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1.
BMC Oral Health ; 19(1): 219, 2019 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-31604449

RESUMO

BACKGROUND: The small-colony variants (SCVs) of Staphylococcus aureus were isolated from persistent and recurrent infections, especially after placement of medical devices having direct contact with human tissues. The emergence of SCVs is a survival strategy of S. aureus which enables them to hide inside host's cells and induces a less severe immune response than to wild-type S. aureus. However, contrary to other medical devices, dental prosthesis as a surface potentially colonized by SCVs of S. aureus has not been examined thus far. We reported the first case of SCVs - S. aureus infection in denture wearer. CASE PRESENTATION: A 62-year-old woman with a complete removable acrylic denture presented extensive elevated erythematous lesions on the palate, compatible with denture stomatitis. The patient had a history of arterial hypertension, cigarette smoking and wearing denture at night. The fungal colonies, identified as Candida albicans, were cultured on Sabouraud agar. From three swabs (from hard palate mucosa, denture surface and angular cheilitis lesions) were cultured of pinpoint, clear, non-pigmented, and non-haemolytic colonies on Columbia agar. The small colonies turned out to be Gram-positive cocci, catalase-, Pastorex Staph Plus -, and clumping factor-positive, and oxidase-negative. Suspected phenotypically SCVs forms were definitively identified as S. aureus based on PCR amplification of species specific nuc and coa genes. Methicillin-resistance was verified by mecA gene detection. The isolates turned out to be susceptible to methicillin (MSSA) and resistant to gentamicin. The isolate was identified as menadione-auxotrophic variant. CONCLUSIONS: This case demonstrated that oral cavity in denture wearers may be a reservoir of small-colony variants of S. aureus, besides C. albicans. The prevalence of these bacteria and their role in the pathogenesis of oral diseases are not understood. Due to problems with their detection and identification, the true prevalence of oral SCVs may be underestimated.


Assuntos
Prótese Dentária/microbiologia , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Estomatite sob Prótese/microbiologia , Antibacterianos/uso terapêutico , Prótese Dentária/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Infecções Estafilocócicas/tratamento farmacológico , Estomatite sob Prótese/diagnóstico , Estomatite sob Prótese/tratamento farmacológico , Resultado do Tratamento
2.
Infect Immun ; 87(12)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31527130

RESUMO

Candida-associated denture stomatitis (DS) is a persistent and chronic oral infection of the denture-bearing palatal mucosa. DS stems from the ability of the fungal opportunistic pathogen Candida albicans to adhere to denture material and invade palatal tissue. Although DS is the most prevalent form of oral candidiasis, there are currently no feasible therapeutic strategies for the prevention of this recurrent condition. We developed a peptide-based antimicrobial bioadhesive formulation specifically designed for oral topical formulation. In this study, we aimed to evaluate the applicability of the novel formulation for the prevention of C. albicans colonization on denture material and development of clinical disease. To that end, using the latest technological advances in dental digital design and three-dimensional (3D) printing, we fabricated an intraoral device for rats with universal fit. The device was successfully installed and used to develop clinical DS. Importantly, by taking a preventative therapeutic approach, we demonstrated the potential clinical utility of the novel formulation as a safe and feasible prophylactic agent against DS.


Assuntos
Antifúngicos/farmacologia , Candida albicans/efeitos dos fármacos , Candidíase Bucal/prevenção & controle , Cimentos Dentários/farmacologia , Estomatite sob Prótese/prevenção & controle , Animais , Antifúngicos/química , Biofilmes/efeitos dos fármacos , Biofilmes/crescimento & desenvolvimento , Candida albicans/crescimento & desenvolvimento , Candidíase Bucal/tratamento farmacológico , Candidíase Bucal/microbiologia , Cimentos Dentários/química , Dentaduras/microbiologia , Modelos Animais de Doenças , Masculino , Mucosa Bucal/microbiologia , Ratos , Ratos Sprague-Dawley , Estomatite sob Prótese/tratamento farmacológico , Estomatite sob Prótese/microbiologia
3.
Photodiagnosis Photodyn Ther ; 28: 98-101, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31454713

