Antimicrobial photodynamic therapy against a dual-species cariogenic biofilm using a ruthenium-loaded resin-based dental material.

BACKGROUND: Streptococcus mutans and Candida albicans are associated with caries recurrence. Therefore, this study evaluated the combination of a Ru(II)-loaded resin-based dental material (RDM) and antimicrobial photodynamic therapy (aPDT) against a dual-species biofilm of S. mutans and C. albicans. METHODS: An aPDT protocol was established evaluating Ru(II)'s photocatalytic activity and antimicrobial potential under blue LED irradiation (440-460 nm, 22.55 mW/cm2) at different energy densities (0.00, 6.25, 20.25, 40.50 J/cm2). This evaluation involved singlet oxygen quantification and determination of minimum inhibitory concentration (MIC) and minimum bactericidal/fungicidal concentration (MBC/MFC). The biofilm was grown (72 h) on resin disks prepared with Ru(II)-doped RDM (0.00, 0.56, or 1.12 %) and samples were exposed to aPDT or dark conditions. The biofilm was then harvested to analyze cell viability (CFU counts) and formation of soluble and insoluble exopolysaccharides. RESULTS: The photocatalytic activity of Ru(II) was concentration and energy density dependent (p < 0.05), and MIC/MBC values were reduced for the microorganisms after LED irradiation (40.5 J/cm2); therefor, this energy density was chosen for aPDT. Although incorporation of Ru(II) into RDM reduced the biofilm growth compared to Ru(II)-free RDM for both species in dark conditions (p < 0.05), aPDT combined with an Ru(II)-loaded RDM (0.56 or 1.12 %) potentialized CFU reductions (p < 0.05). Conversely, only 1.12 % Ru(II) with LED irradiation showed lower levels of both soluble and insoluble exopolysaccharides compared to Ru(II)-free samples in dark conditions (p < 0.05). CONCLUSIONS: When the Ru(II)-loaded RDM was associated with blue LED, aPDT reduced cell viability and lower soluble and insoluble exopolysaccharides were found in the cariogenic dual-species biofilm.

CO2 laser irradiation combined with fluoridated dentifrice improved its protective effect on caries lesion progression regardless of the acidulated phosphate fluoride gel application: An in situ study.

OBJECTIVE: This in situ study aimed to investigate the efficacy of CO2 laser at a 10.6-µm wavelength combined with 1.23% acidulated phosphate fluoride (APF) and fluoridated dentifrice with 1100 µg F/g (FD) to control enamel caries progression. MATERIALS AND METHODS: Sixteen volunteers wore palatal appliances containing eight demineralized enamel specimens for four 14-day phases under sucrose exposure. These specimens were submitted to CO2 laser irradiation and APF alone or combined with FD. Treatment groups were non-fluoridated dentifrice-NFD, NFD + CO2 laser, NFD + APF, NFD + CO2 laser + APF, FD, FD + CO2 laser, FD + APF, and FD + CO2 laser + APF. Mineral loss, calcium fluoride (CaF2), fluorapatite (FAp), and fluoride in the biofilm were analyzed by analysis of variance followed by the Student-Newman-Keuls test, p < 0.05. RESULTS: The highest mineral loss inhibition was noted when FD and CO2 laser irradiation were combined, which did not significantly differ from the FD + CO2 laser + APF group. The CaF2, FAp, and F in the biofilm were more pronounced when the FD and APF were combined. The CO2 laser irradiation promoted a slightly higher concentration of CaF2 in the enamel and F in the biofilm. CONCLUSION: Although APF promotes the high formation of CaF2 and FAp, the combined use of FD with CO2 laser overcomes the APF effect in inhibiting the progression of artificial caries-like lesions in situ. CLINICAL SIGNIFICANCE: Under the in situ design of this study, remineralization of white spot lesions was achieved through CO2 laser irradiation and daily use of fluoridated dentifrice. Future clinical trials are encouraged to substantiate this finding.

Chitosan microparticles loaded with essential oils inhibit duo-biofilms of Candida albicans and Streptococcus mutans.

