviews and specific questionnaire. DIAGNOSES:: halitosis will be evaluated by OralChroma. INTERVENTIONS The participants (n = 40) with halitosis will be randomized into 2 groups: G1-treatment with PDT (n = 20) or G2-cleaning of the tongue with a tongue scraper (n = 20). OUTCOMES Halitosis will be evaluated by measuring volatile sulfur compounds using gas chromatography. After the treatments, a second evaluation will be performed, along with a microbiological analysis (RT-PCR) for the identification of the bacteria T. denticola. The assessment of halitosis and the microbiological analysis will be repeated. After that, patients will receive periodontal treatment. The participants will return after 1 week and 3 months for an additional evaluation. Quality of life will be measured by Oral Health Impact Profile questionnaire (OHIP-14). LESSONS This protocol will determine the effectiveness of phototherapy regarding the reduction of halitosis in adults. clinicaltrials.gov NCT03996915. ETHICS AND DISSEMINATION This protocol received approval from the Human Research Ethics Committee of Universidade Nove de Julho (certificate number: 3.257.104). The data will be published in a peer-reviewed periodical.
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Affiliation(s)
- Sergio dos Santos Romero
- Postgraduate program in Biophotonics Applied to Health Sciences, University Nove de Julho, UNINOVE
| | - Tânia Oppido Schalch
- Postgraduate program in Biophotonics Applied to Health Sciences, University Nove de Julho, UNINOVE
| | - Katia Llanos do Vale
- Postgraduate program in Biophotonics Applied to Health Sciences, University Nove de Julho, UNINOVE
| | - Ellen Sayuri Ando
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo
| | | | - Joanna Paula Gaba Feniar
- Assistant Professor of Specialization in Oral Maxillofacial Surgery and Traumatology at Fundecto – FFO, School of Dentistry – FOUSP, University of São Paulo, São Paulo, Brazil
| | | | - Sandra Kalil Bussadori
- Postgraduate program in Biophotonics Applied to Health Sciences, University Nove de Julho, UNINOVE
| | - Lara Jansiski Motta
- Postgraduate program in Biophotonics Applied to Health Sciences, University Nove de Julho, UNINOVE
| | - Renata Matalon Negreiros
- Postgraduate program in Biophotonics Applied to Health Sciences, University Nove de Julho, UNINOVE
- Assistant Professor of Specialization in Oral Maxillofacial Surgery and Traumatology at Fundecto – FFO, School of Dentistry – FOUSP, University of São Paulo, São Paulo, Brazil
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Ao M, Miyauchi M, Furusho H, Inubushi T, Kitagawa M, Nagasaki A, Sakamoto S, Kozai K, Takata T. Dental Infection of Porphyromonas gingivalis Induces Preterm Birth in Mice. PLoS One 2015; 10:e0137249. [PMID: 26322971 PMCID: PMC4556457 DOI: 10.1371/journal.pone.0137249] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/13/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Epidemiological studies have revealed a link between dental infection and preterm birth or low birth weight (PTB/LBW), however, the underlying mechanisms remain unclear. Progress in understanding the associated mechanisms has been limited in part by lack of an animal model for chronic infection-induced PTB/LBW, mimicking pregnancy under conditions of periodontitis. We aimed to establish a mouse model of chronic periodontitis in order to investigate the link between periodontitis and PTB/LBW. METHODS To establish chronic inflammation beginning with dental infection, we surgically opened mouse (female, 8 weeks old) 1st molar pulp chambers and directly infected with w83 strain Porphyromonas gingivalis (P.g.), a keystone periodontal pathogen. Mating was initiated at 6 wks post-infection, by which time dental granuloma tissue had developed and live P.g. was cultured from extracted tooth root, which serves as a persistent source of P.g. The gestational day (gd) and birth weight were recorded during for P.g.-infected and control mice, and serum and placental tissues were collected at gd 15 to evaluate the systemic and local conditions during pregnancy. RESULTS Dental infection with P.g. significantly increased circulating TNF-α (2.5-fold), IL-17 (2-fold), IL-6 (2-fold) and IL-1β (2-fold). The P.g.-infected group delivered at gd 18.25 vs. gd 20.45 in the non-infected control (NC) group (p < 0.01), and pups exhibited LBW compared to controls (p < 0.01). P.g. was localized to placental tissues by immunohistochemistry and PCR, and defects in placental tissues of P.g. infected mice included premature rupture of membrane, placental detachment, degenerative changes in trophoblasts and endothelial cells, including necrotic areas. P.g. infection caused significantly increased numbers of polymorphonuclear leukocytes (PMNLs) and macrophages in placental tissues, associated with increased local expression of pro-inflammatory mediators including TNF-α and COX-2. Further placental tissue damage was indicated in P.g. infected mice by decreased CD-31 in endothelial cells, increased expression of 8OHdG, an indicator of oxidative DNA damage, and cleaved caspase-3, a marker of apoptosis. In vitro, P.g. lipopolysaccharide significantly increased expression of COX-2, IL-8 and TNF-α, in HTR-8 trophoblasts in an NF-κB-dependent fashion. CONCLUSIONS Our novel mouse model supports previous epidemiological studies signifying dental infection as predisposing factor for PTB/LBW. We demonstrate PTB and LBW in infected mice, translocation of P.g to placental tissues, increased circulating and local pro-inflammatory markers, and the capability of P.g. LPS to directly induce cytokine production in trophoblasts, in vitro. These findings further underscore the importance of local and systemic infections and inflammation during pregnancy and suggest that prevention and/or elimination of dental infections such as marginal or periapical periodontitis before pregnancy may have a beneficial effect on PTB/LBW.
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Affiliation(s)
- Min Ao
- Department of Oral and Maxillofacial Pathobiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
- Department of Pediatric Dentistry, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
| | - Mutsumi Miyauchi
- Department of Oral and Maxillofacial Pathobiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
| | - Hisako Furusho
- Department of Oral and Maxillofacial Pathobiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
| | - Toshihiro Inubushi
- Department of Oral and Maxillofacial Pathobiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
| | - Masae Kitagawa
- Center of Oral Clinical Examination, Hiroshima University Hospital, Hiroshima University, Hiroshima, 734–8553, Japan
| | - Atsuhiro Nagasaki
- Department of Oral and Maxillofacial Pathobiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
| | - Shinichi Sakamoto
- Department of Oral and Maxillofacial Pathobiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
| | - Katsuyuki Kozai
- Department of Pediatric Dentistry, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
| | - Takashi Takata
- Department of Oral and Maxillofacial Pathobiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734–8553, Japan
- * E-mail:
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