RESUMO

AIM: The aim of the present randomized clinical study was to compare the efficacies of photodynamic inactivation (PDI) to nystatin (NST) in terms of prevalence of Candida species in cases with denture stomatitis (DS). METHODS: Thirty-six patients were randomly divided into two groups; 18 in PDI and 18 in NST. Irradiation was carried out by using the GaA1As diode laser with wavelength, mode of transmission, laser output and energy density were standardized at 660 nm, continuous mode, 100 mW power and 28 J/cm2 respectively. The PDI was applied twice a week, with an interval of at least 48 h among the sessions during four weeks. Topical nystatin oral suspension 100,000 IU was used four times daily for 15 days. The existence of Candida spp. was confirmed by employing the microbiological culture technique. Candida colony counts from the palates and dentures surfaces, quantified as colony forming unit (CFU)/mL, measured at baseline, at the end of treatments (day 15), and at follow-up (days 30 and 60) and the prevalence of Candida spp. were identified in the two groups of treatments. RESULTS: The overall CFU/mL values were higher in the dentures of the patients of both the groups than those from the palates. During all time periods of the study, the CFU/mL values obtained from both NST and PDI groups showed no significant differences. For dentures and palates, a significant reduction in mean CFU/mL values was observed on day 15 compared with baseline (day 0) in both NST and PDI groups. It can be seen that the effect size of treatments was large for the palates of patients in the NST group (1.79) and moderate for the palates of patients in the PDI group (0.63). On the other hand, the effect size was very large for the dentures for both groups (NST group = 3.01; PDI group = 1.58). C. albicans was the most common species on both dentures and palates of patients throughout the study period followed by C. tropicalis and C. glabrata. CONCLUSION: Out of all the Candida spp., C. albicans showed the highest prevalence among all species. In addition, PDI was equally effective as nystatin for the treatment of DS.


Assuntos
Antifúngicos/uso terapêutico , Candida , Nistatina/uso terapêutico , Fotoquimioterapia/métodos , Estomatite sob Prótese/tratamento farmacológico , Estomatite sob Prótese/microbiologia , Humanos , Lasers Semicondutores , Antissépticos Bucais , Células-Tronco
4.
Photodiagnosis Photodyn Ther ; 27: 193-197, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31185323

RESUMO

BACKGROUND: Candida species have an influence in the pathogenesis of denture stomatitis. The current study aimed to investigate the efficacy of indocyanine green (ICG)-mediated photodynamic therapy (PDT) in combination with nystatin mouthwash (PDT + nystatin) for the treatment of denture stomatitis in comparison with routine antifungal therapy with nystatin alone. METHODS: In this double-blind randomized clinical trial, 66 patients were randomly assigned into PDT + nystatin (n = 33) and nystatin (n = 33) groups, both groups were treated 3-times a day (15 days) with nystatin mouthwash, and PDT was performed twice once a week for the PDT + nystatin group. Briefly, ICG was applied on the palatal lesion and laser irradiation was performed using a diode laser (810 nm, 56 J/cm2). Nystatin group was also treated with sham laser in order to eliminate the possible psychological effects. The clinical and mycological evaluations were carried out at the baseline, during treatment, and the end of follow-up. Patients who completed the treatment and follow-up were eligible for statistical analysis (each group 28 cases). RESULTS: Patient treatment with nystatin or PDT + nystatin reduced the lesions extension. Candida species were isolated from all patients and the number of Candida CFU in both groups showed a significant reduction at each post-treatment visit; however, the mean reduction achieved in the PDT + nystatin group was significantly higher than nystatin alone. CONCLUSIONS: ICG-mediated PDT in combination with nystatin mouthwash can improve the clinical feature of denture stomatitis with no adverse effects; therefore, it could be used as an alternative to the currently available antifungal therapy using nystatin alone.


Assuntos
Antifúngicos/uso terapêutico , Candidíase Bucal/tratamento farmacológico , Nistatina/uso terapêutico , Fotoquimioterapia/métodos , Estomatite sob Prótese/tratamento farmacológico , Idoso , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Verde de Indocianina/uso terapêutico , Lasers Semicondutores , Masculino , Pessoa de Meia-Idade , Nistatina/administração & dosagem , Fármacos Fotossensibilizantes/uso terapêutico , Estomatite sob Prótese/microbiologia
5.
J Altern Complement Med ; 25(5): 552-558, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30758216

