Substantivity of mouth-rinse formulations containing cetylpyridinium chloride and O-cymen-5-ol: a randomized-crossover trial.

BACKGROUND: The efficacy of mouth-rinses strongly depends upon their substantivity. The use of natural and non-toxic products that avoid secondary effects is gaining interest in preventive dentistry. The purpose of this study was to evaluate the substantivity of two formulations of mouth-washing solutions based on cetylpyridinium (CPC) and O-cymen-5-ol. METHODS: This was a randomized, double-blind, crossover trial conducted at the Faculty of Medicine and Health Sciences of the University of Barcelona. Bacterial re-colonization was followed by live/dead (SYTOTM9 + propidium iodide) bacterial staining and measured by confocal laser scanning microscopy and fluorometry. Unstimulated saliva samples were collected from 16 healthy individuals at baseline saliva and then, at 15 min, 30 min and 1, 2, 3, and 4 h after the following mouth-rinses: (i) a single, 1-min mouth-rinse with 15 ml of placebo (negative control); (ii) a single, 1-min mouth-rinse with 15 ml of CPC (0.05%) ; (iii) a single, 1-min mouth-rinse with 15 ml of O-cymen-5-ol (0.09%); (iv) a single, 1-min mouth-rinse with 15 ml of CPC (0.05%) + O-cymen-5-ol (0.09%). RESULTS: Proportion of dead bacteria was significantly higher for all mouthrinses during the first 15 min compared to baseline (CPC = 48.0 ± 13.9; 95% CI 40.98-56.99; p < 0.001, O-cymen-5-ol = 79.8 ± 21.0; 95% CI 67.71-91.90; p < 0.05, CPC + O-cymen-5-ol = 49.4 ± 14; 95% CI 40.98-56.99; p < 0.001 by fluorometry and 54.8 ± 23.0; 95% CI 41.50-68.06; p < 0.001, 76.3 ± 17.1; 95% CI 66.36-86.14; p < 0.001, 47.4 ± 11.9; 95% CI 40.49-54.30; p < 0.001 by confocal laser scanning microscopy, respectively). Nevertheless, after 4 h, CPC + O-cymen-5-ol was the only one that obtained significant values as measured by the two quantification methods used (80.3 ± 22.8; 95% CI 67.15-93.50; p < 0.05 and 81.4 ± 13.8; 95% CI 73.45-89.43; p < 0.05). The combined use of CPC + O-cymen-5-ol increased the substantivity of the mouthrinse with respect to mouthrinses prepared with either of the two active products alone. CONCLUSION: The synergistic interaction of CPC and O-cymen-5-ol prolongs their substantivity. The resulting formulation may be as effective as other antimicrobials, such as triclosan or chlorhexidine, but without their undesirable secondary effects. Thus, mouthrinsing products based on Combinations of CPC and O-cymen-5-ol may replace in the near future Triclosan and Chlorhexidine-based mouthrinses.

Benefits of non-surgical periodontal treatment in patients with type 2 diabetes mellitus and chronic periodontitis: A randomized controlled trial.

BACKGROUND: Periodontitis and diabetes are highly prevalent conditions whose association has long been recognized. OBJECTIVE: To evaluate the effect of non-surgical periodontal treatment on serum HbA1c (haemoglobin A1c or glycated haemoglobin) levels in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: This was a 6-month, single-masked, randomized clinical trial based on 90 patients (HbA1c: 7.7% (61 mmol/mol) ± 1.13%) who were randomly assigned to either the treatment group (oral hygiene instructions + scaling and root planing using ultrasound and Gracey curettes) or the control group (oral hygiene instructions + supragingival removal of plaque and calculus using ultrasound). Pocket depth, gingival index, and plaque index were assessed at baseline and after 3 and 6 months together with determinations of fasting plasma glucose, HbA1c, and bacterial counts. RESULTS: Treatment significantly improved the periodontal and metabolic parameters (p < .05), whereas in the control group no improvement was observed. These results were consistent with the bacteriological results in most but not all cases. CONCLUSION: Non-surgical periodontal treatment resulted in a better glycaemic status of type 2 diabetes patients and demonstrated the importance of oral health in their general health.

