Synergistic antimicrobial potential of EGCG and fosfomycin against biofilms associated with endodontic infections.

OBJECTIVE: This study aimed to evaluate the cytotoxicity and synergistic effect of epigallocatechin gallate (EGCG) and fosfomycin (FOSFO) on biofilms of oral bacteria associated with endodontic infections. METHODOLOGY: This study determined minimum inhibitory and bactericidal concentration (MIC/MBC) and fractionated inhibitory concentration (FIC) of EGCG and FOSFO against Enterococcus faecalis, Actinomyces israelii, Streptococcus mutans, and Fusobacterium nucleatum. Monospecies and multispecies biofilms with those bacteria formed in polystyrene microplates and in radicular dentin blocks of bovine teeth were treated with the compounds and control chlorhexidine (CHX) and evaluated by bacterial counts and microscopy analysis. Toxicity effect of the compounds was determined on fibroblasts culture by methyl tetrazolium assays. RESULTS: The combination of EGCG + FOSFO demonstrated synergism against all bacterial species, with an FIC index ranging from 0.35 to 0.5. At the MIC/FIC concentrations, EGCG, FOSFO, and EGCG+FOSFO were not toxic to fibroblasts. EGCG+FOSFO significantly reduced monospecies biofilms of E. faecalis and A. israelli, whereas S. mutans and F. nucleatum biofilms were eliminated by all compounds. Scanning electron microscopy of multispecies biofilms treated with EGCG, EGCG+FOSFO, and CHX at 100x MIC showed evident biofilm disorganization and substantial reduction of extracellular matrix. Confocal microscopy observed a significant reduction of multispecies biofilms formed in dentin tubules with 84.85%, 78.49%, and 50.6% of dead cells for EGCG+FOSFO, EGCG, and CHX at 100x MIC, respectively. CONCLUSION: EGCG and fosfomycin showed a synergistic effect against biofilms of oral pathogens related to root canal infections without causing cytotoxicity.

Synergistic antimicrobial potential of EGCG and fosfomycin against biofilms associated with endodontic infections

Abstract Objective This study aimed to evaluate the cytotoxicity and synergistic effect of epigallocatechin gallate (EGCG) and fosfomycin (FOSFO) on biofilms of oral bacteria associated with endodontic infections. Methodology This study determined minimum inhibitory and bactericidal concentration (MIC/MBC) and fractionated inhibitory concentration (FIC) of EGCG and FOSFO against Enterococcus faecalis, Actinomyces israelii, Streptococcus mutans, and Fusobacterium nucleatum. Monospecies and multispecies biofilms with those bacteria formed in polystyrene microplates and in radicular dentin blocks of bovine teeth were treated with the compounds and control chlorhexidine (CHX) and evaluated by bacterial counts and microscopy analysis. Toxicity effect of the compounds was determined on fibroblasts culture by methyl tetrazolium assays. Results The combination of EGCG + FOSFO demonstrated synergism against all bacterial species, with an FIC index ranging from 0.35 to 0.5. At the MIC/FIC concentrations, EGCG, FOSFO, and EGCG+FOSFO were not toxic to fibroblasts. EGCG+FOSFO significantly reduced monospecies biofilms of E. faecalis and A. israelli, whereas S. mutans and F. nucleatum biofilms were eliminated by all compounds. Scanning electron microscopy of multispecies biofilms treated with EGCG, EGCG+FOSFO, and CHX at 100x MIC showed evident biofilm disorganization and substantial reduction of extracellular matrix. Confocal microscopy observed a significant reduction of multispecies biofilms formed in dentin tubules with 84.85%, 78.49%, and 50.6% of dead cells for EGCG+FOSFO, EGCG, and CHX at 100x MIC, respectively. Conclusion EGCG and fosfomycin showed a synergistic effect against biofilms of oral pathogens related to root canal infections without causing cytotoxicity.

Antimicrobial peptide-loaded liquid crystalline precursor bioadhesive system for the prevention of dental caries.

