The role of microbiology in models of dental caries

Caries-inhibiting Effect of Microencapsulated Active Components in Pit and Fissure Sealants

OBJECTIVE

The aim of the present in vitro study was to examine the caries-inhibiting effect of a pit and fissure sealant (PFS) containing ion-releasing microcapsules under cariogenic conditions in a biofilm artificial mouth.

METHODS AND MATERIALS

Forty-eight human third molars were divided into four groups (n=12 per group). Fissures were extended with burs and sealed with experimental PFS. The four groups of specimens were treated as follows: 1) EPFS 1: EPFS (Premier Dental) of increasing viscosity, containing microcapsules loaded with remineralizing agents (calcium, phosphate, and fluoride ions); 2) US: fluoride-releasing PFS (UltraSeal XT plus, UltraDent Products, South Jordan, UT, USA); 3) EPFS 2: experimental PFS of constant viscosity containing microcapsules loaded with calcium, phosphate, and fluoride ions; and 4) FT: glass ionomer cement (GIC) (GC Fuji Triage CAPSULE WHITE glass ionomer cement, GC Europe NV, Leuven, Belgium). FT and US were used as control groups. EPFS 1 and EPFS 2 were the experimental groups. Specimens were stored in distilled water for 14 days at 37°C, subjected to 10,000 thermocycles (5°C and 55°C) and finally exposed to microbiological cycling in a Streptococcus mutans-based artificial mouth for 10 days. Replicas were made for scanning electron microscopic (SEM) evaluation and specimens were cut for fluorescence microscopy.

RESULTS

Overall demineralization depths at the margin of Fuji Triage were significantly shallower than in the other groups (p<0.05). Overall demineralization depths adjacent to the experimental pit and fissure sealant EPFS 2 (59±15 μm) were comparable to the values of the resin-based pit and fissure sealant UltraSeal XT plus (58±10 μm, p≥0.05). SEM revealed surface roughness of the GIC-based PFS.

CONCLUSIONS

The experimental PFS with microcapsules containing active components for remineralization did not show a caries-inhibiting effect compared to a fluoride-releasing resin-based PFS. Lower demineralization depths adjacent to GIC sealants indicate an anticariogenic effect through fluoride ion release.

Antimicrobial and cytotoxic capacity of pyroligneous extracts films of Eucalyptus grandis and chitosan for oral applications

Chitosan films containing distilled pyroligneous extracts of Eucalyptus grandis (DPEC), characterized and developed by Brazilian Agricultural Research Corporation-Embrapa Temperate Agriculture (EMBRAPA-CPACT), were evaluated for antimicrobial activity against Candida albicans, Streptococcus mutans, and Lactobacillus acidophilus by direct contact test. Further, their capacity for the prevention of teeth enamel demineralization and cytotoxicity in vitro were also determined. The natural polymers were tested at different concentrations (1500-7500 µg mL-1) and the formulation of an experimental fluoride varnish with antimicrobial activity was evaluated by direct contact test, whereas cytotoxicity was analyzed through the colorimetric MTT assay. Preliminary data showed no statistically significant differences in cytotoxicity to NIH/3T3 cell line when DPEC is compared to the control group. On the other hand, the antimicrobial capacity and demineralization effects were found between the test groups at the different concentrations tested. Chitosan films containing distilled pyroligneous extracts of E. grandis may be an effective control strategy to prevent biofilm formation related to dental caries when applied as a protective varnish. They may inhibit the colonization of oral microorganisms and possibly control dental caries through a decrease in pH and impairment of enamel demineralization.

Cariogenic Biofilm: Pathology-Related Phenotypes and Targeted Therapy

The initiation and development of cariogenic (that is, caries-related) biofilms are the result of the disruption of homeostasis in the oral microenvironment. There is a daily accumulation of dental biofilm on the surface of teeth and its matrix of extracellular polymers supports the host in its defense against invading microbes, thus helping to achieve oral microbial homeostasis. However, the homeostasis can be broken down under certain circumstances such as during long-term exposure to a low pH environment which results in the dominance of acidogenic and acid-tolerating species in the dental biofilm and, thus, triggers the shift of harmless biofilm to an acidic one. This work aims to explore microbial diversity and the quorum sensing of dental biofilm and their important contributions to oral health and disease. The complex and multispecies ecosystems of the cariogenic biofilm pose significant challenges for the modulation of the oral microenvironment. Promising treatment strategies are those that target cariogenic niches with high specificity without disrupting the balance of the surrounding oral microbiota. Here, we summarized the recent advances in modulating cariogenic biofilm and/or controlling its pathogenic traits.

Comparative Evaluation of Antimicrobial Efficacy of Toothpastes Containing Probiotic and Neem as Primary Ingredient on Salivary Streptococcus mutans in Melmaruvathur Population: An In Vivo Study

Aim

This in vivo study was designed to compare the antimicrobial effect of toothpastes containing probiotics and neem on Streptococcus mutans in 18-30-year-old patients in Melmaruvathur population.

Materials and Methods

The study consisted of 60 patients who were randomly divided into two groups of 30 each. Group I received probiotic-based toothpaste (PerioBiotic), whereas Group II received neem-based toothpaste (Babool) as a preventive measure protocols to control the incidence and prevalence of dental caries.

Study Design Protocols

Participants were instructed to use the dentifrice selected for the study, two times a day for 60 days. Tests were performed on the saliva samples at the beginning of the study, 0 day, 15th day, 30th day, and 60th day following the use of toothpaste. The Statistical Package for the Social Sciences (SPSS-25) software, version, and Chi-square and one-way analysis of variance were used for data analysis.

Results

The toothpastes containing neem and probiotics as primary ingredients were efficient in reducing the number of bacterial count when comparing the baseline data with the 60 days data in both the groups as a therapeutic regimen. Intragroup values showed reduction in the number of bacterial count in both the groups in a gradual manner, whereas the intergroup values between the toothpaste showed no statistically significant difference in the bacterial count, and both toothpastes were efficient in reducing the bacterial count.

Conclusion

This study reveals the influence of probiotics and neem on salivary S. mutans levels. The results revealed that neem-based and probiotic-based toothpaste, which were tested in this study, showed comparable antibacterial activity against the S. mutans. The neem-based toothpaste showed promising and good antimicrobial activity and reduced the level of bacterial count, which can be attributed to the presence of secondary metabolites, such as flavonoids, alkaloids, lectins, and polyphenols, as its active components. The effect of each component against the S. mutans needs to be quantified in further studies, and within the limitation of this short study, it can be considered as a better choice than commercially available toothpaste, which predominantly has chemicals as active ingredients, which in turn can compromise the safety aspects in the patients when used for controlling the dental caries for a longer duration.

