Composition of pooled plaque fluid from caries-free and caries-positive individuals following sucrose exposure

Energy-dispersive Laue diffraction analysis of the influence of statherin and histatin on the crystallographic texture during human dental enamel demineralization

Energy-dispersive Laue diffraction (EDLD) is a powerful method to obtain position-resolved texture information in inhomogeneous biological samples without the need for sample rotation. This study employs EDLD texture scanning to investigate the impact of two salivary peptides, statherin (STN) and histatin-1 (HTN) 21 N-terminal peptides (STN21 and HTN21), on the crystallographic structure of dental enamel. These proteins are known to play crucial roles in dental caries progression. Three healthy incisors were randomly assigned to three groups: artificially demineralized, demineralized after HTN21 peptide pre-treatment and demineralized after STN21 peptide pre-treatment. To understand the micro-scale structure of the enamel, each specimen was scanned from the enamel surface to a depth of 250 µm using microbeam EDLD. Via the use of a white beam and a pixelated detector, where each pixel functions as a spectrometer, pole figures were obtained in a single exposure at each measurement point. The results revealed distinct orientations of hydroxyapatite crystallites and notable texture variation in the peptide-treated demineralized samples compared with the demineralized control. Specifically, the peptide-treated demineralized samples exhibited up to three orientation populations, in contrast to the demineralized control which displayed only a single orientation population. The texture index of the demineralized control (2.00 ± 0.21) was found to be lower than that of either the STN21 (2.32 ± 0.20) or the HTN21 (2.90 ± 0.46) treated samples. Hence, texture scanning with EDLD gives new insights into dental enamel crystallite orientation and links the present understanding of enamel demineralization to the underlying crystalline texture. For the first time, the feasibility of EDLD texture measurements for quantitative texture evaluation in demineralized dental enamel samples is demonstrated.

Supragingival microbiome variations and the influence of Candida albicans in adolescent orthodontic patients with gingivitis

Introduction

Gingivitis is a prevalent complication in adolescents undergoing fixed orthodontic treatments. However, changes in the supragingival microbiome associated with gingivitis and the impact of Candida albicans remain elusive. Therefore, we investigated supragingival microbiome discrepancy and C. albicans colonization in adolescent orthodontic patients with gingivitis.

Methods

Dental plaques were collected from 30 gingivitis patients and 24 healthy adolescents, all undergoing fixed orthodontic treatment. The supragingival microbiome composition was analyzed using 16S rRNA sequencing. C. albicans colonization was determined using fungal culture and real-time quantitative polymerase chain reaction.

Results

Our analysis revealed significantly heightened microbial diversity in the Gingivitis group. Notably, patients with gingivitis exhibited an enrichment of periodontal pathogens, such as Saccharibacteria (TM7) [G-1], Selenomonas, Actinomyces dentalis, and Selenomonas sputigena. Additionally, 33% of the gingivitis patients tested positive for C. albicans, exhibiting significantly elevated levels of absolute abundance, while all healthy patients tested negative. Significant differences in microbial composition were also noted between C. albicans-positive and -negative samples in the Gingivitis group.

Conclusion

Significant disparities were observed in the supragingival microbiome of adolescent orthodontic patients with and without gingivitis. The presence of C. albicans in the supragingival plaque may alter the microbiome composition and potentially contribute to gingivitis pathogenesis.

Amount of Dentifrice and Fluoride Concentration Affect the pH and Inorganic Composition of Dual-Species Biofilms of Streptococcus mutans and Candida albicans

This work assessed the influence of the amount of dentifrice and fluoride (F) concentration in the product on the pH and inorganic components of Streptococcus mutans and Candida albicans dual-species biofilms. The biofilms were treated with suspensions of fluoride dentifrices containing 550 or 1100 ppm of F (550 F or 1100 F, respectively) administered at comparable intensities: (i-1) 550 F/0.08 g or 1100 F/0.04 g; (i-2) 550 F/0.16 g or 1100 F/0.08 g; and (i-3) 550 F/0.32 g or 1100 F/0.16 g. A placebo dentifrice (without NaF, 0.32 g) was used as a negative control. After the last treatment, the biofilm pH was measured and the F, calcium (Ca), and phosphorus (P) concentrations were determined. Data were subjected to an ANOVA/Kruskal-Wallis test, and a Student-Newman-Keuls test. The highest biofilm pH and F concentrations (biomass and fluid) were observed for 1100 F at i-3. Overall, 1100 F resulted in F levels similar to 550 F for i-1 and i-2. In addition, 550 F applied at i-2 and i-3 led to higher F in the biomass/fluid compared to 1100 F applied at i-1 and i-2, respectively. In biomass, the lowest Ca concentrations were observed for 1100 F at i-3. The conclusion drawn is that the treatment intensity holds greater significance as a parameter compared to the concentration of F or the amount of dentifrice when considered individually.

3D printing of a controlled urea delivery device for the prevention of tooth decay

Dental caries is one of the most widespread chronic infectious diseases in the world. It is mainly caused by the production of acid in the biofilm from the bacterial metabolism of carbohydrates. Nowadays, the prevention of caries is mainly based on the use of topical formulations containing fluoride. However, effective fluoride supplementation may not be sufficient in high-risk individuals, leading to the exploration of alternative strategies such as the neutralization of acid in the oral cavity. Urea is hydrolyzed into ammonia by oral bacteria, leading to a local alkalization that may counteract tooth decay. Herein, we report the fabrication of 3D printed personalized dental trays with a local and prolonged release of urea. Composite filaments with tunable urea release kinetics were produced by hot melt extrusion of poly(ε-caprolactone) and poly(vinyl alcohol) or poly(ethylene glycol) blends mixed with urea. The filaments were further used to 3D print by fused deposition modeling objects capable of releasing urea in a sustained and spatially controlled manner. In vitro studies performed in the presence of Streptococcus salivarius demonstrated the ability of urea released from a 3D printed model toothguards to reduce the pH drop induced by carbohydrates. This study showed the potential of urea-loaded devices to reduce cariogenic acidification of the environment surrounding the enamel by delivering urea directly to the tooth surface.