Status of Removable Dentures and Relationship with Oral Candida-Associated Factors in a Geriatric Population in Catalonia.

PURPOSE: Colonization by Candida is related to wearing a denture. How denture type, status, and maintenance play a role in determining Candida colonization remains unknown. This work evaluated removable denture status in an elderly population and explored the association between denture-related factors and oral Candida colonization as determined by systemic and local factors. MATERIALS AND METHODS: Socio-demographic, general health, and behavioral data and oral factors were registered by means of a questionnaire. Oral, dental, and denture-related factors were assessed by clinical examination, and yeasts were isolated from oral and denture specimens. Multiple logistic regression analysis was used to explore the relative relevance of risk factors. RESULTS: Overall, 52.4% of subjects used complete dentures in both lower and upper arches, and 90% of the prostheses were in good condition. Denture plaque index was high in most cases, and 75% of subjects had yeasts in their oral cavities. Oral Candida colonization was significantly associated with low saliva pH, sugar consumption, and the fault of a denture component; however, only sugar consumption was found to be an independent factor related with oral Candida colonization, showing an odds ratio of 3.04 in a multiple logistic regression model. CONCLUSIONS: Elderly people in this study used a complete denture in good condition, with a median age of 15 years. Daily or weekly sugar consumption was found to be highly associated with oral colonization by Candida.

Bacteremia Associated With Oral Surgery: A Review.

OBJECTIVES: Bacterial (infective) endocarditis, a microbial infection of the endocardium surfaces after bacteremia, causes significant morbidity and mortality. Recent epidemiologic studies have reported a prevalence of 2-8 cases per 100,000 individuals per year, with the highest incidence in those aged 70-80 years and those living in developed countries. We systematically reviewed the literature on several critical aspects regarding the development of bacteremia after oral surgery. The purpose of this work is to assess the controversy regarding antibiotic prophylaxis before oral surgery. MATERIALS AND METHODS: Publications between 1976 and 2015 were included. Clinical studies focusing on oral surgery as the underlying cause were included. RESULTS: Among the 32 clinical studies reviewed, 3564 cases, accounting for 12,839 blood cultures, were evaluated. In 10 of these studies, amoxicillin usefulness was studied. Antimicrobial prophylaxis before an invasive dental procedure does not prevent bacteremia, although it can decrease both its magnitude and its persistence. CONCLUSIONS: The highly conflicting data and conclusions of the analyzed work highlight the need for new approaches to the study of bacteremia that would provide reliable evidence and thus appropriate prophylactic and therapeutic standards. Many reports have explored the occurrence of bacteremia after dental procedures, but the results have been conflicting.

Effect of nonsurgical periodontal treatment on glycosylated hemoglobin in diabetic patients: a systematic review.

This review was designed to determine whether non-surgical periodontal treatment is able to reduce serum glycosylated hemoglobin (HbA1c) levels in patients with diabetes mellitus (DM). Several previous reports showed that scaling and root planning (SRP) improve periodontal status in patients with DM, but whether it also improves metabolic control of the disease is unclear. A systematic review was conducted according to the recommendations of the Cochrane Collaboration and PRISMA. A literature search was conducted in October 2012 using three libraries (Cochrane, Web of Knowledge, and Scopus) and the keywords "periodontal disease" and "diabetes mellitus." Only 21 of the articles met the inclusion criteria for this review. A total of 1,454 patients were thus included in this study to evaluate whether periodontal treatment improved serum HbA1c levels. Both the methodological quality and the risk of bias of each study were taken into account using the Jadad scale. Only ten of the included studies had an acceptable-good score of 3-5. Fourteen of the studies reported a significant decrease in serum HbA1c levels (p < 0.05) after periodontal treatment. The remaining seven studies failed to find a significant decrease in serum HbA1c. The findings of this review suggest that the published literature is insufficient and inconclusive to clearly support periodontal treatment as a means to improve serum HbA1c levels in patients with type 1 DM. It also demonstrates the need for homogeneous studies, with larger samples and longer follow-up periods, to properly address this question.

Load-Bearing Capacity of Fiber-Reinforced Composite Abutments and One-Piece Implants.