Recent advances in understanding the fatigue and wear behavior of dental composites and ceramics

Dental composite and ceramic restorative materials are designed to closely mimic the aesthetics and function of natural tooth tissue, and their longevity in the oral environment depends to a large degree on their fatigue and wear properties. The purpose of this review is to highlight some recent advances in our understanding of fatigue and wear mechanisms, and how they contribute to restoration failures in the complex oral environment. Overall, fatigue and wear processes are found to be closely related, with wear of dental ceramic occlusal surfaces providing initiation sites for fatigue failures, and subsurface fatigue crack propagation driving key wear mechanisms for composites, ceramics, and enamel. Furthermore, both fatigue and wear of composite restorations may be important in enabling secondary caries formation, which is the leading cause of composite restoration failures. Overall, developing a mechanistic description of fatigue, wear, and secondary caries formation, along with understanding the interconnectivity of all three processes, are together seen as essential keys to successfully using in vitro studies to predict in vivo outcomes and develop improved dental restorative materials.

Dental Biofilm and Laboratory Microbial Culture Models for Cariology Research

Dental caries form through a complex interaction over time among dental plaque, fermentable carbohydrate, and host factors (including teeth and saliva). As a key factor, dental plaque or biofilm substantially influence the characteristic of the carious lesions. Laboratory microbial culture models are often used because they provide a controllable and constant environment for cariology research. Moreover, they do not have ethical problems associated with clinical studies. The design of the microbial culture model varies from simple to sophisticated according to the purpose of the investigation. Each model is a compromise between the reality of the oral cavity and the simplification of the model. Researchers, however, can still obtain meaningful and useful results from the models they select. Laboratory microbial culture models can be categorized into a closed system and an open system. Models in the closed system have a finite supply of nutrients, and are also simple and cost-effective. Models in the open system enabled the supply of a fresh culture medium and the removal of metabolites and spent culture liquid simultaneously. They provide better regulation of the biofilm growth rate than the models in the closed system. This review paper gives an overview of the dental plaque biofilm and laboratory microbial culture models used for cariology research.

A Review of the Common Models Used in Mechanistic Studies on Demineralization-Remineralization for Cariology Research

Mechanistic studies on demineralization-remineralization play a critical role in investigating caries pathogenicity, testing effects of new caries prevention methods, and developing new caries-preventing products. Simulating the cariogenic challenges in the mouth, various demineralization-remineralization models have been used for cariology research. This review aimed to provide an overview of the common mechanistic studies on demineralization-remineralization for cariology research in recent literature. Most mechanistic studies were in vitro studies (n = 294, 84%) among the 350 cariology studies indexed in the Web of Science from 2014 to 2016. Among these in vitro studies, most studies (257/294, 87%) used chemical models that could be classified as simple mineralization models (159/257, 62%) or pH-cycling models (98/257, 38%). In vitro studies consumed less expense and time than in vivo studies. Furthermore, in vitro conditions were easier to control. However, they could hardly imitate the complex structures of oral cavities, the microbiological effect of oral biofilm, and the hydrodynamic instability of saliva. The advantages of chemical models included simplicity of the study, low cost, efficiency (time saving), reproducibility, and stability of experiments. However, the “caries” generated were not biological. Moreover, the chemical models were generally basic and could not mimic a carious lesion in the complex oral environment.

The Role of Microbiology in Models of Dental Caries: Reaction Paper

Models of the caries process have made significant contributions toward defining the roles of bacteria in caries. Microbiologists use a variety of in vitro systems to model aspects of the caries process. Also, in situ models in humans provide information on the microbiology of caries in vivo. These models do not involve the entire process leading to natural caries; consequently, the results from such studies are used to deduce the roles of bacteria in natural caries. Therefore, they can be described as Inferential Caries Models. In contrast, animal models and some clinical trials in humans involve natural caries and can be described as Complete Caries Models. Furthermore, these models are used in two distinct ways. They can be used as Exploratory Models to explore different aspects of the caries process, or as Test Models to determine the effects of anticaries agents. This dichotomy in approach to the use of caries models results in modification of the models to suit a particular role. For example, if we consider Exploratory Models, the in situ appliance in humans is superior to others for analyzing the microbiology of plaque development and demineralization in vivo. The chemostat and biofilm models are excellent for exploring factors influencing bacterial interactions. Both models can also be used as Test Models. The in situ model has been used to test the effects of fluoride on the microflora and demineralization, while the chemostat and biofilm models allow for the testing of antibacterial agents. Each model has its advantages and disadvantages and role in analysis of the caries process. Selection of the model depends on the scientific question posed and the limitations imposed by the conditions available for the study.

Chamaecyparis obtusa Suppresses Virulence Genes in Streptococcus mutans

Chamaecyparis obtusa (C. obtusa) is known to have antimicrobial effects and has been used as a medicinal plant and in forest bathing. This study aimed to evaluate the anticariogenic activity of essential oil of C. obtusa on Streptococcus mutans, which is one of the most important bacterial causes of dental caries and dental biofilm formation. Essential oil from C. obtusa was extracted, and its effect on bacterial growth, acid production, and biofilm formation was evaluated. C. obtusa essential oil exhibited concentration-dependent inhibition of bacterial growth over 0.025 mg/mL, with 99% inhibition at a concentration of 0.2 mg/mL. The bacterial biofilm formation and acid production were also significantly inhibited at the concentration greater than 0.025 mg/mL. The result of LIVE/DEAD® BacLight™ Bacterial Viability Kit showed a concentration-dependent bactericidal effect on S. mutans and almost all bacteria were dead over 0.8 mg/mL. Real-time PCR analysis showed that gene expression of some virulence factors such as brpA, gbpB, gtfC, and gtfD was also inhibited. In GC and GC-MS analysis, the major components were found to be α-terpinene (40.60%), bornyl acetate (12.45%), α-pinene (11.38%), β-pinene (7.22%), β-phellandrene (3.45%), and α-terpinolene (3.40%). These results show that C. obtusa essential oil has anticariogenic effect on S. mutans.

Antibacterial activity of fluoride compounds and herbal toothpastes on Streptococcus mutans: an in vitro study

BACKGROUND

Streptococcus mutans is an important bacterial species implicated in dental caries. This laboratory study compared the antimicrobial activity of a number of fluoride containing and herbal dentifrices and their components against S. mutans.

METHODS

An agar diffusion method was used with Mueller-Hinton agar. Wells were filled with either 10 commercial fluoride or 6 herbal dentifrices, or with solutions of various fluoride compounds, sodium lauryl sulphate, sodium benzoate, chlorhexidine digluconate or triclosan. Diameters of zones of bacterial growth inhibition surrounding the wells were measured using a micrometer.

