Oral care product formulations, properties and challenges

Repurposing Mouthwashes: Antifungal and Antibiofilm Abilities of Commercially Available Mouthwashes Against Candida spp

Background/Objectives: The main objective was to evaluate and compare the antifungal efficacy against Candida spp. in commercially available mouthwashes distributed in the European market. Indeed, the solution to emerging infectious diseases may no longer lie in costly new drug development but rather in unlocking the untapped potential of existing substances. Materials and Methods: Eighteen mouthwashes, chosen based on their composition, were tested in vitro against ten Candida strains, including clinical isolates of oral origin and reference strains, in both planktonic and biofilm forms. The antifungal susceptibility testing was conducted using the European Committee on Antimicrobial Susceptibility Testing (EUCAST) disc diffusion method and the evaluation of the kinetic growth in planktonic Candida. Biofilm reduction was determined by the evaluation of the minimal biofilm eradication concentration (MBEC). Scanning electron microscopy (SEM) analysis was performed to evaluate potential morphological alterations of Candida biofilms. Results: Most mouthwashes effectively reduced biomass production and colony-forming unit (CFU) count. Parodontax Extra showed the highest efficacy. In the disc diffusion assay, Gum Paroex 0.12% exhibited the largest average inhibition zone diameter. Some unusual trends in the data may be explained by a higher reaction of fungal cells and the release of excess biomass during co-incubation in higher concentration of mouthwashes. SEM images revealed significant morphological alterations. Conclusion: Mouthwashes containing chlorhexidine digluconate, either alone or in combination with cetylpyridinium chloride and other active compounds, emerged as a common factor among the most efficacious formulations. In vivo studies will be essential to validate these findings, but mouthwashes may serve as a valuable adjuvant in the treatment of oral candidiasis.

Efficacy of Toothpaste Containing Polylysine and Funme Peptide on Oral Microbiome and Oral Health

OBJECTIVE

To evaluate the effect of the toothpaste containing ε-poly-L-lysine (ε-PL) and funme peptide (FP) as key components on oral microbial composition and oral health.

METHODS

An oral microbiome study was initially carried out to analyze the variation in the oral microbiota before and after use of antimicrobial peptide (AMP) toothpaste. Subsequently, a clinical trial was independently performed to assess the efficacy of AMP toothpaste by measuring the dental plaque index (PLI), volatile sulfur compounds (VSCs) levels, modified bleeding index (mBI), and bleeding on probing rate (BOP%).

RESULTS

The application of AMP toothpaste increased the α diversity and modified β diversity of oral microbiome across 3 oral niches. AMP toothpaste increased the relative abundance of the commensal oral microbes, and attenuated the abundance of pathogenic bacteria in gingivitis patients to normal levels. The clinical trial showed 44.33% and 12.29% reductions of PLI scores in the test and control groups, respectively, and the test group exhibited a more pronounced decrease in VSC levels. The test group recorded significant reductions in mBI and BOP% by 39.09% and 24.59%, respectively, exceeding the control group's reductions of 4.63% and -0.97% (P < .05).

CONCLUSION

The formulation of toothpaste with ε-PL and FP recalibrated the oral microbiome's diversity and abundance, and mitigated common oral health issues such as plaque, halitosis, and gingivitis while maintaining well safety.

CLINICAL RELEVANCE

Oral care products containing ε-PL and FP can be used as a new treatment for improving oral microbiota and oral diseases.

Reactivity of aragonite with dicalcium phosphate facilitates removal of dental calculus

Dental calculus, a main contributor of periodontal diseases, is mostly composed of inorganic calcium phosphate species such as dicalcium phosphate, whitlockite, octa calcium phosphate, and hydroxyapatite. Under physiological pH 7.4, dicalcium phosphates can gradually interact with calcium carbonate to form hydroxyapatite. Therefore, we hypothesized that aragonite (Arg) could react with dental calculus, facilitating its removal. To assess the reactivity of Arg with dental calculus, we examined the changes in surface morphology, composition, and topography of Arg and dental calculus upon exposure to each other in an aqueous environment. The impact of Arg on the removal of dental calculus was assessed by brushing polished sections of dental calculus, enamel, and dentin with slurries of Arg and measuring the depth of abrasion using a stylus profilometer. Our results demonstrate that Arg can react with dental calculus in aqueous environment. This reaction increases calculus surface roughness which in turn facilitate dental calculus removal by brushing. Aragonite could be a promising abrasive for toothpaste design for management of dental calculus.

