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Ikäläinen H, Guzman C, Saari M, Söderling E, Loimaranta V. Real-time acid production and extracellular matrix formation in mature biofilms of three Streptococcus mutans strains with special reference to xylitol. Biofilm 2024; 8:100219. [PMID: 39281714 PMCID: PMC11402442 DOI: 10.1016/j.bioflm.2024.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 08/08/2024] [Accepted: 08/26/2024] [Indexed: 09/18/2024] Open
Abstract
Background Acidogenicity and production of an extracellular matrix (ECM) are important virulence factors for the dental caries-associated bacteria, such as Streptococcus mutans, that live in biofilms on tooth surface. The ECM protects the bacteria from the flushing and buffering effects of saliva resulting in highly acidic microenvironments inside the biofilm. Materials and methods In this in vitro study, we applied real-time assays to follow biofilm formation and pH decrease in a growth medium and saliva by three S. mutans strains, as well as acid neutralization inside the mature biofilm. Results were compared with the biofilm composition. Effects of a non-fermentable polyol, xylitol, on acid production and acid neutralization in mature biofilms were evaluated by real-time pH measurements and confocal microscopy. Results Combination of real-time pH measurements with biofilm accumulation assays revealed growth media dependent differences in the pH decrease and biofilm accumulation, as well as strain differences in acid production and biofilm formation but not in the buffer diffusion through ECM. The presence of xylitol reduced the pH drop during biofilm formation of all strains. In addition, with strain Ingbritt xylitol reduced the amount of ECM in biofilm, which increased the rate of acid neutralization inside the biofilm after buffer exposure. Conclusion Our results stress the importance of biofilm matrix in creating the acidic environment inside a S. mutans biofilm, especially in the presence of saliva. In addition, our results suggest a novel mechanism of xylitol action. The observed increase in the permeability of the S. mutans ECM after xylitol exposure may allow acid-neutralizing saliva to reach deeper layer of the biofilms and thus, in part, explain previous clinical observations of reduced plaque acidogenicity after frequent xylitol use.
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Affiliation(s)
- Henna Ikäläinen
- Institute of Dentistry, University of Turku, Lemminkaisenkatu 2, 20520, Turku, Finland
| | - Camilo Guzman
- Cell Imaging and Cytometry Core, Turku Bioscience, University of Turku and Åbo Akademi University, Turku, Finland
- Euro-Bioimaging ERIC, Turku, Finland
| | - Markku Saari
- Cell Imaging and Cytometry Core, Turku Bioscience, University of Turku and Åbo Akademi University, Turku, Finland
| | - Eva Söderling
- Institute of Dentistry, University of Turku, Lemminkaisenkatu 2, 20520, Turku, Finland
| | - Vuokko Loimaranta
- Institute of Dentistry, University of Turku, Lemminkaisenkatu 2, 20520, Turku, Finland
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2
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Liang NL, Luo BW, Sun IG, Chu CH, Duangthip D. Clinical Effects of Sugar Substitutes on Cariogenic Bacteria: A Systematic Review and Meta-Analysis. Int Dent J 2024; 74:987-998. [PMID: 38599933 DOI: 10.1016/j.identj.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND The use of sugar substitutes in food products has recently increased. Limited information regarding the role of various sugar substitutes in caries prevention was found. This systematic review and meta-analysis was conducted to investigate the effects of sugar substitute consumption on reducing cariogenic bacteria in dental plaque and saliva. METHODS We systematically searched PubMed, EMBASE, and Web of Science (inception to July 2023) for prospective controlled trials published in English and investigated the effects of sugar substitute consumption on cariogenic bacteria in dental plaque and saliva. The primary outcome was the changes in cariogenic bacteria. Two independent reviewers screened the papers. Quality was assessed using the Cochrane risk-of-bias tools. RESULTS From 977 studies identified, 32 trials were included. Almost half (14/32, 44%) of the included studies had a high risk of bias. Almost all (31/32, 96.88%) were investigations of xylitol and other sugar alcohols (low-intensity sweeteners), such as sorbitol, erythritol, and maltitol. Only one trial investigated stevia, a high-intensity sweetener, whereas no studies on other high-intensity sweeteners, such as sucralose, saccharin, or aspartame, were found. Almost all studies (30/32, 93.75%) showed the consumption of low-intensity sweeteners led to a significant reduction of different types of cariogenic bacteria. The results of the meta-analysis showed that consumption of low-intensity sweeteners led to a significant reduction of cariogenic bacteria in both dental plaque and saliva compared to no treatment. CONCLUSION The consumption of low-intensity sweeteners helps reduce cariogenic bacteria in dental plaque and saliva. There is limited clinical evidence regarding the role of high-intensity sweeteners in reducing cariogenic bacteria.
