Effectiveness of different cleaning agents against the colonization of Candida spp and the in vitro detection of the adherence of these yeast cells to denture acrylic surfaces

Scientific evidence on the efficacy of effervescent tablets for cleaning removable prostheses. A systematic review and meta-analysis

STATEMENT OF PROBLEM

Scientific evidence to determine the optimal method of cleaning and disinfecting removable prostheses is lacking.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of effervescent tablets in the cleaning and sanitizing of removable prostheses compared with other chemical and physical methods by assessing the reduction of biofilm, microbial levels, and material stability.

MATERIAL AND METHODS

A systematic literature search and meta-analysis was conducted in August 2021 in the MEDLINE/PubMed, Cochrane, Embase, Scopus, and Web of Science databases. Randomized and nonrandomized controlled clinical trials published in English were included without publication year limits. A total of 23 studies were included in the systematic review and 6 in the meta-analysis, which had been registered in the international prospective register of systematic reviews (PROSPERO) database (CRD42021274019). The Cochrane Collaboration tool was used to assess the risk of bias of randomized clinical trials. The physiotherapy evidence database (PEDro) scale was used to analyze the internal validity of clinical trials by assessing the quality of the data obtained. The studies included in the meta-analysis were combined by using a random-effects model with the inverse variance method. Publication bias was analyzed by using the Duvall and Tweedie trim-and-fill method.

RESULTS

With regard to biofilm reduction, the standardized mean difference estimated with the 4 studies combined in the meta-analysis was P=.012: mean difference=-1.92; 95% confidence interval=-3.45 to -0.38, indicating a "large" effect of the combination of brushing and effervescent tablet versus brushing alone. To estimate the reduction in the total bacteria levels in the 3 combined studies, a "large" effect size was obtained for the combination of brushing and using an effervescent tablet versus brushing alone, P<.001: mean difference=-4.43; 95% confidence interval=-8.29 to -0.55. Finally, when the 3 studies were combined to assess the reduction of Candida or fungal infection, a "moderate" effect size was obtained for the combination of brushing combined with the use of an effervescent tablet, P<.001: mean difference=-0.78; 95% confidence interval=-1.19 to -0.37.

CONCLUSIONS

The combination of brushing and the use of effervescent tablets versus brushing alone had a significantly higher effect on reducing biofilm and bacterial counts and a moderate effect on reducing Candida. Regarding color and dimensional stability, few studies were found, with the results depending on the concentration of the product and the immersion time of the device.

Enhancing Presurgical Infant Orthopedic Appliances: Characterization, Mechanics, and Biofilm Inhibition of a Novel Chlorhexidine-Halloysite Nanotube-Modified PMMA

Objectives

This in vitro study aimed to develop a novel nanocomposite acrylic resin with inherent antimicrobial properties. This study evaluated its effectiveness against microbial biofilm formation, while also assessing its physical and mechanical properties.

Methods

Polymethylmethacrylate (PMMA) was modified with four different concentrations of chlorhexidine halloysite nanotubes (CHX-HNTs): 1%, 1.5%, 3%, and 4.5 wt.% by weight, along with a control group (0 wt.% CHX-HNTs). The biofilm inhibition ability of the modified CHX-HNTs acrylic against Candida albicans, Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus agalactiae was assessed using microtiter biofilm test. In addition, ten samples from each group were then tested for flexural strength, surface roughness, and hardness. Statistical analysis was performed using one-way ANOVA and Tukey's test for comparison (P < 0.05).

Results

CHX-HNTs effectively reduced the adhesion of Candida albicans and bacteria to the PMMA in a dose-dependent manner. The higher the concentration of CHX-HNTs, the greater the reduction in microbial adhesion, with the highest concentration (4.5 wt.%) showing the most significant effect with inhibition rates ≥98%. The addition of CHX-HNTs at any tested concentration (1%, 1.5%, 3%, and 4.5 wt.%) did not cause any statistically significant difference in the flexural strength, surface roughness, or hardness of the PMMA compared to the control group.

Conclusions

The novel integration of CHX-HNT fillers shows promising results as an effective biofilm inhibitor on acrylic appliances. This new approach has the potential to successfully control infectious diseases without negatively affecting the mechanical properties of the acrylic resin. Clinical Relevance. The integration of CHX-HNTs into presurgical infant orthopedic appliances should be thoroughly assessed as a promising preventive measure to mitigate microbial infections. This evaluation holds significant potential for controlling infectious diseases among infants with cleft lip and palate, thereby offering a valuable contribution to their overall well-being.