Exploring the potential of mucoadhesive buccal films in geriatric medicine

As the global demographic shifts toward an aging society, the geriatric patient population is steadily increasing. These patients often suffer from comorbidities and require numerous oral medications, which can be especially challenging for dysphagic geriatric patients. Mucoadhesive buccal films (MBFs) seem promising and could reduce pill burden, simplify administration, and enable individualized drug therapy. This review aims to explore the age-related changes in the oral cavity and their impact on MBF delivery, including potential strategies to overcome these age-related barriers to drug delivery. It was observed that aging impacts the oral mucosa as well the properties of the saliva. There are several studies in the application of buccal films including the use of a wide range of permeation enhancers. The 3D printing of buccal films seems to introduce dosing flexibility to buccal film manufacturing.

Assessing the Effect of Toothpastes on Enamel Surface Roughness Using a Custom-Designed and Fabricated Toothbrush Simulator Device for Evaluation

The primary objective of this study is to emphasize the importance of maintaining optimal oral health through regular toothbrushing practices. To achieve this objective, a custom-designed electromechanical toothbrush simulator device was developed. This innovative tool enables researchers to investigate the impact of abrasive-based whitening toothpastes on enamel surface roughness compared to brushing without toothpaste. The device design is composed of multiple systems, including mechanical, motorization, and toothpaste irrigation components. The device incorporates various components, including mechanical, motorization, and toothpaste irrigation systems. Specifically, the mechanical aspect comprises fabricated metal parts, 3D printed elements, and a load cell for measuring brushing force. The motorization section integrates a microcontroller and a stepper motor, allowing for the adjustment of brushing cycles and speed. Furthermore, the toothpaste irrigation system employs a pump with adjustable speed, along with a toothpaste canister and a waste receptacle. By providing a controlled environment for evaluating the effects of different toothpaste formulations on enamel integrity, this simulator device contributes significantly to advancements in oral care research and product development.

Microplastics as an Emerging Potential Threat: Toxicity, Life Cycle Assessment, and Management

The pervasiveness of microplastics (MPs) in terrestrial and aquatic ecosystems has become a significant environmental concern in recent years. Because of their slow rate of disposal, MPs are ubiquitous in the environment. As a consequence of indiscriminate use, landfill deposits, and inadequate recycling methods, MP production and environmental accumulation are expanding at an alarming rate, resulting in a range of economic, social, and environmental repercussions. Aquatic organisms, including fish and various crustaceans, consume MPs, which are ultimately consumed by humans at the tertiary level of the food chain. Blocking the digestive tracts, disrupting digestive behavior, and ultimately reducing the reproductive growth of entire living organisms are all consequences of this phenomenon. In order to assess the potential environmental impacts and the resources required for the life of a plastic product, the importance of life cycle assessment (LCA) and circularity is underscored. MPs-related ecosystem degradation has not yet been adequately incorporated into LCA, a tool for evaluating the environmental performance of product and technology life cycles. It is a technique that is designed to quantify the environmental effects of a product from its inception to its demise, and it is frequently employed in the context of plastics. The control of MPs is necessary due to the growing concern that MPs pose as a newly emergent potential threat. This is due to the consequences of their use. This paper provides a critical analysis of the formation, distribution, and methods used for detecting MPs. The effects of MPs on ecosystems and human health are also discussed, which posed a great challenge to conduct an LCA related to MPs. The socio-economic impacts of MPs and their management are also discussed. This paper paves the way for understanding the ecotoxicological impacts of the emerging MP threat and their associated issues to LCA and limits the environmental impact of plastic.