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Affiliation(s)
| | - Bella Weijia Luo
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Ivy Guofang Sun
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Duangporn Duangthip
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China; College of Dentistry, The Ohio State University, Columbus, Ohio, USA.
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3
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Murugan C, Kailasam V. The effect of chewing gum on the rate of en-masse space closure: A randomised controlled trial. J Orthod 2024:14653125241256672. [PMID: 39049440 DOI: 10.1177/14653125241256672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
AIM To evaluate the effect of chewing gum on the rate of space closure, oral hygiene, pain during space closure and appliance breakage in patients undergoing fixed appliance therapy. DESIGN A prospective, single-centre, two-arm, parallel, double-blinded randomised controlled trial. SETTING Orthodontic unit of a privately funded hospital, Chennai, India. PARTICIPANTS In total, 28 participants were randomly allocated into a chewing gum group (CGG) (n = 14) or a control group (CG) (n = 14). METHODS Baseline data were collected at the start of retraction (T0), at 4 weeks (T1), 8 weeks (T2) and 12 weeks (T3) after the start of retraction. Rate of space closure, pain, oral hygiene and appliance breakage were assessed at T1, T2 and T3. Data were analysed using an independent t-test with P < 0.05 considered to be statistically significant. RESULTS The mean rate of space closure in the CGG was 0.9 ± 0.2 mm/month and 0.8 ± 0.2 mm/month in the CG (P = 0.07, 95% confidence intervals [CI] were 0.80-1.01 for the CGC and 0.70-0.91 for the CG). In both the groups, oral hygiene became worse between T0 and T3. At T0 and T1, participants in the CGG reported less pain at 24 h and 7 days when compared to the CG (P < 0.05). At T2 and T3, participants in the CGG reported less pain at 0 h, 24 h and 7 days when compared to the CG (P < 0.05). Appliance breakage in both groups was minimal, with an odds ratio of 0.7 (95% CI 0.1-3.8) and was similar (P = 0.66). CONCLUSION There was minimal increase that was clinically not significant in the rate of space closure with chewing gum. Chewing gum ensured better oral hygiene, helped alleviate pain and had no effect on appliance breakage during space closure.
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Affiliation(s)
- Chandnee Murugan
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, TN, India
| | - Vignesh Kailasam
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, TN, India
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4
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Lu Y, Wang X, Wallace TC. Chewing Gum Is Associated with Better Diet Quality but Not Oral Health Measures in U.S. Adults. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2024; 43:404-411. [PMID: 38194338 DOI: 10.1080/27697061.2023.2300441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/25/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Chewing gum (especially sugar-free gum) has been linked to improved oral health, however there is an absence of observational research using nationally-representative data in the United States. We sought to examine the factors associated with chewing gum and its relationship with the oral health status of U.S. adults. METHODS Cross-sectional data from the U.S. National Health and Nutrition Examination Survey (NHANES) 2013-2018 cycles were used in these analyses. Primary outcomes were the odds of having gum disease, treatment for gum disease, ever being told of bone loss around teeth, root caries, caries, and restoration. Unadjusted and multivariate logistic regression models were used to investigate the relationship of chewing gum use with demographic/lifestyle factors and the oral health status of participants. RESULTS 2.40% (n = 365) of adults were users of chewing gum and the average among users was 5.20 ± 0.40 g/d. Users of chewing gum were more likely to be female, younger in age, and non-Hispanic Black or Hispanic. Self-reported chewing gum use did not affect the oral health status of U.S. adults (OR: 1.10, 95% CI: 0.42-2.88 for gum disease; OR: 1.34, 95% CI: 0.64-2.81 for treatment for gum disease; OR: 0.56, 95% CI: 0.27-1.17 for bone loss around teeth; OR: 1.01, 95% CI: 0.32-3.12 for root caries; OR: 0.96, 95% CI: 0.54-1.69 for caries), except for restoration (OR: 3.54, 95% CI: 1.78-7.06), but was associated with improved diet quality (OR: 1.86, 95% CI: 1.11-3.12 for a healthy eating index (HEI) of 51-59; OR: 1.96, 95% CI: 1.08-3.56 for HEI of 60-93); and decreased intakes of snacks (OR: 1.64, 1.01-2.69), and added sugars. CONCLUSION Future observational studies that more accurately capture chewing gum usage are needed, as these analyses have several limitations.