Effect of Calcium Ion Supplementation on Oral Microbial Composition and Biofilm Formation In Vitro

The oral cavity contains a variety of ecological niches with very different environmental conditions that shape biofilm structure and composition. The space between the periodontal tissue and the tooth surface supports a unique anaerobic microenvironment that is bathed in the nutrient-rich gingival crevicular fluid (GCF). During the development of periodontitis, this environment changes and clinical findings reported a sustained level of calcium ion concentration in the GCF collected from the periodontal pockets of periodontitis patients. Here, we report the effect of calcium ion supplementation on human oral microbial biofilm formation and community composition employing an established SHI medium-based in vitro model system. Saliva-derived human microbial biofilms cultured in calcium-supplemented SHI medium (SHICa) exhibited a significant dose-dependent increase in biomass and metabolic activity. The effect of SHICa medium on the microbial community composition was evaluated by 16S rRNA gene sequencing using saliva-derived microbial biofilms from healthy donors and periodontitis subjects. In this study, intracellular microbial genomic DNA (iDNA) and extracellular DNA (eDNA) were analyzed separately at the genus level. Calcium supplementation of SHI medium had a differential impact on iDNA and eDNA in the biofilms derived from healthy individuals compared to those from periodontitis subjects. In particular, the genus-level composition of the eDNA portion was distinct between the different biofilms. This study demonstrated the effect of calcium in a unique microenvironment on oral microbial complex supporting the dynamic transformation and biofilm formation.

Oralbiotica/Oralbiotics: The Impact of Oral Microbiota on Dental Health and Demineralization: A Systematic Review of the Literature

The oral microbiota plays a vital role in the human microbiome and oral health. Imbalances between microbes and their hosts can lead to oral and systemic disorders such as diabetes or cardiovascular disease. The purpose of this review is to investigate the literature evidence of oral microbiota dysbiosis on oral health and discuss current knowledge and emerging mechanisms governing oral polymicrobial synergy and dysbiosis; both have enhanced our understanding of pathogenic mechanisms and aided the design of innovative therapeutic approaches as ORALBIOTICA for oral diseases such as demineralization. PubMed, Web of Science, Google Scholar, Scopus, Cochrane Library, EMBEDDED, Dentistry & Oral Sciences Source via EBSCO, APA PsycINFO, APA PsyArticles, and DRUGS@FDA were searched for publications that matched our topic from January 2017 to 22 April 2022, with an English language constraint using the following Boolean keywords: ("microbio*" and "demineralization*") AND ("oral microbiota" and "demineralization"). Twenty-two studies were included for qualitative analysis. As seen by the studies included in this review, the balance of the microbiota is unstable and influenced by oral hygiene, the presence of orthodontic devices in the oral cavity and poor eating habits that can modify its composition and behavior in both positive and negative ways, increasing the development of demineralization, caries processes, and periodontal disease. Under conditions of dysbiosis, favored by an acidic environment, the reproduction of specific bacterial strains increases, favoring cariogenic ones such as Bifidobacterium dentium, Bifidobacterium longum, and S. mutans, than S. salivarius and A. viscosus, and increasing of Firmicutes strains to the disadvantage of Bacteroidetes. Microbial balance can be restored by using probiotics and prebiotics to manage and treat oral diseases, as evidenced by mouthwashes or dietary modifications that can influence microbiota balance and prevent or slow disease progression.

On the release of fluoride from biofilm reservoirs during a cariogenic challenge: an in situ study

Biofilm fluoride reservoirs may be a source of fluoride to the fluid phase during a sugar challenge reducing tooth mineral loss. However, the evidence for that is conflicting and has not been studied in biofilms containing different fluoride levels. In order to test fluoride release from biofilms with distinct fluoride concentrations, biofilms were grown in situ exposed to a combination of placebo, calcium and fluoride rinses forming biofilms with no (fluoride-free rinses), low (fluoride-only rinses) or high (calcium followed by fluoride rinses) fluoride concentrations, and collected before and 5 min after a sucrose challenge. Rinsing with fluoride increased fluoride concentration in the biofilm (p < 0.05), mainly when a calcium pre-rinse was used before the fluoride (p < 0.05). However, after a sugar challenge, no significant increase in the biofilm fluid fluoride concentration was observed, even in the fluoride-rich biofilms (p > 0.05). Fluoride-rich biofilms do not release fluoride to the fluid phase during a sugar challenge.

A high salivary calcium concentration is a protective factor for caries development during orthodontic treatment

Background

This research aimed to evaluate the salivary concentrations of fluoride (F-), calcium (Ca2+), and phosphate (Pi) after brackets bonding, and to identify the role of [F-], [Ca2+], and [Pi] on the development of active caries lesion (ACL) in individuals under fixed orthodontic treatment.

Material and Methods

A longitudinal investigation with twenty-two individuals from 11 to 22 years of age was performed in four phases (baseline and after 1, 3, and 6 months). Analyses were carried out considering the salivary concentration of [F-], [Ca2+], and [Pi], as well as the caries index. Data were analyzed using the Friedman test, followed by the Wilcoxon test and the multivariate Cox model (p≤0.05).

Results

1 and 3 months after appliance bonding, the [Ca2+] was statistically lower than after 6 months (p<0.0083). On the other hand, salivary [F-] and [Pi] did not show any significant difference during the follow-up. The Cox model demonstrated that the increase of 1 µg/mL in Ca2+ decreased the risk of ACL development by 27%. In conclusion, the levels of Ca2+ changed during orthodontic treatment.

Conclusions

A high Ca2+ level in the saliva is a protective factor for ACL development over time.

Key words:Adolescents, bioinorganic chemistry, dental caries, orthodontic appliances.

Changes in the salivary electrolytic dynamic after sucrose exposure in children with Early Childhood Caries

This study sought to explore if the effect of 20% sucrose rinse (SR) on the salivary electrolytic concentration of calcium (Ca2+), phosphate (Pi) and fluoride (F-) in children with Early Childhood Caries (ECC) is different from healthy children. Here, fifty-eight  preschoolers aged 3 to 5 years were divided into 2 groups: caries-free (CF) and with ECC. Changes in saliva flow rate, pH and buffering capacity (BC), as well as in concentrations of Ca2+, Pi, and F-, and the degree of saturation in relation to hydroxyapatite (DSS HAp) and fluorapatite (DSS FAp) were evaluated. The pre-rinse [Ca2+] was higher in the ECC group in the CF group. A significant increase in [Ca2+] was demonstrated after SR in the CF group (p = 0.05). The [Pi] was reduced by 18% after SR in the ECC group (p = 0.007). The [F-] reduced in both groups after SR (p < 0.000). There was a moderate positive correlation between [Ca2+] and the DSS HAp and DSS FAp. Multivariate analysis showed that children with a higher [Ca2+] in pre-rinse saliva are more likely to have ECC. In conclusion, the effect of a 20% sucrose rinse on the electrolytic concentration of Ca2+, Pi and F- was different when children with ECC were compared with CF children.