BACKGROUND: Anticaries agents must interfere with the adhesion of Streptococcus mutans and its proliferation in dental biofilm, without causing host toxicity and bacterial resistance. Natural substances, including cationic antimicrobial peptides (CAMPs) and their fragments, such as ß-defensin-3 peptide fragment (D1-23), have been widely studied. However, the chemical and physical stability of CAMPs may be compromised by external factors, such as temperature and pH, reducing the period of antimicrobial activity. METHODS: To overcome the aforementioned disadvantage, this study developed and character-ized a drug delivery system and evaluated the cytotoxicity and effect against S. mutans biofilm of a D1-23-loaded bioadhesive liquid crystalline system (LCS). LCS was composed of oleic acid, polyoxypropylene-(5)-polyoxyethylene-(20)-cetyl alcohol, Carbopol® 974P and Carbopol® 971P. LCS was analyzed by polarized light microscopy (PLM), rheology (viscoelasticity and flow properties) and in vitro bioadhesion. The viability of epithelial cells was evaluated. Minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) against S. mutans were determined for D1-23 for further evaluation of the effect against S. mutans biofilm after 4 and 24 h of exposure to treatments. RESULTS: PLM, rheology, and in vitro bioadhesion tests showed that both viscosity and bioadhesion of LCS increased after it was diluted with artificial saliva. D1-23-loaded LCS system presented better activity against S. mutans biofilm after 24 h when compared to 4 h of treatment, showing a cumulative effect. Neither LCS nor D1-23-loaded LCS presented toxicity on human epithelial cells. CONCLUSION: D1-23-loaded LCS is a promising drug delivery system for the prevention of dental caries.

Development and characterization of p1025-loaded bioadhesive liquid-crystalline system for the prevention of Streptococcus mutans biofilms.

Formation of a dental biofilm by Streptococcus mutans can cause dental caries, and remains a costly health problem worldwide. Recently, there has been a growing interest in the use of peptidic drugs, such as peptide p1025, analogous to the fragments 1025-1044 of S. mutans cellular adhesin, responsible for the adhesion and formation of dental biofilm. However, peptides have physicochemical characteristics that may affect their biological action, limiting their clinical performance. Therefore, drug-delivery systems, such as a bioadhesive liquid-crystalline system (LCS), may be attractive strategies for peptide delivery. Potentiation of the action of LCS can be achieved with the use of bioadhesive polymers to prolong their residence on the teeth. In line with this, three formulations - polyoxypropylene-(5)-polyoxyethylene-(20)-cetyl alcohol, oleic acid, and Carbopol C974P in different combinations (F1C, F2C, and F3C) were developed to observe the influence of water in the LCS, with the aim of achieving in situ gelling in the oral environment. These formulations were assessed by polarized light microscopy, small-angle X-ray scattering, rheological analysis, and in vitro bioadhesion analysis. Then, p1025 and a control (chlorhexidine) were incorporated into the aqueous phase of the formulation (F + p1025 and F + chlorhexidine), to determine their antibiofilm effect and toxicity on epithelial cells. Polarized light microscopy and small-angle X-ray scattering showed that F1C and F2C were LCS, whereas F3C was a microemulsion. F1C and F2C showed pseudoplastic behavior and F3C Newtonian behavior. F1C showed the highest elastic and bioadhesive characteristics compared to other formulations. Antibiofilm effects were observed for F + p1025 when applied in the surface-bound salivary phase. The p1025-loaded nanostructured LCS presented limited cytotoxicity and effectively reduced S. mutans biofilm formation, and could be a promising p1025-delivery strategy to prevent the formation of S. mutans dental biofilm.

In vitro and in vivo evaluations of glass-ionomer cement containing chlorhexidine for Atraumatic Restorative Treatment.

