A novel chlorhexidine-hexametaphosphate coating for titanium with antibiofilm efficacy and stem cell cytocompatibility.

Dental implants are an increasingly popular way to replace missing teeth. Whilst implant survival rates are high, a small number fail soon after placement, with various factors, including bacterial contamination, capable of disrupting osseointegration. This work describes the development of chlorhexidine-hexametaphosphate coatings for titanium that hydrolyse to release the antiseptic agent chlorhexidine. The aim was to develop a coating for titanium that released sufficient chlorhexidine to prevent biofilm formation, whilst simultaneously maintaining cytocompatibility with cells involved in osseointegration. The coatings were characterised with respect to physical properties, after which antibiofilm efficacy was investigated using a multispecies biofilm model, and cytocompatibility determined using human mesenchymal stem cells. The coatings exhibited similar physicochemical properties to some implant surfaces in clinical use, and significantly reduced formation of multispecies biofilm biomass up to 72 h. One coating had superior cytocompatibility, with mesenchymal stem cells able to perform normal functions and commence osteoblastic differentiation, although at a slower rate than those grown on uncoated titanium. With further refinement, these coatings may have application in the prevention of bacterial contamination of dental implants at the time of surgery. This could aid a reduction in rates of early implant failure.

Alginate films augmented with chlorhexidine hexametaphosphate particles provide sustained antimicrobial properties for application in wound care.

All chronic wounds are colonised by bacteria; for some, colonisation progresses to become infection. Alginate wound dressings are used for highly exuding chronic wounds as they are very absorbent, taking up large quantities of exudate while maintaining a moist wound bed to support healing. Some alginate dressings are doped with antimicrobials, most commonly silver, but evidence regarding the efficacy of these is largely inconclusive. This manuscript describes the development and in vitro assessment of alginate materials doped with chlorhexidine hexametaphosphate (CHX-HMP), a sparingly soluble salt which when exposed to aqueous environments provides sustained release of the common antiseptic chlorhexidine. Comparator materials were a commercial silver alginate dressing material and an alginate doped with chlorhexidine digluconate (CHXdg). CHX-HMP alginates provided a dose-dependent CHX release which was sustained for over 14 days, whereas CHXdg alginates released limited CHX and this ceased within 24 h. CHX-HMP and silver alginates were efficacious against 5 major wound pathogens (MRSA, E. coli, P. aeruginosa, K. pneumoniae, A. baumannii) in a total viable count (TVC) and an agar diffusion zone of inhibition (ZOI) model. At baseline the silver alginate was more effective than the CHX-HMP alginate in the TVC assay but the CHX-HMP alginate was the more effective in the ZOI assay. After 7 days' artificial aging the CHX-HMP alginate was more effective than the silver alginate for four of the five bacteria tested in both assays. These materials may ultimately find application in the development of wound dressings for chronic wounds that provide sustained antimicrobial protection.

Chlorhexidine hexametaphosphate as a coating for elastomeric ligatures with sustained antimicrobial properties: A laboratory study.

INTRODUCTION: White spot lesions are a common side effect of orthodontic treatment. This laboratory study aimed to explore the suitability of chlorhexidine hexametaphosphate (CHX-HMP) as a coating for orthodontic elastomeric ligatures to provide sustained chlorhexidine (CHX) release. METHODS: Dissolution kinetics of CHX-HMP were firstly explored using spectroscopy and a colorimetric phosphate assay. Elastomeric ligatures were categorized into 3 groups-acetone-conditioned, ethanol-conditioned, and as received-and were then immersed in 5 mM CHX-HMP suspension or 5 mM chlorhexidine digluconate solution and rinsed. CHX release was measured over 8 weeks, and the effects of conditioning and immersion on elastomeric force and extension at rupture and surface topography were investigated. RESULTS: CHX-HMP exhibited a gradual equilibration that had not reached equilibrium within 8 weeks, releasing soluble CHX and a mixture of polyphosphate and orthophosphate. CHX digluconate-treated ligatures showed no CHX release, whereas CHX-HMP-treated ligatures showed varying degrees of release. As received, CHX-HMP-treated ligatures showed a modest release of CHX up to 7 days. Acetone conditioning did not enhance CHX-HMP uptake or subsequent CHX release and caused a deterioration in mechanical properties. Ethanol conditioning enhanced CHX-HMP uptake (6×) and led to a sustained CHX release over 8 weeks without affecting mechanical properties. CONCLUSIONS: Within the inherent limitations of this in-vitro study, CHX-HMP led to a sustained release of CHX from orthodontic elastomeric ligatures after ethanol conditioning. Conditioned and coated elastomeric ligatures may ultimately find application in the prevention of white spot lesions in orthodontic patients.