Fluoride Binding to Dental Biofilm Bacteria: Synergistic Effect with Calcium Questioned

It has been suggested that fluoride binding to dental biofilm is enhanced when more bacterial calcium binding sites are available. However, this was only observed at high calcium and fluoride concentrations (i.e., when CaF2 precipitation may have occurred). We assessed fluoride binding to Streptococcus mutans pellets treated with calcium and fluoride at concentrations allowing CaF2 precipitation or not. Increasing calcium concentration resulted in a linear increase (p < 0.01) in fluoride concentration only in the pellets in which CaF2 precipitated. The results suggest that CaF2 precipitation, rather than bacterially bound fluoride, is responsible for the increase in fluoride binding to dental biofilm with the increase in calcium availability.

A randomized triple-blind crossover trial of a hydrocolloid-containing dentifrice as a controlled-release system for fluoride

OBJECTIVE

To evaluate retention of intraoral fluoride in biofilm and saliva, an experimental dentifrice containing hydrocolloid (tara gum) was used as a controlled-release system for fluoride (F).

MATERIALS AND METHODS

In a triple-blind randomized crossover trial with washout, 18 individuals used the following different dentifrices for a week: 100-TGF (sodium fluoride NaF associated with tara gum, 1100 mg/L), 50-TGF (50% NaF associated with tara gum + 50% free NaF, 1100 mg/L), PC (free NaF, 1100 mg/L), TG (with tara gum and without F), and placebo (without F or tara gum). On the seventh day of dentifrice use, biofilm was collected at 1 and 12 h, and saliva was collected up to 60 min and 12 h after the last toothbrushing. F concentrations were determined by physico-chemical analysis of fluoride using the hexamethyldisiloxane-facilitated diffusion technique. Data were subjected to two-way analysis of variance (repeated measures) and Spearman's correlation coefficient (p < 0.05) testing.

RESULTS

No significant difference was observed with the same dentifrice regarding F retention in biofilm at 1 and 12 h after toothbrushing for the 100-TGF, placebo, and TG groups (p > 0.05). The highest area under the curve values in saliva were found for the 50-TGF, 100-TGF, and PC groups.

CONCLUSION

The dentifrice containing hydrocolloid as a controlled-release system for F promoted F retention in the oral cavity, even at 12 h after brushing.

CLINICAL RELEVANCE

Hydrocolloid added to dentifrices as a controlled-release system for F might contribute to a higher anti-caries effect.

TRIAL REGISTRATION

NCT02809014.

Kinetics of calcium binding to dental biofilm bacteria

Dental biofilm bacteria can bind calcium ions and release them during a pH drop, which could decrease the driving force for dental demineralization (i.e. hydroxyapatite dissolution) occurring at reduced pHs. However, the kinetics of this binding and release is not completely understood. Here we validated a method to evaluate the kinetics of calcium binding and release to/from Streptococcus mutans, and estimated the importance of this reservoir as a source of ions. The kinetics of calcium binding was assessed by measuring the amount of bound calcium in S. mutans Ingbrit 1600 pellets treated with PIPES buffer, pH 7.0, containing 1 or 10 mM Ca; for the release kinetics, bacterial pellets previously treated with 1 mM or 10 mM Ca were exposed to the calcium-free or 1 mM Ca PIPES buffer, pH 7.0, for up to 60 min. Binding and release curves were constructed and parameters of kinetics were calculated. Also, calcium release was assessed by exposing pellets previously treated with calcium to a pH 5.0 buffer for 10 min. Calcium binding to bacteria was concentration-dependent and rapid, with maximum binding reached at 5 min. On the other hand, calcium release was slower, and according to the calculations, would never be complete in the groups pretreated with 10 mM Ca. Decreasing pH from 7.0 to 5.0 caused a release of calcium able to increase the surrounding fluid calcium concentration in 2 mM. The results suggest that dental biofilm bacteria may act as a calcium reservoir, rapidly binding ions from surrounding fluids, releasing them slowly at neutral pH and promptly during a pH drop.

Ca, Pi, and F in the Fluid of Biofilm Formed under Sucrose

Calcium (Ca), inorganic phosphorus (Pi), and fluoride (F) concentrations are low in the whole plaque biofilm formed under exposure to sucrose. It was hypothesized that this would be reflected in the biofilm fluid, where these low values should greatly influence the de/remineralization process. Dental biofilms were formed in situ over enamel blocks mounted in palatal appliances and exposed 8 times/day to distilled water, glucose+fructose, or sucrose solutions for 14 days. While Ca, Pi, and F concentrations in the whole biofilms were significantly lower in the glucose+fructose and sucrose groups, no effect on biofilm fluid was observed, even after a cariogenic challenge. An increase in whole biofilm mineral ions was observed 24 hrs after the carbohydrate treatments were suspended, but this effect was also not observed in the fluid. These results suggest that there is a homeostatic mechanism that maintains biofilm fluid mineral ion concentration, regardless of its total concentration in the whole biofilm.

Remineralization effects of two pediatric dentifrices and one regular dentifrice on artificial carious lesion in primary teeth: An in vitro study

Aim:

The aim of the following study is to know the efficacy of remineralization of two pediatric dentifrices and one regular dentifrice on artificial carious lesions in primary teeth.

Materials and Methods:

A total of 21 teeth coated with nail varnish leaving a window of 1 mm were subjected to demineralization for 72 h. These 21 teeth were then sectioned into two equal parts with a diamond disc. The 42 sections obtained were then evaluated under the stereomicroscope and the demineralization values were noted. The 42 sections were divided into three groups: Group 1: Kidodent, Group 2: Cheeriogel, Group 3: Colgate Total and subjected to remineralization respectively for 7 days. The specimens were again evaluated under the stereomicroscope for the remineralisation values.

Results:

All the three dentifrices showed remineralization with artificial carious lesions. Colgate Total showed higher remineralization rates compared with the other two pediatric dentifrices. Kidodent showed a slightly higher remineralisation rate compared with Cheeriogel which was not significant.

Conclusion/Hypothesis:

The pediatric dentifrices also showed remineralization with artificial carious lesions. Hence, we conclude that, this amount of remineralization was more or less, when compared to the regular dentifrice which showed higher remineralization rates, which could lead to adverse effects, like fluorosis if not used judiciously. On basis of which we hypothetize: Pediatric dentifrices have an appropriate fluoride content, as required by the children, and also does not minimize the cariostatic effects.