Fiber-reinforced composites (FRC) can potentially help in a physiologic stress transmission due to its excellent biomechanical matching with living tissues. Novel one-piece FRC implants and abutments with two different fiber orientations were loaded until failure to assess the load-bearing capacity, fracture patterns, and precision of fit. The one-piece FRC implants showed significantly higher load-bearing capacity compared to FRC abutments regardless of the fiber orientation (p < 0.001). For FRC abutments, bidirectional abutments showed significantly higher loads compared to unidirectional abutments (p < 0.001). The type of structure and fiber orientation are strong determinant factors of the load-bearing capacity of FRC implants and abutments.

Risk factors for denture-related oral mucosal lesions in a geriatric population.

STATEMENT OF PROBLEM: Denture-related mucosal lesions have been broadly studied. However, no consensus has been reached regarding the risk factors associated with these lesions, and few studies have used multivariable analysis to determine the relative significance of different risks. PURPOSE: The purpose of this study was to determine the relationship between systemic, local, and denture factors on the risk of denture-related oral mucosal lesions in an elderly population by using multivariable analysis. MATERIAL AND METHODS: Eighty-four elderly denture wearers recruited from geriatric residences and day care centers participated in this cross-sectional study. All data were obtained by means of a questionnaire-interview, a physical examination, and complementary tests. Bivariate relationship and multiple logistic regression analyses were performed (α=.05). RESULTS: Angular cheilitis (34%), traumatic ulcers (15%), and denture stomatitis (14%) were the 3 most common lesions, and the prevalence of at least 1 denture-related mucosal lesion was 54%. The presence of denture stomatitis was related to low saliva pH, never having smoked, and regular sugar consumption. Angular cheilitis was associated with age, complete edentulism, the presence of oral Candida, a lack of denture stability, and a reduced occlusal vertical dimension. The presence of traumatic ulcers was related to a resorbed residual alveolar ridge. The presence of at least 1 lesion was associated with poor masticatory efficiency, being resident in a care facility, oral Candida, and a lack of denture stability. CONCLUSIONS: Several systemic, local, and denture-related characteristics are independent risk factors for denture-related mucosal lesions in an elderly population.

Antimicrobial Activity of Selenium Nanoparticles (SeNPs) against Potentially Pathogenic Oral Microorganisms: A Scoping Review.

Biofilms are responsible for the most prevalent oral infections such as caries, periodontal disease, and pulp and periapical lesions, which affect the quality of life of people. Antibiotics have been widely used to treat these conditions as therapeutic and prophylactic compounds. However, due to the emergence of microbial resistance to antibiotics, there is an urgent need to develop and evaluate new antimicrobial agents. This scoping review offers an extensive and detailed synthesis of the potential role of selenium nanoparticles (SeNPs) in combating oral pathogens responsible for causing infectious diseases. A systematic search was conducted up until May 2022, encompassing the MEDLINE, Embase, Scopus, and Lilacs databases. We included studies focused on evaluating the antimicrobial efficacy of SeNPs on planktonic and biofilm forms and their side effects in in vitro studies. The selection process and data extraction were carried out by two researchers independently. A qualitative synthesis of the results was performed. A total of twenty-two articles were considered eligible for this scoping review. Most of the studies reported relevant antimicrobial efficacy against C. albicans, S. mutans, E. faecalis, and P. gingivalis, as well as effective antioxidant activity and limited toxicity. Further research is mandatory to critically assess the effectiveness of this alternative treatment in ex vivo and in vivo settings, with detailed information about SeNPs concentrations employed, their physicochemical properties, and the experimental conditions to provide enough evidence to address the construction and development of well-designed and safe protocols.

Bactericidal activity of erbium, chromium:yttrium-scandium-gallium-garnet laser in root canals.