RESUMO

Objective: An alcohol-free mouthwash of curcuminoids purified from the turmeric (Curcuma longa Linn.) rhizome was formulated using a cosolvent system, comprising chitosan and polyethylene glycol (PEG) 400, and determined for its efficacy and safety in management of denture stomatitis (DS) in comparison with a chlorhexidine (CHX) mouthwash. Design: A single-center, randomized, controlled parallel-arm trial was conducted. Setting: The study took place at the Faculty of Dentistry, Prince of Songkla University, Hat-Yai, Thailand, between June 2016 and June 2017. Subjects: Participants were 20 years old or older adults of both genders, using removable dentures, and with a confirmed diagnosis of DS from an oral medicine specialist. Interventions: A total of 30 patients were randomly assigned to 3 different interventions, including the chitosan-curcuminoid (CHI-CUR) mouthwash, CHX mouthwash, and a vehicle formulation comprising chitosan and PEG 400. Ten milliliters of each intervention was given to the patient to be used for 30 sec, three times a day at 8 am, 12 pm, and 4 pm, for 2 weeks. Outcome measures: Outcome measures included complete relief of erythematous lesions under the denture and reduction in the number of candida colonies present in the denture-fitting surface. Results: Eight of 10 patients (80%) using the CHI-CUR mouthwash had a complete response after the 2-week treatment course compared with 30% of patients using the CHX mouthwash (p < 0.05). Both interventions exerted comparable anticandida efficacy. No oral or systemic adverse events that could possibly be related to the use of mouthwash were documented. Conclusions: The finding indicated that an alcohol-free CHI-CUR mouthwash may serve as a safe and potential topical therapeutic alternative in treating generalized or candida-associated DS.


Assuntos
Quitosana/uso terapêutico , Clorexidina/uso terapêutico , Curcumina/uso terapêutico , Antissépticos Bucais , Estomatite sob Prótese/tratamento farmacológico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antissépticos Bucais/efeitos adversos , Antissépticos Bucais/química , Antissépticos Bucais/uso terapêutico , Satisfação do Paciente , Resultado do Tratamento
6.
Int J Biol Macromol ; 125: 761-766, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30543887

RESUMO

Tissue conditioners are commonly used to improve the adaptation of ill-fitting dentures. These materials are easily colonized by Candida albicans (C. albicans), resulting in "denture stomatitis". Chitosan and its derivative possess inherent antifungal activity. This study aims to formulate a chitosan-based tissue conditioner and assess its anti-fungal efficacy against C. albicans over time. A chitosan oligosaccharide (COS) was synthesized from commercially purchased chitosan and was characterized by Fourier Transform Infrared spectroscopy (FTIR) and X-ray diffraction analysis (XRD). The minimum inhibitory concentration (MIC) of COS and commercial chitosan against C. abicans was evaluated using broth micro-dilution assay (n = 3). Next, it was incorporated into tissue conditioners and two experimental groups i.e. tissue conditioner modified by chitosan (TC-CH) and tissue conditioner modified by COS (TC-COS) were prepared. The in-vitro antifungal activity of experimental group was compared with a control group (chitosan-free tissue conditioner) by counting numbers of colony forming units (CFUs) (n = 3). The antifungal potential of experimental formulations over time in a simulated oral environment was also evaluated using a spectrophotometry (n = 3). A potent in-vitro antifungal activity against C. albicans was observed. The minimum inhibitory concentration (MIC) of pure commercial chitosan and COS was 0.625 mg/ml and 0.3125 mg/ml respectively. Compared to the control group, experimental groups showed a reduction in number of CFUs of C. albicans density. Once immersed in saliva, the TC-CH retained its inhibitory effect for 24 h, while TC-COS exhibited improved inhibition until the third day, beyond which a gradual reduction in the inhibitory effect was observed. Experimental formulations showed a reduction in C. albicans density compared to the control group. Thus, a novel combination of chitosan and tissue conditioners is a promising alternative for prevention and treatment of denture stomatitis.


Assuntos
Antifúngicos/farmacologia , Candida albicans/efeitos dos fármacos , Quitosana/química , Estomatite sob Prótese/tratamento farmacológico , Antifúngicos/química , Testes de Sensibilidade Microbiana/métodos , Oligossacarídeos/química , Oligossacarídeos/farmacologia
7.
J Prosthet Dent ; 120(4): 498-505, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29807743

RESUMO

STATEMENT OF PROBLEM: Denture stomatitis (DS) is an inflammatory oral lesion that occurs mostly in elderly denture wearers and that can negatively affect their quality of life. The conventional treatment plan for DS is topical or systemic fungicidal drug therapy, which are not without side effects. PURPOSE: The purpose of this systematic review was to evaluate the clinical outcomes of using low-level laser therapy (LLLT) or photodynamic therapy (PDT) in the treatment of DS by reviewing high-quality published articles. MATERIAL AND METHODS: The Cochrane Library, Web of Science, Google Scholar, PubMed, ProQuest, Scopus, Embase, and Ovid databases were searched using appropriate key words. Related titles and abstracts published up to May 2017 were screened and selected based on defined inclusion criteria. The full texts of all selected articles were read, and citation lists were checked for missing references. All randomized controlled trials (RCT) were subjected to quality assessments. RESULTS: A total of 760 articles were included in the study after the initial search. Six studies were selected for assessment of eligibility, and 4 of them were sufficiently reliable in methodology and randomization to be included in the study. The applied wavelength varied from 455 nm to 830 nm. Also, the highest energy patients were exposed to was 122 J/cm2, and the lowest was 1 J/cm2. Exposure times ranged from 10 seconds to 26 minutes in the reviewed studies. CONCLUSIONS: Based on the available RCTs, LLLT has a significant role in the clinical treatment of DS. However, the results of PDT were similar to those of conventional antifungal therapies.