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Affiliation(s)
- Yang Lu
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Xichen Wang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Taylor C Wallace
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
- School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA
- Think Healthy Group, LLC, Washington, District of Columbia, USA
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Dagli N, Haque M, Kumar S. Bibliometric Analysis of Clinical Trials on the Effect of Sugar Alcohol Consumption on Oral Health: Trends, Insights, and Future Directions (1967-2024). Cureus 2024; 16:e60248. [PMID: 38872648 PMCID: PMC11170056 DOI: 10.7759/cureus.60248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
In recent years, the quest for healthier alternatives to sugar has led to the widespread use of sugar alcohol in various food and beverage products. Sugar alcohols, such as xylitol, sorbitol, and erythritol, are popular substitutes due to their sweet taste and lower calorie content than sucrose. Beyond their role in calorie reduction, sugar alcohols have garnered attention for their potential impact on oral health. The bibliometric analysis of clinical trials on sugar alcohol and oral health in PubMed reveals a dynamic and multifaceted research landscape shaped by various factors. Fluctuations in publication rates over time suggest influences such as shifts in research interests, technological advancements, regulatory changes, and evolving consumer behaviors. Key authors like Makinen KK, Makinen PL, and Soderling E emerge as prolific contributors with collaborative solid networks within the research community. The University of Turku in Finland has been identified as the highest contributing university, while Caries Research is the most contributing journal based on the number of clinical trials published. The country-wise analysis highlights Italy and the United States as substantial contributors, with diverse trajectories of research activity observed across nations. The subject-specific words with the highest cooccurrence are xylitol, dental caries, chewing gum, Streptococcus mutans, and saliva. Thematic analysis dives deep into how sugar alcohols relate to oral health, using different methods to study their effectiveness, safety, and how they affect the oral microbiome. The analysis of topic trends indicates ongoing exploration of sorbitol and xylitol, with an increasing emphasis on the potential advantages of xylitol. Additionally, there is notable attention on cariostatic agents, strategies for dental caries prevention, and the emergence of novel research domains like probiotics and erythritol, showcasing the dynamic evolution of oral health research focuses and developments. Overall, this analysis provides valuable insights into the distribution and trends of clinical trial publications, contributing to a nuanced understanding of the research landscape in sugar alcohol and oral health.
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Affiliation(s)
- Namrata Dagli
- Karnavati Scientific Research Center, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Mainul Haque
- Karnavati Scientific Research Center, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
- Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
| | - Santosh Kumar
- Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
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Bellanco A, Celcar Š, Martínez-Cuesta MC, Requena T. The food additive xylitol enhances the butyrate formation by the child gut microbiota developed in a dynamic colonic simulator. Food Chem Toxicol 2024; 187:114605. [PMID: 38537869 DOI: 10.1016/j.fct.2024.114605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/07/2024] [Accepted: 03/16/2024] [Indexed: 04/01/2024]
Abstract
The gut microbiota should be included in the scientific processes of risk assessment of food additives. Xylitol is a sweetener that shows low digestibility and intestinal absorption, implying that a high proportion of consumed xylitol could reach the colonic microbiota. The present study has evaluated the dose-dependent effects of xylitol intake on the composition and the metabolic activity of the child gut-microbiota. The study was conducted in a dynamic simulator of the colonic microbiota (BFBL Gut Simulator) inoculated with a child pooled faecal sample and supplemented three times per day, for 7 days, with increasing xylitol concentrations (1 g/L, 3 g/L and 5 g/L). Sequencing of 16S rRNA gene amplicons and group-specific quantitative PCR indicated a xylitol dose-response effect on the abundance of Lachnospiraceae, particularly the genera Blautia, Anaerostipes and Roseburia. The microbial changes observed with xylitol corresponded with a dose-dependant effect on the butyrate concentration that, in parallel, favoured an increase in epithelial integrity of Caco-2 cells. The study represents a detailed observation of the bacterial taxa that are the main contributors to the metabolism of xylitol by the child gut microbiota and the results could be relevant in the risk assessment re-evaluation of xylitol as a sweetener.