Divalent cations enhance fluoride binding to Streptococcus mutans and Streptococcus sanguinis cells and subsequently inhibit bacterial acid production

One preventive effect of topical fluoride application is derived from the fact that fluoride can inhibit bacterial acid production. Furthermore, divalent cations such as Ca(2+) and Mg(2+) increase the binding of fluoride to bacterial cells. These findings suggest that exposure of oral bacteria to fluoride in the presence of divalent cations increases fluoride binding to bacterial cells and subsequently enhances fluoride-induced inhibition of bacterial acid production. This study investigated the effects of fluoride exposure (0-20,000 ppm F) in the presence of Ca(2+) or Mg(2+) prior to glucose challenge on pH fall ability by bacterial sugar fermentation, as well as fluoride binding to bacterial cells by exposure to fluoride, and fluoride release from bacterial cells during bacterial sugar fermentation, using caries-related bacteria, Streptococcus mutans and Streptococcus sanguinis. The pH fall by both streptococci was inhibited by exposure to over 250 ppm F in the presence of Ca(2+) (p < 0.01), whereas in the presence of Mg(2+), the pH fall by S. mutans and S. sanguinis was inhibited after exposure to over 250 and 950 ppm F, respectively (p < 0.05). The amounts of fluoride binding to and released from streptococcal cells increased with the concentration of fluoride the cells were exposed to in the presence of Mg(2+), but were high enough even after 250 ppm F exposure in the presence of Ca(2+). The enhanced inhibition of acid production in the presence of divalent cations is probably due to the improved efficiency of fluoride binding to bacterial cells being improved via these divalent cations.

Calcium binding to S. mutans grown in the presence or absence of sucrose

Sucrose is the most cariogenic dietary carbohydrate because it is a substrate for insoluble extracellular polysaccharide (IEPS) production in dental biofilms, which can proportionally decrease bacterial density and, consequently, the number of biofilm calcium (Ca) binding sites. Ca bound to bacterial cell walls can be released into the biofilm fluid during a cariogenic challenge, reducing the driving force for mineral dissolution provoked by the pH drop. Thus, we investigated the effect of an IEPS-rich extracellular matrix on bacterial Ca binding after treatment with Ca solutions. Streptococcus mutans Ingbritt 1600 was cultivated in culture broths supplemented with 1.0% sucrose or 0.5% glucose + 0.5% fructose. The IEPS concentration in bacterial pellets was determined after alkaline extraction. Bacterial pellets were treated with 1 mM or 10 mM Ca++ solutions at 37ºC for 10 to 60 min. Ca binding to bacterial pellets, determined after acid extraction using the Arsenazo III reagent, was fast and concentration dependent. Although the IEPS concentration was approximately ten times higher in bacterial pellets cultivated in sucrose as compared to its monossaccharides, bound Ca concentration after Ca treatment was similar in both conditions. These results suggest that IEPS may not influence the amount of Ca bound to reservoirs of dental biofilms.

Mineral ions in the fluid of biofilms formed on enamel and dentine shortly after sugar challenge

To test the effect of distinct solubilities of dentine and enamel on mineral ion concentration in the biofilm fluid during a sugar-induced pH drop, dental biofilms were formed in situ for 4 days on acrylic (control), dentine or enamel. On the 5th day, they were treated with water (control) or 20% glucose and collected 5 min later. Significantly lower pH values and higher calcium concentrations were found in the biofilm fluid after glucose exposure, without significant differences among the three substrates. During pH drop, biofilm reservoirs release calcium to the fluid, masking the differential solubility between enamel and dentine.

Subsurface degradation of resin-based composites

OBJECTIVES

To determine the depth of a degraded subsurface layer produced in dental composites as a result of exposure to lactic acid or NaOH, by observing the penetration of AgNO(3) solution.

METHODS

Specimens were prepared from four resin composites; Point 4 (Kerr), Premise (Kerr), Filtek Supreme (3M/ESPE), Ceram X (Dentsply), and two polyacid-modified resin composites; Dyract (Dentsply) and F2000 (3M/ESPE). The specimens were immersed in distilled water for 1 week, transferred to one of three aqueous media at 60 degrees C for 2 weeks; distilled water, 0.01mol/L lactic acid or 0.1N NaOH, washed and immersed in 50% (w/w) aqueous silver nitrate for 10 days at 60 degrees C and placed in a photodeveloper solution. After reduction of the silver, specimens were embedded in epoxy resin, sectioned and polished, coated with carbon, and examined by backscattered mode scanning electron microscopy. The depth of silver penetration into the degraded area was measured from the SEM micrographs. Energy dispersive analysis X-ray (EDAX) was used to confirm the presence of silver.

RESULTS

NaOH produced the greatest depth of degradation and lactic acid the least. Premise showed the greatest depth of silver penetration when subjected to NaOH, and Filtek Supreme the second with peeling of the surface and cracking, whereas F2000 and Point 4 showed the least in NaOH and lactic acid.

SIGNIFICANCE

ANOVA and Tukey's test showed that the depth of silver penetration was material and solution dependent, and the differences were significant for most of the materials (P<0.05).

The role of sucrose in cariogenic dental biofilm formation--new insight

Dental caries is a biofilm-dependent oral disease, and fermentable dietary carbohydrates are the key environmental factors involved in its initiation and development. However, among the carbohydrates, sucrose is considered the most cariogenic, because, in addition to being fermented by oral bacteria, it is a substrate for the synthesis of extracellular (EPS) and intracellular (IPS) polysaccharides. Therefore, while the low pH environment triggers the shift of the resident plaque microflora to a more cariogenic one, EPS promote changes in the composition of the biofilms' matrix. Furthermore, it has recently been shown that the biofilm formed in the presence of sucrose presents low concentrations of Ca, P(i), and F, which are critical ions involved in de- and remineralization of enamel and dentin in the oral environment. Thus, the aim of this review is to explore the broad role of sucrose in the cariogenicity of biofilms, and to present a new insight into its influence on the pathogenesis of dental caries.

First molar eruption related to plaque acidogenicity in children of different socio-economic status

OBJECTIVE

The aim of this study was to evaluate the association between the eruption stage of the lower first permanent molar and dental plaque acidogenicity. Socio-economic status (SES), gender, and oral hygiene condition were also variables considered.

MATERIAL AND METHODS

230 children between 6 and 8 years of age were recruited from one public and one private primary school with different SES in Lima, Peru. Clinical examinations were performed to assess lower first permanent molar eruption stage, plaque acidogenicity, and oral hygiene condition. Bivariate associations were analyzed through chi-square tests and the variable interactions were analyzed through a hierarchical log-linear analysis with backward elimination.