Assuntos
Terapia com Luz de Baixa Intensidade , Fotoquimioterapia , Estomatite sob Prótese/tratamento farmacológico , Estomatite sob Prótese/radioterapia , Humanos , Resultado do Tratamento
8.
Ther Deliv ; 9(5): 359-374, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29681233

RESUMO

AIM: An anthocyanin complex (AC), combined Zea mays and Clitoria ternatea extracts, was evaluated for topical oral wound healing in rats and a clinical trial in orthodontic patients. METHODS/RESULTS: AC enhanced anthocyanin permeation in vitro. In rats, 10% w/w of AC in a mucoadhesive gel (AG) reduced erythema and sizes of oral wounds after topical applications at higher extent than its placebo gel. Acute orthodontic wounds in 68 volunteers were randomly assigned to topically receive either AG or placebo gel and double-blind assessed. Wound size reduction and wound closure enhancement were obvious in AG-treated group on day 3 (p < 0.05). CONCLUSION: At 10% w/w, AC promoted wound closure and possessed a potential in healing stimulation of acute oral wounds.


Assuntos
Antocianinas/farmacologia , Mucosa Bucal/lesões , Extratos Vegetais/farmacologia , Estomatite sob Prótese/tratamento farmacológico , Cicatrização/efeitos dos fármacos , Administração através da Mucosa , Adulto , Animais , Antocianinas/uso terapêutico , Clitoria/química , Método Duplo-Cego , Avaliação Pré-Clínica de Medicamentos , Feminino , Humanos , Masculino , Mucosa Bucal/metabolismo , Braquetes Ortodônticos/efeitos adversos , Extratos Vegetais/uso terapêutico , Ratos , Ratos Wistar , Estomatite sob Prótese/etiologia , Resultado do Tratamento , Adulto Jovem , Zea mays/química
9.
Photodiagnosis Photodyn Ther ; 22: 212-216, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29678677

RESUMO

Denture stomatitis (DS) is the most common oral fungal infection in denture wearers. Photodynamic inactivation (PDI) has been showing to be an effective technique in vivo against fungi, including fungal infections in the oral cavity. The disinfection of both oral mucosa and denture may represent a real advantage in terms of fungus control. This clinical study was designed to explore methylene blue (MB)-mediated PDI on oral mucosa and prosthesis of patients with DS. Subjects with DS were divided into two groups. One group received treatment based on the use of oral miconazole gel 2% (MIC). The other group received treatment by PDI using MB at 450 µg/mL and a diode laser (λ = 660 nm) with 100 mW and fluence of 28 J/cm2. Clinical outcome was evaluated regarding the degree of oral mucosa erythema and microbiological reduction of Candida spp. located in both palatal mucosa and prosthesis. Our results showed that PDI was significantly more effective than MIC in ameliorating inflammation after 15 days. Following 30 days, no statistically significant differences were observed between groups. Regarding the fungal burden, although the MIC group has presented more pronounced inactivation than PDI for both mucosa and prosthesis, no statistically significant differences were detected between them. This clinical study suggests that PDI can reduce fungal load and decrease the inflammation degree in patients with Candida-associated denture stomatitis.


Assuntos
Candida/efeitos dos fármacos , Dentaduras/microbiologia , Mucosa Bucal/efeitos dos fármacos , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/farmacologia , Estomatite sob Prótese/tratamento farmacológico , Idoso , Antifúngicos/farmacologia , Feminino , Humanos , Lasers Semicondutores , Masculino , Miconazol/farmacologia , Pessoa de Meia-Idade , Mucosa Bucal/microbiologia , Fotoquimioterapia/efeitos adversos , Fármacos Fotossensibilizantes/efeitos adversos , Estomatite sob Prótese/microbiologia
10.
Photodiagnosis Photodyn Ther ; 21: 168-171, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29198763