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Affiliation(s)
- Alicia Bellanco
- Department of Food Biotechnology and Microbiology, Institute of Food Science Research (CIAL-CSIC), Madrid, Spain
| | - Špela Celcar
- Department of Food Biotechnology and Microbiology, Institute of Food Science Research (CIAL-CSIC), Madrid, Spain
| | - M Carmen Martínez-Cuesta
- Department of Food Biotechnology and Microbiology, Institute of Food Science Research (CIAL-CSIC), Madrid, Spain
| | - Teresa Requena
- Department of Food Biotechnology and Microbiology, Institute of Food Science Research (CIAL-CSIC), Madrid, Spain.
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7
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Pienihäkkinen K, Hietala-Lenkkeri A, Arpalahti I, Söderling E. The effect of xylitol chewing gums and candies on caries occurrence in children: a systematic review with special reference to caries level at study baseline. Eur Arch Paediatr Dent 2024; 25:145-160. [PMID: 38430364 PMCID: PMC11058973 DOI: 10.1007/s40368-024-00875-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 01/24/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE A systematic review of published data was carried out to assess the caries-preventive effects of xylitol chewing gums and candies in children. METHODS Electronic and hand searches were performed to find clinical studies on the effects of xylitol chewing gums and candies on dental caries in children (≤ 18 years). Prospective randomised or controlled clinical trials published before 2023 were included in the review. RESULTS The initial search identified 365 titles to be evaluated. After applying inclusion and exclusion criteria, 15 articles with either fair or low quality were reviewed. Nine articles studied chewing gums, five candies, and one both of them. In the ten evaluated xylitol chewing gum studies xylitol consumption significantly reduced caries occurrence when compared with no treatment or a placebo polyol gum. The effect was clinically significant in studies with high or moderate caries level at study baseline. The results also suggested that the caries-reducing effect of xylitol gums may differ from sorbitol/polyol gums. In five of the six heterogenous xylitol candy studies, no caries-reducing effect was found independent of caries level. In addition to caries level, also the daily xylitol dose was a confounding factor. CONCLUSION The present findings suggest that the caries-reducing effect of adding xylitol chewing gum to the daily diet has been well demonstrated in children and adolescents with high or moderate caries level at study baseline. Xylitol gum use could benefit subjects with active incipient caries lesions on smooth tooth surfaces.
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Affiliation(s)
- K Pienihäkkinen
- Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520, Turku, Finland
| | - A Hietala-Lenkkeri
- Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520, Turku, Finland
| | - I Arpalahti
- Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520, Turku, Finland
| | - E Söderling
- Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520, Turku, Finland.
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8
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Rajala O, Mäntynen M, Loimaranta V. Pine-Oil-Derived Sodium Resinate Inhibits Growth and Acid Production of Streptococcus mutans In Vitro. Dent J (Basel) 2024; 12:40. [PMID: 38392244 PMCID: PMC10887496 DOI: 10.3390/dj12020040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024] Open
Abstract
S. mutans is a key pathogen in dental caries initiation and progression. It promotes oral biofilm dysbiosis and biofilm acidification. Sodium resinate is a salt of pine-oil-derived resin which has antimicrobial properties. Pine-oil-derived resin consists of terpenes, diterpenes, and abietic acids. The aim of this study was to determine the effects of pine (Pinus sylvestris) oil resinate (RS) on growth and acid production of cariogenic S. mutans strains in planktonic form and biofilm. The S. mutans type strain NCTC10449 and clinical isolate CI2366 were grown on 96-well plates for testing of RS effects on growth and biofilm formation, and on plates with integrated pH-sensitive optical ensors for real-time measurements of the effects of RS on bacterial acid production. We found that even short-time exposure to RS inhibits the growth and acid production of S. mutans in the planktonic phase and biofilms. In addition, RS was able to penetrate the biofilm matrix and reduce acid production inside S. mutans biofilm. RS thus shows potential as a novel antibacterial agent against cariogenic bacteria in biofilm.
