Preventive Applications of Polyphenols in Dentistry-A Review.

Polyphenols are natural substances that have been shown to provide various health benefits. Antioxidant, anti-inflammatory, and anti-carcinogenic effects have been described. At the same time, they inhibit the actions of bacteria, viruses, and fungi. Thus, studies have also examined their effects within the oral cavity. This review provides an overview on the different polyphenols, and their structure and interactions with the tooth surface and the pellicle. In particular, the effects of various tea polyphenols on bioadhesion and erosion have been reviewed. The current research confirms that polyphenols can reduce the growth of cariogenic bacteria. Furthermore, they can decrease the adherence of bacteria to the tooth surface and improve the erosion-protective properties of the acquired enamel pellicle. Tea polyphenols, especially, have the potential to contribute to an oral health-related diet. However, in vitro studies have mainly been conducted. In situ studies and clinical studies need to be extended and supplemented in order to significantly contribute to additive prevention measures in caries prophylaxis.

Effect of vegetable oils applied over acquired enamel pellicle on initial erosion.

OBJECTIVE: The prevalence of dental erosion has been recently increasing, requiring new preventive and therapeutic approaches. Vegetable oils have been studied in preventive dentistry because they come from a natural, edible, low-cost, and worldwide accessible source. This study aimed to evaluate the protective effect of different vegetable oils, applied in two concentrations, on initial enamel erosion. MATERIAL AND METHODS: Initially, the acquired pellicle was formed in situ for 2 hours. Subsequently, the enamel blocks were treated in vitro according to the study group (n=12/per group): GP5 and GP100 - 5% and pure palm oil, respectively; GC5 and GC100 - 5% and pure coconut oil; GSa5 and GSa100 - 5% and pure safflower oil; GSu5 and GSu100 - 5% and pure sunflower oil; GO5 and GO100 - 5% and pure olive oil; CON- - Deionized Water (negative control) and CON+ - Commercial Mouthwash (Elmex® Erosion Protection Dental Rinse, GABA/positive control). Then, the enamel blocks were immersed in artificial saliva for 2 minutes and subjected to short-term acid exposure in 0.5% citric acid, pH 2.4, for 30 seconds, to promote enamel surface softening. The response variable was the percentage of surface hardness loss [((SHi - SHf) / SHf )×100]. Data were analyzed by one-way ANOVA and Tukey's test (p<0.05). RESULTS: Enamel blocks of GP100 presented similar hardness loss to GSu100 (p>0.05) and less than the other groups (p<0.05). There was no difference between GP5, GC5, GC100, GSa5, GSu100, GSa100, GSu5, GO5, GO100, CON- and CON+. CONCLUSION: Palm oil seems to be a promising alternative for preventing enamel erosion. However, further studies are necessary to evaluate a long-term erosive cycling.

Effect of vegetable oils applied over acquired enamel pellicle on initial erosion

Abstract Objective The prevalence of dental erosion has been recently increasing, requiring new preventive and therapeutic approaches. Vegetable oils have been studied in preventive dentistry because they come from a natural, edible, low-cost, and worldwide accessible source. This study aimed to evaluate the protective effect of different vegetable oils, applied in two concentrations, on initial enamel erosion. Material and Methods Initially, the acquired pellicle was formed in situ for 2 hours. Subsequently, the enamel blocks were treated in vitro according to the study group (n=12/per group): GP5 and GP100 - 5% and pure palm oil, respectively; GC5 and GC100 - 5% and pure coconut oil; GSa5 and GSa100 - 5% and pure safflower oil; GSu5 and GSu100 - 5% and pure sunflower oil; GO5 and GO100 - 5% and pure olive oil; CON− - Deionized Water (negative control) and CON+ - Commercial Mouthwash (Elmex® Erosion Protection Dental Rinse, GABA/positive control). Then, the enamel blocks were immersed in artificial saliva for 2 minutes and subjected to short-term acid exposure in 0.5% citric acid, pH 2.4, for 30 seconds, to promote enamel surface softening. The response variable was the percentage of surface hardness loss [((SHi - SHf) / SHf )×100]. Data were analyzed by one-way ANOVA and Tukey's test (p<0.05). Results Enamel blocks of GP100 presented similar hardness loss to GSu100 (p>0.05) and less than the other groups (p<0.05). There was no difference between GP5, GC5, GC100, GSa5, GSu100, GSa100, GSu5, GO5, GO100, CON− and CON+. Conclusion Palm oil seems to be a promising alternative for preventing enamel erosion. However, further studies are necessary to evaluate a long-term erosive cycling.

Fatty acid profile of the initial oral biofilm (pellicle): an in-situ study.