RESUMO

Antimicrobial Photodynamic Therapy (aPDT) mediated by Photodithazine® (PDZ) has shown efficacy in the inactivation of Candida spp. in in vitro and in vivo studies. This preliminary study reports five clinical cases of patients with denture stomatitis (DS) treated with PDZ-mediated aPDT. Five individuals diagnosed with DS were selected and submitted to aPDT 3 times a week for 15 days (6 sessions). In each session, 200 mg/L of PDZ gel was applied on the upper prostheses and on the palate of the patients for 20 min, then, illuminated by a light emitting diode at 660 nm (50 J/cm2). Microbiological samples from prostheses and palates were also performed and cultured on Sabouraud Dextrose Agar and Blood Agar. The values ​​of colony forming units per milliliter (CFU/mL) were determined. Standardized photographs of the palates were taken prior the treatment (initial), at the end (final) and until 45 days after the completion of treatments. The results demonstrated that the aPDT treatment reduced Candida spp. and the total microbiota viability ​​at the end of the treatment. For most patients, the CFU/mL values obtained in the last microbiological collection (day 45) were lower than those found before the treatment (initial). Three patients presented clinical resolution of DS (no DS signal) after aPDT treatment. One individual demonstrated reduction in palatal inflammation and another one did not show improvement in the oral lesion. Recurrence of DS was observed in all individuals in the follow-up period. PDZ-mediated aPDT may be a promising treatment for DS.


Assuntos
Candida/efeitos dos fármacos , Glucosamina/análogos & derivados , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Estomatite sob Prótese/tratamento farmacológico , Idoso , Feminino , Glucosamina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade
11.
J Oral Sci ; 59(3): 425-430, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28904319

RESUMO

This study investigated the antifungal effects of low-molecular-weight chitosan solution on Candida albicans in denture stomatitis in comparison with nystatin suspension. This randomized, sing-leblind clinical trial included 40 patients diagnosed with denture stomatitis. Patients were divided into two groups, wherein one was treated with chitosan and the other with nystatin for 2 weeks. Changes in the erythematous area were recorded during and after treatment. A palatal smear was obtained for each patient before and after treatment to determine the number of blastospores and mycelia of C. albicans. The results were compared using the Mann-Whitney U test, revealing that the chitosan solution significantly decreased the erythematous surface area, burning sensation, time required for clinical improvement, and number of blastospores and mycelia. The antifungal efficacy of chitosan along with its inherent biocompatibility makes it a promising candidate for use as an antifungal mouthwash.


Assuntos
Antifúngicos/farmacologia , Candida albicans/efeitos dos fármacos , Quitosana/farmacologia , Estomatite sob Prótese/tratamento farmacológico , Quitosana/química , Humanos , Peso Molecular , Nistatina/farmacologia , Método Simples-Cego , Estomatite sob Prótese/microbiologia
12.
Oral Health Prev Dent ; 15(3): 259-268, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28674706

RESUMO

PURPOSE: Systemic immune activation has been recently linked to chronic inflammatory disorders of the oral cavity, particularly to periodontitis. The purpose of this study was to determine whether treatment of a fungus-induced oral inflammation, namely denture-related stomatitis (DRS), can affect the activation of the systemic immune response. MATERIALS AND METHODS: Peripheral blood from patients with denture-related stomatitis caused by Candida albicans infection (n = 15) was collected at three time points: before treatment with nystatin, at the end of therapy and 2 months after finishing therapy. Activation of T cells and monocytes was assessed by flow cytometry. RESULTS: The percentages of peripheral lymphocytes, T cells and their subpopulations, as well as monocytes were similar before, immediately following and two months after nystatin treatment. Cells expressing early activation marker CD69 and RANTES C-C chemokine receptor type 5 significantly increased immediately after treatment and returned to baseline levels after two months. Th17 cells, which have been implicated in the pathogenesis of DRS, remained unchanged. Central memory CD4+ subset and intermediate subset of monocytes were lower after therapy and this effect was sustained for two months. CONCLUSION: Treatment of denture-related stomatitis does not seem to affect the general state of the cellular components of the immune system. The results suggest a potential proinflammatory effect of the antifungal agent, nystatin. Although transient and not intense, this effect might be of particular clinical importance, because of relationships between inflammation and certain diseases. Further studies are required to clarify this aspect.