RESULTS

21.8% of the population had highly acidogenic plaque, 34.3% acidogenic plaque, and 43.9% non-acidogenic plaque. Of the lower first permanent molars, 46.1% were fully erupted, whereas 53.9% were partially erupted. According to the final log-linear model, children with fully erupted molars and non-acidogenic plaque are less frequent in low than in high SES. Also, the frequency of children with partially erupted molars and acidogenic to highly acidogenic plaque is higher in males than in females. Finally, fully erupted molars and non-acidogenic plaque are more frequent in children with good hygiene than in children with moderate to poor hygiene.

CONCLUSIONS

Association between eruption stage of the lower first permanent molar and plaque acidogenicity was not significant in a bivariate context. However, in a multivariate context, socio-economic status, oral hygiene condition, and gender had an impact on the association between the two main variables.

Influence of pH environment on polymer based dental material properties

OBJECTIVE

This study aims to analyze the influence of different pH environments causing degradation to the properties of polymer based materials.

DATA AND SOURCES

Studies were identified by searching published material in medical and dental literature using general and specialist databases, hand searching key dental journals and searching abstracts from conference proceedings.

STUDY SELECTION

Evaluation of published laboratory studies regarding the effects of different pH mediums on resin-based material properties.

CONCLUSION

For laboratory studies, slightly low pH mediums are the ones of choice to best mimic some in vivo conditions, but the effect seems to be slow acting. If the purpose is to accelerate dental composite hydrolysis and produce quick micro-structural damage to evaluate in vitro mechanical performances, suitable alternatives would be the use of high alkaline or very low acidic mediums.

Effect of an Essential Oil Mouthrinse, with and without Fluoride, on Plaque Metabolic Acid Production and pH after a Sucrose Challenge

This clinical study evaluated the effect of rinsing with an essential oil-containing antiseptic mouthrinse, with or without 100 mg/kg fluoride ion, on the plaque metabolic acid production and plaque pH response after a sucrose challenge. This observer-blind, randomized study used a three-way crossover design. Twenty-four subjects rinsed with 20 ml of one of the following rinses: (1) essential oil (EO) mouthrinse, (2) essential oil mouthrinse plus 100 mg/kg fluoride, or (3) negative control, for 30 s, twice daily for 16 days. On day 17, 1 h after the last mouthrinse, subjects rinsed with 20 ml of mass fraction 10% sucrose solution for 1 min. Seven minutes after the sucrose challenge, supragingival plaque was collected from molar and premolar teeth. Plaque pH and metabolic acid ions were analyzed using a micro pH electrode and capillary electrophoresis, respectively. The results showed that after EO mouthrinse dental plaque produced 36% less lactate, 36% less acetate and 44% less propionate than after the negative control rinse. The dental plaque also exhibited a pH 0.42 unit higher after EO rinse than after the negative control rinse. These results were not affected by the addition of 100 mg/kg fluoride to the EO mouthrinse. From these results we concluded that this EO antiseptic mouthrinse, with or without fluoride ion, is effective in reduction of plaque acidogenicity after a sucrose challenge.

The effect of a 2% zinc citrate, 0.3% Triclosan dentifrice on plaque acid production following consumption of a snackfood

OBJECTIVES

A) To assess plaque lactate production following consumption of three foods (cake, chocolate/caramel bar, sweetened coffee), and B) To measure the effect of a fluoride dentifrice containing 2% zinc citrate and 0.3% Triclosan on plaque lactate and pH drop following consumption of cake.

METHODS

A) 10 subjects completed the first study. Plaque samples taken before and at 8,15 and 30 minutes after eating. Samples were analysed for lactate via Capillary Electrophoresis. B) 30 subjects completed the second study. Plaque samples were taken before and after cake and use of test dentifrice or no treatment control. Plaque pH and lactate content were assessed.

RESULTS

A) Plaque lactate levels increased after all three foods; peak lactate levels occurred 8 minutes after eating. B) Plaque lactate concentrations after eating cake were 39.2mM for the control treatment and a significantly lower value, 23.6mM, for the test 2% zinc citrate, 0.3% Triclosan dentifrice. After food challenge, pH values were 5.53 for the no treatment group and a significantly higher value of 5.79 for the test dentifrice group.

CONCLUSIONS

A toothpaste containing 2% zinc citrate, 0.3% Triclosan can significantly reduce plaque lactate generation and pH drop induced by cake, compared to no treatment control.

The effects of the solubility of artificial fissures on plaque pH

Dissolution of the fissure walls may buffer acids formed in plaque and thus prevent the penetration of acids into the fissure. To test this, five volunteers wore dentin, enamel, and polyacrylate specimens with narrow grooves for 7 days to accumulate plaque. Temporal (pre- and post-glucose) and spatial (0-0.7 mm) pH profiles were recorded in the grooves in a flow-through reactor with pH microsensors. Mineral loss was assessed by transverse microradiography. We observed that resting pH did not differ among substrata. The median pH 1 hr post-glucose at the bottoms of dentin, enamel, and polyacrylate grooves was 6.7, 6.2, and 5.7, respectively (p < 0.01). On subject level, lesions formed in dentin correlated with pH changes in polyacrylate, where no buffering of acids due to mineral dissolution occurred. We conclude that fluoride-deficient tissue at the bottom of a fissure is at increased risk for caries, if acids are not buffered near the entrance to the fissure.

Plaque minerals in the prediction of caries activity

BACKGROUND/AIMS

Attempts to identify subjects who will develop caries lesions in future years have been only moderately successful, suggesting that one or more important risk factors are being overlooked. The aim of this study was to validate the use of plaque calcium, phosphate and fluoride concentrations as significant risk factors in caries.

METHODS

DMFS and DMFT rates were measured three times over 2 years in a group of rural Chinese schoolchildren initially aged 12 years and not living in a high-fluoride area. At the baseline and year 1 examinations, dental plaque was accumulated for 3 days and, after collection, was analysed for Ca, P and F. Plaque scores, dental health behaviour and parents' occupation data were also recorded.

RESULTS

The mean DMFS increment over 2 years was 1.14 with a range of -2 to +9. Regression analysis taking all factors into account identified only plaque Ca concentration, baseline DMFS score and toothbrushing frequency as significant factors in identifying high-risk individuals. Plaque Ca also showed predictive ability on its own. For example, when high caries was defined as 3+ new DMFS and a Ca cut-off value of 200 nmol/mg dry wt was selected, sensitivity was 0.84 and specificity 0.38. However, with this cut-off value the percentage predicted to have high caries risk was unrealistically high at 66%. As in several other studies, baseline caries score was a useful predictor of future caries.

CONCLUSION

Low plaque Ca concentration showed a modest ability to predict future caries, and since it is implicated directly in the chain of events leading to caries, its use in caries prediction should be considered further. Plaque P and F showed no predictive ability in this study.