The aim of this study was to investigate the effectiveness of the erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser by measuring its bactericidal effect inside root canals experimentally colonized with Enterococcus faecalis. We also determined the optimal conditions for the Er,Cr:YSGG laser to achieve the maximal bactericidal effect. An Er,Cr:YSGG Waterlase laser was used, and its antimicrobial effect was compared with that of sodium hypochlorite (NaOCl) at various concentrations as widely used in clinics. This laser emits photons at a wavelength of 2.78 microm. It is a pulsed laser operating at 20 Hz (20 pulses/s). Significant differences between measurements in the different groups (P < 0.05) were observed, depending on time and power used. The use of NaOCl 5% was the most effective procedure, with NaOCl 0.5% being the least effective; however, laser treatment was as effective as NaOCl 5% when applied at 2 W for 60 s.

Er,Cr:YSGG Laser-Activated Irrigation and Passive Ultrasonic Irrigation: Comparison of Two Strategies for Root Canal Disinfection.

Objective: To compare the antibacterial effectiveness of 0.5% sodium hypochlorite (NaOCl) activated by the Er,Cr:YSGG laser-activated irrigation (LAI) and passive ultrasonic irrigation (PUI) against a 10-day-old intracanal Enterococcus faecalis biofilm. Background: LAI and PUI are regarded as alternative methods to release the irrigant in the inner regions of the root canal system achieving enhanced cleaning ability. Nevertheless, little evidence regarding the activation of low concentrations of NaOCl has been reported. Materials and methods: Seventy-two single-rooted teeth were instrumented, inoculated (E. faecalis ATCC 29212), and incubated for 10 days to allow biofilm formation. Specimens were randomly divided into six groups (n = 12 each): (1) 0.5% NaOCl+Er,Cr:YSGG LAI, (2) saline+Er,Cr:YSGG LAI, (3) 0.5% NaOCl+PUI, (4) saline+PUI, (5) positive control (no treatment), and (6) negative control (no bacteria). The activation time was distributed as follows: 30 sec of activation, followed by a rest phase of 30 sec, and ending with 30 sec of activation. The number of bacterial survivors was determined by plate counting. Results: Both irrigation regimens LAI and PUI reduced the number of colony-forming unit. Moreover, LAI +0.5% NaOCl and the rest of groups significantly differ (p < 0.001 for all comparisons). Conclusions: Er,Cr:YSGG LAI proved to be more effective than PUI in enhancing the antimicrobial activity of 0.5% NaOCl against 10-day-old intracanal E. faecalis biofilms.

Er,Cr:YSGG Laser-Activation Enhances Antimicrobial and Antibiofilm Action of Low Concentrations of Sodium Hypochlorite in Root Canals.

The onset and persistence of endodontic infections due to residual biofilm after chemical disinfection promotes secondary bacterial infection. Alternative methods to disinfect operated root canals are a matter of great interest. The aim was to evaluate the antibacterial effectiveness of sodium hypochlorite (NaOCl) at low concentrations activated by the Er,Cr:YSGG laser-activated irrigation (LAI) against 10-day-old intracanal Enterococcus faecalis biofilm. Biofilms were formed inside the root canals and divided into 7 groups (n13): 0.5% NaOCl + Er,Cr:YSGG; Saline + Er,Cr:YSGG; 0.5% NaOCl + syringe irrigation(SI); 2.5% NaOCl + SI; 5% NaOCl + SI; positive and negative controls. Bacterial survivors were counted and specimens visualized under scanning electron and confocal laser scanning microscopy. Treatments with 0.5% NaOCl + Er,Cr:YSGG and 2.5% NaOCl + SI gave a significant reduction in the number of CFU/mm2. Moreover, scanning electron microscopy and confocal laser scanning microscopy imaging confirmed and reinforced bacteriological data. Thus, Er,Cr:YSGG LAI proved to be able to improve the intracanal distribution of 0.5% NaOCl after 60 s of activation, reaching the same level of effectiveness than 2.5% NaOCl. This is regarded as of clinical interest, since working with lower concentrations may contribute to reduce undesired effects.

Benznidazole Nanoformulates: A Chance to Improve Therapeutics for Chagas Disease.