OBJECTIVE: Oral candidiasis is a common fungal infection that affects the oral mucosa, and happens when Candida albicans interacts with bacteria in the oral microbiota, such as Streptococcus mutans, causing severe early childhood caries. C. albicans and S. mutans mixed biofilms are challenging to treat with conventional antimicrobial therapies, thus, new anti-infective drugs are required. This study aimed to test a drug delivery system based on chitosan microparticles loaded with geranium and lemongrass essential oils to inhibit C. albicans and S. mutans mixed biofilms. METHODOLOGY: Chitosan microparticles loaded with essential oils (CM-EOs) were obtained by spray-drying. Susceptibility of planktonic were performed according CLSI at 4 to 2,048 µg/mL. Mixed biofilms were incubated at 37ºC for 48 h and exposed to CM-EOs at 256 to 4,096 µg/mL. The antimicrobial effect was evaluated using the MTT assay, with biofilm architectural changes analyzed by scanning electron microscopy. RAW 264.7 cell was used to evaluate compound cytotoxicity. RESULTS: CM-EOs had better planktonic activity against C. albicans than S. mutans. All samples reduced the metabolic activity of mixed C. albicans and S. mutans biofilms, with encapsulated oils showing better activity than raw chitosan or oils. The microparticles reduced the biofilm on the slides. The essential oils showed cytotoxic effects against RAW 264.7 cells, but encapsulation into chitosan microparticles decreased their toxicity. CONCLUSION: This study demonstrates that chitosan loaded with essential oils may provide an alternative method for treating diseases caused by C. albicans and S. mutans mixed biofilm, such as dental caries.

Chitosan microparticles loaded with essential oils inhibit duo-biofilms of Candida albicans and Streptococcus mutans

Abstract Oral candidiasis is a common fungal infection that affects the oral mucosa, and happens when Candida albicans interacts with bacteria in the oral microbiota, such as Streptococcus mutans, causing severe early childhood caries. C. albicans and S. mutans mixed biofilms are challenging to treat with conventional antimicrobial therapies, thus, new anti-infective drugs are required. Objective This study aimed to test a drug delivery system based on chitosan microparticles loaded with geranium and lemongrass essential oils to inhibit C. albicans and S. mutans mixed biofilms. Methodology Chitosan microparticles loaded with essential oils (CM-EOs) were obtained by spray-drying. Susceptibility of planktonic were performed according CLSI at 4 to 2,048 µg/mL. Mixed biofilms were incubated at 37ºC for 48 h and exposed to CM-EOs at 256 to 4,096 µg/mL. The antimicrobial effect was evaluated using the MTT assay, with biofilm architectural changes analyzed by scanning electron microscopy. RAW 264.7 cell was used to evaluate compound cytotoxicity. Results CM-EOs had better planktonic activity against C. albicans than S. mutans. All samples reduced the metabolic activity of mixed C. albicans and S. mutans biofilms, with encapsulated oils showing better activity than raw chitosan or oils. The microparticles reduced the biofilm on the slides. The essential oils showed cytotoxic effects against RAW 264.7 cells, but encapsulation into chitosan microparticles decreased their toxicity. Conclusion This study demonstrates that chitosan loaded with essential oils may provide an alternative method for treating diseases caused by C. albicans and S. mutans mixed biofilm, such as dental caries.

Erosive Effect of Analgesics on Primary Tooth Enamel - An in Vitro Study

Abstract Objective: To evaluate in vitro erosive effect of analgesics on primary tooth enamel. Material and Methods: The pH and the titratable acidity measurements of the medicines were performed in triplicate using a digital pH meter. Enamel slabs of primary teeth flat and polished were selected by initial surface microhardness analysis. Medications were selected and specimens were assigned into five groups (n=12): Dalsy; Magnopyrol; Paracetamol; Tylenol; and distilled water (negative control). Specimens were immersed in 5 ml of each group solution for 30 min, 4x/day for three days and stored in artificial saliva at 37 °C between immersions and at night. Final microhardness was determined. The data were submitted to Oneway ANOVA and Tukey's test. Scanning electron microscopy (SEM) analysis was performed in three specimens of each group. Results: Medicines showed acidic pH and mean values of titratable acidity ranged from 1.46 to 11.66 ml of 0.1N NaOH. The mineral loss of Magnopyrol was statistically significant in relation to the control group (p<0.01). Magnopyrol showed higher values when compared to Tylenol (p<0.05). SEM images displayed microstructure alterations in the Paracetamol group. Conclusion: Despite the low pH values, only Magnopyrol showed greater enamel softening. Paracetamol demonstrated morphological changes in primary tooth enamel (AU).

Prevalência de obesidade infantil: há motivo de preocupação? / Prevalence of childhood obesity: is there a cause for concern?