Genetics of acid adaptation in oral streptococci

A growing body of information has provided insights into the mechanisms by which the oral streptococci maintain their niches in the human mouth. In at least one case, Streptococcus mutans, the organism apparently uses a panel of proteins to survive in acidic conditions while it promotes the formation of dental caries. Oral streptococci, which are not as inherently resistant to acidification, use protective schemes to ameliorate acidic plaque pH values. Existing information clearly shows that while the streptococci are highly related, very different strategies have evolved for them to take advantage of their particular location in the oral cavity. The picture that emerges is that the acid-adaptive regulatory mechanisms of the oral streptococci differ markedly from those used by Gram-negative bacteria. What future research must determine is the extent and complexity of the acid-adaptive systems in these organisms and how they permit the organisms to maintain themselves in the face of a low-pH environment and the microbial competition present in their respective niches.

Association of caries activity with the composition of dental plaque fluid

This study tests the hypothesis that caries activity is associated with lower degrees of saturation with respect to enamel mineral in dental plaque fluid following sucrose exposure. Plaque fluids were obtained from caries-free, caries-positive, and caries-active subjects. Samples were collected before and at 3 and 7 min after a sucrose rinse on consecutive weeks and analyzed for organic acids, inorganic ions, pH, calcium activity, and, in selected samples, total protein. After sucrose, pH values were significantly lower in the caries-active group in comparison with the caries-free and caries-positive groups. Total and free calcium concentrations increased with decreasing pH, with free calcium being about one-third of total calcium. The caries-active group exhibited significantly lower degrees of saturation with respect to enamel mineral, after sucrose, and had significantly higher mutans streptococci levels in plaque than did the caries-free samples. Thus, saturation levels in post-sucrose plaque fluids reflect the cariogenic potential of dental plaque.

Adaptation of oral streptococci to low pH

The strategies employed by oral streptococci to resist the inimical influences of acidification reflect the diverse and dynamic niches of the human mouth. All of the oral streptococci are capable of rapid degradation of sugar to acidic end-products. As a result, the pH value of their immediate environment can plummet to levels where glycolysis and growth cease. At this point, the approaches for survival in acid separate the organisms. Streptococcus mutans, for example, relies on its F-ATPase, to protect itself from acidification by pumping protons out of the cells. S. salivarius responds by degrading urea to ammonia and S. sanguis produces ammonia by arginolysis. The mechanisms by which these organisms regulate their particular escape route are now being explored experimentally. The picture that emerges is that the acid-adaptive regulatory mechanisms of the oral streptococci differ markedly from those employed by Gram-negative bacteria. What remains to be elucidated are the breadth of the acid-response systems in these organisms and how they permit the microbes to sustain themselves in the face of low pH and the bacterial competition present in their respective niches. In this article, we summarize reports concerning the means by which oral streptococci either utilize acidification to subdue their competitors or protect themselves until pH values return to a more favorable level.

Effects of an anticariogenic casein phosphopeptide on calcium diffusion in streptococcal model dental plaques

Casein phosphopeptides (CPP) stabilize amorphous calcium phosphate (ACP) and may be used to localize ACP in dental plaque, maintaining a state of supersaturation with respect to tooth enamel, reducing demineralization and enhancing remineralization. The aim here was to investigate these effects by measuring the effect of CPP-ACP on calcium diffusion in plaque. Using Dibdin's effusion system, calcium diffusion was measured in streptococcal model plaques. This demonstrated that by providing a large number of possible binding sites for calcium, 0.1% CPP-ACP reduces the calcium diffusion coefficient by about 65% at pH 7 and 35% at pH 5. Hence, CPP-ACP binds well to plaque, providing a large calcium reservoir within the plaque and slowing diffusion of free calcium. This is likely to restrict mineral loss during a cariogenic episode and provide a potential source of calcium for subsequent remineralization. Overall, once in place, CPP-ACP will restrict the caries process.

The role of calcium in oral streptococcal aggregation and the implications for biofilm formation and retention

Much work on bacterial adhesion has focussed on the colonisation of surfaces and the removal of mature biofilms. Little attention has been devoted to interactions within mature biofilms and how these might be manipulated in the cause of novel therapies. Calcium binding to oral streptococci displays characteristics of positive cooperativity and calcium uptake does not follow the same mechanism as calcium release [Rose et al., J. Dent. Res. 72 (1993) 78-84]. An investigation of the variation in dissociation constants found with respect to cell concentration (from 2.77+/-0.66 mmol/l at 5 g/l [cell] to 1.28+/-0.37 mmol/l at 20 g/l), and in particular the non-zero value of the apparent binding constant (K(app)) on extrapolation to zero cell concentration, revealed that calcium uptake could be explained by a ligand-facilitated mechanism of cell association. Hence, cell association follows a route that starts with essentially irreversible long-range interactions between the cells, mediated by as yet unidentified macromolecules, followed by reversible calcium bridging. This suggests that cells are held in place within biofilms by a web of polymers, but that proximity to neighbouring cells is dependent on calcium bridging and that this may be manipulated to allow increased penetration of therapeutic agents.

Effect in vitro acidification on plaque fluid composition with and without a NaF or a controlled-release fluoride rinse

Plaque fluid ion concentration changes, especially fluoride, in response to the pH decrease associated with a cariogenic episode are important components of the caries process. A "controlled-release" (CR) fluoride rinse, based on the controlled release of fluoride in the presence of calcium, has been shown to form large fluoride reservoirs in resting plaque. In this study, the in vitro acid-induced release of fluoride, and other ions, was examined in 48-hour-fasted plaque fluid from subjects (n = 11) who received no rinse, or who used a 228-ppm CR or NaF fluoride rinse 1 hr before being sampled. After collection, the plaque was centrifuged to yield plaque fluid, acidified (0.1 microL of 0.5 mol/L HCl per milligram plaque), and then re-centrifuged before a second sample was obtained. Although previous studies indicated a higher plaque fluid fluoride after the new rinse relative to NaF, no statistically significant difference was observed here. Average fluoride release after acidification (average pH, 5.2) was statistically greater following the use of the CR rinse (153 micromol/L) compared with the NaF rinse (17 micromol/L). No fluoride release was seen in the no-rinse samples. The pH, free calcium, phosphate, acetate, propionate, and buffer capacity were not affected by the different amounts of fluoride deposited in the plaque. However, following acid addition, an increase in free calcium and phosphate was observed, which was also independent of the rinse. The large release of fluoride following acidification suggests that the new rinse may provide an improved cariostatic effect.