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

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

Anti-fungal efficacy of Miswak Extract (Salvadora Persica) and commercial cleaner against Candida albicans on heat cured polymethylmethacrylate denture base

AIM

The aim of the study was to compare the antifungal efficacy between commercial cleaner (Corega) and Miswak extract (Salvadora persica) against Candida albicans on heat cured Polymethyl methacrylate (PMMA) acrylic denture base resin.

MATERIALS AND METHODS

Forty-eight samples of heat cured PMMA acrylic denture base resin were fabircated in the study. The sterile acrylic resin specimens were immersed in standardized cell suspension of Candida albicans and incubated for 60 min at 370°C for cell adhesion and 2 h at 370°C for biofilm formation. After 24 h biofilm was evaluated by cell viability (CFUs) on SDA and cell counting of Candida albicans under light microscope at 400× magnification. The fungicidal effect of commercial cleaner and Miswak extract on Candida albicans biofilm was then evaluated by colony-forming units on SDA and cell counting under light microscope at 400× magnification.

RESULTS

Screening test agar disk-diffusion assay showed mean inhibitory zone of 3 mm for commercial cleaner as compared to Miswak extract, which showed mean inhibitory zone of 2 and 1 mm for different concentrations. Broth microdilution method showed 31 mg/ml MIC and 62.5 mg/ml Minimal Fungicidal Concentration (MFC) values for commercial cleaner as compared to Miswak extract that showed 125 mg/ml MIC and 250 mg/ml MFC values against Candida albicans. A significant difference (p < 0.05) was observed between pre and post treatment of both commercial cleaner and Miswak extract, for CFUs and cell count for Candida albicans.

CONCLUSION

Commercial denture cleaner (Corega) showed better antifungal (C albicans) activity than Miswak extract (Salvadora persica) on heat cured PMMA acrylic denture base resin.

Removal effect of Candida albicans biofilms from the PMMA resin surface by using a manganese oxide nanozyme-doped diatom microbubbler

To prevent oral candidiasis, removal of the Candida biofilms from dentures is important. However, common denture cleaners are insufficiently effective in removing biofilms. A manganese oxide (MnO₂) nanozyme-doped diatom microbubbler (DM) can generate oxygen gas microbubbles by a catalase-mimicking activity in hydrogen peroxide (H₂O₂). DM can invade and destroy biofilms with the driving force of continuously generated microbubbles. In this study, the Candida biofilm removal efficiency by co-treatment of DM and H₂O₂ was investigated. Diatom particles were reacted with (3-aminopropyl)triethoxysilane to prepare amine-substituted diatom particles. These particles were reacted with potassium permanganate to fabricate DMs. The morphology and components of DM were analyzed by using a scanning electron microscope (SEM). Four types of denture base resin specimens on which biofilms of Candida albicans were formed were treated with phosphate-buffered saline (PBS group), Polident 5-Minute (Polident group), 0.12% chlorhexidine gluconate (CHX group), 3% H₂O₂ (H₂O₂ group), and co-treatment of 3 mg/mL of DM and 3% H₂O₂ (DM group). The biofilm removal effect of each group was quantitatively analyzed by crystal violet assay, and the results were visually confirmed by SEM images. After each treatment, the remaining C. albicans were stained with Hoechst 33342/propidium iodide, and observed with confocal laser scanning microscopy (CLSM) to evaluate the viability. MnO₂ nanozyme sheets were successfully doped on the surface of the fabricated DM. Although biofilms were not effectively removed in the Polident and CHX groups, CLSM images showed that CHX was able to effectively kill C. albicans in the biofilms on all resin specimen types. According to the crystal violet analysis, the H₂O₂ groups removed the biofilms on heat-activated and 3D-printed resins (P < .01), but could not remove the biofilms on autopolymerizing and milled resins significantly (P = .1161 and P = .1401, respectively). The DM groups significantly removed C. albicans from all resin specimen types (P < .01).

A Proposal of Remedies for Oral Diseases Caused by Candida: A Mini Review

An opportunistic pathogen, Candida is not only related to oral problems such as oral candidiasis and denture stomatitis, but also to systemic diseases such as aspiration pneumonia and fungemia. The carriage rate of Candida species in the oral cavity of individuals wearing dentures and with removable orthodontic appliances, has increased. Moreover, it is one of the causal pathogens in refractory infected root canals because of its resistance to antifungal drugs in root canal therapy and poses a great challenge during the treatment of patients. This problem has led to the search for alternative strategies for the treatment and management of C. albicans infections. In this mini review, recent preventive strategies against Candida infection in the oral mucosa with natural product-derived antifungal molecules were discussed. Inhibitory strategies by introducing competitive naturally-derived antifungal peptide molecules with Candida adhesion molecules were specifically introduced. In addition, novel sterilization methods for Candida-infected root canals and tooth structures in the oral cavity were considered, with focused attention on the activities of reactive oxygen species. The possibility of application of these novel strategies in clinical treatments and daily life was also proposed.