The clinical and microbiological efficacy of a zinc-citrate/hydroxyapatite/potassium-citrate containing toothpaste: a double-blind randomized controlled clinical trial

OBJECTIVES

To evaluate the antibacterial efficacy of two fluoride-containing (1450 ppm F) toothpastes with or without zinc-citrate (ZCT), hydroxyapatite (HAP) and potassium-citrate (KCit); to assess and compare their clinical effects in terms of tooth sensitivity, plaque accumulation and gingivitis, as well as patients' satisfaction.

MATERIALS AND METHODS

Healthy, adult patients were selected and randomly assigned to two groups (n = 50): Experimental: ZCT-, HAP-, KCit- and fluoride-containing toothpaste; Control: fluoride-containing toothpaste. Salivary counts of Streptococcus mutans (S. mutans), plaque and gingival index, as well as clinically diagnosed sensitivity were recorded at baseline, and after 4 weeks. A custom-made questionnaire was used to assess patients' self-reported sensitivity (baseline and after 4 weeks) and overall satisfaction with the tested toothpastes. Data were statistically analyzed (α = 0.05).

RESULTS

After 4 weeks, a statistically significant salivary reduction of S. mutans was observed in both groups (p = 0.001). Furthermore, the percentage of S. mutans decrease was significantly higher in Experimental group (p = 0.014). There were no statistically significant differences between the groups in terms of plaque and gingival index (p > 0.05). After 4 weeks, the self-reported tooth sensitivity was lower in Experimental group (p < 0.001).

CONCLUSIONS

Both toothpastes showed good antimicrobial effect after 4 weeks; however, the toothpaste containing ZCT, HAP, KCit and fluoride was found to be more effective in reducing the salivary counts of S. mutans than the product containing fluoride alone.

CLINICAL RELEVANCE

Toothpaste containing ZCT, HAP, KCit and fluoride can be recommended for patients at risk for developing caries and may also be beneficial for individuals experiencing dental sensitivity.

Multifunctional Temporary Dental Nanofillers Enhanced with Synergistically Active Chlorine-Containing Molecules against Streptococcus mutans and Its Effects on Oral Epithelial Cells

Temporary dental fillers are critical for safeguarding teeth during the period between caries removal and permanent restoration. However, conventional fillers often lack sufficient antimicrobial properties to prevent bacterial colonization. To address this issue, the study researches on the development of antimicrobial Temporary Dental Nano-Fillers (TDNF) capable of targeting multiple cariogenic pathogens, including Streptococcus mutans, Lactobacillus casei, Candida albicans, and mixed-species planktonic cells/biofilms, which play a significant role in the progression of dental caries. The TDNF was formulated using a combination of Chloramine-T (CRT) and Cetylpyridinium Chloride (CPC), both known for their antimicrobial efficacy, and embedded in a nanoparticle matrix of hydroxyapatite (HAP) and silicon dioxide (SiO2). The synergistic antimicrobial effect of CRT and CPC, with MIC90 values of 12.5 and 6.25 ppm, respectively, displayed potent activity against S. mutans. Proteomic analysis, including gene ontology and protein-protein interaction network evaluations, further confirmed significant disruptions in S. mutans metabolic and stress response pathways, highlighting the bactericidal effectiveness of the formulation against S. mutans. Additionally, the formulation demonstrated sustained antimicrobial efficacy against other cariogenic pathogens such as L. casei, C. albicans and mixed-species planktonic cells and biofilms over a 16-day period. The TDNF (HAP+SiO2+CRT+CPC matrix) exhibited superior mechanical properties with a compressive strength of 237.7 MPa, flexural strength of 124.3 MPa, and shear bond strength of 52 MPa. Biocompatibility tests conducted on human oral squamous carcinoma cells (OECM-1) indicated over 95% cell viability, affirming its safety for preclinical or clinical applications. The multifunctional TDNF developed in this study successfully combines mechanical reinforcement with broad-spectrum antimicrobial efficacy, offering a promising interim solution in dental restorations. Its ability to protect against microbial colonization, while maintaining structural stability, positions it as an effective temporary material that enhances patient outcomes during the period before permanent restoration.