O objetivo deste estudo foi determinar a prevalência de sobrepeso/obesidade em pré-escolares e investigar a relação entre o índice de massa corporal (IMC) das crianças e o de seus pais. Para tanto, conduziu-se uma pesquisa transversal com 968 crianças, de 3-5 anos, regularmente matriculadas em pré-escolas públicas. O estado nutricional infantil foi definido pelo IMC após aferição do peso e estatura no próprio ambiente escolar, considerando-se o sexo e a idade em meses. De acordo com os critérios da Organização Mundial da Saúde (OMS), as crianças foram classificadas em eutróficas, baixo peso, risco de sobrepeso, sobrepeso ou obesas. O IMC dos pais foi calculado com os dados de peso e estatura obtidos por meio de questionário. Observou-se que 1% de crianças tinham baixo peso, 62% eram eutróficas, 17% apresentavam risco de sobrepeso, 12% sobrepeso e 8% obesidade. O IMC infantil mostrou-se positivamente correlacionado com o IMC materno e paterno (p < 0,05). Concluiu-se que a prevalência de obesidade e sobrepeso infantil na população estudada é alarmante e que o IMC da criança foi correlacionado ao dos pais. Tais achados devem ser motivo de preocupação das autoridades, reforçando a necessidade de estratégias de atenção à saúde abrangendo todo o núcleo familiar.

This study aimed to determine the prevalence of overweight/obesity in preschoolers and to investigate the relationship between the body mass index (BMI) of the children and of their parents. Therefore, a cross-sectional study was conducted with 968 children aging 3-5 years old from public preschools. The children's nutritional status was defined by the BMI, after measuring their weight and height at the preschool, considering sex and age in months. According to the World Health Organization (WHO) criteria, the children were classified as eutrophic, thin, at risk of being overweight, overweight or obese. The parents' BMI was calculated using weight and height data obtained through a questionnaire. One percent of children were thin, 62% eutrophic, 17% at risk of overweight, 12% were overweight and 8% obese. Children's BMI was positively correlated with maternal and paternal BMI (p <0.05). It was concluded that the prevalence of obesity and overweight in the population studied is alarming, and the child's BMI was correlated to their parents' BMI. Such findings should be of concern for the authorities, reinforcing the need for health care strategies covering the entire family.

Antimicrobial photodynamic therapy mediated by methylene blue coupled to ß-cyclodextrin reduces early colonizing microorganisms from the oral biofilm.

OBJECTIVE: To test the effect of antimicrobial photodynamic therapy (A-PDT) on the oral biofilm formed with early colonizing microorganisms, using the photosensitizer methylene blue coupled with ß-cyclodextrin nanoparticles and red light sources laser or LED (λ =660 nm). METHODS: The groups were divided into (n = 3, in triplicate): C (negative control, 0.9 % NaCl), CX (positive control, 0.2 % chlorhexidine), P (Photosensitizer/Nanoparticle), L (Laser), LED (light-emitting diode), LP (Laser + Photosensitizer/Nanoparticle) and LEDP (LED + Photosensitizer/Nanoparticle). A multispecies biofilm composed ofS. gordonii, S. oralis, S. mitis, and S. sanguinis was grown in microplates containing BHI supplemented with 1% sucrose (w/v) for 24 h. Light irradiations were applied with a laser at 9 J for 90 s (320 J/cm2), or with LED, at 8.1 J for 90 s (8.1 J/cm2). The microbial reduction was assessed by counting viable biofilm microorganisms in selective culture media, before and after the treatments. Data normality was assessed by the Shapiro-Wilk test, and the results were submitted to Kruskal-Wallis analysis, followed by Dunn's test, with a significance level of 5%. RESULTS: The groups LP and LEDP were able to significantly reduce the biofilm microorganism counts by as much as 4 log10 times compared to the negative control group (p < 0.05) and did not statistically differ from the positive control group (CX) (p > 0.05). CONCLUSION: The A-PDT mediated by encapsulated ß-cyclodextrin methylene blue irradiated by Laser or LED was effective in the microbial reduction of multispecies biofilm composed of early colonizing microorganisms.

Quantification and gene expression of Lactobacillus casei group species associated with dentinal lesions in early childhood caries.