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Affiliation(s)
- Otto Rajala
- Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland
| | - Matias Mäntynen
- Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland
| | - Vuokko Loimaranta
- Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland
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Kulchar RJ, Singh R, Ding S, Alexander E, Leong KW, Daniell H. Delivery of biologics: Topical administration. Biomaterials 2023; 302:122312. [PMID: 37690380 PMCID: PMC10840840 DOI: 10.1016/j.biomaterials.2023.122312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/27/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Abstract
Biologics are unaffordable to a large majority of the global population because of prohibitively expensive fermentation systems, purification and the requirement for cold chain for storage and transportation. Limitations of current production and delivery systems of biologics were evident during the recent pandemic when <2.5% of vaccines produced were available to low-income countries and ∼19 million doses were discarded in Africa due to lack of cold-chain infrastructure. Among FDA-approved biologics since 2015, >90% are delivered using invasive methods. While oral or topical drugs are highly preferred by patients because of their affordability and convenience, only two oral drugs have been approved by FDA since 2015. A newly launched oral biologic costs only ∼3% of the average cost of injectable biologics because of the simplified regulatory approval process by elimination of prohibitively expensive fermentation, purification, cold storage/transportation. In addition, the cost of developing a new biologic injectable product (∼$2.5 billion) has been dramatically reduced through oral or topical delivery. Topical delivery has the unique advantage of targeted delivery of high concentration protein drugs, without getting diluted in circulating blood. However, only very few topical drugs have been approved by the FDA. Therefore, this review highlights recent advances in oral or topical delivery of proteins at early or advanced stages of human clinical trials using chewing gums, patches or sprays, or nucleic acid drugs directly, or in combination with, nanoparticles and offers future directions.
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Affiliation(s)
- Rachel J. Kulchar
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia PA 19104, USA
| | - Rahul Singh
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia PA 19104, USA
| | - Suwan Ding
- Department of Biomedical Engineering, Columbia University, New York City NY 10032, USA
| | - Elena Alexander
- Department of Biomedical Engineering, Columbia University, New York City NY 10032, USA
| | - Kam W Leong
- Department of Biomedical Engineering, Columbia University, New York City NY 10032, USA
| | - Henry Daniell
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia PA 19104, USA
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Zen I, Delbem ACB, Hosida TY, Sampaio C, de Morais LA, Martins TP, Monteiro DR, Pessan JP. Antimicrobial Effect of Low-Fluoride Toothpastes Containing Polyphosphate and Polyols: An In Vitro Assessment of Inhibition Zones. Antibiotics (Basel) 2023; 12:1333. [PMID: 37627754 PMCID: PMC10451983 DOI: 10.3390/antibiotics12081333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 08/27/2023] Open
Abstract
This study evaluated the antimicrobial effect of toothpastes containing 200 ppm fluoride (200F), xylitol (X, 16%), erythritol (E, 4%), and sodium trimetaphosphate (TMP, 0.25%), alone or in different associations, against Streptococcus mutans (SM), Lactobacillus casei (LC), Actinomyces israelii (AI), and Candida albicans (CA). Suspensions of the micro-organisms were added to a BHI Agar medium. Five wells were made on each plate to receive toothpaste suspensions at different dilutions. Toothpastes containing no actives (placebo) or 1100 ppm F (1100F) were used as negative and positive controls. Two-way ANOVA and Tukey's HDS test were used (p < 0.05). For SM, the largest halo was for 200F+TMP at all dilutions, followed by the 200F+X+E toothpaste (p < 0.001). For LC, the overall trend showed that the polyols effectively inhibited microbial growth, and the association with the other compounds enhanced such effects (p < 0.001). For AI, a less-defined trend was observed. For CA, the experimental toothpaste (200F+X+E+TMP) was consistently more effective than the other treatments, followed by 200F+X+E (p < 0.001). The association of polyols and TMP in a low-fluoride toothpaste effectively reduced the growth of cariogenic micro-organisms (SM, CA, and LC), suggesting that this formulation could be an interesting alternative for children due to its low fluoride content.