Protective Effect of Phosphates and Fluoride on the Dissolution of Hydroxyapatite and Their Interactions with Saliva.

This study aimed to investigate the effect of phosphates and fluoride, alone or in combination, and the influence of salivary pellicle on hydroxyapatite (HA) dissolution. The baseline dissolution rate of HA discs was measured using a pH-stat system (0.3% citric acid, pH 3.2). In the first series of experiments, HA discs (n = 8/group) were treated with: a placebo solution (PLA, deionised water); sodium trimetaphosphate (TMP), sodium tripolyphosphate (TRI) and sodium pyrophosphate (PYRO) at 1 or 8%; 500 ppm F; 1,100 ppm F; 1,100 ppm F/1% TMP; 1,100 ppm F/8% TMP; 1,100 ppm F/1% TRI; 1,100 ppm F/8% TRI. In the second phase, HA discs were immersed in pooled human saliva (37°C/2 h) and treated with PLA, 1,100 ppm F/1% TMP, 1,100 ppm F/8% TMP, 1,100 ppm F/1% TRI, and 1,100 ppm F/8% TRI. After treatments, final dissolution rates were measured from 3 consecutive 30-min assays. Statistical analyses were performed using 2-way ANOVA followed by the Fisher test (α = 0.05). The type and concentration of phosphate tested significantly influenced HA dissolution; 8% TRI showed the highest reduction (36.9%) among all treatment solutions. Fluoride alone (1,100 ppm F) significantly reduced HA dissolution by 20.7%. When fluoride and phosphates were associated, 1,100 ppm F/1% TMP, 1,100 ppm F/8% TMP, and 1,100 ppm F/8% TRI showed the highest percentage reductions of dissolution (40.3-46.1%). Salivary pellicle led to a greater and more sustained protective effect of the treatment solutions compared to their counterparts without salivary coating. It was concluded that the association of phosphate and fluoride enhanced their protective effect against HA dissolution when compared with these compounds alone, especially in the presence of salivary pellicle.

Functional regions of Candida albicans hyphal cell wall protein Als3 that determine interaction with the oral bacterium Streptococcus gordonii.

The opportunistic pathogen Candida albicans colonizes the oral cavity and gastrointestinal tract. Adherence to host cells, extracellular matrix and salivary glycoproteins that coat oral surfaces, including prostheses, is an important prerequisite for colonization. In addition, interactions of C. albicans with commensal oral streptococci are suggested to promote retention and persistence of fungal cells in mixed-species communities. The hyphal filament specific cell wall protein Als3, a member of the Als protein family, is a major determinant in C. albicans adherence. Here, we utilized site-specific in-frame deletions within Als3 expressed on the surface of heterologous Saccharomyces cerevisiae to determine regions involved in interactions of Als3 with Streptococcus gordonii. N-terminal region amino acid residue deletions Δ166-225, Δ218-285, Δ270-305 and Δ277-286 were each effective in inhibiting binding of Strep. gordonii to Als3. In addition, these deletions differentially affected biofilm formation, hydrophobicity, and adherence to silicone and human tissue proteins. Deletion of the central repeat domain (Δ434-830) did not significantly affect interaction of Als3 with Strep. gordonii SspB protein, but affected other adherence properties and biofilm formation. Deletion of the amyloid-forming region (Δ325-331) did not affect interaction of Als3 with Strep. gordonii SspB adhesin, suggesting this interaction was amyloid-independent. These findings highlighted the essential function of the N-terminal domain of Als3 in mediating the interaction of C. albicans with S. gordonii, and suggested that amyloid formation is not essential for the inter-kingdom interaction.

Chlorhexidine hexametaphosphate nanoparticles as a novel antimicrobial coating for dental implants.