Efficacy of denture cleaners on the surface roughness and Candida albicans adherence of sealant agent coupled denture base materials

This study investigated the effect of denture cleansers on the surface roughness and Candida albicans adherence of surface sealant agent coupled denture base resins. One hundred and twenty specimens were fabricated from 2 polymethyl methacrylate (PMMA) (Meliodent; Acron MC) and 1 polyamide (Deflex) denture base materials, coated with a sealant agent (Palaseal) and divided into 4 groups (n=10) according to overnight cleaning procedures: distilled water (control), 5% sodium hypochlorite (NaOCl) and two different sodium perborate (Corega; Rapident). The surface roughness values were measured with a profilometer before (R_a0) and after 90 days immersion in denture cleaners (R_a1). Specimens were incubated with Candida albicans suspension and Candida colony- forming units (CFU) (Cfu/mm) were counted. Significant differences were found, between the R_a0 and R_a1 values of 5% NaOCl applied Acron MC, Deflex and also Rapident applied Deflex groups (p<0.05). Denture cleaning procedures had no significant effects on the quantitiy of Candida albicans.

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

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

Microbial evaluation of the effectiveness of different methods for cleansing clear orthodontic retainers: A randomized clinical trial

OBJECTIVE

To compare effectiveness of brushing an Essix retainer with water only and brushing followed by soaking in one of three commercial cleansing tablets.

MATERIALS AND METHODS

A double-blind, parallel, randomized clinical trial with a split-mouth design was completed with 60 volunteers with specific eligibility criteria assigned to three groups to compare the cleansing effectiveness of brushing an Essix retainer with water only, followed by soaking in one of three alkaline peroxide-based commercial cleansing tablets (Retainer Brite®, Kukis®, and Corega®). Each participant wore an upper Essix retainer (with an electronic microsensor) on a full-time basis for 14 days and used one of the three products on one side of the retainer for 15 min/d. The effectiveness of the cleansing tablets was tested by the scanning electron microscopy, bacterial identification, bacterial quantification, and disk diffusion methods.

RESULTS

Bacterial quantification tests demonstrated nonsignificant statistical differences between the control and test sides of the three cleansing tablets: Retainer Brite®, Kukis®, and Corega® (Mann-Whitney test P-values were .6, .37, and .5, respectively). A Kruskal-Wallis test also showed nonstatistical difference in the bacterial counts between the three groups (P-value = .5). In vitro tests showed a minimal inhibition zone of Staphylococcus epidermidis only with Corega® tablets.

CONCLUSIONS

Using chemical cleansing tablets after mechanical cleansing did not significantly reduce the bacterial count in Essix retainers when compared to use of mechanical cleansing alone. However, the tablets seem to be effective against "cocci" bacterial species.

Efficacy of Propolis on the Denture Stomatitis Treatment in Older Adults: A Multicentric Randomized Trial

Our hypothesis tested the efficacy and safety of a mucoadhesive oral gel formulation of Brazilian propolis extract compared to miconazole oral gel for the treatment of denture stomatitis due to Candida spp. infection in older adults. Forty patients were randomly allocated in a noninferiority clinical trial into two groups. The control group (MIC) received 20 mg/g miconazole oral gel and the study group (PROP) received mucoadhesive formulation containing standardized extract of 2% (20 mg/g) propolis (EPP-AF®) during 14 days. Patients were examined on days 1, 7, and 14. The Newton's score was used to classify the severity of denture stomatitis. The colony forming unity count (CFU/mL) was quantified and identified (CHROMagar Candida®) before and after the treatment. Baseline characteristics did not differ between groups. Both treatments reduced Newton's score (P < 0.0001), indicating a clinical improvement of the symptoms of candidiasis with a clinical cure rate of 70%. The microbiological cure with significant reduction in fungal burden on T14 was 70% in the miconazole group and 25% in the EPP-AF group. The EPP-AF appears to be noninferior to miconazole considering the clinical cure rate and could be recommended as an alternative treatment in older patients.

Colonization of stickers used for the identification of intravenous lines: results from an in vitro study

BACKGROUND

Clear differentiation of arterial and intravenous (IV) lines is a safety strategy recommended by the World Health Organization, and signaling stickers attached to IV lines are implemented in many institutions. However, the risk of colonization of the stickers' surface has not been evaluated. Our objective was to assess the colonization rate of stickers used for IV lines identification in an in vitro model using 3 different contamination degrees.