This article describes the characterization of various encapsulated formulations of benznidazole, the current first-line drug for the treatment of Chagas disease. Given the adverse effects of benznidazole, safer formulations of this drug have a great interest. In fact, treatment of Chagas disease with benznidazole has to be discontinued in as much as 20% of cases due to side effects. Furthermore, modification of delivery and formulations could have potential effects on the emergence of drug resistance. The trypanocidal activity of new nanostructured formulations of benznidazole to eliminate Trypanosoma cruzi was studied in vitro as well as their toxicity in two cultured mammalian cell lines (HepG2 and Fibroblasts). Nanoparticles tested included nanostructured lipid carriers, solid lipid nanoparticles, liposomes, quatsomes, and cyclodextrins. The in vitro cytotoxicity of cyclodextrins-benznidazole complexes was significantly lower than that of free benznidazole, whereas their trypanocidal activity was not hampered. These results suggest that nanostructured particles may offer improved therapeutics for Chagas disease.

Irrigación Activada por Láser en Endodoncia

RESUMEN: El objetivo de la endodoncia es prevenir o curar la periodontitis apical. Por lo tanto, los microorganismos que han colonizado el sistema de canales radiculares deben ser eliminados para promover la regeneración y cicatrización. Desafortunadamente, la existencia de canales accesorios, anastomosis, istmos, así como ramificaciones apicales, genera una compleja red tridimensional en el interior de la raíz, lo que dificulta la eliminación total de bacterias y detritus. La te rapia endodóntica convencional utilizada actualmente presenta una serie de limitaciones.Se ha demostrado que los instrumentos endodónticos dejan un 35 % o más de superficie dentinaria sin tratar. Por otro lado, la imposibilidad de generar un flujo turbulento en el interior de los canales, impide que el irrigante llegue a zonas de difícil acceso. Esto facilita la persistenc ia de biopelículas bacterianas y la supervivencia de un número importante de bacterias viables. La irrigación activada por láser (LAI) ha sido propuesta como una tecnología co-adyuvante a la terapia quimio-mecánica para optimizarla limpieza y desinfección. Los láseresde Er,Cr:YSGG (2780nm) y Er:YAG (2940nm) son los más utilizados. Estas dos longitudes de onda son capaces de ser absorbidas ampliamente por diferentes soluciones irrigantes, teniendo en cuenta un uso seguro y respetando los parámetros clínicos aceptados. La absorción de la energía del láser por parte de los irrigantes, genera burbujas de vapor en el interior del fluido, que liberan fuerzas de cizalla al implosionar. Este fenómeno, denominado cavitación, genera mayor limpieza y desinfección del interior del sistema de canales radiculares, incluso en zonas de difícil acceso. Diversos estudios microbiológicos y microscópicos, han demostrado la efectividad antibacteriana de LAI. Recientemente, se ha publicado que LAI tendría la capacidad de incrementarla capacidad antibacteriana del hipoclorito de sodio a baja concentración (un buen desinfectante pero extraordinariamente tóxico), lo que permitiría trabajar con concentraciones menores y por lo tanto más seguras para el paciente.

ABSTRACT: The goal of endodontics is to prevent or cure apical periodontitis. Therefore, microorganisms that have colonized the root canal system must be eliminated to promote regeneration and healing. Unfortunately, the existence of accessory canals, anastomoses, isthmus, as well as apical ramifications, form a complex three-dimensional network inside the root, which makes difficult the total elimination of bacteria and detritus. Conventional endodontic therapy has several limitations. Endodontic instruments have been shown to leave 35 % or more of the dentin surface untreated. On the other hand, the inability of generating a turbulent flow, prevents the irrigant from reaching areas that are difficult to access. This facilitates the persistence of bacterial biofilms and the survival of a significant number of viable bacteria. Laser-activated Irrigation (LAI) has been proposed as a co-adjuvant to chemo-mechanical therapy to improve cleaning and disinfection. Er, Cr: YSGG (2780nm) and Er: YAG (2940nm) lasers are the most widely used. These two wavelengths are capable of being widely absorbed by different irrigating solutions, taking into account safe use and respecting accepted clinical parameters.The deep absorption of laser energy generates steam bubbles inside the fluid, which release shear forces when imploding. This phenomenon, called cavitation, is responsible for greater cleaning and disinfection within the root canal system, even in areas difficult to access. Several studies have demonstrated the antibacterial effectiveness of LAI through microbiological methods and microscopic techniques. Recently, it has been reported that LAI would have the ability to increase the antibacterial capacity of low concentration of sodium hypochlorite (a good disinfectant but extremely toxic), which would allow working with concentrations that are safer for the patient.