Dental implants are an increasingly popular solution to missing teeth. Implants are prone to colonisation by pathogenic oral bacteria which can lead to inflammation, destruction of bone and ultimately implant failure. The aim of this study was to investigate the use of chlorhexidine (CHX) hexametaphosphate (HMP) nanoparticles (NPs) with a total CHX concentration equivalent to 5 mM as a coating for dental implants. The CHX HMP NPs had mean diameter 49 nm and composition was confirmed showing presence of both chlorine and phosphorus. The NPs formed micrometer-sized aggregated surface deposits on commercially pure grade II titanium substrates following immersion-coating for 30 s. When CHX HMP NP-coated titanium specimens were immersed in deionised water, sustained release of soluble CHX was observed, both in the absence and presence of a salivary pellicle, for the duration of the study (99 days) without reaching a plateau. Control specimens exposed to a solution of aqueous 25 µM CHX (equivalent to the residual aqueous CHX present with the NPs) did not exhibit CHX release. CHX HMP NP-coated surfaces exhibited antimicrobial efficacy against oral primary colonising bacterium Streptococcus gordonii within 8 h. The antimicrobial efficacy was greater in the presence of an acquired pellicle which is postulated to be due to retention of soluble CHX by the pellicle.

Development of a novel antimicrobial-releasing glass ionomer cement functionalized with chlorhexidine hexametaphosphate nanoparticles.

BACKGROUND: Glass ionomer cements (GICs) are a class of dental biomaterials. They have a wide range of uses including permanent restorations (fillings), cavity linings, fissure sealants and adhesives. One of the most common reasons for replacing a dental restoration is recurrent bacterial tooth decay around the margins of the biomaterial. Therefore, a dental biomaterial which creates a sustained antimicrobial environment around the restoration would be of considerable clinical benefit. In this manuscript, the formulation of a GIC containing novel antimicrobial nanoparticles composed of chlorhexidine hexametaphosphate at 1, 2, 5, 10 and 20% powder substitution by mass is reported. The aim is to create GICs which contain chlorhexidine-hexametaphosphate nanoparticles and characterize the nanoparticle size, morphology and charge and the release of chlorhexidine and fluoride, tensile strength and morphology of the GICs. RESULTS: The GICs released chlorhexidine, which is a broad spectrum antimicrobial agent effective against a wide range of oral bacteria, over the duration of the experiment in a dose-dependent manner. This was not at the expense of other properties; fluoride release was not significantly affected by the substitution of antimicrobial nanoparticles in most formulations and internal structure appeared unaffected up to and including 10% substitution. Diametral tensile strength decreased numerically with substitutions of 10 and 20% nanoparticles but this difference was not statistically significant. CONCLUSION: A series of GICs functionalized with chlorhexidine-hexametaphosphate nanoparticles were created for the first time. These released chlorhexidine in a dose-dependent manner. These materials may find application in the development of a new generation of antimicrobial dental nanomaterials.

Effects of Calcium and Phosphate on Dissolution of Enamel, Dentin and Hydroxyapatite in Citric Acid.

The aim was to evaluate the effect of dissolved calcium and phosphate on dissolution rate of enamel, dentin and compressed hydroxyapatite (HA) in citric acid solution as a function of pH. At pH 2.5, dissolution rate of enamel increased significantly by 6% in 20 mmol/L added calcium but, otherwise, dissolution rates of neither enamel, dentin nor HA were significantly affected by 10 or 20 mmol/L calcium. However, enamel dissolution rate was reduced by > 50 mmol/L calcium. At pH 3.25 and 4.0, 10-20 mmol/L calcium inhibited dissolution of enamel by 29-100% and HA by 65-75% but did not affect dentin dissolution. Phosphate (10 or 20 mmol/L) did not inhibit dissolution of enamel, dentin or HA at any pH, but there were increases in dissolution rate of all three substrates at pH 2.5 and, in one test with dentine (at 20 mmol/L phosphate), at pH 3.25. The results suggest that calcium addition to soft drinks and other acidic products such as medications may reduce erosivity against enamel, provided that pH is not too low; that phosphate would not reduce erosivity against enamel; and that neither calcium nor phosphate at these concentrations would reduce erosivity against dentin.

Interaction of Candida albicans cell wall Als3 protein with Streptococcus gordonii SspB adhesin promotes development of mixed-species communities.