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Affiliation(s)
- Igor Zen
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Rua José Bonifácio, 1193, Araçatuba 16015-050, SP, Brazil; (I.Z.); (A.C.B.D.); (T.Y.H.); (C.S.); (L.A.d.M.); (T.P.M.); (D.R.M.)
| | - Alberto Carlos Botazzo Delbem
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Rua José Bonifácio, 1193, Araçatuba 16015-050, SP, Brazil; (I.Z.); (A.C.B.D.); (T.Y.H.); (C.S.); (L.A.d.M.); (T.P.M.); (D.R.M.)
| | - Thayse Yumi Hosida
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Rua José Bonifácio, 1193, Araçatuba 16015-050, SP, Brazil; (I.Z.); (A.C.B.D.); (T.Y.H.); (C.S.); (L.A.d.M.); (T.P.M.); (D.R.M.)
| | - Caio Sampaio
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Rua José Bonifácio, 1193, Araçatuba 16015-050, SP, Brazil; (I.Z.); (A.C.B.D.); (T.Y.H.); (C.S.); (L.A.d.M.); (T.P.M.); (D.R.M.)
| | - Leonardo Antônio de Morais
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Rua José Bonifácio, 1193, Araçatuba 16015-050, SP, Brazil; (I.Z.); (A.C.B.D.); (T.Y.H.); (C.S.); (L.A.d.M.); (T.P.M.); (D.R.M.)
| | - Tamires Passadori Martins
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Rua José Bonifácio, 1193, Araçatuba 16015-050, SP, Brazil; (I.Z.); (A.C.B.D.); (T.Y.H.); (C.S.); (L.A.d.M.); (T.P.M.); (D.R.M.)
| | - Douglas Roberto Monteiro
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Rua José Bonifácio, 1193, Araçatuba 16015-050, SP, Brazil; (I.Z.); (A.C.B.D.); (T.Y.H.); (C.S.); (L.A.d.M.); (T.P.M.); (D.R.M.)
- Postgraduate Program in Health Sciences, University of Western São Paulo (UNOESTE), Presidente Prudente 19050-920, SP, Brazil
| | - Juliano Pelim Pessan
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Rua José Bonifácio, 1193, Araçatuba 16015-050, SP, Brazil; (I.Z.); (A.C.B.D.); (T.Y.H.); (C.S.); (L.A.d.M.); (T.P.M.); (D.R.M.)
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Pørksen CJ, Keller MK, Damholt A, Frederiksen AKS, Ekstrand KR, Markvart M, Larsen T, Bakhshandeh A. The effect of a lozenge combining prebiotic arginine and probiotics on caries increment in children during 10-12 months, a randomized clinical trial. J Dent 2023; 135:104599. [PMID: 37356561 DOI: 10.1016/j.jdent.2023.104599] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 06/27/2023] Open
Abstract
OBJECTIVES To investigate the effect of daily use of a lozenge containing arginine and probiotics for 10-12 months on caries increment, gingivitis- and plaque occurrence in children aged 5-9 years. METHODS In this placebo-controlled, double-blinded, parallel-grouped randomized clinical trial, 343 children were randomly assigned to one of the study arms (1:1). The intervention group (n = 172) received a lozenge containing Lacticaseibacillus rhamnosus, LGG® (DSM33156), Lactobacillus paracasei subsp. paracasei, L. CASEI 431® (DSM33451) and prebiotic (arginine 2%). The placebo group (n = 171) received an identical lozenge without arginine or probiotics. Primary canines and molars, and permanent first molars were examined clinically (d/D= ICDAS1-6) and radiographically (d/D = R1-6) at baseline and follow-up. Missing (m/M), sealed (s/S), and filled (f/F) surfaces (-s/-S) in both dentitions were also included. Utilizing clinical and radiographic scorings, caries experience was classified as dICDAS1-6msf-s (primary teeth), DICDAS1-6MSF-S (permanent teeth), d/DICDAS1-6 m/M-s/S-f/F-s/S (mixed dentition). A weighted and an unweighted score system was applied. RESULTS The study was completed by 288 children. The dropout rate was 15%. The increase in ∆mean dICDAS3-6msf-s and ∆mean d/DICDAS3-6m/M-s/S-f/F-s/S was lower in the intervention group (p = 0.007). No differences were found for gingivitis- and plaque occurrence. No product-related side effects were reported. This study followed ICH-GCP including external monitoring. CONCLUSION Daily consumption of a lozenge containing prebiotic arginine and two strains of probiotics showed safe use and statistically significantly reduction in caries incrementbut no effect on the mean plaque or gingivitis occurrence in children. The use of a lozenge with arginine and probiotics combined has a promising potential as a supplementary tool for future management of caries. www. CLINICALTRIALS gov (NCT03928587). CLINICAL SIGNIFICANCE The combination of prebiotic arginine and probiotics shows clinical potential as a supplementary approach to toothbrushing with fluoride toothpaste in managing caries increment in children. A new era in the management of caries may be emerging.