RESULTS

Significant differences were found for growth inhibition between the 10 fluoridated dentifrices (p < 0.0001), with Colgate Total having the greatest effect. There was not a direct correlation with fluoride type or fluoride concentration. The antibacterial activities of the 6 herbal toothpastes varied, with Herbal Fresh being the strongest. Sodium lauryl sulphate showed strong antimicrobial activity against S. mutans at the levels used in dentifrices.

CONCLUSIONS

Antimicrobial activity of commercial dentifrices against S. mutans may be exerted by components other than fluoride. Ingredients such as triclosan and sodium lauryl sulphate have larger antimicrobial effects than fluorides in this model.

Correlation between the cariogenic response in biofilms generated from saliva of mother/child pairs

This study aimed to correlate the cariogenic responsiveness of biofilms generated from the saliva of mothers and children. The mother-child pairs were classified according to the children's caries levels: caries-free, early childhood caries (ECC) or severe ECC. Microcosm biofilms were grown on enamel discs for 10 days. Factors under evaluation were caries experience levels, inoculum source (mothers and children) and growth conditions including cariogenic challenge (growth medium provided with and without sucrose) and no cariogenic challenge (growth medium sucrose-free). Statistical analysis was performed with ANOVA and Tukey's test, and the Spearman correlation test. Regular sucrose exposure resulted in a higher surface hardness change (%SHC). The correlation between biofilms formed from saliva of mother-child pairs was significant regarding pH, total aciduric microorganisms and lactobacilli counts under cariogenic challenge. Biofilm growth originating from mother-child pairs under regular sucrose exposure promoted the same cariogenic response independently of caries experience and the microbiological profile of the donors.

Dentifrice fluoride and abrasivity interplay on artificial caries lesions

Incipient caries lesions on smooth surfaces may be subjected to toothbrushing, potentially leading to remineralization and/or abrasive wear. The interplay of dentifrice abrasivity and fluoride on this process is largely unknown and was investigated on three artificially created lesions with different mineral content/distribution. 120 bovine enamel specimens were randomly allocated to 12 groups (n = 10), resulting from the association of (1) lesion type [methylcellulose acid gel (MeC); carboxymethylcellulose solution (CMC); hydroxyethylcellulose gel (HEC)], (2) slurry abrasive level [low (REA 4/ RDA 69); high (REA 7/RDA 208)], and (3) fluoride concentration [0/275 ppm (14.5 mM) F as NaF]. After lesion creation, specimens were brushed in an automated brushing machine with the test slurries (50 strokes 2×/day). Specimens were kept in artificial saliva in between brushings and overnight. Enamel surface loss (SL) was determined by optical profilometry after lesion creation, 1, 3 and 5 days. Two enamel sections (from baseline and post-brushing areas) were obtained and analyzed microradiographically. Data were analyzed by analysis of variance and Tukey's tests (α = 5%). Brushing with high-abrasive slurry caused more SL than brushing with low-abrasive slurry. For MeC and CMC lesions, fluoride had a protective effect on SL from day 3 on. Furthermore, for MeC and CMC, there was a significant mineral gain in the remaining lesions except when brushed with high-abrasive slurries and 0 ppm F. For HEC, a significant mineral gain took place when low-abrasive slurry was used with fluoride. The tested lesions responded differently to the toothbrushing procedures. Both slurry fluoride content and abrasivity directly impacted SL and mineral gain of enamel caries lesions.

Protective effects of SnF2 - Part III. Mechanism of barrier layer attachment

OBJECTIVE

To assess the ability of various fluoride salts to protect enamel against acid attack via a barrier mechanism.

METHODS

Extracted human enamel specimens were cleaned and rinsed, then soaked in pooled human saliva for 1 hour to initiate formation of an early pellicle. Groups of three specimens each were etched for 10 minutes in 1% citric acid (pH 2.3), treated in a 1:3 slurry of dentifrice [1,100 ppm F as stannous fluoride (SnF2 ), 1,100 ppm F as sodium fluoride (NaF), 1,000 ppm F as sodium monofluorophosphate (SMFP), or 1,400 ppm F as amine fluoride (AmF)] and saliva for 2 minutes, exposed to 2% alizarin red-S (a calcium-selective dye) and rinsed again. The relative ability of each test product to deposit a barrier layer on the enamel surface was measured by its ability to protect against attachment of the calcium-selective dye.

RESULTS

Specimens treated with the SnF2 dentifrice showed the least dye attachment, indicating a high level of surface protection. On a five-point scale, with 0 being no dye deposition (100% protection) and four being complete dye coverage (0% protection), the SnF2 -treated specimens scored an average of 0.25, with NaF scoring 3.4, SMFP scoring 3.4 and AmF scoring 3.7. Protection of the enamel surface was significantly higher for the SnF2 product than for the other products (P < 0.05), with no significant differences among the other three F salts.

CONCLUSIONS

These results demonstrate that after an aggressive acid challenge, SnF2 deposits a barrier layer onto the pellicle-coated enamel surface, and the barrier layer which attaches onto acid challenged tooth surfaces is different from any that might be provided by treatment with the other fluoride compounds tested.

Mechanical performance of novel bioactive glass containing dental restorative composites

OBJECTIVES

Bioactive glass (BAG) is known to possess antimicrobial properties and release ions needed for remineralization of tooth tissue, and therefore may be a strategic additive for dental restorative materials. The objective of this study was to develop BAG containing dental restorative composites with adequate mechanical properties comparable to successful commercially available composites, and to confirm the stability of these materials when exposed to a biologically challenging environment.

METHODS

Composites with 72 wt% total filler content were prepared while substituting 0-15% of the filler with ground BAG. Flexural strength, fracture toughness, and fatigue crack growth tests were performed after several different soaking treatments: 24h in DI water (all experiments), two months in brain-heart infusion (BHI) media+Streptococcus mutans bacteria (all experiments) and two months in BHI media (only for flexural strength). Mechanical properties of new BAG composites were compared along with the commercial composite Heliomolar by two-way ANOVA and Tukey's multiple comparison test (p≤0.05).

RESULTS

Flexural strength, fracture toughness, and fatigue crack growth resistance for the BAG containing composites were unaffected by increasing BAG content up to 15% and were superior to Heliomolar after all post cure treatments. The flexural strength of the BAG composites was unaffected by two months exposure to aqueous media and a bacterial challenge, while some decreases in fracture toughness and fatigue resistance were observed. The favorable mechanical properties compared to Heliomolar were attributed to higher filler content and a microstructure morphology that better promoted the toughening mechanisms of crack deflection and bridging.

SIGNIFICANCE

Overall, the BAG containing composites developed in this study demonstrated adequate and stable mechanical properties relative to three successful commercial composites.