METHODS

A set of 30 stickers used for IV lines identification were exposed to low, medium, and high contamination degrees for up to 15 days. Twice a day, a single manipulator vigorously touched the surface of the stickers simulating the daily handling. Surface cultures of all stickers were performed daily. The microorganisms recovered were counted and identified by phenotypic characteristics.

RESULTS

Colonization occurred after 5 days in low and medium manipulation models and after 3 days in the high manipulation model. Nonadhesive sticker sides were associated with greater significant numbers of colony forming units when manipulation was performed without gloves.

CONCLUSION

Stickers used for the identification of IV lines may become potential reservoirs of catheter colonization. Clinical studies to validate these data and design policies of stickers' changes are required.

Surface characteristics and microbial adherence ability of modified polymethylmethacrylate by fluoridated glass fillers

BACKGROUND

The current study objectives were to evaluate the influence of fluoridated glass fillers loading on the surface roughness, wettability, and adherence of candida and bacteria with and without saliva presence to a polymethylmethacrylate (PMMA) denture base material surface.

METHODS

Four concentrations of fluoridated glass fillers were added to PMMA: 1%, 2.5%, 5% and 10% by weight pre-polymerization and 0% was the control. Discs of each concentration were fabricated (n = 5 for each variable). Surface roughness (Ra ) was measured using atomic force microscopy (AFM). Wettability was assessed by measuring the contact angle of a sessile drop of water. Specimens were incubated with Candida albicans, or Streptococcus mutans with and without saliva coating. Adherence was presented as a percentage of the colonized surface area, counted using an optical microscope at x100 magnification.

RESULTS

The 10% group showed significantly greater roughness than the control and 1% groups; however, no significant differences in contact angle values were detected. The microbial adhesion was inversely proportional to the fluoridated glass fillers concentration where 10% concentration significantly decreased candidal and bacterial adhesion compared to others. Saliva coating significantly decreased microbial adhesion.

CONCLUSIONS

It was concluded that fluoridated glass fillers could decrease microbial adhesion to acrylic denture base without adversely affecting surface properties.

Anticandidal efficacy of denture cleansing tablet, Triphala, Aloe vera, and Cashew leaf on complete dentures of institutionalized elderly

With an increase in the number of dependent elderly, there is a need to introduce few natural products for denture cleansing, which are easily and economically available. Hence the aim of this study was to compare the anticandidal efficacy of denture cleansing tablet (sodium bicarbonate and sodium perborate monohydrate), Triphala (Phyllanthus emblica, Terminalia chebula and Terminalia belerica fruits powders in equal proportion), cashew leaf, Aloe vera and water (control) on complete dentures of institutionalized elderly. Study population consisted of 50 institutionalized elderly of Mangalore, Karnataka, with 10 in each group. Swabs were collected from the dentures before and after the use of denture cleansing tablet, Triphala, cashew leaf, Aloe vera, and water (control). Thereafter, the swabs were cultured on Sabouraud dextrose agar and the total candida counts were determined. Denture cleansing tablet and Triphala Churna showed a statistically significant reduction in Candida counts (P < 0.05). Denture cleansing tablet and Triphala Churna were found to be more effective.

Antifungal activity of components used for decontamination of dental prostheses on the growth of Candida albicans

Introduction: The effectiveness of antimicrobial solutions employed in dental prosthesis decontamination is still uncertain. Aim: To evaluate the antifungal activity of cleaners used in the decontamination of dental prostheses on the growth of Candida albicans. Material and method: The evaluated products were: Corega Tabs(r) (S1), Sodium Hypochlorite 1% (S2), Sodium Bicarbonate 1% (S3), Hydrogen Peroxide 1% (S4), Chlorhexidine Digluconate 0.12% - Periogard (r) (S5), Mouthrinse based on essential oils - Listerine(r) (S6), essential oil from Rosmarinus officinalis (rosemary) at concentrations of 1% (S7) and 2% (S8). The antifungal activity of the products was evaluated by agar diffusion technique and the determination of microbial death curve of samples of C. albicans (ATCC 90028) in concentration 1.5 × 106 CFU/mL. The tests were performed in triplicate and statistical analysis was made by ANOVA Two-Way and Tukey tests, with the confidence level of 95%. Result: The average of the zones of inhibition growth, in millimeters, obtained for the products were: 0.0 (S1), 44.7 (S2), 0.0 (S3), 21.6 (S4), 10.0 (S5), 6.1 (S6), 0.0 (S7) and 2.4 (S8). Considering the determination of microbial death curve, all products showed a statistical difference (p<0.01) from control (0.85% sodium chloride) and S3 groups. Fungal growth less than 2×104 CFU/mL and an accentuation of the microbial death curve were observed after 30 minutes, with exception for S3 and control groups. Conclusion: The studied compounds, with the exception of Sodium Bicarbonate, have antifungal effect against C. albicans, which contribute for dental prostheses hygiene.