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Affiliation(s)
- Camilla Juhl Pørksen
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Allé 20, København N 2200 Denmark.
| | - Mette Kirstine Keller
- Clinical Development, Human Health, Health and Nutrition, Chr. Hansen A/S, Kogle Allé 6, Hørsholm 2970, Denmark
| | - Anders Damholt
- Clinical Development, Human Health, Health and Nutrition, Chr. Hansen A/S, Kogle Allé 6, Hørsholm 2970, Denmark
| | | | - Kim Rud Ekstrand
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Allé 20, København N 2200 Denmark
| | - Merete Markvart
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Allé 20, København N 2200 Denmark
| | - Tove Larsen
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Allé 20, København N 2200 Denmark
| | - Azam Bakhshandeh
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Allé 20, København N 2200 Denmark
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Hartshorn JE, Nair RU. Dental innovations which will influence the oral health care of baby boomers. SPECIAL CARE IN DENTISTRY 2023; 43:359-369. [PMID: 36782274 DOI: 10.1111/scd.12835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/13/2023] [Accepted: 01/27/2023] [Indexed: 02/15/2023]
Abstract
From the widespread use of smartphones and tablets to the multitude of applications available, older adults are showing an interest in utilizing technology to maintain their independence and to improve their quality of life. As technology continues to advance and be incorporated into many day-to-day activities, the baby boom generation will see these changes affecting the way they access and utilize dental services. Innovative toothbrushes and chemotherapeutics are continuing to be developed and utilized by many older adults. Within the dental office, older adults are seeing greater application of technology in every day dental procedures. These include the use of teledentistry, artificial intelligence (AI), innovative restorative materials, digitization of fixed and removable prosthodontics, cone beam computed tomography (CBCT) scans to guide dental implant placement and endodontic procedures. There is also new technology to aid in cancer detection and shielding during cancer treatment. Improved communication between the medical and dental fields has become increasingly necessary to facilitate effective patient care and a few innovative healthcare systems have begun to consolidate these services. Overall, the baby boom generation will continue to see dental innovations that will change the way they experience everyday life and dental services.
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Affiliation(s)
- Jennifer E Hartshorn
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa, USA
| | - Rohit U Nair
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa, USA
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Söderling E, Pienihäkkinen K, Gursoy UK. Effects of sugar-free polyol chewing gums on gingival inflammation: a systematic review. Clin Oral Investig 2022; 26:6881-6891. [PMID: 36239787 PMCID: PMC9708815 DOI: 10.1007/s00784-022-04729-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/01/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES A systematic review of published data was conducted with the aim of assessing the effects of sugar-free polyol chewing gums on gingival inflammation. MATERIALS AND METHODS Electronic and hand searches were performed to find clinical studies concerning the effects of sugar-free chewing gums on gingival scores. Prospective randomized controlled clinical trials published between 1971 and 2021 were included in the review. RESULTS The initial search identified 46 erythritol, 102 xylitol, 23 sorbitol, and nine maltitol chewing gum articles. After applying inclusion and exclusion criteria, seven xylitol chewing gum studies, one sorbitol, and one maltitol chewing gum study with either high or fair quality were reviewed. In five out of the seven xylitol studies, xylitol gum decreased gingival scores. In two studies, xylitol decreased gingival scores compared to a polyol gum, and in three studies compared to no gum/gum base. As for sorbitol and maltitol, only sorbitol gum chewing showed a small decrease in gingival scores compared to the controls. CONCLUSIONS Habitual xylitol gum chewing may reduce gingival inflammation. The low number of studies and their heterogeneity provide clear indications that the effects of sugar-free polyol chewing gums on gingival inflammation need further, well-controlled studies. CLINICAL RELEVANCE Sugar-free chewing gums, especially xylitol gum, may function as adjuncts to toothbrushing for reducing gingival inflammation, but the evidence so far is inconclusive.