BACKGROUND: Considering that the Lactobacillus casei group is strongly associated with caries progression, the use of lactobacilli as probiotics must be balanced due to their possible involvement in dental caries. OBJECTIVE: This study aimed to detect and quantify L. paracasei, L. rhamnosus, and L. casei group species in the active and arrested dentinal lesions of preschoolers. It also aimed to determine the expression profiles of lactobacilli genes related to adhesion, extracellular polymeric substance regulation, and pyruvate oxidation. METHODS: Total ribonucleic acid (RNA) was extracted from dentinal lesion samples (25 active, 13 arrested) of children between 2 and 5 years of age. The samples were converted to complementary deoxyribonucleic acid (cDNA), and quantitative polymerase chain reaction (qPCR) analyses were performed to quantify and determine the relative abundance (measured by percentage of total bacteria) of L. paracasei, L. rhamnosus, and L. casei group species. The expression profiles of L. paracasei/casei genes (spaC and spxB) and L. rhamnosus genes (spaE and wzb) were assessed. The Student t-test and the Mann-Whitney U test were used for comparisons. RESULTS: The L. casei group species were found to be part of the viable microbial community in dentinal caries. L. paracasei (p = 0.001), L. rhamnosus (p = 0.022), and L. casei (p = 0.004) group species were abundant in the active dentinal lesions compared to the arrested dentinal lesions. Only the wzb gene (p = 0.006) exhibited a statistically significant difference between the active and arrested lesions in terms of its expression profile; it was expressed to a higher extent in the active dentinal lesions. CONCLUSIONS: The L. casei group species presented in large numbers in the active dentinal caries lesions, indicating that these microorganisms are related to caries activity, and the wzb gene may play an important role in caries progression.

Plaque Fluoride Levels as a Predictor of Caries Development in Early Childhood with High Sugar Exposure - A Preliminary Study.

OBJECTIVE: This longitudinal study aimed to investigate if the plaque fluoride (PF) concentration can predict the early childhood caries onset. Design: As part of a larger study, 188 preschoolers were clinically evaluated for early childhood caries diagnosis, at baseline and after 1-year follow-up. After that, the final sample comprised: 1. children who had already caries at baseline (decayed, missing or filled surfaces, as well as white chalky white spot lesions adjacent to gingival margins) and developed at least one more cavitation after one year (n=16), and 2. children who never had or developed any caries lesions, including active white spots lesions (n=15). Before the clinical examinations, dental plaque was collected. PF concentration was determined with an ion-specific electrode. A chart was used to estimate the mean daily sugar exposure. The results were statistically analyzed by Spearman correlation and logistic regression analyses (α=0.05). RESULTS: After one year, a positive significant correlation between caries development and liquid sucrose, total sugar and total sucrose consumption increments was found (p<0.05). Moreover, the solid sugar, solid sucrose and total sugar exposure at baseline were positively correlated with the presence of dental plaque at follow-up (p<0.05). To top it all, children with PF concentrations ≤0.1 µg/mg at baseline were 10 times more likely to develop caries. CONCLUSION: In conclusion, this study demonstrated for the first time in vivo that low PF concentration is a predictor of caries development in primary teeth.

Selective, stepwise, or nonselective removal of carious tissue: which technique offers lower risk for the treatment of dental caries in permanent teeth? A systematic review and meta-analysis.

OBJECTIVES: This study aimed to systematically review the literature regarding the risk of selective removal-in comparison with stepwise and nonselective removal-of carious tissue in permanent teeth. MATERIALS AND METHODS: Controlled clinical trials and cohort studies involving patients with dental caries in permanent teeth were included. Databases used were PubMed, Embase, and Scopus. The test group should be composed of patients undergoing selective removal of carious tissues, and the control group should comprise patients undergoing nonselective removal and/or stepwise removal of carious tissue. Laboratory tests, studies on primary teeth, and studies that used temporary restorations were excluded, as were literature reviews. The primary outcome was overall success of maintaining pulpal health (both clinically and radiographically). Quality of the restoration, pulp exposure, dentin deposition, and microbiological examination were also assessed. A meta-analysis, using the pooled risk ratio (RR) and its 95% confidence interval (CI), was performed to assess the success of maintaining pulpal health, using the different control treatments as a subgroup analysis. RESULTS: A total of 2333 articles were retrieved, of which 10 were included in the systematic review and four in the meta-analysis. In the qualitative evaluation, the control groups presented a higher risk of pulp exposure in relation to the selective removal. In the meta-analysis, the selective carious tissue removal showed significantly higher overall success (RR, 95% CI 1.11, 1.02-1.21). CONCLUSIONS: The selective carious tissue removal presented higher success of maintaining pulpal health. CLINICAL RELEVANCE: In permanent teeth, selective carious tissue removal should be performed, as this technique results in lower numbers of pulp complications, such as pulp exposure, as compared with nonselective removal.

Addition of hydrogen peroxide to methylene blue conjugated to ß-cyclodextrin in photodynamic antimicrobial chemotherapy in S. mutans biofilm.