OBJECTIVES: Addition of chlorhexidine has enhanced the antimicrobial effect of glass ionomer cement (GIC) indicated to Atraumatic Restorative Treatment (ART); however, the impact of this mixture on the properties of these materials and on the longevity of restorations must be investigated. The aim of this study was to evaluate the effects of incorporating chlorhexidine (CHX) in the in vitro biological and chemical-mechanical properties of GIC and in vivo clinical/ microbiological follow-up of the ART with GIC containing or not CHX. MATERIAL AND METHODS: For in vitro studies, groups were divided into GIC, GIC with 1.25% CHX, and GIC with 2.5% CHX. Antimicrobial activity of GIC was analyzed using agar diffusion and anti-biofilm assays. Cytotoxic effects, compressive tensile strength, microhardness and fluoride (F) release were also evaluated. A randomized controlled trial was conducted on 36 children that received ART either with GIC or GIC with CHX. Saliva and biofilm were collected for mutans streptococci (MS) counts and the survival rate of restorations was checked after 7 days, 3 months and one year after ART. ANOVA/Tukey or Kruskal-Wallis/ Mann-Whitney tests were performed for in vitro tests and in vivo microbiological analysis. The Kaplan-Meier method and Log rank tests were applied to estimate survival percentages of restorations (p<0.05). RESULTS: Incorporation of 1.25% and 2.5% CHX improved the antimicrobial/anti-biofilm activity of GIC, without affecting F release and mechanical characteristics, but 2.5% CHX was cytotoxic. Survival rate of restorations using GIC with 1.25% CHX was similar to GIC. A significant reduction of MS levels was observed for KM+CHX group in children saliva and biofilm 7 days after treatment. CONCLUSIONS: The incorporation of 1.25% CHX increased the in vitro antimicrobial activity, without changing chemical-mechanical properties of GIC and odontoblast-like cell viability. This combination improved the in vivo short-term microbiological effect without affecting clinical performance of ART restorations.

In vitro and in vivo evaluations of glass-ionomer cement containing chlorhexidine for Atraumatic Restorative Treatment

Abstract Objectives: Addition of chlorhexidine has enhanced the antimicrobial effect of glass ionomer cement (GIC) indicated to Atraumatic Restorative Treatment (ART); however, the impact of this mixture on the properties of these materials and on the longevity of restorations must be investigated. The aim of this study was to evaluate the effects of incorporating chlorhexidine (CHX) in the in vitro biological and chemical-mechanical properties of GIC and in vivo clinical/ microbiological follow-up of the ART with GIC containing or not CHX. Material and Methods: For in vitro studies, groups were divided into GIC, GIC with 1.25% CHX, and GIC with 2.5% CHX. Antimicrobial activity of GIC was analyzed using agar diffusion and anti-biofilm assays. Cytotoxic effects, compressive tensile strength, microhardness and fluoride (F) release were also evaluated. A randomized controlled trial was conducted on 36 children that received ART either with GIC or GIC with CHX. Saliva and biofilm were collected for mutans streptococci (MS) counts and the survival rate of restorations was checked after 7 days, 3 months and one year after ART. ANOVA/Tukey or Kruskal-Wallis/ Mann-Whitney tests were performed for in vitro tests and in vivo microbiological analysis. The Kaplan-Meier method and Log rank tests were applied to estimate survival percentages of restorations (p<0.05). Results: Incorporation of 1.25% and 2.5% CHX improved the antimicrobial/anti-biofilm activity of GIC, without affecting F release and mechanical characteristics, but 2.5% CHX was cytotoxic. Survival rate of restorations using GIC with 1.25% CHX was similar to GIC. A significant reduction of MS levels was observed for KM+CHX group in children saliva and biofilm 7 days after treatment. Conclusions: The incorporation of 1.25% CHX increased the in vitro antimicrobial activity, without changing chemical-mechanical properties of GIC and odontoblast-like cell viability. This combination improved the in vivo short-term microbiological effect without affecting clinical performance of ART restorations.

Efeito microbiológico e citotóxico de sistemas nanoestruturados bioadesivos contendo fragmentos de peptídeos / Microbiological and citotoxicity effect of nanostructured bioadhesive system containing peptide fragments