Assuntos
Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candidíase Bucal/sangue , Candidíase Bucal/dietoterapia , Monócitos/efeitos dos fármacos , Nistatina/farmacologia , Nistatina/uso terapêutico , Estomatite sob Prótese/sangue , Estomatite sob Prótese/tratamento farmacológico , Linfócitos T/efeitos dos fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estomatite sob Prótese/microbiologia
13.
Trials ; 18(1): 211, 2017 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-28476133

RESUMO

BACKGROUND: Denture-related erythematous stomatitis (DES) is a chronic biofilm-mediated disease, affecting one in every three complete denture wearers. Antifungals are the treatment most commonly prescribed by oral health professionals, based on the belief that colonization by Candida spp. is the main cause of DES. However, high recurrence rates and adverse effects are commonly observed, prompting the need for practice guidelines regarding treatment. Results from our pilot study demonstrate that palatal brushing can reduce the palatal inflammation and potentially associated Candida carriage without any need for antifungal therapy. The objective of this study is to validate these pilot results by means of a randomized controlled trial (RCT) and provide a practice guideline for clinicians. METHODS/DESIGN: A pragmatic, two-parallel-arm, multicenter RCT will be conducted in Canada, Brazil, and Chile. Fifty-two adult complete denture wearers presenting with moderate to severe DES will be allocated randomly to two groups: the Intervention arm will consist of palatal brushing and standard oral and denture hygiene measures, while the Control arm will include only standard oral and denture hygiene measures. The study outcome will be the oral Candida carriage. Participants will be assessed at baseline, and at 3 and 6 months post intervention. Descriptive, bivariate, and mixed models with repeated measures will be performed following the intention-to-treat principle. DISCUSSION: This pragmatic RCT will serve to provide a clinical practice guideline regarding the use of preventive measures in the treatment of biofilm-mediated oral diseases. Moreover, it will have a great impact on reducing the harm of antifungal overtreatment on patients suffering from DES. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02686632 . Registered on 15 February 2016.


Assuntos
Antifúngicos/uso terapêutico , Biofilmes/efeitos dos fármacos , Candidíase Bucal/tratamento farmacológico , Prótese Total/efeitos adversos , Estomatite sob Prótese/tratamento farmacológico , Biofilmes/crescimento & desenvolvimento , Brasil , Candidíase Bucal/diagnóstico , Candidíase Bucal/microbiologia , Chile , Protocolos Clínicos , Prótese Total/microbiologia , Fidelidade a Diretrizes , Humanos , Análise de Intenção de Tratamento , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Quebeque , Recidiva , Projetos de Pesquisa , Método Simples-Cego , Estomatite sob Prótese/diagnóstico , Estomatite sob Prótese/microbiologia , Fatores de Tempo , Resultado do Tratamento
14.
PLoS One ; 12(5): e0176755, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28493889

RESUMO

Candida albicans biofilms play a key role in denture stomatitis, one of the most common oral pathologies in elderly people. Because biofilms are highly resistant to antifungals, new pharmacological strategies are needed. Aspirin and nitric oxide-donor molecules have both shown antibiofilm effects on C. albicans, making them promising candidates for treatment. In this study, we evaluated the antifungal/antibiofilm effect of a nitric-oxide releasing aspirin (NO-ASA) on C. albicans isolates from denture stomatitis patients in vitro. Disk diffusion assays showed that while NO-ASA had no antifungal effect, the drug potentiated fluconazole inhibition zone diameters, increasing the effect of fluconazole by 20-30% (p<0.05). The effect of NO-ASA on the morphogenesis of C. albicans was evaluated using light microscopy after inducing hyphae formation. For all clinical strains assayed, 125 µM NO-ASA significantly decreased the number of filamentous cells present (p<0.01). Adhesion to abiotic surfaces, a critical event for biofilm formation, was evaluated in 96-well polystyrene plates using crystal violet assay; 125 µM NO-ASA significantly inhibited adhesion. Biofilms were observed with scanning electron microscopy (SEM) and quantified using XTT reduction assay. NO-ASA decreased biofilm formation (IC50 ranging from 300 µM to 700 µM), consistent with SEM findings of altered biofilm microarchitecture. PGE2 and carboxy-PTIO (an NO scavenger) both blocked the antibiofilm effects of NO-ASA, suggesting that the efficacy of NO-ASA may be associated with both inhibition of PGE2 synthesis and release of NO. NO-ASA is a promising novel antibiofilm agent for treating fluconazole-resistant strains of C. albicans.