Comparative effects of denture cleansers on physical properties of polyamide and polymethyl methacrylate base polymers

The purpose of this study was to evaluate the effect of denture cleansers on the surface roughness, hardness and color stability of two polyamides (Valpast, Deflex), a butadiene styrene copolymer PMMA (Rodex), and PMMA polymer as a control group (Paladent). Each material was divided into 5 sub-groups (n=7) as two control and three test groups. Three test groups were immersed for 20 days in commercially available three denture cleansers (CO-Corega, PR-Protefix, VA-Valclean). Two-way analysis of variance and Tukey's post hoc HSD test were used to evaluate surface roughness and hardness data (α=0.05). ΔE, ΔL*, Δa*and Δb* mean values were used for ANOVA, Tamhane test was used as post hoc. Polyamides showed low hardness and high roughness before and after immersion. A significant decrease in hardness was observed for all resins except Rodex after immersion (p<0.05). The denture cleansers changed the roughness, hardness and color of some resins.

Cleaning removable orthodontic appliances: a survey

OBJECTIVE

The aim of this survey was to analyze the recommendations commonly followed in Germany for cleaning removable orthodontic appliances (ROAs) and to compare these with published procedures.

METHODS

A total of 450 randomly-selected orthodontists were contacted by telephone and asked for their recommendations for cleaning ROA.

RESULTS

The most frequent recommendation was mechanical cleaning with a toothbrush (99.8%). Chemical detergents (37.1%) and treatment with diluted vinegar or citric acid (30.5%) were mentioned less often.

CONCLUSION

The use of cleaning solutions was recommended comparatively infrequently, even though the scientific literature suggests that this is the most hygienic way to care for ROA.

Evidence-based guidelines for the care and maintenance of complete dentures: a publication of the American College of Prosthodontists

The current rates of edentulism have been estimated to be between 7% and 69% of the adult population internationally. In the United States, while the incidence of edentulism continues to decline, rapid population growth coupled with current economic conditions suggest that edentulism and conventional denture use will continue at current or higher numbers. Unfortunately, evidence-based guidelines for the care and maintenance of removable complete denture prostheses do not exist. In 2009, the American College of Prosthodontists (ACP) formed a task force to establish evidence-based guidelines for the care and maintenance of complete dentures. The task force comprised members of the ACP, the Academy of General Dentistry, American Dental Association (ADA) Council on Scientific Affairs, the American Dental Hygienists' Association, the National Association of Dental Laboratories, and representatives from GlaxoSmithKline Consumer Healthcare. The review process included the assessment of over 300 abstracts and selection of over 100 articles meeting inclusion criteria of this review. The task force reviewed synopses of the literature and formulated 15 evidence-based guidelines for denture care and maintenance. These guidelines were reviewed by clinical experts from the participating organizations and were published in February 2011 issue of The Journal of the American Dental Association for widespread distribution to the dental community. These guidelines reflect the views of the task force.

Biofilm Formation on Dental Restorative and Implant Materials

Biomaterials for the restoration of oral function are prone to biofilm formation, affecting oral health. Oral bacteria adhere to hydrophobic and hydrophilic surfaces, but due to fluctuating shear, little biofilm accumulates on hydrophobic surfaces in vivo. More biofilm accumulates on rough than on smooth surfaces. Oral biofilms mostly consist of multiple bacterial strains, but Candida species are found on acrylic dentures. Biofilms on gold and amalgam in vivo are thick and fully covering, but barely viable. Biofilms on ceramics are thin and highly viable. Biofilms on composites and glass-ionomer cements cause surface deterioration, which enhances biofilm formation again. Residual monomer release from composites influences biofilm growth in vitro, but effects in vivo are less pronounced, probably due to the large volume of saliva into which compounds are released and its continuous refreshment. Similarly, conflicting results have been reported on effects of fluoride release from glass-ionomer cements. Finally, biomaterial-associated infection of implants and devices elsewhere in the body is compared with oral biofilm formation. Biomaterial modifications to discourage biofilm formation on implants and devices are critically discussed for possible applications in dentistry. It is concluded that, for dental applications, antimicrobial coatings killing bacteria upon contact are more promising than antimicrobial-releasing coatings.