O uso de agentes antimicrobianos naturais que reduzam a adesão e proliferação de S. mutans no biofilme poderia ser uma estratégia interessante para o controle da cárie dentária. No entanto, a estabilidade química e física de alguns desses agentes, como os peptídeos catiônicos antimicrobianos e fragmentos de peptídeos, pode ser comprometida por fatores externos, como temperatura e pH, reduzindo sua ação antimicrobiana. Com isso, os objetivos deste estudo foram desenvolver e caracterizar sistemas de liberação de fármaco nanoestruturados bioadesivos para a incorporação dos fragmentos peptídicos D1-23 e P1025 e avaliar seu efeito citotóxico e atividade contra biofilme de S. mutans. A primeira formulação (F1), composta de ácido oleico, polyoxypropylene-(5)-polyoxyethylene-(20)-cetyl alcohol (PPCA), Carbopol® 974P e Carbopol® 971P, foi analisada por microscopia de luz polarizada (MLP), reologia e bioadesão in vitro. A concentração inibitória mínima (CIM) e concentração bactericida mínima (CBM) de D1-23 foram determinadas contra S. mutans para posterior avaliação da atividade sobre biofilme formado após 4h e 24h de tratamento. A segunda formulação (F2) foi selecionada a partir de três diferentes concentrações de ácido oleico, PPCA e Carbopol® 974P. Cada formulação foi analisada por MLP, espalhamento de raios x a baixo ângulo (SAXS), reologia e bioadesão. CIM e CBM de P1025 sobre S. mutans e seu efeito quando incorporado ou não em F2 sobre biofilme de S. mutans em formação foram analisados. A citotoxicidade em células epiteliais HaCat foi avaliada para os dois sistemas líquido cristalino (SLC) usando testes de MTT. Análise descritiva foi realizada para os dados dos ensaios de caracterização e para os ensaios microbiológicos e citotóxicos os dados foram submetidos aos testes de ANOVA/Tukey ou Kruskall-Wallis/Mann-Whitney U (p<0.05). Os resultados indicaram que F1 apresentou características de SLC com alta viscosidade e bioadesão. CIM e CBM de D1-23 foram de 15,60 e 31,25µg/mL, respectivamente. D1-23 incorporado em F1 apresentou melhores resultados contra biofilme de S. mutans que quando em solução, após 24h de tratamento. F2 apresentou melhores propriedades reológicas e força bioadesiva comparada aos demais sistemas, caracterizando um SLC. P1025 teve somente efeito inibitório sobre S. mutans (CIM=0.25 mg/mL). O efeito antibiofilme de P1025 incorporado em F2 foi observado após 24h de tratamento, principalmente quando aplicado na fase de adesão. Ambos os SLC contendo D1-23 e P1025 não apresentaram toxicidade sobre as células epiteliais, nas condições de tempo e concentrações avaliadas. A incorporação de peptídeos em SLC bioadesivos nanoestruturados aumenta suas propriedades antimicrobianas, podendo ser uma interessante estratégia para a prevenção da cárie dentária(AU)

The use of natural antimicrobial agents for reducing the adhesion and proliferation of S. mutans in the biofilm could be an interesting strategy for the control of dental caries. However, the chemical and physical stability of some natural antimicrobials, such as cationic antimicrobial peptides and peptide fragments, can be compromised by external factors such as temperature and pH, reducing their antimicrobial action. Thus, the objectives of this study were to develop and characterize nanostructured bioadhesive drug delivery systems for the incorporation of D1-23 and P1025 peptide fragments and to evaluate their citotoxicy and activity against S. mutans biofilm. The first formulation (F1) was composed of oleic acid, polyoxypropylene- (5) -polyoxyethylene- (20) - cetyl alcohol (PPCA), Carbopol® 974P and Carbopol® 971P and analyzed by polarized light microscopy (PLM), rheology and in vitro bioadhesion. Minimum inhibitory concentration (MIC) and minimal bacterial concentration (MBC) of D1-23 were determined against S. mutans for further evaluation of activity against S. mutans biofilm after 4h and 24h of treatment. The second formulation was selected from three different concentrations of oleic acid, PPCA and Carbopol® 974P. Each formulation was analyzed by PLM, small-angle x-ray scattering (SAXS), rheology and bioadhesion. MIC and MBC of P1025 were determined against S. mutans. Thus, P1025 was incorporated in the best formulation (F2). The effect of P1025 incorporated or not into F2 on S. mutans biofilm formation was analyzed. Cytotoxicity in HaCat epithelial cells for both formulations was evaluated using MTT assays. Descriptive analysis was performed for the characterization assays and data from microbiological and cytotoxic assays were submitted to ANOVA / Tukey or Kruskall-Wallis / Mann-Whitney U (p<0.05). The results indicated that F1 presented characteristics of liquid-crystalline type system (LCS) with high viscosity and bioadhesion. The MIC and MBC of D1-23 were 15.60 and 31.25µg / mL, respectively. D1-23 incorporated in F1 showed better results than D1-23 in solution against S. mutans biofilm after 24h. F2 had better rheological properties and bioadhesive strength compared to other systems analyzed and characteristics of LCS. P1025 had only inhibitory effect against S. mutans (MIC=0.25mg/mL). The antibiofilm effect of P1025 incorporated into F2 was observed after 24h of treatment, mainly when applied in surface-bound salivary phase. Both LCS had no toxicity on epithelial cells, considering time and concentrations tested. The incorporation of peptides in nanostructured bioadhesive LCS increased their antimicrobial properties and could be an interesting strategy for caries prevention(AU)