Effect of Different Concentrations of Chlorhexidine on Anti-Plaque in Oral Care Practice: A Systematic Review and Network Meta-Analysis

OBJECTIVES

The aim of this network meta-analysis was to compare the anti-plaque effects and adverse effects of different concentrations of chlorhexidine (CHX).

METHODS

PubMed, OVID Embase and the Cochrane Library were searched from inception to October 2023 for randomised controlled trials (RCTs) of different concentrations of CHX in healthy populations. Random-effects network meta-analyses were performed to summarise the evidence, and the Grading of Recommendations Assessment, Development and Evaluation framework was used to rate the certainty of evidence. Cohen's d standardised mean differences were calculated as the measure of effect size.

RESULTS

Thirty-eight RCTs involving 2011 participants and six concentrations of CHX (0.2%, 0.12%, 0.1%, 0.3%, 1% and 0.06%) were included. The anti-plaque effects of CHX at all concentrations were compared with placebo. Moderate to very low certainty evidence established 0.2% CHX as the most effective on anti-plaque. 0.12% and 0.1% CHX also showed significant anti-plaque effects. However, the ranking probabilities showed that the adverse effects of 0.12% and 0.1% CHX were < 0.2% CHX.

CONCLUSIONS

Compared with placebo, 0.2%, 0.12% and 0.1% CHX had significant anti-plaque effects, with moderate to very low certainty evidence that 0.2% CHX was most effective on anti-plaque. However, 0.2% CHX had larger adverse effects than 0.12% and 0.1% CHX.

TRIAL REGISTRATION

PROSPERO: Number CRD: 42022327083.

A multimodal in vitro approach to assess the safety of oral care products using 2D and 3D cellular models

Introduction

Periodontitis, affecting approximately 3.9 billion individuals globally, significantly impacts quality of life and has raised interest in its potential systemic effects. Sodium perborate, a common component in oral care products for biofilm control, is widely used, though concerns about its safety persist. This study aimed to evaluate the in vitro toxicity of six commercial oral care products and varying concentrations of sodium perborate, utilizing human gingival fibroblasts (HGF) and keratinocytes (HaCat) as cell models.

Methods

Experiments were performed in both 2D monolayer and 3D cultures using MTT and electrical impedance assays, adhering to the manufacturer's recommended exposure time of 30-60 s for product testing. For the reconstructed epidermis model, a prolonged exposure time of 42 min was applied, following the Organization for Economic Cooperation and Development (OECD) Test Guideline 439.

Results

Results indicated that all products and sodium perborate at 1 mg/mL were cytotoxic in monolayer cultures. However, at concentrations relevant to commercial formulations (0.06 mg/mL sodium perborate), no significant toxicity was observed. In contrast, the 3D culture models, including spheroids and reconstructed epidermis, exhibited minimal to no cytotoxic effects for the commercial products, with sodium perborate showing no significant toxicity below 0.1 mg/mL. The reconstructed epidermis model, used as surrogate for oral mucosa, further confirmed that the products were non-irritating, in compliance with OECD TG 439 standards.

Discussion

This study highlights the importance of considering exposure time, dosage, and cellular model when assessing the safety of oral care products. While 2D models are useful for preliminary screenings, 3D models provide a more physiologically relevant assessment, emphasizing the need for robust testing protocols to ensure product safety.

Investigation of the constituents of commercially available toothpastes

OBJECTIVES

Toothpaste plays a pivotal role in oral and dental hygiene. This cross-sectional study not only investigates the constituents of toothpastes available in the market and their frequency across different brands but also delves into the potential side effects, irritations, or unfavourable outcomes of these constituents, emphasizing the broader health and environmental implications.

METHODS

The largest of the five major chain markets in each district of Istanbul was visited, and adult toothpastes were included in this study. All the constituents that make up the toothpaste were individually recorded in an Excel database. Subsequently, literature regarding the purposes, toxic and potential side effects of each ingredient was gathered using databases such as Google Scholar, PubMed and ScienceDirect. The percentages of these ingredients' occurrence among all the toothpastes were calculated, and the ingredients were categorized into 15 distinct groups based on their usage purposes.