Assuntos
Aspirina/análogos & derivados , Biofilmes/efeitos dos fármacos , Candida albicans/isolamento & purificação , Nitrocompostos/farmacologia , Estomatite sob Prótese/microbiologia , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Aspirina/farmacologia , Aspirina/uso terapêutico , Aderência Bacteriana/efeitos dos fármacos , Candida albicans/efeitos dos fármacos , Candida albicans/ultraestrutura , Dinoprostona/metabolismo , Farmacorresistência Fúngica/efeitos dos fármacos , Fluconazol/farmacologia , Fluconazol/uso terapêutico , Depuradores de Radicais Livres/farmacologia , Humanos , Concentração Inibidora 50 , Viabilidade Microbiana/efeitos dos fármacos , Nitrocompostos/uso terapêutico , Estomatite sob Prótese/tratamento farmacológico
17.
J Prosthodont Res ; 60(4): 231-239, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27085676

RESUMO

PURPOSE: The aim of this review is to investigate the current state of knowledge on the incorporation of antifungal agents into the tissue conditioners for the treatment of denture induced stomatitis. STUDY SELECTION: Studies reporting the incorporation of antifungal/antimicrobial agents in to tissue conditioners were included in the review. In order to search the studies on the topic "incorporation of antifungal agents in tissue conditioners for the treatment of denture induced stomatitis" ISI web of science, PubMed/MEDLINE, and Google-Scholar databases were searched from 1970 up to and including July 2015 using various keywords such as antifungal agents, tissue conditioners, Candida albicans, denture stomatitis, etc. RESULTS: Various studies reported the efficacy and effectiveness of adding conventional organic antifungal medicines (nystatin, azole group derivatives and chlorhexidine, antimicrobials/antifungals other than organic (silver zeolite, silver nano-particles, photo-catalysts and metallic oxides) and natural and herbal antimicrobials (tea tree oil, lemongrass essential oil and origanum oil) into various tissue conditioners. The review literature reported that incorporation of antifungal agents into tissue conditioners is effective with minimal or no effects on physical and mechanical properties of tissue conditioners. CONCLUSIONS: Incorporation of different antifungal medicaments to commercially available tissue conditioners can be recommended for the management of denture induced stomatitis.


Assuntos
Anti-Infecciosos/administração & dosagem , Antifúngicos/administração & dosagem , Dentaduras/efeitos adversos , Estomatite sob Prótese/tratamento farmacológico , Estomatite sob Prótese/prevenção & controle , Condicionamento de Tecido Mole Oral , Candidíase Bucal , Bases de Dados Bibliográficas , Humanos , Estomatite sob Prótese/etiologia , Estomatite sob Prótese/microbiologia
18.
J Dent ; 48: 62-70, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26948665

RESUMO

OBJECTIVES: This study aimed to develop a new mixed-species acidogenic biofilm model and use it to assess the antimicrobial properties of a novel fluoride-releasing copolymer. METHODS: Stubs composed of a copolymer of methyl methacrylate (MMA) and 2-hydroxyethyl methacrylate (HEMA) with polymethyl methacrylate (PMMA) were produced by chemically-activated free radical polymerization. A fluoride-releasing copolymer was developed by incorporating sodium fluoride in place of a portion of the PMMA. Samples were mounted in polysulfone Modified Robbins Devices (MRDs) and were optimized for single- and mixed-species biofilm formation by Candida albicans, Lactobacillus casei and Streptococcus mutans. RESULTS: Fluoride release was sustained for at least 48h in flowing conditions. Fluoride did not affect the colonization and biofilm growth of any of the microorganisms in monocultures. However, in mixed-species biofilms, cell densities of all three species were reduced approximately ten-fold (p<0.05) on the fluoridated material compared with the non-fluoridated copolymer. CONCLUSIONS: These data demonstrate that intermicrobial interactions in mixed-species acidogenic biofilms are sensitive to fluoride, and that the inclusion of fluoride in a denture lining copolymer reduces the formation of polymicrobial biofilms. CLINICAL SIGNIFICANCE: The growth of acidogenic microorganisms on denture materials is associated with denture stomatitis and dental caries on surrounding teeth. A fluoride-releasing copolymer that inhibits acidogenic mixed-species biofilms, such as the material described in this study, has the potential to control these diseases by limiting biofilm growth.


Assuntos
Anti-Infecciosos/farmacologia , Biofilmes/efeitos dos fármacos , Materiais Dentários/química , Prótese Dentária , Fluoretos/química , Fluoretos/farmacologia , Candida albicans/efeitos dos fármacos , Candida albicans/genética , Cárie Dentária/tratamento farmacológico , Cárie Dentária/microbiologia , Placa Dentária/tratamento farmacológico , Placa Dentária/microbiologia , Bases de Dentadura/microbiologia , Dentaduras/microbiologia , Humanos , Lactobacillus casei/efeitos dos fármacos , Lactobacillus casei/genética , Metacrilatos/química , Microscopia Confocal , Polimetil Metacrilato/química , Fluoreto de Sódio/farmacologia , Estomatite sob Prótese/tratamento farmacológico , Estomatite sob Prótese/microbiologia , Streptococcus mutans/efeitos dos fármacos , Streptococcus mutans/genética
19.
Colloids Surf B Biointerfaces ; 140: 19-27, 2016 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-26731194