Oral Microbiota, Periodontal Status, and Osteoporosis in Postmenopausal Females.

BACKGROUND: Alterations in hormone levels during menopause decrease bone density and may worsen oral health, favoring the growth of periodontal pathogens, whose detection could improve the diagnosis of periodontitis. The aim of this study is to detect and quantify the main periodontal pathogens in the oral microbiota of postmenopausal females and to explore the relationship between clinical and periodontal parameters. METHODS: This was an observational cross-sectional study of 76 postmenopausal females. Dental examinations and sampling for microbiologic evaluation were performed, and a history of osteoporosis/osteopenia was collected. Real-time polymerase chain reaction was used for detecting and quantifying Fusobacterium nucleatum (Fn), Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Campylobacter rectus (Cr), and Tannerella forsythia (Tf). The results obtained were subjected to statistical analyses. Statistical significance was defined as P <0.05. RESULTS: Periodontitis was detected in 77.1% of females with osteoporosis/osteopenia (P >0.05). A significant correlation was found between osteoporosis and missing teeth. T. forsythia and C. rectus were detected in 100% of the samples, Fn and Pg in 98.7%, and Aa in 73.7%. CONCLUSIONS: Osteoporosis did not influence the prevalence of periodontitis among postmenopausal females. The presence of periodontopathogenic bacteria was not sufficient to confirm disease. A preventive maintenance program for postmenopausal females, particularly osteoporotic females, who are at greater risk of tooth loss, could minimize the potential effects of bone loss on periodontal tissues.

Bacterial adhesion efficiency on implant abutments: a comparative study.

The attachment of Escherichia coli ATCC 25922 and Staphylococcus aureus ATCC 28213 onto six different materials used to manufacture dental implant abutments was quantitatively determined after 2 and 24 h of contact between the materials and the bacterial cultures. The materials were topographically characterized and their wettability determined, with both parameters subsequently related to bacterial adhesion. Atomic force microscopy, interferometry, and contact angle measurement were used to characterize the materials' surfaces. The results showed that neither roughness nor nano-roughness greatly influenced bacterial attachment whereas wettability strongly correlated with adhesion. After 2 h the degree of E. coli attachment markedly differed depending on the material whereas similar differences were not observed for S. aureus, which yielded consistently higher counts of adhered cells. Nevertheless, after 24 h the adhesion of the two species to the different test materials no longer significantly differed, although on all surfaces the numbers of finally adhered E. coli were higher than those of S. aureus.

Virus en Endodoncia / Viruses in Endodontics

La infección endodóntica es la infección que afecta al sistema de conductos radiculares y, sin duda, es el principal agente etiológico de las periodontitis apicales. Además, de las bacterias patógenas endodónticas, se ha buscado en los últimos años asociar la presencia de virus en distintos tipos de patología endodóntica. Los virus que más se han buscado y asociado son los pertenecientes a la familia herpesvirus, los cuales se han encontrado presentes en patologías periapicales principalmente. Se ha buscado además, relacionar su presencia a patologías que cursan con mayor sintomatología, o que presentan a la imagen radiográfica destrucciones óseas periapicales mayores. El rol de los virus en las lesiones apicales de origen endodóntico está aún poco claro, se habla de efectos acumulativos a los de las bacterias, además de posibles inmunosupresiones locales que favorecerían el crecimiento y el efecto de estas últimas.

Endodontic infection is an infection of the root canal system and undoubtedly is the main etiological agent of apical periodontitis. In recent years, research has aimed to associate the presence of virus and endodontic bacterial pathogens in the different types of endodontic disease. The most common viruses that have been researched and associated are members of the herpesvirus family, which are mainly present in periapical pathologies. Furthermore, research has been carried out relating their presence to pathologies with important symptoms, or those where radiographic imaging shows extensive apical bone reabsorption. The role of viruses in apical lesions of endodontic origin are still unclear, it hypothesizes the cumulative effect with bacteria, in addition to possible local immunosuppression that favors the growth and the effect of bacteria.