Potentials of mouthwashes in disinfecting cariogenic bacteria and biofilms leading to inhibition of caries

OBJECTIVES

The aim of this study was to compare the effects of certain commercially available mouthwashes on cariogenic bacteria and biofilms, following the acquisition of inhibition potentials of caries.

MATERIALS AND METHODS

Mouthwashes containing I) chlorhexidine gluconate (CHG; 0.0005% w/v), II) benzethonium chloride (BTC; 0.01% w/v), III) an essential oil (Listerine), and IV) povidone-iodine (PVP-I; 0.035% w/v) were tested on planktonic cariogenic bacteria, biofilms, and an ex vivo caries model. Bacterial aliquots were inoculated with each solution separately and vortexed for 10 seconds at room temperature. Bacterial viability was subsequently investigated by fluorescence microscopy (FM) after staining with a BacLight viability kit and the number of colony-forming units (CFUs) was counted. Similarly, mouthwash solutions were applied to artificial cariogenic biofilms, and bacterial viability of the biofilms was investigated as stated above. Inhibition potentials of two selected mouthwashes of carious lesions were investigated using biofilm-induced caries and a secondary caries model. In all steps, a phosphate-buffered saline (PBS) solution was included as a control.

RESULTS

Planktonic cariogenic bacteria and bacteria embedded in biofilms were killed in remarkably large numbers with Listerine and PVP-I treatment compared to PBS and other gargles. CFU counts also showed significant reduction after treatment with Listerine and PVP-I compared to other solutions (P<0.05). Listerine also displayed significant (P<0.05) inhibition effects in preventing the progression of demineralization.

CONCLUSION

Bactericidal potencies of the mouthwashes varied significantly, suggesting that mouthwashes like Listerine can be useful for the prevention of caries and secondary caries.

The efficacy of laser fluorescence to detect in vitro demineralization and remineralization of smooth enamel surfaces

OBJECTIVE

The purpose of this study was to evaluate the efficacy of the laser fluorescence (LF) device in detecting in vitro demineralization and remineralization of smooth surface caries-like lesions.

BACKGROUND DATA

The early detection of smooth surface caries-like lesions is important to provide proper management of carious lesions, and allows monitoring of them over time. Also, some authors suggest that LF could be useful in monitoring the caries pathological process.

MATERIALS AND METHODS

Seventy-eight blocks of bovine teeth were obtained, and then submitted to artificial caries lesion induction and to a pH-cycling process. Superficial microhardness (SMH) and laser fluorescence analysis were performed at baseline, after induction of caries-like lesions, and after the pH-cycling regimen to promote remineralization.

RESULTS

Friedman's and multiple comparison tests were performed for all variables. SMH analysis showed significant differences (p +/- 0.05) between baseline (286.77 +/- 1.49 Vickers hardness number [VHN] units), before (38.48 +/- 0.85 VHN), and after remineralization (131.93 +/- 2.63 VHN). Baseline values for LF were extremely low (2.71 +/- 0.05), and a statistically significant difference was observed only after remineralization (3.61 +/- 0.08), as demonstrated by the increase in LF values.

CONCLUSION

The LF device did not show efficacy for monitoring in vitro demineralization and remineralization of smooth enamel surfaces.

Inhibitory activity by barley coffee components towards Streptococcus mutans biofilm

It was shown that barley coffee (BC) interferes with Streptococcus mutans adsorption to hydroxyapatite. After BC component fractionation by dialysis and gel filtration chromatography (GFC), it was found that the low molecular mass (<1,000 Da) fraction (LMM fraction) containing polyphenols, zinc and fluoride ions and, above all, a high molecular mass (HMM > 1,000 kDa) melanoidin fraction display strong anti-adhesive properties towards S. mutans. In this study, we have further examined the potential of BC, BC LMM fraction and BC HMM melanoidin fraction as caries controlling agents by evaluating their anti-biofilm activity.The effects of BC and BC fractions on biofilm formation by S. mutans ATCC 25175 and its detachment from pre-developed biofilms were evaluated by microtiter plate assay. It was found that BC and its fractions, at concentrations ranging from 60 to 15 mg ml(-1) that are devoid of antimicrobial activity, inhibited S. mutans biofilm formation. An increase of S. mutans ATCC 25175 detachment from 24 h developed biofilm was observed at the highest tested concentrations. Interestingly, BC and BC fractions also showed anti-biofilm activity towards a variety of S. mutans clinical strains isolated from saliva, plaque and caries lesions of adult donors. In general, the HMM melanoidin fraction was more active than the LMM fraction. These findings, classifying BC LMM fraction and BC HMM melanoidin fractions as natural anti-biofilm agents, represent the basis for studying their possible use as anti-caries agents.

Development of an in vitro denture plaque biofilm to model denture malodour

This study aimed to develop an in vitro denture plaque biofilm to model denture malodour. No previous studies have attempted to characterize the malodour associated with dentures and the effect of Candida spp. (main aetiological agent of denture-related stomatitis) on malodour. Pooled denture plaque microcosms and 'model' denture plaque biofilms (pooled saliva supplemented with additional microbial species) with and without addition of candida were grown aerobically at 37 °C for up to 13 days in a constant depth film fermenter (CDFF) on denture acrylic discs. Sample discs were removed, rinsed in sterile water and placed in phosphate buffered saline (PBS). The discs were vortex mixed to remove the biofilms, diluted in PBS and plated in duplicate onto general and selective media. The composition and stability of the biofilms over time were assessed. CDFF-grown microcosms and 'model' denture plaque biofilms were relatively stable in composition, with streptococci remaining the dominant microbial group. Model denture plaque biofilms were comparable in composition to denture plaque microcosms. This model system has the potential for evaluation of agents that might affect these parameters such as denture cleansers and other oral hygiene treatments.

The utility of affinity-tags for detection of a streptococcal protein from a variety of streptococcal species

There is no systematic examination of affinity tag utility in Gram-positive bacteria, which limits the investigation of protein function in this important group of bacteria as specific antibodies for many of native proteins are generally not available. In this study, we utilized an E. coli-streptococcal shuttle vector pVT1666 and constructed two sets of expression plasmids pVPT-CTag and pVPT-NTag, with each set containing five affinity tags (GST, GFP, HSV, T7 and Nano) that can be fused to either the C- or N-terminus of a target protein. A putative glycosyltransferase (Gtf2) essential for Fap1 glycosylation was used to demonstrate the utility of the cassettes in detection of Gtf2 fusion proteins, and the biological relevance of the proteins in our working strain Streptococcus parasanguinis. GFP and T7 tags were readily expressed in S. parasanguinis as either an N- or C-terminal fusion to Gtf2. Only the C- terminal fusion of GST and HSV were able to be identified in S. parasanguinis. The Nano tag was not detected in either E. coli or S. parasanguinis. Genetic complementation experiments indicated that all the tagged Gtf2 fusion proteins could restore the Gtf2 function in the null mutant except for the Nano-tagged Gtf2 at its N-terminal fusion. Using a T7-tagged Gtf2 fusion construct, we demonstrated that the fusion cassette is also useful in detection of the fusion tag expression in other streptococci including S. mutans, S. pneumoniae and S. sanguinis. Therefore, the expression cassettes we constructed will be a useful tool not only to investigate protein-protein interactions in Fap1 biogenesis in S. parasanguinis, but also to study protein functions in other gram-positive bacteria in which pVT1666 replicates.