RESULTS

There were 160 different varieties of toothpaste belonging to 19 different brands on the market shelves. Although a total of 244 different ingredients were identified, only 78 of them were included in the study. Among the analysed toothpaste types, 105 of them were found to contain 1450 ppm fluoride, whilst 26 toothpaste variants were discovered to have fluoride levels below this value. Among the various ingredients analysed, particular attention was drawn to commonly debated compounds in oral care products. Specifically, titanium dioxide was found in 68% (n = 111) of the varieties, sodium lauryl sulphate in 67% (n = 108) and paraben in 2% (n = 4), respectively.

CONCLUSION

Whilst certain ingredients may raise concerns for potential side effects and health considerations within the human body, the toothpaste has long been regarded as an indispensable tool for maintaining optimal oral and dental health. However, gaining a deeper understanding and conducting research on each constituent that comprises the toothpaste, as well as raising awareness in this regard, holds significant importance for human health.

Are Mouthwashes Really Effective against Candida spp.?

Oral candidiasis is an opportunistic infection caused by fungi of the genus Candida. Nystatin, fluconazole, and miconazole are the most widely used antifungal drugs in dentistry, but in recent years, they have been shown to be less effective due to the increase in the resistance to antifungal drugs. The growing challenge of antifungal resistance emphasizes the importance of exploring not only alternative strategies in the fight against Candida spp. infections but also supportive treatment for pharmacological treatment for oral candidiasis. This review aims to evaluate and compare the in vitro reports on antifungal efficacy against Candida spp. exhibited by mouthwashes distributed on the European market. The research question was elaborated through the PEO framework recommended by PRISMA 2020. A bibliographic search strategy was developed for the scientific online databases Pubmed and ScienceDirect. According to the eligibility criteria, 21 papers were included in this study over a 27-year period. Mouthwashes containing chlorhexidine digluconate, cetylpyridinium chloride, hexetidine, and fluorine compounds among others, and natural antimicrobials, such as menthol, thymol, eucalyptol, and Glycyrrhiza glabra extracts, have demonstrated antifungal effectiveness. Nonetheless, the methodological variance introduces ambiguity concerning the comparative efficacy of distinct molecules or mouthwash formulations and complicates the evaluation and the comparison of results between studies. Some mouthwashes commercially available in Europe have the potential to be used in anti-Candida therapy and prevention since they have shown antifungal effect.

Antibacterial, Antibiofilm, and Tooth Color Preservation Capacity of Magnesium Oxide Nanoparticles Varnish (in vitro Study)

Purpose

Antibacterial and antibiofilm properties of magnesium oxide nanoparticles (MgONPs) mixture assessed against Streptococcus mutans (S. mutans), in addition to examining MgONPs varnish impact on the preservation of the tooth color and inhibition of methylene blue diffusion to the enamel.

Methods

MgONPs mixture was prepared in deionized water (DW), absolute ethanol (E), and rosin with ethanol (RE), named varnish. The antibacterial and antibiofilm capacities of MgONPs mixtures were tested by agar well diffusion, colony-forming unit (CFU), and biofilm inhibition microtiter methods in triplicate and compared to sodium fluoride varnish (NaF) and chlorhexidine mouthwash (ChX). A spectrophotometer was used to record basic tooth color. The artificial demineralization was initiated for 96 h. Then, experimental materials were applied to the corresponding group, and 10-day pH cycles proceeded. Then, the color was recorded in the same ambient environment. The methylene blue diffusion was evaluated by staining the samples for 24 h. After that, the diffusion test was calculated by a digital camera attached to the stereomicroscope.

Results

The agar well diffusion test expressed a significant inhibition zone with all MgONPs mixtures (p = 0.000), and maximum inhibition zone diameter associated with MgONPs-RE. The same finding was observed in the CFU test. Additionally, 2.5%, 5%, and 10% MgONPs-RE varnish showed strong biofilm inhibition capacity (p = 0.039) compared to NaF and ChX groups that inhibit biofilm formation moderately (p = 0.003). The study shows that the 5% MgONPs-RE varnish maintains basic tooth color with minimal methylene blue diffusion compared to NaF varnish (p = 0.00).