Cytotoxicity and the effect of cationic peptide fragments against cariogenic bacteria under planktonic and biofilm conditions.

This study evaluated the cytotoxicity and effect of fragments derived from three oral cationic peptides (CP): LL-37, D6-17 and D1-23 against cariogenic bacteria under planktonic and biofilm conditions. For cytotoxicity analysis, two epithelial cell lines were used. The minimum inhibitory concentration and the minimal bactericidal concentration were determined for the CP fragments and the control (chlorhexidine-CHX) against cariogenic bacteria. The fractional inhibitory concentration was obtained for the combinations of CP fragments on Streptococcus mutans. Biofilm assays were conducted with the best antimicrobial CP fragment against S. mutans. The results indicated that D6-17 was not cytotoxic. D1-23, LL-37 and CHX were not cytotoxic in low concentrations. D1-23 presented the best bactericidal activity against S. mutans, S. mitis and S. salivarius. Combinations of CP fragments did not show a synergic effect. D1-23 presented a higher activity against S. mutans biofilm than CHX. It was concluded that D1-23 showed a substantial effect against cariogenic bacteria and low cytotoxicity.

Anti-dentine Salivary SIgA in young adults with a history of dental trauma in deciduous teeth.

Anti-dentin autoantibodies are associated with inflammatory root resorption in permanent teeth and are modulated by dental trauma and orthodontic force. However, it is not known whether deciduous tooth trauma can stimulate the development of a humoral immune response against dentin. The aim of this study was to evaluate the levels of salivary SIgA reactivity against human dentin extract in young adults with a history of trauma in the primary dentition. A sample of 78 patients, aged 18 to 25, who had completed an early childhood (0 to 5 years old) caries prevention program years earlier at the Universidade Estadual de Londrina Pediatric Clinic, underwent radiographic examination and salivary sampling. Anti-dentin SIgA levels were analyzed by immunoenzymatic assay and Western blotting. Although dental trauma to deciduous teeth had occurred in 34 (43.6%) of the patients, no differences in SIgA levels were detected between individuals who had experienced trauma and those who had not (p > 0.05). Multivariate regression analysis showed no association between dental trauma and SIgA levels (p > 0.05). Patients with a history of deciduous trauma presented low levels of anti-dentin antibodies, associated with orthodontic root resorption (p < 0.05). Western blot analysis showed that salivary antibodies recognized a single band of approximately 45 kDa in dentin extract. We concluded that salivary SIgA recognizes a specific component of the dentin matrix and that anti-dentin antibodies were not triggered by trauma to primary teeth. However, trauma to deciduous teeth may down-modulate SIgA in response to orthodontic root response.

Highlights in peptide nanoparticle carriers intended to oral diseases.