Candida albicans colonizes human mucosa and prosthetic surfaces associated with artificial joints, catheters, and dentures. In the oral cavity, C. albicans coexists with numerous bacterial species, and evidence suggests that bacteria may modulate fungal growth and biofilm formation. Streptococcus gordonii is found on most oral cavity surfaces and interacts with C. albicans to promote hyphal and biofilm formation. In this study, we investigated the role of the hyphal-wall protein Als3p in interactions of C. albicans with S. gordonii. Utilizing an ALS3 deletion mutant strain, it was shown that cells were not affected in initial adherence to the salivary pellicle or in hyphal formation in the planktonic phase. However, the Als3(-) mutant was unable to form biofilms on the salivary pellicle or deposited S. gordonii DL1 wild-type cells, and after initial adherence, als3Δ/als3Δ (ΔALS3) cells became detached concomitant with hyphal formation. In coaggregation assays, S. gordonii cells attached to, and accumulated around, hyphae formed by C. albicans wild-type cells. However, streptococci failed to attach to hyphae produced by the ΔALS3 mutant. Saccharomyces cerevisiae S150-2B cells expressing Als3p, but not control cells, supported binding of S. gordonii DL1. However, S. gordonii Δ(sspA sspB) cells deficient in production of the surface protein adhesins SspA and SspB showed >50% reduced levels of binding to S. cerevisiae expressing Als3p. Lactococcus lactis cells expressing SspB bound avidly to S. cerevisiae expressing Als3p, but not to S150-2B wild-type cells. These results show that recognition of C. albicans by S. gordonii involves Als3 protein-SspB protein interaction, defining a novel mechanism in fungal-bacterial communication.

Human and bovine enamel erosion under 'single-drink' conditions.

Tooth-surface pH is lowered, during drinking, to a value close to the pH of the drink itself. After the drink is swallowed, the pH rises to baseline values but this process can take several minutes. Few techniques can quantify enamel erosion at timescales representative of single drinks. The objective of this study was to compare human and bovine erosion over acid-exposure times of 2 s to 1 h. Human and bovine enamel softening was compared in vitro using nanoindentation (2-60 s of exposure to acid) and tissue loss was compared using optical profilometry (1-60 min of exposure to acid). Nanoindentation revealed statistically significant softening after 2 s (human) and 5 s (bovine); there were no significant differences in hardness reduction for the two tissues at any time-point. Profilometry demonstrated statistically significant tissue loss after 20 min (human) and 10 min (bovine); bovine tissue loss progressed 30% faster than human tissue loss. These results support the use of bovine enamel as a substitute for human enamel in erosion studies, with the understanding that for moderate exposure times bovine enamel erodes 30% faster than human enamel. Nanoindentation can be used to detect enamel dissolution at timescales comparable to the oral dwell-time of a single 'mouthful' of a beverage.

Inhibition of hydroxyapatite dissolution by whole casein: the effects of pH, protein concentration, calcium, and ionic strength.

Formulating drinks with reduced erosive potential is one approach for reducing dental erosion. In this study, whole casein was added to citric acid solutions representative of soft drinks, and the hydroxyapatite dissolution rate was assessed. Adding 0.02% (w/v) casein to acid solutions significantly reduced the hydroxyapatite dissolution rate by 51 +/- 4% at pH values of 2.80, 3.00, 3.20, 3.40, and 3.60, although the baseline dissolution rates of course varied as a function of pH. The protein concentration [0.002, 0.02, and 0.2% (w/v) casein] had no significant effect on dissolution inhibition. Adding both casein and calcium to citric acid resulted in a further reduction in the dissolution rate at low and intermediate calcium concentrations (5 and 10 mM) but not at higher calcium concentrations (20 and 50 mM). Ionic strength had no significant impact on the efficacy of casein. Casein also significantly reduced the hydroxyapatite dissolution rate when the hydroxyapatite was coated with a salivary pellicle. The reduction in dissolution rate is ascribed to firmly adsorbed casein on the hydroxyapatite surface, which stabilizes the crystal surface and inhibits ion detachment.

Electronic voting in dental materials education: the impact on students' attitudes and exam performance.