Conclusion

Evaluating MgONPs as a mixture revealed antibacterial and antibiofilm capacity against S. mutans with a higher effect of MgONPs-RE varnish. Also, examining the topical effect of MgONPs-RE varnish on the preservation of the tooth color after pH cycle challenges and methylene blue diffusion to enamel confirmed the high performance of MgONPs-RE varnish at 5%.

Effect of whitening toothpastes with different hydrogen peroxide concentrations: Penetration into the pulp chamber and color change

OBJECTIVES

This study evaluated the efficacy of simulated brushing with toothpastes containing different concentrations of hydrogen peroxide (HP) in pulp chamber penetration and color change. Also, physical-chemical properties (concentration, pH and viscosity) were evaluated.

METHODS

Forty-nine premolars were divided into seven groups (n = 7): untreated (control); whitening gel (White Class 6 %, 6 %BG) with one 90  min application (6 %BG 90  min) and 14 applications of 90  min (6 %BG 14×90 min); toothpastes (Colgate Luminous White Glow 3 %, 3 %TP; Crest 3D White Brilliance 4 %, 4 %TP; Colgate Optic White Pro-Series 5 %, 5 %TP) and 6 %BG toothbrushing for 14 applications of 90 s. HP penetration into the pulp chamber was measured through UV-Vis spectrophotometry and color change with a spectrophotometer (ΔEab, ΔE00, and ΔWID). Initial concentration, pH, and viscosity were measured through Titration, Digital pH-meter, and Rheometer, respectively. Statistical analysis used one-way ANOVA and Tukey's test (α = 0.05).

RESULTS

6 %BG (14×90 min) and 4 %TP groups showed acidic pH and higher concentrations of HP in the pulp chamber compared to the other groups (p < 0.05). On the other side, 3 %TP and 5 %TP groups showed alkaline pH, higher viscosity between the toothpastes and lower HP penetration (p < 0.05). The 6 %BG AH (14×90 min) group exhibited the most significant color change (ΔEab, ΔE00, and ΔWID) (p < 0.05).

CONCLUSIONS

Brushing with whitening toothpaste with an acidic pH leads to greater HP penetration into pulp chamber; but, even when a high concentrated HP whitening toothpaste was used, a lower whitening effect was observed when compared to a two-week at-home bleaching.

CLINICAL SIGNIFICANCE

Whitening toothpastes containing up to 5 % HP produced lower whitening effect than two-week at-home bleaching. Additionally, HP was detected within the pulp chamber which can potentially impact in tooth sensitivity.

On the mucoadhesive properties of synthetic and natural polyampholytes

HYPOTHESIS

The mucoadhesive characteristics of amphoteric polymers (also known as polyampholytes) can vary and are influenced by factors such as the solution's pH and its relative position against their isoelectric point (pHIEP). Whilst the literature contains numerous reports on mucoadhesive properties of either cationic or anionic polymers, very little is known about these characteristics for polyampholytes EXPERIMENTS: Here, two amphoteric polymers were synthesized by reaction of linear polyethylene imine (l-PEI) with succinic or phthalic anhydride and their mucoadhesive properties were compared to bovine serum albumin (BSA), selected as a natural polyampholyte. Interactions between these polymers and porcine gastric mucin were studied using turbidimetric titration and isothermal titration calorimetry across a wide range of pHs. Model tablets were designed, coated with these polymers and tested to evaluate their adhesion to porcine gastric mucosa at different pHs. Moreover, a retention study using fluorescein isothiocyanate (FITC)-labelled polyampholytes deposited onto mucosal surfaces was also conducted FINDINGS: All these studies indicated the importance of solution pH and its relative position against pHIEP in the mucoadhesive properties of polyampholytes. Both synthetic and natural polyampholytes exhibited strong interactions with mucin and good mucoadhesive properties at pH < pHIEP.