RESUMO

Candida-associated denture stomatitis (CADS), caused by colonization and biofilm-formation of Candida species on denture surfaces, is a significant clinical concern. We show here that modification of conventional denture materials with functional groups can significantly increase drug binding capacity and control drug release rate of the resulting denture materials for potentially managing CADS. In our approach, poly(methyl methacrylate) (PMMA)-based denture resins were surface grafted with three kinds of polymers, poly(1-vinyl-2-pyrrolidinone) (PNVP), poly(methacrylic acid) (PMAA), and poly(2-hydroxyethyl methacrylate) (PHEMA), through plasma-initiated grafting polymerization. With a grafting yield as low as 2 wt%, the three classes of new functionalized denture materials showed significantly higher drug binding capacities toward miconazole, a widely used antifungal drug, than the original PMMA denture resin control, leading to sustained drug release and potent biofilm-controlling effects against Candida. Among the three classes of functionalized denture materials, PNVP-grafted resin provided the highest miconazole binding capability and the most powerful antifungal and biofilm-controlling activities. Drug binding mechanisms were studied. These results demonstrated the importance of specific interactions between drug molecules and functional groups on biomaterials, shedding lights on future design of CADS-managing denture materials and other related devices for controlled drug delivery.


Assuntos
Antifúngicos/farmacologia , Biofilmes/efeitos dos fármacos , Candida albicans/efeitos dos fármacos , Miconazol/farmacologia , Antifúngicos/administração & dosagem , Antifúngicos/metabolismo , Biofilmes/crescimento & desenvolvimento , Candida albicans/fisiologia , Candidíase Bucal/tratamento farmacológico , Candidíase Bucal/microbiologia , Materiais Dentários/metabolismo , Sistemas de Liberação de Medicamentos/métodos , Humanos , Miconazol/administração & dosagem , Miconazol/metabolismo , Microscopia de Força Atômica , Microscopia Eletrônica de Varredura , Poli-Hidroxietil Metacrilato/metabolismo , Ácidos Polimetacrílicos/metabolismo , Polimetil Metacrilato/metabolismo , Polivinil/metabolismo , Pirrolidinonas/metabolismo , Espectroscopia de Infravermelho com Transformada de Fourier , Estomatite sob Prótese/tratamento farmacológico , Estomatite sob Prótese/microbiologia
20.
Microbiol Spectr ; 3(3)2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26397003

RESUMO

During infection, fungi frequently transition to a biofilm lifestyle, proliferating as communities of surface-adherent aggregates of cells. Phenotypically, cells in a biofilm are distinct from free-floating cells. Their high tolerance of antifungals and ability to withstand host defenses are two characteristics that foster resilience. Biofilm infections are particularly difficult to eradicate, and most available antifungals have minimal activity. Therefore, the discovery of novel compounds and innovative strategies to treat fungal biofilms is of great interest. Although many fungi have been observed to form biofilms, the most well-studied is Candida albicans. Animal models have been developed to simulate common Candida device-associated infections, including those involving vascular catheters, dentures, urinary catheters, and subcutaneous implants. Models have also reproduced the most common mucosal biofilm infections: oropharyngeal and vaginal candidiasis. These models incorporate the anatomical site, immune components, and fluid dynamics of clinical niches and have been instrumental in the study of drug resistance and investigation of novel therapies. This chapter describes the significance of fungal biofilm infections, the animal models developed for biofilm study, and how these models have contributed to the development of new strategies for the eradication of fungal biofilm infections.


Assuntos
Aspergillus/efeitos dos fármacos , Biofilmes/efeitos dos fármacos , Candida albicans/efeitos dos fármacos , Cateteres/microbiologia , Próteses e Implantes/microbiologia , Animais , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/patologia , Aspergillus/crescimento & desenvolvimento , Aspergillus/patogenicidade , Biofilmes/crescimento & desenvolvimento , Candida albicans/crescimento & desenvolvimento , Candida albicans/patogenicidade , Candidíase/tratamento farmacológico , Candidíase/patologia , Adesão Celular/fisiologia , Dentaduras/microbiologia , Modelos Animais de Doenças , Farmacorresistência Fúngica , Humanos , Camundongos , Estomatite sob Prótese/tratamento farmacológico , Estomatite sob Prótese/microbiologia
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