OBJECTIVE: This study evaluated the effect of hydrogen peroxide addition on ß-cyclodextrin-conjugated methylene blue in antimicrobial photodynamic therapy(a-PDT) in S. mutans biofilm model using laser or light emitting diode (LED) (λ = 660 nm). METHODS: A preliminary assay was performed to evaluate the cytotoxicity of hydrogen peroxide in oral fibroblasts by the colorimetric method (MTT). Afterwards, groups were divided into (n = 3, in triplicate): C (negative control), CX - chlorhexidine 0.2% (positive control), P (methylene blue/ß-cyclodextrin), H (Hydrogen Peroxide at 40 µM), PH, L (Laser), LP, LH (Laser+Hydrogen Peroxide), LPH, LED, LEDP, LEDH, and LEDPH. The biofilm was formed in 24 h with BHI + 1% sucrose (w/v). Light irradiations were conducted with laser, 9 J, 323 J/cm2, 113 s or with LED, 8.1 J, 8.1 J/cm2 for 90 s. Microbial reduction was evaluated by counting the viable microorganisms of the biofilm after the respective treatments, in a selective culture medium, and laser confocal microscopy evaluation. RESULTS: LP, LH, LPH, LEDP, LEDH, and LEDPH groups statistically reduced the counts of S.mutans compared with the C group and the log reductions were of 1.87, 1.94, 2.19, 0.91, 0.92, and 1.33, respectively; the addition of hydrogen peroxide did not potentiate the microbial reductions (LPH and LEDPH) compared with the LP and LEDP groups. CONCLUSION: The association of hydrogen peroxide with the conjugated ß-cyclodextrin nanoparticle as photosensitizer did not result in an enhanced effect of a-PDT; hydrogen peroxide behaved as a photosensitizer, since it reduced the number of S. mutans when associated with laser light.

Combined Effectiveness of ß-Cyclodextrin Nanoparticles in Photodynamic Antimicrobial Chemotherapy on In Vitro Oral Biofilms.

Objective: This study aimed to investigate if ß-cyclodextrin nanoparticles potentiate the photodynamic antimicrobial chemotherapy (PACT) effects in single and microcosm oral biofilms using methylene blue (MB) and a red laser. Background data: Studies of PACT have demonstrated promising effects; however, the association of nanoparticles with photosensitizers could enhance the antimicrobial result. Materials and methods: Biofilms were grown on enamel blocks either with Streptococcus mutans or in a microcosm model (salivary microorganisms) supplemented with sucrose. PACT using 50 µM MB associated or not with 32 µM encapsulated ß-cyclodextrin with MB for 5 min, followed by irradiation with red laser (λ = 660 nm, 320 J/cm2), was conducted and the counts of viable microorganisms in proper selective media were determined. Data were analyzed by one-factor ANOVA, followed by Tukey's test, or Kruskal-Wallis test, followed by Dunn's post hoc test, all with a significance level of 5%. Results: In the single-species biofilm model, a significant reduction in S. mutans counts was found for all groups when light was present. In the microcosm biofilm model, no significant difference was found among the groups for total streptococci, but a significant reduction of S. mutans was observed for the PACT group of encapsulated ß-cyclodextrin+MB. However, no statistically significant difference was observed among the PACT groups. Conclusions: PACT with ß-cyclodextrin mediated with MB associated with a red laser reduced S. mutans in microcosm biofilms. However, the presence of ß-cyclodextrin nanoparticles did not potentiate the PACT effects in single or microcosm oral biofilms.

Comparative Effect of Two Red Lights on Streptococcus mutans Biofilms and Assessment of Temperature Variances in Human Teeth During In Vitro Photodynamic Antimicrobial Chemotherapy.

Objective: The goals of this investigation were to compare the effect of photodynamic antimicrobial chemotherapy (PACT) with two different red lights on in vitro Streptococcus mutans biofilms, as well as to assess the temperature variances caused by PACT on human teeth. Methods: S. mutans biofilms (n = 3) were grown on hydroxyapatite disks, and the antimicrobial effect of PACT was evaluated using toluidine blue O (100 µg/mL) associated with Laserbeam® (LB 56.6 J/cm2) and LumaCare™ (LC -56.6, 158.5, 317.0, and 475.6 J/cm2). Pulpal temperature variances were analyzed using a digital thermocouple placed into the pulp chamber and positioned at the cement-enamel junction level of five teeth samples during irradiation times of 300, 600, and 900 sec for LB, and 22, 60, 120, and 180 sec for LC. The mean average temperature variance was calculated for each group. All data were analyzed through analysis of variance. Results: LB (900 sec) and LC (22 sec) induced similar reductions in the viability of microorganisms. LB did not cause statistically significant increase of temperature, regardless of experimental time, and LC caused temperature increase within the safe spectrum up to 60 sec. Conclusions: PACT seems to be a minimal invasive approach for reducing the viability of cariogenic bacteria. Thus, when applied in vitro for times equal or inferior to 900 and 60 sec for LB and LC, respectively, these light sources might be considered harmless to tooth structures.