Interaction between two putative glycosyltransferases is required for glycosylation of a serine-rich streptococcal adhesin

Fap1, a serine-rich glycoprotein, is essential for fimbrial biogenesis and biofilm formation of Streptococcus parasanguinis (formerly S. parasanguis). Fap1-like proteins are conserved in many streptococci and staphylococci and have been implicated in bacterial virulence. Fap1 contains two serine-rich repeat regions that are modified by O-linked glycosylation. A seven-gene cluster has been identified, and this cluster is implicated in Fap1 biogenesis. In this study, we investigated the initial step of Fap1 glycosylation by using a recombinant Fap1 as a model. This recombinant molecule has the same monosaccharide composition profile as the native Fap1 protein. Glycosyl linkage analyses indicated that N-acetylglucosamine (GlcNAc) is among the first group of sugar residues transferred to the Fap1 peptide. Two putative glycosyltransferases, Gtf1 and Gtf2, were essential for the glycosylation of Fap1 with GlcNAc-containing oligosaccharide(s) in both S. parasanguinis as well as in the Fap1 glycosylation system in Escherichia coli. Yeast two-hybrid analysis as well as in vitro and in vivo glutathione S-transferase pull-down assays demonstrated the two putative glycosyltransferases interacted with each other. The interaction domain was mapped to an N-terminal region of Gtf1 that was required for the Fap1 glycosylation. The data in this study suggested that the formation of the Gtf1 and Gtf2 complex was required for the initiation of the Fap1 glycosylation and that the N-terminal region of Gtf1 was necessary.

Effect of a CPP-ACP agent on the demineralization and remineralization of dentine in vitro

OBJECTIVES

The aim of this study was to determine in vitro the effect of a commercial paste based on CPP-ACP complex on the demineralization of sound human dentine and on remineralization potential of artificial caries-like lesions formed on dentine surfaces.

METHODS

Forty dentine specimens were prepared with hard tissue microtome. The specimens were divided in four groups the A, B, C and D (n=10). The specimen surfaces were subjected to surface analysis by Fourier transformance micro multiple internal reflectance infrared spectroscopy (micro MIR-FTIR). Tooth mousse was applied on surface specimens of A group, while no agent were applied on the specimens of B group. Afterwards, groups A, B, C and D were immersed in demineralization solution for 7 days. Afterwards, the surfaces were subjected to micro MIR-FTIR analysis and the mineral to matrix ratio was used to assess the extent of dentin demineralization (DM). Tooth mousse was applied on specimens of group C, while no agent was applied on specimens of group D. The groups C and D immersed in artificial saliva for 7 days and were subjected to analysis by micro MIR-FTIR and the mineral to matrix ratio was used to assess the extent of dentin remineralization (RM).

RESULTS

Group A showed significant lower %DM in comparison to group B. Group C resulted in a significant higher %RM compared to group D.

CONCLUSIONS

The presence of agent CPP-ACP on dentine surfaces provoked lower demineralization and higher remineralization in comparison with the dentine surfaces without agent.

Saliva from subjects harboring Actinobacillus actinomycetemcomitans kills Streptococcus mutans in vitro

BACKGROUND

Previous research indicated that patients with localized aggressive periodontitis (LAgP) had minimal proximal decay. We speculated that differences in these two proximal dental diseases (LAgP and proximal decay) in LAgP could be due to the effect of saliva on the growth of key microorganisms related to these two infections. Carbon dioxide (CO(2)) is required for growth of Actinobacillus actinomycetemcomitans (Aa), the reputed cause of LAgP. Bicarbonate, a source of CO(2), buffers acid production by Streptococcus mutans (Sm), a key organism associated with caries. The purpose of this study was to determine whether the saliva of LAgP patients and subjects with Aa had higher levels of bicarbonate, or an elevated pH, and/or reduced survival of Sm.

METHODS

Eleven Aa-positive subjects (seven with LAgP) were matched with 11 Aa-negative controls. A total of 5 ml saliva obtained from each subject was tested for CO(2) levels, pH, and effects on survival of Aa and Sm. Saliva from 22 additional subjects was used for confirmatory data.

RESULTS

CO(2) levels in the test group (Aa-positive subjects) and controls (Aa-negatives) were similar. No clinically relevant differences were found in salivary pH. However, saliva from the test group killed Sm by more than two logs (P <0.05). No effect was seen on Aa. The saliva from the Aa-negative group killed Aa by two logs (P <0.05). No effect was seen on Sm.

CONCLUSION

Aa-positive subjects had a salivary factor that significantly reduced survival of Sm, which may help to explain the fact that this group typically has minimal proximal decay.

Two gene determinants are differentially involved in the biogenesis of Fap1 precursors in Streptococcus parasanguis

Mature Fap1, a 200-kDa fimbria-associated adhesin, is required for fimbrial biogenesis and biofilm formation in Streptococcus parasanguis. Fap1-like proteins are found in the genomes of many streptococcal and staphylococcal species. Fap1 is a serine-rich glycoprotein modified by O-linked glycan moieties. In this study, we identified a seven-gene cluster including secY2, orf1, orf2, orf3, secA2, gtf1, and gtf2 that is localized immediately downstream of fap1. The lower G+C contents and the presence of a putative transposase element suggest that this gene cluster was horizontally transferred from other bacteria and represents a genomic island. At least two genes in this island mediated Fap1 biogenesis. Mutation of a glucosyltransferase (Gtf1) gene led to accumulation of a Fap1 precursor, which had no detectable glycan moieties. Inactivation of a gene coding for an accessory Sec protein (SecY2) resulted in expression of a distinct Fap1 precursor, which reacted with one glycan-specific Fap1 antibody but not with another glycan-specific antibody. Furthermore, partially glycosylated Fap1 was detected on the cell surface and in the culture supernatant. These data suggest that SecY2 has a role in complete glycosylation of Fap1 and imply that SecY2 is not the only translocation channel for the Fap1 precursor and that alternative secretion machinery exists. Together, Gtf1 and SecY2 are involved in biogenesis of two distinct Fap1 precursors in S. parasanguis. Discovery of the effect of an accessory Sec protein on Fap1 glycosylation suggests that Fap1 secretion and glycosylation are coupled during Fap1 biogenesis.