The first step of bioadhesion on dental surfaces is the formation of the acquired pellicle. This mainly acellular layer is formed instantaneously on all solid surfaces exposed to oral fluids. It is composed of proteins, glycoproteins and lipids. However, information on the lipid composition is sparse. The aim of the present study was to evaluate the fatty acid (FA) profile of the in-situ pellicle for the first time. Furthermore, the impact of rinses with safflower oil on the pellicle's FA composition was investigated. Pellicles were formed in situ on bovine enamel slabs mounted on individual upper jaw splints. The splints were carried by ten subjects over durations of 3-240 min. After comprehensive sample preparation, gas chromatography coupled with electron impact ionization mass spectrometry (GC-EI/MS) was used in order to characterize qualitatively and quantitatively a wide range of FA (C12-C24). The relative FA profiles of the pellicle samples gained from different subjects were remarkably similar, whereas the amount of FA showed significant interindividual variability. An increase in FA in the pellicle was observed over time. The application of rinses with safflower oil resulted in an accumulation of its specific FA in the pellicle. Pellicle formation is a highly selective process that does not correlate directly with salivary composition, as shown for FA.

Do edible oils reduce bacterial colonization of enamel in situ?

OBJECTIVE: Edible oils are an empiric approach for the prevention of oral diseases. The present in situ study investigated the effect of edible oils on initial bacterial colonization of enamel surfaces. METHODS AND MATERIALS: Initial biofilm formation was performed on enamel specimens mounted on maxillary splints and carried by eight subjects. After 1 min of pellicle formation, rinses with safflower oil, olive oil and linseed oil were performed for 10 min. Application of chlorhexidine for 1 min served as positive control. Afterwards, the slabs were carried for 8 h overnight. Samples carried for 8 h without any rinse served as negative controls. The amount of adherent bacteria was determined by DAPI staining (4',6-diamidino-2-phenylindole) and live-dead staining (BacLight). Additionally, determination of colony forming units was performed after desorption of the bacteria. TEM evaluation was carried out after application of the rinses. RESULTS: The number of adherent bacteria on control samples was 6.1 ± 8.1 × 10(5)/cm(2) after 8 h (DAPI). Fluorescence microscopic data from DAPI staining and live-dead staining as well as from the determination of CFU revealed no significant effects of rinsing with oils on the amount of adherent bacteria compared to the non-rinsed control samples. However, with chlorhexidine a significant reduction in the number of bacteria by more than 85 % was achieved (DAPI, chlorhexidine: 8.2 ± 17.1 × 10(4)/cm(2)). The ratio of viable to dead bacteria was almost equal (1:1) irrespective of the rinse adopted as recorded with BacLight. TEM indicated accumulation of oil micelles at the pellicle's surface and modification of its ultrastructure. CONCLUSION: Rinses with edible oils have no significant impact on the initial pattern and amount of bacterial colonization on enamel over 8 h. CLINICAL RELEVANCE: Rinses with edible oils cannot be recommended for efficient reduction of oral biofilm formation.

Lipids in preventive dentistry.

OBJECTIVES: There is still a great demand for the improvement of oral prophylaxis methods. One repeatedly described approach is rinsing with edible oils. The aim of the present review paper was to analyze the role of lipids in bioadhesion and preventive dentistry. MATERIALS AND METHODS: Despite limited sound scientific data, extensive literature search was performed to illustrate possible effects of lipids in the oral cavity. RESULTS: It is to be assumed that lipophilic components modulate the process of bioadhesion to the oral hard tissues as well as the composition and ultrastructure of the initial oral biofilm or the pellicle, respectively. Thereby, lipids could add hydrophobic characteristics to the tooth surface hampering bacterial colonization and eventually decreasing caries susceptibility. Also, a lipid-enriched pellicle might be more resistant in case of acid exposure and could therefore reduce the erosive mineral loss. Furthermore, anti-inflammatory effects on the oral soft tissues were described. However, there is only limited evidence for these beneficial impacts. Neither the lipid composition of saliva and pellicle nor the interactions of lipids with the initial oral biofilm and the pellicle layer have been investigated adequately until now. CONCLUSION: Edible oils might qualify as mild supplements to conventional strategies for the prevention of caries, erosion, and periodontal diseases but further research is necessary. CLINICAL RELEVANCE: Against the background of current scientific and empirical knowledge, edible oils might be used as oral hygiene supplements but a decisive benefit for the oral health status is questionable.

Effect of safflower oil on the protective properties of the in situ formed salivary pellicle.