Dental materials is an integral part of any undergraduate dental curriculum and is most commonly taught in a traditional didactic, lecture-based format. It suffers from the ignominy of being viewed by many as a dry, factual subject with little to excite or engage the student. In this article, the author presents the experimental use of an electronic voting (eVoting) system in an undergraduate dental materials course. The practical and aspirational aspects of its application are described. The objective was to assess the student perception of the experiment and the impact on end-of-course examination results. The eVoting system proved overwhelmingly popular with the students with 95 percent in favor of its use at the beginning of the course and 91 percent at the end. There was, however, no statistically significant impact on the results of the examination at the end of the course, when compared to the previous year's cohort of students for whom eVoting was not used. eVoting encouraged student interaction and engagement and contributed to student satisfaction but was not seen to affect the outcome measurement (end-of-course examination result).

A novel flow-system to establish experimental biofilms for modelling chronic wound infection and testing the efficacy of wound dressings.

Several models exist for the study of chronic wound infection, but few combine all of the necessary elements to allow high throughput, reproducible biofilm culture with the possibility of applying topical antimicrobial treatments. Furthermore, few take into account the appropriate means of providing nutrients combined with biofilm growth at the air-liquid interface. In this manuscript, a new biofilm flow device for study of wound biofilms is reported. The device is 3D printed, straightforward to operate, and can be used to investigate single and mixed species biofilms, as well as the efficacy of antimicrobial dressings. Single species biofilms of Staphylococcus aureus or Pseudomonas aeruginosa were reproducibly cultured over 72 h giving consistent log counts of 8-10 colony forming units (CFU). There was a 3-4 log reduction in recoverable bacteria when antimicrobial dressings were applied to biofilms cultured for 48 h, and left in situ for a further 24 h. Two-species biofilms of S. aureus and P. aeruginosa inoculated at a 1:1 ratio, were also reproducibly cultured at both 20 °C and 37 °C; of particular note was a definitive Gram-negative shift within the population that occurred only at 37 °C.

Glass ionomer cements with milled, dry chlorhexidine hexametaphosphate filler particles to provide long-term antimicrobial properties with recharge capacity.

OBJECTIVE: Glass ionomer cements (GICs) are a versatile material, offering the opportunity for ion exchange with the oral environment. The aim of this study was to develop a GIC that delivers a controlled, rechargeable dose of chlorhexidine (CHX) over an extended period without compromising mechanical properties. METHODS: GICs were supplemented with finely milled particles of chlorhexidine hexametaphosphate (CHX-HMP). CHX release into artificial saliva was measured over 660 days, and recharge with CHX and CHX-HMP was investigated. Mechanical properties were investigated, and an agar diffusion test was carried out to assess antimicrobial properties using Streptococcus mutans and Scardovia wiggsiae. RESULTS: Dose-dependent CHX release was observed, and this was ongoing at 660 days. Compared with related studies of GICs containing CHX-HMP, the fine, dry particles resulted in fewer adverse effects on mechanical properties, including tensile, compressive and biaxial flexural strength, with 1% CHX-HMP GICs indistinguishable from control specimens. The GICs could be recharged with CHX using both a conventional CHX digluconate solution comparable to commercial mouthrinses, and a suspension of CHX-HMP of equivalent concentration. Recharging with CHX digluconate increased subsequent CHX release by 50% compared with no recharge, and recharging with CHX-HMP increased subsequent CHX release by 100% compared with no recharge. The GICs inhibited growth of St. mutans and Sc. wiggsiae in a simple agar diffusion model. SIGNIFICANCE: These materials, which provide sustained CHX release over clinically relevant timescales, may find application as a restorative material intended to inhibit secondary caries as well as in temporary restorations and fissure sealants.

An investigation using atomic force microscopy nanoindentation of dental enamel demineralization as a function of undissociated acid concentration and differential buffer capacity.

Acidic drinks and foodstuffs can demineralize dental hard tissues, leading to a pathological condition known as dental erosion, which is of increasing clinical concern. The first step in enamel dissolution is a demineralization of the outer few micrometres of tissue, which results in a softening of the structure. The primary determinant of dissolution rate is pH, but the concentration of undissociated acid, which is related to buffer capacity, also appears to be important. In this study, atomic force microscopy nanoindentation was used to measure the first initial demineralization (softening) induced within 1 min by exposure to solutions with a range of undissociated acid concentration and natural pH of 3.3 or with an undissociated acid concentration of 10 mmol l-1 and pH adjusted to 3.3. The results indicate that differential buffering capacity is a better determinant of softening than undissociated acid concentration. Under the conditions of these experiments, a buffer capacity of >3 mmol l-1 pH-1 does not have any further effect on dissolution rate. These results imply that differential buffering capacity should be used for preference over undissociated acid concentration or titratable acidity, which are more commonly employed in the literature.