Interaction between GIC and S. sanguis biofilms: Antibacterial properties and changes of surface hardness

OBJECTIVE

The aim of this study was to investigate the interaction of Streptococcus sanguis with two glass-ionomer formulations (GIC:A containing fluoride and GIC:B without fluoride) with particular reference to bacterial growth and changes in hardness of the cement with respect to time.

MATERIALS AND METHODS

Discs of two water activated glass-ionomer cements were prepared according to the manufacturer's instruction. Hydroxyapatite discs (HA) were used as controls. 3D laser scanning technique was used to characterize surface roughness and area of the substrate prior to growing biofilms. Surface hardness was evaluated before and after biofilm growth. A constant depth film fermenter system (CDFF) was used to grow S. sanguis biofilms on the specimens in a similar manner to that described previously by Wilson et al. in 1995. For susceptibility measurement, specimens were removed from CDFF aseptically over periods up to 14d after the first colonization with bacteria. Counts of viable bacterial in the accumulating biofilm layer on each surface were measured and converted to colony forming units per unit surface area. To determine the effect of storage media, hardness discs were exposed to distilled water, lactic acid pH 4, lactic acid pH 5, citric acid pH 5, artificial saliva and S. sanguis biofilms. Twenty-four hours after preparing and subsequent autoclaving, specimens were transferred to a vessel containing 40 ml storage medium. The specimens were investigated for periods up to 7d.

RESULTS

The viable counts of S. sanguis per mm2 on GIC:A were significantly less than those on HA and GIC:B during the first 5d (p<0.05). The viable counts of bacteria on the surface of GIC:B were lower during the initial 5d when compared to HA. Exposure of GIC:A and GIC:B to different medium produced softening to the surface of cement. It is apparent that the effects of the biofilms are significantly greater than storage in water but similar to storage in lactic acid pH 5.

CONCLUSIONS

This investigation showed that the growth of S. sanguis biofilms were significantly affected by both glass-ionomer formulations, the greater reduction being noted on the surface of the fluoride containing GIC. S. sanguis biofilms produced reduction on the surface hardness of the cement equivalent to that seen after immersion in lactic acid at pH 5. This indicates that while S. sanguis biofilm is affected by the GIC, there is also a decrease in hardness of the cement indicating some cement degradation.

The in vitro effect of fluoridated milk in a bacterial biofilm--enamel model

OBJECTIVES

The purpose of this study was to investigate the effect of milk and fluoridated milk on bacterially induced caries-like lesions.

SAMPLE AND METHODS

Extracted impacted human molars were cut in half and covered with a varnish leaving a 4*4 mm window. The samples were coated with biofilm of S. sobrinus and were further divided into three experimental groups of S. sobrinus, S. sobrinus and milk and S. sobrinus and fluoridated milk. As negative controls served teeth incubated in saline. Of twenty tooth halves serial ground sections were cut through the lesions and investigated with polarization light microscopy (PLM) and scanning electron microscopy (SEM) and EDX element analysis. The PLM photographs were used for 3D reconstruction, volumetric assessment and determination of the extension of the lesion zones. Of eight tooth halves the biofilm on the enamel surface was studied with SEM and EDX element analysis.

RESULTS

Volumetric assessment showed a statistically significant difference in the volume of the body of the lesion and the translucent zone between the milk group and fluoridated milk group. Quantitative element analysis demonstrated significant differences between sound enamel and the superficial layer in the fluoridated milk group. The biofilm on the enamel surface showed an increased Ca content in the milk group and fluoridated milk group.

CONCLUSIONS

Milk as a common nutrient seems to play a complex role in in-vitro biofilm--enamel interactions stimulating bacterial demineralization on one hand, and, as effective fluoride carrier, inhibits caries-like demineralization.

Preparation of sodium fluoride-loaded gelatin microspheres, characterization and cariostatic studies

Sodium fluoride-loaded gelatin microspheres (NaF-GMS) were prepared using double-phase emulsified condensation polymerization. The average diameter of microspheres was (11.33+/-5.56) microm. The drug content and encapsulation efficiency were 8.80% and 76.73%, respectively. The fluoride releasing profiles of NaF-GMS in physiological saline and artificial saliva (pH 4.5, pH 6.8) showed that NaF-GMS had a sustained-release property and fluoride release rate was increased in pH 4.5 artificial saliva. Experiments conducted in rabbits' oral cavity using NaF-GMS and NaF solution as control revealed NaF-GMS could maintain oral fluoride retention longer than NaF solution. Cariostatic abilities of NaF-GMS including demineralization prohibition in vitro, fluoride deposition in artificial dental plaque and the ability of targeting to cariogenic bacteria were investigated in artificial dental plaque. The results indicated NaF-GMS with lower fluoride concentrations could achieve equivalent cariostatic effect to the concentrated NaF solution, at the same time, could prolong fluoride retention in dental plaque. Microscopic observation showed that NaF-GMS carrying fusion protein of glucan-binding domain could adhere more bacteria than NaF-GMS and this might indicate the possibility of targeting to cariogenic bacteria when NaF-GMS were properly modified.

Chemical or microbiological models of secondary caries development around different dental restorative materials

This study evaluated artificial secondary caries around restorative materials, induced by means of chemical or microbiological models. The following materials were used randomly to restore 130 dental blocks: (1) zinc-oxide eugenol-free temporary filling: Coltosol (Coltène/Whaledent Inc.; n = 30), (2) silver amalgam: Permite C (SDI Limited, n = 20), (3) composite resin: Filtek Z250 (3M ESPE; n = 20), (4) glass-ionomer cement: Fuji II (GC America Inc.; n = 20), (5) resin-modified glass ionomer: Vitremer (3M ESPE; n = 20), and (6) polyacid modified resin: Dyract AP (Dentsply; n = 20). Ten specimens of Group 1 were kept in humidity, and had no carious formation (NC). Ten specimens of each group were submitted to pH cycling (CG, n = 60), and the others were immersed in a medium containing Streptococcus mutans and sucrose (BG, n = 60). Mineral content was determined by microhardness assessment, and lesion depth was measured in polarized light photomicrographs. In the chemical model (CG), mineral content values in the vicinities of restoration were high for Groups 5 (75.7 +/- 11.9), 4 (70.8 +/- 14.2), and NC (95.4 +/- 3.8); intermediate for Groups 1 (55.8 +/- 18.5), 6 (45.6 +/- 11.0), and 2 (44.3 +/- 11.2); and reduced for Group 3 (34.7 +/- 9.7). In the microbiological model (BG), results were similar to CG, although there was less demineralization. The highest lesion depths were found for Groups 3 (182.3 +/- 33.2) in CG and 6 (126.5 +/- 42.8) in BG, when compared to Group 5 (114.6 +/- 26.0 and 56.2 +/- 33.2, respectively). In both models of caries induction, ionomeric materials showed a superior cariostatic effect when compared to the other restorative materials.