Effects of organic acid anions on growth, glycolysis, and intracellular pH of oral streptococci

Oral streptococci produce large quantities of organic acids as the end-products of carbohydrate fermentation. In an approach to determine if oral streptococci exhibit differential sensitivities to organic acid anions, we determined the effects of formate, lactate, and acetate on intracellular pH maintenance, glycolysis, and growth of Streptococcus mutans and Streptococcus sanguis. Growth was determined as maximum culture optical density in the presence of the organic acid anions at pH 7.1, 6.7, 6.3, and 6.1, and the effects of the anions on glycolytic activity and intracellular pH were determined at pH 7.0 and 5.0. At pH 7.1, the organic acid anions had little effect on growth of either species. At the lower pH values, all of the anions reduced the maximum culture optical density of both species in a pH- and concentration-dependent manner, with S. sanguis being more sensitive to growth inhibition than S. mutans. The organic acid anions had little or no effect on glycolytic activity of either species at pH 7.0. However, all of the organic acid anions tested reduced glycolytic activity at pH 5.0 in a concentration-dependent manner, with S. sanguis being more sensitive than S. mutans. The inhibition of glycolysis could be related to the pKa of the organic acid, with formate and lactate being more inhibitory than acetate. The organic acid anions decreased the intracellular pH of S. mutans and S. sanguis, glycolyzing at an extracellular pH of 5.0, such that the reduction in glycolytic activity caused by the organic acid anions could be directly attributed to the fall in intracellular pH. In conclusion, the production of lactic acid in plaque would not only lower pH, thereby having a disadvantageous effect on less aciduric oral streptococci, such as S. sanguis, but would also increase their sensitivity to the effects of low pH, helping S. mutans to become more dominant.

Composition of plaque and saliva following use of an alpha-tricalcium-phosphate-containing chewing gum and a subsequent sucrose challenge

Previous studies demonstrated that the chewing of a 2.5% (mass fraction) alpha-tricalcium-phosphate-fortified (alpha-TCP) experimental chewing gum released sufficient calcium and phosphate to eliminate any fall in the tooth mineral saturation of plaque fluid after a sucrose rinse (Vogel et al., 1998). In contrast, the chewing of a conventional sugar-free gum did not eliminate this decrease in saturation. The purpose of this study was to examine if the release of ions from plaque calcium-phosphate pools induced by this gum could provide protection during subsequent exposure to cariogenic conditions. Fourteen subjects accumulated plaque for 48 hrs, fasted overnight, chewed a control or experimental gum for 15 min, and subsequently rinsed 1 min with a mass fraction 10% sucrose solution. Before gum chewing, and at 7 min and 15 min afterward, whole plaque, plaque fluid, and salivary samples were obtained and analyzed by micro-analytical techniques. Additional samples were collected and analyzed at 25 min (7 min after the sucrose rinse). Although the results confirmed the deposition of large amounts of calcium and phosphates in plaque seen in the previous study, only a small increase was seen in plaque-fluid-free calcium and phosphate before sucrose administration. This suggests that few of the mineral ions were mobilized under non-cariogenic conditions. However, 7 min after the sucrose rinsing, an increase in these concentrations was seen which, based on hydroxyapatite ion activity product calculations, indicated a decrease in the driving force for demineralization compared with that seen with the control gum. These results suggest that the chewing of the experimental gum deposits a labile mineral reservoir in plaque that can resist a subsequent cariogenic challenge.

Influence of environmental conditions on hydrogen peroxide formation by Streptococcus gordonii

Hydrogen peroxide generated by viridans group streptococci has an antagonistic effect on many bacterial species, including a number of pathogens, in the oral environment. This study examines the influence of a variety of environmental conditions on rates of hydrogen peroxide synthesis by Streptococcus gordonii. Hydrogen peroxide was synthesized at every concentration of glucose and sucrose tested from 10 microM to 1 M, with the highest rates occurring at 0.1 mM sucrose and 1 mM glucose. S. gordonii appeared to have an intracellular store of polysaccharide which supported hydrogen peroxide formation even when the assay buffer contained no carbohydrate. Most heavy metal ions inhibited peroxidogenesis, and anaerobic conditions induced adaptive down-regulation of hydrogen peroxide synthesis; however, peroxidogenesis was generally insensitive to moderate increases in salt concentration, alteration of the mineral content of the assay solution, and changes in pH between 5.0 and 7.5. In contrast, stimulation of peroxidogenesis occurred in 1 mM Mg(2+) and 10 to 50 mM potassium L-lactate. Maximum peroxidogenesis occurred during the mid-logarithmic and late-logarithmic phases of bacterial growth. These bacterial responses may have significant implications for oral ecology and oral health.

1H-NMR analysis of microbial-derived organic acids in primary root carious lesions and saliva

In addition to lowered pH values, the molecular profile and concentrations of microbial-derived organic acids in carious dentin are important demineralization parameters involved in the induction, development and progression of dental caries. High-resolution proton ((1)H) NMR spectroscopy was employed to examine the organic acid status of primary root carious lesions. (1)H-NMR analysis of post-neutralized perchloric acid extracts of active carious lesions revealed that at an operating frequency of 600 MHz, the (1)H-NMR-detectable organic acid composition of carious dentin samples (mean molecular percentage content +/- standard error; the mean molecular percentage content is defined here as the mean of the concentration of each (1)H-NMR-visible organic acid/anion expressed as a percentage of total (1)H-NMR-detectable organic acid/anion level in each sample) was acetate 51 +/- 2%, formate 37 +/- 2%, lactate 5 +/- 1%, propionate 3 +/- 0.8%, pyruvate 2.4 +/- 0.3%, n-butyrate 1.2 +/- 0.2%; succinate 0.1 +/- 0.1%; iso-butyrate, n- and iso-valerate, and n- and iso-caproate (total) <0.2%. Further components detectable included alanine, glycine, choline, phosphorylcholine, trimethylamine oxide, methanol, glycolate and assorted saccharides. In view of their high dissociation constants (K(a)), our results demonstrate that formic and pyruvic acids (K(a) = 1.77 x 10(-4) and 3.20 x 10(-3) mol/dm(3), respectively) contribute substantially to the decreased pH values associated with active caries lesions (cf. lactate K(a) = 1.40 x 10(-4) mol/dm(3)), and hence the pathogenesis of primary root caries.