The role of erosion, abrasion and attrition in tooth wear.

There is increasing clinical awareness of erosion of enamel and dentine by dietary acids and the consequent increased susceptibility to physical wear. Enamel erosion is characterized by acid-mediated surface softening that, if unchecked, will progress to irreversible loss of surface tissue, potentially exposing the underlying dentine. In comparison, dentine erosion is less well understood as the composition and microstructure are more heterogeneous. Factors which affect the erosive potential of a solution include pH, titratable acidity, common ion concentrations, and frequency and method of exposure. Abrasion and attrition are sources of physical wear and are commonly associated with tooth brushing and tooth-to-tooth contact, respectively. A combination of erosion and abrasion or attrition exacerbates wear; however, further research is required to understand the role of fluoride in protecting mineralized tissues from such processes. Abrasive wear may be seen in a wide range of patients, whereas attritive loss is usually seen in individuals with bruxism. Wear processes are implicated in the development of dentine hypersensitivity. Saliva confers the major protective function against wear due to its role in pellicle formation, buffering, acid clearance, and hard tissue remineralization. This review focuses on the physiochemical factors impacting tooth wear.

Glass ionomer cements functionalised with a concentrated paste of chlorhexidine hexametaphosphate provides dose-dependent chlorhexidine release over at least 14 months.

OBJECTIVES: The aim of this study was to create prototype glass ionomer cements (GICs) incorporating a concentrated paste of chlorhexidine-hexametaphosphate (CHX-HMP), and to investigate the long-term release of soluble chlorhexidine and the mechanical properties of the cements. The purpose is the design of a glass ionomer with sustained anticaries efficacy. METHODS: CHX-HMP paste was prepared by mixing equimolar solutions of chlorhexidine digluconate and sodium hexametaphosphate, adjusting ionic strength, decanting and centrifuging. CHX-HMP paste was incorporated into a commercial GIC in substitution for glass powder at 0.00, 0.17, 0.34, 0.85 and 1.70% by mass CHX-HMP. Soluble chlorhexidine release into artificial saliva was observed over 436 days using absorbance at 255nm. Diametral tensile and compressive strength were measured after 7 days' setting (37°C, 100% humidity) and tensile strength after 436 days' aging in artificial saliva. 0.34% CHX-HMP GICs were tested for their ability to inhibit growth of Streptococcus mutans in vitro. RESULTS: GICs supplemented with CHX-HMP exhibited a sustained dose-dependent release of soluble chlorhexidine. Diametral tensile strength of new specimens was unaffected up to and including 0.85% CHX-HMP, and individual values of tensile strength were unaffected by aging, but the proportion of CHX-HMP required to adversely affect tensile strength was lower after aging, at 0.34%. Compressive strength was adversely affected by CHX-HMP at substitutions of 0.85% CHX-HMP and above. CONCLUSIONS: Supplementing a GIC with CHX-HMP paste resulted in a cement which released soluble chlorhexidine for over 14 months in a dose dependent manner. 0.17% and 0.34% CHX-HMP did not adversely affect strength at baseline, and 0.17% CHX-HMP did not affect strength after aging. 0.34% CHX-HMP GICs inhibited growth of S. mutans at a mean distance of 2.34mm from the specimen, whereas control (0%) GICs did not inhibit bacterial growth. CLINICAL SIGNIFICANCE: Although GICs release fluoride in vivo, there is inconclusive evidence regarding any clinical anticaries effect. In this study, GICs supplemented with a paste of chlorhexidine-hexametaphosphate (CHX-HMP) exhibited a sustained release of chlorhexidine over at least 14 months, and small additions of CHX-HMP did not adversely affect strength.

Effects of polyphosphates and fluoride on hydroxyapatite dissolution: A pH-stat investigation.