In vitro growth, acidogenicity and cariogenicity of predominant human root caries flora

Streptococcus mutans (Sm), Lactobacillus acidophilus (La) and Actinomyces israelii (Ai) have been associated with root surface caries, which is an increasing problem in elderly Chinese. The aim of this study therefore, was to evaluate in vitro, the growth, acidogenicity and cariogenicity of these organisms, both in mono- and co-cultures using an in vitro model. Forty-eight root specimens were prepared using intact extracted human molars. Fresh, wild-type bacteria obtained from root caries lesions were assembled into seven experimental groups as either mono- or co-cultures and incubated with the root specimens. Appropriate controls were included. Growth curve of each experimental group was monitored for 24h, aerobically, at 37 degrees C using a microplate reader. The pH of the medium was recorded after 24-h incubation using a pH meter. Mean depths of artificial root lesions produced in each cultural group were measured using polarized light microscopy in specimens cut into thin sections (100+/-20 microm). Compared with mono-cultures, synergistic growth was observed in co-cultures of 'La+Sm', 'Ai+La' and 'Ai+La+Sm'. Mean lesion depth produced in La group was significantly shallower than other mono- or co-culture groups (p<0.01). The pH values of all culture media were similar after 24-h incubation. The current data elucidate the complex interactions of three predominant bacterial species considered prime agents of human root surface caries.

A simple approach to examine early oral microbial biofilm formation and the effects of treatments

BACKGROUND/AIMS

A simple in vivo approach to examine early dental plaque formation in the human mouth and to determine the effects of common dietary and oral hygiene procedures on biofilm formation is reported.

METHODS

A custom designed device that fits securely behind the teeth of the mandibular arch provides a surface for microbial colonization. This device is prepared with denture acrylic and can be repeatedly used by the subject, exposing a large and constant surface area for microbial accumulation.

RESULTS

Large numbers of oral bacteria colonized the device by 2 h; these increased significantly by 4 h (P < 0.05). Bacterial colonization increased significantly after rinsing with a sucrose solution (P < 0.05) but remained unaffected after rinsing with water, a commercially available fluoride mouthrinse without antimicrobial agents, or brushing with a fluoride dentifrice (P > 0.05). Rinsing with mouthrinses formulated with chlorhexidine, cetylpyridinium chloride or triclosan/copolymer significantly inhibited colonization (P < 0.05). A dose-dependent inhibition was noted with chlorhexidine rinses (P < 0.05). Brushing with a triclosan/copolymer dentifrice significantly inhibited microbial colonization compared with a control (P < 0.05).

CONCLUSION

This simple approach was useful for examining the effects of common dietary and oral hygiene procedures. Significant biofilm inhibitory effects were noted with formulations that demonstrated efficacy in previous clinical studies.

In vivo vs in vitro anticariogenic behavior of glass-ionomer and resin composite restorative materials

OBJECTIVE

To evaluate the in vivo vs the in vitro anticariogenic potential of glass-ionomer and resin composite restoratives, utilizing a standardized interfacial gap model.

METHODS

(a) In vitro study. Box shaped cavities were prepared at the buccal surfaces of extracted premolars limited to enamel. The incisal cavity walls received no treatment and were covered with 40 microm-thick metal spacers. The cavities were restored with a glass-ionomer (Ketac-Fil, n=8) and a fluoride-free resin composite (Scotchbond MP Plus/Z100, n=8). After 4 weeks immersion in an acidic gel (pH 4), thin sections were produced and examined under polarized-light microscopy.(b) In vivo study. Four low caries activity volunteers, with first four premolars, each planned to be extracted for orthodontic reasons, participated in the study. Cavities were prepared as before and filled contralaterally per patient with glass-ionomer (n=8) and resin composite (n=8). After 6 months in vivo, the teeth were extracted, sectioned and investigated by polarized-light microscopy, Raman microspectroscopy and SEM-EDS X-ray microanalysis. Unpaired t-test (lesion dimensions) and one-way ANOVA and Newman-Keuls tests (Ca, P wt%, Ca/P ratios) were used to identify statistically significant differences in lesion analysis (alpha=0.05).

RESULTS

(a) In vitro study. All restorations developed lesions at incisal and cervical margins. At gap-free regions glass-ionomers showed reduced lesion dimensions compared to those of composites (p<0.05). At regions with gaps, no significant differences were found in lesion depth between the restorative groups tested. Lesion length was increased in composite, and decreased in glass-ionomer, whereas lesion depth in both restorative groups was increased in comparison to gap-free regions (p<0.05).(b) In vivo study. No lesions were observed at gap-free regions. At gap regions, 75.5% of glass-ionomer and 62.5% of composite restorations developed lesions. The lesion dimensions were significantly greater in glass-ionomer (p<0.05). A reduction in PO4(3-), CO3(2-), Ca and P was found in lesions compared to intact tissues. No F was detected and no CaF2 lattice vibrations were found at the enamel margins facing the gap adjacent to glass-ionomers.

SIGNIFICANCE

In the presence of a standardized interfacial gap, no preventive effect was exerted in vivo from the glass-ionomer to protect the adjacent enamel wall from secondary caries attack. The lack of any correlation between the in vivo and in vitro models tested implies that artificial caries experiments have a negligible clinical relevance in predicting the in vivo effect.

Natural genetic transformation of Streptococcus mutans growing in biofilms

Streptococcus mutans is a bacterium that has evolved to be dependent upon a biofilm "lifestyle" for survival and persistence in its natural ecosystem, dental plaque. We initiated this study to identify the genes involved in the development of genetic competence in S. mutans and to assay the natural genetic transformability of biofilm-grown cells. Using genomic analyses, we identified a quorum-sensing peptide pheromone signaling system similar to those previously found in other streptococci. The genetic locus of this system comprises three genes, comC, comD, and comE, that encode a precursor to the peptide competence factor, a histidine kinase, and a response regulator, respectively. We deduced the sequence of comC and its active pheromone product and chemically synthesized the corresponding 21-amino-acid competence-stimulating peptide (CSP). Addition of CSP to noncompetent cells facilitated increased transformation frequencies, with typically 1% of the total cell population transformed. To further confirm the roles of these genes in genetic competence, we inactivated them by insertion-duplication mutagenesis or allelic replacement followed by assays of transformation efficiency. We also demonstrated that biofilm-grown S. mutans cells were transformed at a rate 10- to 600-fold higher than planktonic S. mutans cells. Donor DNA included a suicide plasmid, S. mutans chromosomal DNA harboring a heterologous erythromycin resistance gene, and a replicative plasmid. The cells were optimally transformed during the formation of 8- to 16-h-old biofilms primarily consisting of microcolonies on solid surfaces. We also found that dead cells in the biofilms could act as donors of a chromosomally encoded antibiotic resistance determinant. This work demonstrated that a peptide pheromone system controls genetic competence in S. mutans and that the system functions optimally when the cells are living in actively growing biofilms.