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Affiliation(s)
- Eva Söderling
- Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520, Turku, Finland.
| | - Kaisu Pienihäkkinen
- Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520, Turku, Finland
| | - Ulvi Kahraman Gursoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520, Turku, Finland
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Daniell H, Nair SK, Guan H, Guo Y, Kulchar RJ, Torres MDT, Shahed-Al-Mahmud M, Wakade G, Liu YM, Marques AD, Graham-Wooten J, Zhou W, Wang P, Molugu SK, de Araujo WR, de la Fuente-Nunez C, Ma C, Short WR, Tebas P, Margulies KB, Bushman FD, Mante FK, Ricciardi RP, Collman RG, Wolff MS. Debulking different Corona (SARS-CoV-2 delta, omicron, OC43) and Influenza (H1N1, H3N2) virus strains by plant viral trap proteins in chewing gums to decrease infection and transmission. Biomaterials 2022; 288:121671. [PMID: 35953331 PMCID: PMC9290430 DOI: 10.1016/j.biomaterials.2022.121671] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 12/13/2022]
Abstract
Because oral transmission of SARS-CoV-2 is 3-5 orders of magnitude higher than nasal transmission, we investigated debulking of oral viruses using viral trap proteins (CTB-ACE2, FRIL) expressed in plant cells, delivered through the chewing gum. In omicron nasopharyngeal (NP) samples, the microbubble count (based on N-antigen) was significantly reduced by 20 μg of FRIL (p < 0.0001) and 0.925 μg of CTB-ACE2 (p = 0.0001). Among 20 delta or omicron NP samples, 17 had virus load reduced below the detection level of spike protein in the RAPID assay, after incubation with the CTB-ACE2 gum powder. A dose-dependent 50% plaque reduction with 50-100 ng FRIL or 600-800 μg FRIL gum against Influenza strains H1N1, H3N2, and Coronavirus HCoV-OC43 was observed with both purified FRIL, lablab bean powder or gum. In electron micrographs, large/densely packed clumps of overlapping influenza particles and FRIL protein were observed. Chewing simulator studies revealed that CTB-ACE2 release was time/dose-dependent and release was linear up to 20 min chewing. Phase I/II placebo-controlled, double-blinded clinical trial (IND 154897) is in progress to evaluate viral load in saliva before or after chewing CTB-ACE2/placebo gum. Collectively, this study advances the concept of chewing gum to deliver proteins to debulk oral viruses and decrease infection/transmission.
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Affiliation(s)
- Henry Daniell
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Smruti K Nair
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Hancheng Guan
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Yuwei Guo
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Rachel J Kulchar
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Marcelo D T Torres
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Md Shahed-Al-Mahmud
- Genomics Research Center, Taiwan Academy of Sciences, 128 Academia Rd. Section 2, Nangang District, Taipei, 11529, Taiwan
| | - Geetanjali Wakade
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Yo-Min Liu
- Genomics Research Center, Taiwan Academy of Sciences, 128 Academia Rd. Section 2, Nangang District, Taipei, 11529, Taiwan
| | - Andrew D Marques
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jevon Graham-Wooten
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Wan Zhou
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ping Wang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sudheer K Molugu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - William R de Araujo
- Institute of Chemistry, State University of Campinas - UNICAMP, Campinas, Sao Paulo, 13083-970, Brazil
| | | | - Che Ma
- Genomics Research Center, Taiwan Academy of Sciences, 128 Academia Rd. Section 2, Nangang District, Taipei, 11529, Taiwan
| | - William R Short
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Pablo Tebas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kenneth B Margulies
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Frederic D Bushman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Francis K Mante
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Robert P Ricciardi
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ronald G Collman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Mark S Wolff
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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