OBJECTIVES: This study investigated the immediate and sustained effect of sodium trimetaphosphate (TMP) and sodium hexametaphosphate (HMP) associated or not with fluoride (F) on hydroxyapatite (HA) dissolution using an erosion-like model, considering as well as the influence of salivary coating. DESIGN: Baseline dissolution rates were determined for HA discs using a pH-stat system. In the first set of experiments, HA discs were treated with 1100µgF/mL, 1% or 8% of HMP, 1% or 8% of TMP and 1100µgF/mL associated with 1% or 8% of HMP or TMP, totaling 9 groups (n=8). In a second phase, HA discs were kept in pooled human saliva at 37°C for 2h before treatment with deionised water and 1100µgF/mL associated with 1% or 8% of HMP or TMP, totaling 5 groups (n=8). The post-treatment dissolution rate was determined from three consecutive 30-min assays. Data were analysed using 2 and 3-way ANOVA followed by Fisher and Holm-Sidak methods, respectively (α=0.05). RESULTS: All test solutions promoted reduction in HA dissolution rate when compared to baseline control in the first post-treatment run (p<0.001). However, a synergistic effect was only observed between fluoride and 1% HMP. Moreover, the duration of inhibitory effect was greater when 8% HMP and 1 or 8% HMP associated with F were assessed (p<0.001). The presence of salivary coating led to higher protection for all groups when compared to discs without coating (p<0.001). CONCLUSION: The reduction of HA dissolution rate, as well as the duration of this effect were influenced by fluoride, type and concentration of phosphate salt and the presence of a salivary coating.

Chlorhexidine hexametaphosphate as a wound care material coating: antimicrobial efficacy, toxicity and effect on healing.

AIM: In this study, chlorhexidine hexametaphosphate (CHX-HMP) is investigated as a persistent antimicrobial coating for wound care materials. MATERIALS & METHODS: CHX-HMP was used as a wound care material coating and compared with chlorhexidine digluconate materials with respect to antimicrobial efficacy, toxicity and wound closure. RESULTS: Antimicrobial efficacy at day 1, 3 and 7 was observed with experimental and commercial materials. CHX-HMP coated materials had less toxic effect on human placental cells than commercial chlorhexidine dressings. CHX-HMP in pluronic gel did not delay healing but reduced wound colonization by E. faecalis. CONCLUSION: CHX-HMP could become a useful component of wound care materials with sustained antimicrobial efficacy, lower toxicity than chlorhexidine digluconate materials, and reduction in wound colonization without affecting closure.

An antifungal coating for dental silicones composed of chlorhexidine nanoparticles.

OBJECTIVES: The aims of this study were to synthesise a range of chlorhexidine-containing nanoparticles (CHX-NPs), and investigate the feasibility of using these as an antifungal coating for dental silicones. METHODS: CHX-NPs were precipitated in aqueous reaction by mixing solutions of CHX digluconate with solutions of sodium triphosphate (TP), trimetaphosphate (TMP) or hexametaphosphate (HMP). CHX-NPs were deposited on commercial dental silicones by immersion coating, and these were characterised for hydrophilicity (contact angle) and water uptake (mass change). Soluble CHX elution into artificial saliva was measured using ultraviolet spectrophotometry. Antifungal efficacy against Candida albicans was investigated using a cell proliferation assay. RESULTS: Coating silicones with CHX-NPs did not significantly affect hydrophilicity, as assessed using water contact angle, or water uptake as assessed by mass change following 16 weeks' immersion in artificial saliva. CHX-NP-coated silicone specimens released soluble CHX into artificial saliva. The salt of CHX and the immersion time affected the rate, concentration and duration of CHX release, with CHX-HMP exhibiting a slow, sustained release and CHX-TP and CHX-TMP exhibiting a faster, more concentrated release. C. albicans metabolic activity was inhibited by presence of CHX-HMP-NPs in suspension. CONCLUSIONS: CHX-NPs provided a localised, controlled dose of soluble CHX at the surface of dental silicones without adversely affecting hydrophilicity or water uptake. CHX-HMP NPs provided effective antifungal control of C. albicans in a cell proliferation assay. Coating materials with these nanoparticles could be an effective way of delivering low, but clinically relevant, concentrations of chlorhexidine in the oral environment. CLINICAL SIGNIFICANCE: Denture stomatitis is a common oral infection and is associated with fungal infestation of denture soft lining and obturator materials, which are often silicones such as those used here. Our study suggests that CHX-NPs may be a useful strategy in design of antifungal coatings for these materials.