Development of multi-species consortia biofilms of oral bacteria as an enamel and root caries model system

The aim was to establish defined-species consortium plaque biofilms to investigate enamel and root caries in an artificial mouth. Strains of the putative enamel and root caries pathogens, Streptococcus mutans, Strep. sobrinus, Actinomyces naeslundii and Lactobacillus rhamnosus, were screened in batch culture for potential cariogenic properties: a low terminal pH, ability to aggregate, and catabolic diversity. The strains selected were grown as monoculture biofilms and as consortium plaque biofilms in a multiplaque artificial mouth. The biofilms were supplied with a constant flow of a simulated oral fluid and were given periodic sucrose (and in some instances glucose) to simulate meals. All the bacteria except L. rhamnosus formed large, monospecies biofilms with resting pH in the range 5.3-5.8. The consortia biofilms were larger and had a resting pH of 4.9-5.3. The consortia biofilms supplied with 8-hourly carbohydrate comprised mainly 'mutans' streptococci (58, SD 5.5%) and L. rhamnosus (42, SD 5.7%). A. naeslundii characteristically was absent or present in a low percentage (up to 4% colony-forming units). All biofilms demineralized polished bovine enamel and dentine blocks, as assessed by microradiography and enamel-surface microhardness measurement. The consortia also demineralized intact enamel and tooth roots; they were more cariogenic to enamel than any of the monoculture biofilms, as measured by enamel-surface softening, but variation in lesion depth was proportional to biofilm wet weight irrespective of acidogen composition (r = 0.93, p < 0.05). Enamel lesions had a well-mineralized intact surface and a zone of subsurface demineralization, typical of early natural lesions. Dentine and root lesions showed extensive demineralization but lacked a pronounced surface mineralized zone. Substitution of glucose for sucrose had no effect on the cariogenicity of the consortium to bovine enamel or human roots and had no major effect on the plaque composition. Continuously supplied fluoride (19 parts/10(6)) resulted in a substantially reduced enamel surface softening and subsurface demineralization of intact roots. It was concluded that consortia biofilms of selected caries pathogens generate realistic caries lesions in all tooth hard tissues under controlled growth conditions in the artificial mouth. This in vitro caries experimental model may prove useful for the study of interrelations between the plaque biofilm, tooth tissues and the oral environment, and for the development of procedures to modify the course of caries development.

Germ theory vs. community theory in understanding and controlling the proliferation of biofilms

Germ theory and pure culture methods have provided invaluable information concerning the role of bacteria in diseases resulting from a single organism which bypasses a host's defenses. However, they do not provide sufficient information concerning the synergisms which allow the members of biofilm communities to proliferate more effectively as communities rather than as individuals. The mechanisms of these synergies are potential targets for antimicrobial agents as well as potential mechanisms of resistance to antimicrobial agents. Understanding community-level phenomena in oral biology requires the culture, identification, and classification of functional plaque communities as well as new methods of identifying and quantifying communal relationships. Cultured biofilm communities also provide ideal models of bacterial self-organization in which information related to adaptive strategies arises not only through the recombination of genes within genomes, but also through the recombination of organisms within communities.

Artificial dental plaque biofilm model systems

Difficulties with in vivo studies of natural plaque and its complex, heterogeneous structure have led to development of laboratory biofilm plaque model systems. Technologies for their culture are outlined, and the rationale, strengths, and relative uses of two complementary approaches to microbial models with a focus on plaque biodiversity are analyzed. Construction of synthetic consortia biofilms of major plaque species has established a variety of bacterial interactions important in plaque development. In particular, the 'Marsh' nine-species biofilm consortia systems are powerful quasi steady-state models which can be closely specified, modified, and analyzed. In the second approach, microcosm plaque biofilms are evolved in vitro from the natural oral microflora to the laboratory model most closely related to plaque in vivo. Functionally reproducible microcosm plaques are attainable with a biodiverse microbiota, heterogeneous structure, and pH behavior consistent with those of natural plaque. The resting pH can be controlled by urea supply. Their growth patterns, pH gradient formation, control of urease levels by environmental effectors, and plaque mineralization have been investigated. Microcosm biofilms may be the only useful in vitro systems where the identity of the microbes and processes involved is uncertain. Together, these two approaches begin to capture the complexity of plaque biofilm development, ecology, behavior, and pathology. They facilitate hypothesis testing across almost the whole range of plaque biology and the investigation of antiplaque procedures yielding accurate predictions of plaque behavior in vivo.

In situ caries models

By using in situ models, we have the potential to study both fundamental aspects of the caries process as well as more applied research problems such as the effect of food on dental caries and the role of fluoride in caries prevention in human subjects without actually causing caries in the natural dentition. The key experimental parameters that need to be considered in the development of an in situ model are the characteristics of the subject panel, the physical design of the model, the type of hard tissue substrate and the method of assessing mineral status, and the study design and clinical protocol. Each parameter must be carefully considered in relation to the objectives of the research, study design requirements, ethical considerations, impact on clinical relevance, and impact on the control of variation. The major source of variation associated with in situ models should be of biological and not experimental origin. The design and conduct of proper in situ model studies require a clear understanding of the caries process, sound analytical support, and a knowledge of how to work with research subjects to achieve a high level of compliance. Given the complex nature of caries, a combination of hard tissue substrates--including sound, surface-softened lesions and subsurface lesions--may be necessary to model all aspects of caries progression and prevention successfully. Internal validation of in situ models using fluoride dose-response controls is considered to be necessary for studies evaluating the efficacy of new fluoride dentifrice formulations.

Role of Models in Assessing New Agents for Caries Prevention-Non-Fluoride Systems: Reaction Paper

Several important issues have been raised concerning the need for consideration of alternatives to fluoride. The principle reason to do so has been the lack of comprehensive effectiveness of fluoride, which in turn reveals incomplete understanding of the caries process. Included among the topics required for clarification of caries initiation would be quantitative methods for relating plaque pH values to the formation of caries. Thus, methods for assessing the activity of anticaries agents over time would be of considerable assistance in monitoring the effects of these test compounds on bacteria. The use of recombinant oral micro-organisms containing genetic fusions, to provide information on the effects of agents on bacteria growing in model systems, is discussed as a possible means of obtaining relevant data in situ.