Extraction and purification of RNA from human carious dentine: an approach to enable bacterial gene expression studies / Extração e purificação de RNA proveniente de dentina humana cariada: uma abordagem para viabilizar estudos de expressão gênica

Background: RNA isolation from bacteria within dentine caries lesions could be difficult due to reduced amount of collectable biomass and high mRNA instability. Attempting to overcome this challenge we describe one protocol developed to extract and purify total RNA from dentine lesions. Objective: customize a bacterial RNA extraction and purification method from human carious dentine. Methods: quantity and purity of extracted RNA were measured with a microvolume UV-VIS spectrophotometer, RNA integrity was assessed by standard denaturing agarose gel electrophoresis and images were captured under ultraviolet light with camera and analyzed. DNase treatment removed genomic DNA and an additional step of purification was carried out in silica spin column. Results: final yield (ng/µl) was 67.01 ± 22.33, absorbance ratio A260/A280 = 2.0 ± 0.07 and RNA integrity were obtained. The purified samples were reversely transcribed and the expression of atpD and fabM gene from Streptococcus mutans analyzed by quantitative real-time PCR. Conclusion: the extraction methodology developed produced high-quality RNA from dentine microbiota for transcriptional analysis.

Introdução: o isolamento de RNA de bactérias dentro de lesões de dentina cariada pode ser difícil devido à quantidade reduzida de biomassa e alta instabilidade de mRNA. Na tentativa de superar esse desafio, descrevemos um protocolo desenvolvido para extrair e purificar o RNA total das lesões dentinárias. Objetivo: personalizar um método de extração e purificação de RNA bacteriano a partir da dentina cariada humana. Métodos: a quantidade e a pureza do RNA extraído foram medidas com um espectrofotômetro UV-VIS de microvolume, a integridade do RNA foi avaliada por eletroforese em gel de agarose desnaturante padrão e as imagens foram capturadas sob luz ultravioleta e analisadas. O tratamento com DNase removeu o DNA genômico e uma etapa adicional de purificação foi realizada em coluna de spin de sílica. Resultados: o rendimento final (ng / µl) foi de 67,01 ± 22,33, a razão de absorbância A260 / A280 = 2,0 ± 0,07 e a integridade do RNA foram obtidas. As amostras purificadas foram transcritas reversamente e a expressão do gene atpD e fabM de Streptococcus mutans analisadas por PCR quantitativo em tempo real (RT-qPCR). Conclusão: a metodologia de extração desenvolvida produziu RNA de alta qualidade da microbiota dentinária para análises transcricionais.

Scientific evidence in antimicrobial photodynamic therapy: An alternative approach for reducing cariogenic bacteria.

Several studies of antimicrobial photodynamic therapy (aPDT) have been performed to verify the efficiency of this treatment against caries-related microorganisms. Thus, the aim of this study is to describe the characteristics of aPDT and to review the literature regarding its effects on cariogenic microorganisms organized in biofilms and/or caries lesions. The literature was searched for reviews and original papers about aPDT and its outcomes against Streptococcus mutans as well as other caries-associated microorganisms or caries lesions. Moreover, research on photosensitizers and light sources are also reviewed. The publications were selected using PubMed, Web of Science, and manual search of references cited in key papers. The descriptors used were "dental caries" and "photodynamic therapy". The relative efficacy of aPDT to reduce the population of cariogenic bacteria in in vitro biofilms is demonstrated by large number of laboratory studies. Preclinical (in situ models) and clinical studies show a less pronounced bacterial reduction for aPDT than for in vitro models, especially in dentin carious lesions, since the bacteria in dentin caries may be less susceptible to this therapy due to the limited photosensitizer penetration as well as reduced diffusion of light along dentin structures. Although aPDT may be an efficient and less invasive complementary approach to disinfect deep caries lesions, there is insufficient scientific evidence of its efficacy to warrant a clinical recommendation for its use.