Kinetics of enamel demineralization in vitro

Previously, we reported that the rate (R) of hydroxyapatite dissolution in acetic, lactic, and phosphoric acid solutions is a function of the degree of saturation with respect to the dissolving mineral, DS (defined as the ratio of the mean ionic activity product for hydroxyapatite [Ca5OH(PO4)3] in solution to its solubility product constant), and the sum of the acid activities (sumBiH) in solution: R = K(1-DS)m(sumBiH)n. The present study was undertaken to explore the general validity of this model in describing the kinetics of enamel demineralization. Thin sections of human enamel were exposed to partially saturated 0.1 mol/L lactic acid solutions, at two different DS levels, and at pH values of 4.3 to 6.0. Thin sections of human enamel were also exposed to solutions with four different concentrations of acetic and lactic acids (pH 4.3) with three different DS values and, at one DS value, to solutions of propionic acid. Mineral loss was monitored by quantitative microradiography. In solutions with pH values of 4.3 and 5.0, "lesions" were formed with well-defined surface layers, whereas, in solutions with pH 6.0, "lesions" were produced with no apparent surface layers. The formation of relatively intact surface layers was consistent with predicted phase transformations. Rates of mineral loss were found to be inversely proportional to both the degree of saturation with respect to enamel mineral, DS(En), and the pH of the solution and increased with increased activities of each organic acid, consistent with the proposed model. However, at the same DS(En) and acid activity, rates of demineralization were the same in the acetic and propionic acid solutions, whereas rates of demineralization in lactic acid were greater. It is suggested that specific interactions of acid species with enamel mineral may modify the rate of enamel demineralization. These in vitro findings suggest that relatively small differences in DS(En) values found in plaque fluid may result in very significant differences in the rate of enamel demineralization in vivo.

Release of mineral ions in dental plaque following acid production

The release of appreciable amounts of calcium, phosphate and fluoride found in whole plaque into the plaque-fluid phase, following bacterial acid production, can potentially reduce the driving force for tooth demineralization. However, limited information is available on this topic, particularly on the release of fluoride. This study sought to determine the change in calcium, phosphate and fluoride concentrations in plaque fluid after sucrose exposure. 48 h overnight-fasted supragingival plaque samples were collected from all tooth surfaces (with the exception of the lower lingual anterior teeth) of one half of an individual mouth, following a 1 min water rinse. Plaque samples were then collected from the other half of the same mouth, following a 292 mM sucrose rinse. Plaque fluid was isolated by centrifugation and analysed for total calcium and phosphate (ion chromatography) and for free fluoride (ion-specific electrode). Samples were collected from seven individuals. Following sucrose exposure, plaque-fluid pH decreased significantly from 6.5+/- 0.3 to 5.4+/-0.2; calcium concentrations (mmol/l) also increased significantly (p < 0.01) from 1.9+/-0.5 to 5.0+/-2.1. Fluoride and phosphate concentrations in plaque fluid, however, did not increase significantly after sucrose exposure: mean concentrations (mmol/l) of fluoride after the water and sucrose rinses were 0.006+/-0.003 and 0.005+/-0.002, respectively, and mean phosphate concentrations (mmol/l) were 11.0+/-2.0 and 12.0+/-3.0, respectively. When results were expressed per wet plaque weight, phosphate concentrations were also found to increase significantly. The same trends were observed when additional plaque samples were treated in vitro with sucrose: fluoride-ion activity did not increase in plaque under in vivo-like conditions.

Composition of plaque and saliva following a sucrose challenge and use of an alpha-tricalcium-phosphate-containing chewing gum

Calcium phosphate concentrations in plaque, plaque fluid, and saliva play an important role in caries prevention. In this study, we used a microanalytical technique to examine the anticaries potential of a 2.5% (mass fraction) alpha-tricalcium-phosphate-fortified experimental gum by measuring the pH, free and total calcium, and total phosphate in plaque fluid, whole plaque, and saliva, and centrifuged saliva from 14 subjects who (1) accumulated plaque for 48 hours, (2) fasted overnight, (3) rinsed for 1 min with sucrose, and (4) chewed a control or experimental gum for 15 min. From these data, the hydroxyapatite (HAp) ion activity products (IAP[HAp]) of saliva and plaque fluid were calculated as a measure of tooth mineral saturation. Results, compared with those of the control gum, show significant increases in pH and in free calcium and phosphate concentrations in plaque fluid and saliva when the experimental gum was chewed following sucrose ingestion. These increases result in a rise in fluid saturation with respect to tooth mineral that, for plaque fluid, nearly cancels the decrease seen with the control gum after the sucrose rinse. This suggests that the experimental gum may be more effective than a conventional gum in ameliorating the cariogenic effects of sucrose. Similar statistically significant increases were also seen in the total calcium content of the plaque fluid, centrifuged saliva, whole saliva, and whole plaque, and in the total phosphate of whole plaque and whole saliva. These results suggest that the deposition of a mineral reservoir in plaque and saliva by the experimental gum may help resist future cariogenic challenges.

Factors affecting the resting pH of in vitro human microcosm dental plaque and Streptococcus mutans biofilms

The aim was to examine factors that potentially control the resting pH, defined as the pH unaffected by meals, of microcosm dental plaques and Streptococcus mutans biofilms under standard conditions, and to examine the effect of supplying urea at concentrations found intraorally. Microcosm plaques were cultured from plaque bacteria-enriched saliva in an 'artificial mouth' with a continuous supply of a medium including 0.25% mucin [Basal Medium Mucin, (BMM), 3.6 ml/hr per plaque] and a periodic supply of sucrose. The steady-state resting pH was 6.4 (range +/- 0.1) in BMM containing no urea and supplied at the standard flowrate. This is a robust property of the ecosystem. In one experiment with a replicated (n = 9) set of measurements, the resting pH was approx. pH 6.3, 6.4, 6.7 and 7.3 with 0, 1, 5 and 20 mmol/l urea in the BMM. The magnitude of sucrose- and urea-induced pH responses was unaffected by elevating the resting pH to produce parallel pH curves. The sucrose-induced pH curves were analogous to those classically reported by Stephan that showed an association between caries activity and increasingly acidic plaque pH responses to glucose. Stopping the BMM flow caused a pH rise, indicating continuing net alkali generation from BMM components in the absence of a fluid flow. Step. mutans monoculture biofilms had an acidic resting pH of 5.0 to 5.3, which increased to 6.8 following an adventitious superinfection by Bacillus cereus. It was concluded that the resting pH in plaque results from a delicate balance between alkali and acid generation, which is in turn dependent both on the bacterial composition of the plaque and on the supply of substrates and buffers from, and metabolite clearance into, flowing oral fluid. In vivo the resting pH will vary with site-specific changing saliva flows. Urea continuously supplied at concentrations normal for saliva and gingival crevicular fluid can raise the resting pH of microcosm plaque by an amount tat in vivo would probably be significant in reducing dental caries.