New biocompatible nanomaterials are leading to a range of emerging health treatments. Thus, peptide drugs present in oral diseases, such as caries, periodontal diseases and oral cancer, are highlighting into clinical practice because the peptides can have an influence the growth of tumor cells or microorganisms and its can exhibit direct cytotoxic activity towards cancer cells or microbial cells. Therefore, it is interesting to speculate what are the natural or synthetic peptides that can be used to develop novel strategies to fight cancer diseases or microbial cells, and so, to represent a novel family of anticancer or antimicrobial agents. The use of buccal drug delivery systems, especially nanoparticles, to carrier peptides shows to be very interesting, because these systems can protect the peptide against enzymatic degradation, in addition to target inaccessible sites. However, this peptide delivery system seems to be unexplored by researchers. On the hand, the application of drug delivery systems for oral diseases could be a proposed treatment for these diseases, including the treatment or co-treatment with other therapies, such as photodynamic therapy, of antimicrobial, periodontal diseases and cancer, or even in the early diagnosis of cancer. The objective of this study is to present a systematic review of nanotechnology-based peptides delivery systems intended to oral diseases.

Anti-dentine Salivary SIgA in young adults with a history of dental trauma in deciduous teeth

Anti-dentin autoantibodies are associated with inflammatory root resorption in permanent teeth and are modulated by dental trauma and orthodontic force. However, it is not known whether deciduous tooth trauma can stimulate the development of a humoral immune response against dentin. The aim of this study was to evaluate the levels of salivary SIgA reactivity against human dentin extract in young adults with a history of trauma in the primary dentition. A sample of 78 patients, aged 18 to 25, who had completed an early childhood (0 to 5 years old) caries prevention program years earlier at the Universidade Estadual de LondrinaPediatric Clinic, underwent radiographic examination and salivary sampling. Anti-dentin SIgA levels were analyzed by immunoenzymatic assay and Western blotting. Although dental trauma to deciduous teeth had occurred in 34 (43.6%) of the patients, no differences in SIgA levels were detected between individuals who had experienced trauma and those who had not (p > 0.05). Multivariate regression analysis showed no association between dental trauma and SIgA levels (p > 0.05). Patients with a history of deciduous trauma presented low levels of anti-dentin antibodies, associated with orthodontic root resorption (p < 0.05). Western blot analysis showed that salivary antibodies recognized a single band of approximately 45 kDa in dentin extract. We concluded that salivary SIgA recognizes a specific component of the dentin matrix and that anti-dentin antibodies were not triggered by trauma to primary teeth. However, trauma to deciduous teeth may down-modulate SIgA in response to orthodontic root response.

Influência da atenção odontológica precoce na experiência de cárie em adultos jovens

Os programas preventivos para crianças em idade pré-escolar são eficazes para prevenção e manutenção da saúde bucal. No entanto, a efetividade dessas ações preventivas após o término do programa até a idade adulta ainda não foi investigada. O objetivo do trabalho foi avaliar a influência da atenção odontológica precoce durante a idade pré-escolar na experiência de cárie em adultos jovens. Foram avaliados 72 indivíduos (18 a 25 anos, 41,7% gênero masculino) que participaram do programa preventivo da Bebê-Clínica/UEL durante seus cinco primeiros anos de vida, e 36 indivíduos (18 a 25 anos, 41,7% gênero masculino) que não participaram de programas preventivos (grupo controle). Aplicou-se questionário estruturado com questões englobando aspectos sociodemográficos, hábitos dietéticos e hábitos de higiene bucal. Em seguida realizou-se exame clínico para diagnóstico de placa visível e índices CPOD (número de dentes cariados, perdidos e obturados) e CPOS (número de superfícies cariadas, perdidas e obturadas), além de coleta de saliva para quantificar SIgA salivar e anticorpos SIgA anti-S. mutans por ensaio imunoenzimático. As médias dos índices CPOD e CPOS encontrados foram de 2,72 ± 2,8 e 3,07± 3,3 para o grupo de estudo (n=72), e 3,06 ± 2,9 e 3,92 ± 4,6 para o grupo controle (n=36), sem diferença estatisticamente significativa. No grupo de estudo, o gênero masculino apresentou prevalência de cárie significativamente menor que o gênero feminino. Níveis menores de anticorpos SIgA anti-S. mutans foram observados no grupo de estudo. Conclui-se que a atenção odontológica precoce não influenciou significativamente a prevalência de cárie em adultos jovens, porém, prode ter promovido modulação negativa na resposta imunológica humoral bucal contra os S. mutans