AIM: The prevalence of dental erosion is still increasing. A possible preventive approach might be rinsing with edible oils to improve the protective properties of the pellicle layer. This was tested in the present in situ study using safflower oil. METHODS: Pellicle formation was carried out in situ on bovine enamel slabs fixed buccally to individual upper jaw splints (6 subjects). After 1 min of pellicle formation subjects rinsed with safflower oil for 10 min, subsequently the samples were exposed in the oral cavity for another 19 min. Enamel slabs without oral exposure and slabs exposed to the oral cavity for 30 min without any rinse served as controls. After pellicle formation in situ, slabs were incubated in HCl (pH 2; 2.3; 3) for 120 s, and kinetics of calcium and phosphate release were measured photometrically (arsenazo III, malachite green). Furthermore, the ultrastructure of the pellicles was evaluated by transmission electron microscopy (TEM). RESULTS: Pellicle alone reduced erosive calcium and phosphate release significantly at all pH values. Pellicle modification by safflower oil resulted in an enhanced calcium loss at all pH values and caused an enhanced phosphate loss at pH 2.3. TEM indicated scattered accumulation of lipid micelles and irregular vesicle-like structures attached to the oil-treated pellicle layer. Acid etching affected the ultrastructure of the pellicle irrespective of oil rinsing. CONCLUSION: The protective properties of the pellicle layer against extensive erosive attacks are limited and mainly determined by pH. The protective effects are modified and reduced by rinses with safflower oil.

Preventing erosion with novel agents.

OBJECTIVES: This in vitro study aimed to investigate the protective effect of four commercial novel agents against erosion. METHODS: Ninety human molars were distributed into 9 groups, and after incubation in human saliva for 2 h, a pellicle was formed. Subsequently, the specimens were submitted to demineralization (orange juice, pH 3.6, 3 min) and remineralization (paste slurry containing one of the tested novel agents, 3 min) cycles, two times per day, for 4 days. The tested agents were: (1) DenShield Tooth; active ingredient: 7.5% W/W NovaMin(®) (calcium sodium phosphosilicate); (2) Nanosensitive hca; active ingredient: 7.5% W/W NovaMin(®); (3) GC Tooth Mousse; active ingredient: 10% Recaldent™ (CPP-ACP); (4) GC MI Paste Plus; active ingredients: 10% Recaldent™, 900 ppm fluoride. Two experimental procedures were performed: in procedure 1, the tested agents were applied prior to the erosive attack, and in procedure 2 after the erosive attack. A control group receiving no prophylactic treatment was included. Surface nanohardness (SNH) of enamel specimens was measured after pellicle formation and after completion of daily cyclic treatment. RESULTS: SNH significantly decreased at the end of the experiment for all groups (p<0.05). In both procedures, there was no statistically significant difference between the control group and those treated with paste slurries (p>0.05). In addition, the changes in SNH (ΔSNH=SNHbaseline-SNHfinal) did not show statistically significant difference between both procedures (p>0.05). CONCLUSION: Tooth erosion cannot be prevented or repaired by these novel agents, regardless of fluoride content.

Morphological and chemical characterization of tooth enamel exposed to alkaline agents.

OBJECTIVES: In this study, morphological and chemical changes in teeth enamel exposed to alkaline agents, with or without surfactants, have been investigated. In addition, chemical effects of the organic surface layer, i.e. plaque and pellicle, were also investigated. METHODS: The present study was conducted using several techniques: Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD) and scanning electron microscopy (SEM). RESULTS: From XPS-measurements, it was found that exposure to alkaline solutions resulted in a massive removal of carbon from the tooth surface, and that the addition of surfactants increased the rate under present conditions. Based on the results from the FTIR-analysis, no substitution reactions between phosphate, carbonate and hydroxide ions in the enamel apatite could be detected. From a minor SEM-analysis, degradation and loss of substance of the enamel surface was found for the exposed samples. From XRD-analysis, no changes in crystallinity of the enamel apatite could be found between the samples. CONCLUSIONS: The findings in this study show that exposure to alkaline solutions results in a degradation of enamel surfaces very dissimilar from acidic erosion. No significant erosion or chemical substitution of the apatite crystals themselves could be discerned. However, significant loss of organic carbon at the enamel surface was found in all exposed samples. The degradation of the protective organic layer at the enamel surface may profoundly increase the risk for caries and dental erosion from acidic foods and beverages.

[The effects of natural medicine on adherence of Streptococcus mutans to salivary acquired pellicle].

OBJECTIVE: To investigate the effects of 5 kinds of natural medicine such as Radix et Rhizoma Rhei on the adherence of Streptococcus mutans to salivary acquired pellicle, and to screen effective natural medicines for the prevention of caries. METHODS: The in vitro model of experimental pellicle was saliva-coated hydroxyapatites (S-HA). Streptococcus mutans and S-HA were treated with natural medicines respectively, and then the adherence of bacteria to S-HA was tested. RESULTS: Radix et Rhizoma Rhei, Semen Arecae and Rhizoma Liguistici Chuanxiong could decrease the attachment of Streptococcus mutans to S-HA, and Semen Arecae was the most effective one. Radix Angelicae Dahuricae had no remarkable effect, and Catechu inhibited the adherence only after the bacteria being under treatment. CONCLUSION: Radix et Rhizoma Rhei, Semen Arecae, Rhizoma Liquistici Chuanxiong and Catechu could effectively inhibit the adherence of Streptococcus mutans to salivary acquired pellicle, but the effect of Radix Angelicae Dahuricae on the adherence is un-noticeable.