Fontes de estresse, bem-estar psicológico e saúde entre estudantes de Odontologia: uma comparação entre fases pré-clínica e clínica e entre os sexos / Sources of stress, psychological well-being and health among dental students: a comparison between preclinical and clinical phases and between sexes

O objetivo do estudo foi avaliar bem-estar psicológico, saúde geral e fontes de estresse de estudantes de Odontologia de quatro cursos, comparando as fases pré-clínica e clínica e os sexos. Três instrumentos foram aplicados: Dental Environment Stress (DES), Psychological General Well-Being Index (PGWB) e Health Survey (SF-36), respondidos por 203 estudantes, sendo 75 (37%) em fase pré-clínica e 128 (63%) em clínica. Desses, 59 (29%) eram homens e 144 (71%) mulheres. As comparações foram realizadas pelo teste de Mann-Whitney, adotando um nível de significância de 5%. Nos domínios analisados pelo DES (performance acadêmica; dificuldades e inseguranças sobre o futuro profissional; responsabilidade com pacientes; fatores pessoais e institucionais; relações interpessoais), estudantes em fase pré-clínica demonstraram escores significativamente menores quando comparados a estudantes em fase clínica. No escore total de PGWB e em dois domínios (ansiedade e saúde geral), observou-se também escores menores em estudantes em fase pré-clínica. Quatro domínios do SF-36 (dor corporal, funcionamento físico, funcionamento social e papel físico), apresentaram significativa melhor saúde geral dos estudantes em fase pré-clínica. Entre os sexos, dois domínios do DES (performance acadêmica, dificuldade e insegurança sobre o futuro profissional) mostraram menores fatores estressores para o sexo masculino. O PGWB demonstrou diferença significativa em quatro domínios (estado deprimido; autocontrole; saúde geral; vitalidade), com melhor bem-estar psicológico para homens. O sexo masculino apresentou melhor vitalidade no domínio do SF-36. Concluiu-se que estudantes em fase pré-clínica e do sexo masculino demonstraram menores fontes de estresse, melhor bem-estar psicológico e percepção de saúde geral (AU).

The aim of this study was to evaluate psychological well-being, overall health, and sources of stress among dental students from four Doctor of Dental Surgery (DDS) programs, comparing the preclinical and clinical phases and sexes. Three instruments were applied: Dental Environment Stress (DES), Psychological General Well-Being Index (PGWB) and Health Survey (SF-36), answered by 203 students, with 75 (37%) in the preclinical phase and 128 (63%) in the clinical one. Among them, 59 were male (29%) and 144 were female (71%). Comparisons were performed using the Mann-Whitney test, adopting a significance level of 5%. In the domains analyzed using DES (academic performance, difficulties and insecurities about their professional future, responsibilities with patients, personal and institutional factors, interpersonal relationships), preclinical students showed significantly lower scores than students enrolled in the clinical phases. For PGWB total score and in two domains (anxiety and general health), lower scores were also observed in preclinical students. Four domains of SF-36 (bodily pain, physical functioning, social functioning and role-physical) showed significantly better overall health for preclinical students. Among the sexes, two DES domains (academic performance and difficulties and insecurities about their professional future) showed lower stressors for males. PGWB showed a significant difference in four domains (depressed mood, self-control, general health and vitality), with better psychological well-being for males. Males showed better vitality in the SF-36 domain. Concluding, preclinical and male students showed lower sources of stress, better psychological well-being and better perception of their overall health (AU).

Quantitative analysis of biofilm bacteria according to different stages of early childhood caries.

OBJECTIVE: Monitoring selected key species related to health or disease may facilitate caries risk assessment and discovery of novel ecological preventive and therapeutic approaches. This study aimed at quantifying Actinomyces naeslundii, Bifidobacterium spp., Lactobacillus acidophilus, Lactobacillus casei group, Streptococcus gordonii, Mitis group and Streptococcus mutans by quantitative polymerase chain reaction (qPCR) in dental biofilm from Brazilian children with different stages of early childhood caries (ECC). DESIGN: Seventy-five preschool children were clinically evaluated by ICDAS criteria and divided into groups: caries-free (CF; n = 20), enamel caries lesions (ECL; n = 17) and dentine caries lesions (DCL; n = 38). Plaque samples from all children were collected for detection and quantification of the selected bacteria. RESULTS: L. acidophilus and L. casei group were absent in almost all plaque samples. No differences in relative proportions of A. naeslundii, Mitis group and S. gordonii were observed in any stage of caries. However, S. mutans and Bifidobacterium spp. were present at higher concentrations in the biofilm of children with DCL (p < 0.001). Multivariate analysis showed that S. mutans and Bifidobacterium spp. were strongly associated with biofilm in children with DCL. CONCLUSION: Differences were observed in the proportion of acidogenic and aciduric bacteria with dental caries progression. The data indicate that S. mutans and Bifidobacterium spp. in dental biofilm may be involved in some progression processes for ECC.

Active compounds and derivatives of camellia sinensis responding to erosive attacks on dentin.

This research explored the potential of Camellia sinensis-derived teas and active compounds to be used as treatments to prevent dentin wear. Human root dentin slabs were randomly assigned to 5 groups (n = 10) as follows: distilled water (DW, control), epigallocatechin-3-gallate (EGCG), theaflavin gallate derivatives (TF), commercial green tea (GT), and commercial black tea (BT). The samples were submitted to a pellicle formation and an erosive cycling model (5x/day, demineralization using 0.01 M hydrochloric acid/60 s) followed by remineralization (human stimulated saliva/60 min) for three days. The samples were treated for 5 min using the test group solutions between the erosive cycles. Dentin changes were assessed with profilometry analysis and FT-Raman spectroscopy. The data regarding wear were analyzed by ANOVA followed by Tukey's test (p < 0.05). EGCG, TF derivatives, and both regular teas significantly suppressed erosive dentin loss (38-47%, p < 0.05). No obvious changes in the Raman spectra were detected in the specimens; however, the DW group had a minor relationship of 2880/2940 cm-1. The phenolic contents in both green and black tea and the important catechins appear to have protective effects on dentin loss.

The effect of magnesium hydroxide-containing dentifrice using an extrinsic and intrinsic erosion cycling model.

OBJECTIVE: To evaluate, in vitro, the effect of Mg(OH)2 dentifrice, and the influence of the number of experimental days, on the extrinsic (citric acid -CA) and intrinsic (hydrochloric acid -HCl) enamel erosion models. DESIGN: Human enamel slabs were selected according to surface hardness and randomly assigned to 3 groups (n=9) as follows: non-fluoridated (negative control), NaF (1450ppm F- positive control) and Mg(OH)2 (2%) dentifrices. The slabs were daily submitted to a 2-h period of pellicle formation and, over a period of 5days, submitted to cycles (3×/day) of erosive challenge (CA 0.05M, pH=3.75 or HCl 0.01M, pH=2 for 30s), treatment (1min -1:3w/w of dentifrice/distilled water) and remineralization (artificial saliva/120min). Enamel changes were determined by surface hardness loss (SHL) for each day and mechanical profilometry analysis. Data were analyzed by two-way ANOVA followed by Tukey's test to % SHL and one-way ANOVA to profilometry (p<0.05). RESULTS: The number of experimental days influenced the erosion process for the two types of erosion models (p<0.001). Mg(OH)2-containing dentifrices were effective in reducing enamel extrinsic acid erosion as determined by % SHL (p<0.001) when compared to the control group, being better than positive control (p<0.001); however, the dentifrices were not effective for the intrinsic model (p=0.295). With regards to surface wear, no statistically significant differences were found among the groups for CA (p=0.225) and HCl (p=0.526). CONCLUSION: The findings suggest that Mg(OH)2 dentifrices might protect enamel against slight erosion, but protection was not effective for stronger acid erosion.

Stressors, psychological well-being, and overall health amongst students from public and private dental schools

Aim: This study aimed to correlate stressors with psychological well-being and health factors in dental students from public and private schools. Methods: From February to May 2015, three different instruments (Dental Environment Stress ­ DES ­ Psychological General Well-Being ­ PGWB ­ and SF-36 Health Survey) were applied to students from two public and two private dental schools from the State of Ceará, Brazil. Mann-Whitney test or t test for independent samples were used in order to compare the stressors between private and public dental schools students. Correlations to each DES domain were performed using Kendall's Tau C test. Results: A total of 92 (45.32%) and 111 (56.68%) students from public and private schools, respectively, answered the questionnaire. Students from public schools demonstrated significantly higher scores in DES/academic performance and DES/personal and institutional factors (p<0.05). Significant negative correlations were detected between PGWB/anxiety and PGWB/general with all DES domains for both public and private schools (p<0.05). Additionally, DES/academic performance was significantly correlated with several SF-36 domains, such as physical function, vitality, and social functioning, to both public and private schools (p<0.05). However, DES/academic performance and SF-36/role physical was only significantly correlated in private school students (r=-0.171, p=0.039), while SF-36/bodily pain (r=-0.274, p<0.001), general health (r=-0.245, p=0.001), and mental health (r=-0.286, p<0.001) were significantly correlated with DES/academic performance only in public school students. Conclusion: Students from public and private dental schools presented different stressor patterns. Additionally, most of DES domains were significantly associated with PGWB and SF-36 to both public and private schools