Analysis of Covarine Particle in Toothpaste Through Microfluidic Simulation, Experimental Validation, and Electrical Impedance Spectroscopy

Covarine, copper phthalocyanine, a novel tooth whitening ingredient, has been incorporated into various toothpaste formulations using diverse technologies such as larger flakes, two-phase pastes, and microbeads. In this study, we investigated the behavior of covarine microbeads (200 μm) in Colgate advanced white toothpaste when mixed with artificial and real saliva. Our analysis utilized a custom-designed microfluidic mixer with 400 μm wide channels arranged in serpentine patterns, featuring a Y-shaped design for saliva and toothpaste flow. The mixer, fabricated using stereolithography 3D printing technology, incorporated a flexible transparent resin (Formlabs' Flexible 80A resin) and PMMA layers. COMSOL simulations were performed by utilizing parameters extracted from toothpaste and saliva datasheets, supplemented by laboratory measurements, to enhance simulation accuracy. Experimental assessments encompassing the behavior of covarine particles were conducted using an optical profilometer. Viscosity tests and electrical impedance spectroscopy employing recently developed all-carbon electrodes were employed to analyze different toothpaste dilutions. The integration of experimental data from microfluidic chips with computational simulations offers thorough insights into the interactions of covarine particles with saliva and the formation of microfilms on enamel surfaces.

Time-Delayed Anticancer Effect of an Extremely Low Frequency Alternating Magnetic Field and Multimodal Protein-Tannin-Mitoxantrone Carriers with Brillouin Microspectroscopy Visualization In Vitro

The effect of an extremely low frequency alternating magnetic field (ELF AMF) at frequencies of 17, 48, and 95 Hz at 100 mT on free and internalized 4T1 breast cancer cell submicron magnetic mineral carriers with an anticancer drug, mitoxantrone, was shown. The alternating magnetic field (100 mT; 17, 48, 95 Hz; time of treatment-10.5 min with a 30 s delay) does not lead to the significant destruction of carrier shells and release of mitoxantrone or bovine serum albumin from them according to the data of spectrophotometry, or the heating of carriers in the process of exposure to magnetic fields. The most optimal set of factors that would lead to the suppression of proliferation and survival of cells with anticancer drug carriers on the third day (in comparison with the control and first day) is exposure to an alternating magnetic field of 100 mT in a pulsed mode with a frequency of 95 Hz. The presence of magnetic nanocarriers in cell lines was carried out by a direct label-free method, space-resolved Brillouin light scattering (BLS) spectrometry, which was realized for the first time. The analysis of the series of integrated BLS spectra showed an increase in the magnetic phase in cells with a growth in the number of particles per cell (from 10 to 100) after their internalization. The safety of magnetic carriers in the release of their constituent ions has been evaluated using atomic absorption spectrometry.

The Influence of Dental Virtualization, Restoration Types, and Placement Angles on the Trueness and Contact Space in 3D-Printed Crowns: A Comprehensive Exploration

The current digital dentistry workflow has streamlined dental restoration production, but the effectiveness of digital virtual design and 3D printing for restorations still needs evaluation. This study explores the impact of model-free digital design and 3D-printing placement angles on restorations, including single crowns and long bridges produced with and without casts. The restorations are 3D printed using resin at placement angles of 0°, 60°, and 90°. Each group of samples was replicated ten times, resulting in a total of 120 restorations. The Root Mean Square Error (RMSE) value was used to evaluate the surface integrity of the restoration. In addition, the contact space, edge gap, and occlusal space of restorations produced by different processes were recorded. The results indicate that there was no significant difference in the RMSE value of the crown group (p > 0.05). Changing the bridge restoration angle from 0° to 90° resulted in RMSE values increasing by 2.02 times (without casts) and 2.39 times (with casts). Furthermore, the marginal gaps in the crown group were all less than 60 μm, indicating good adaptation. In contrast, the bridge group showed a significant increase in marginal gaps at higher placement angles (p > 0.05). Based on the findings, virtual fabrication without casts does not compromise the accuracy of dental restorations. When the position of the long bridge exceeds 60 degrees, the error will increase. Therefore, designs without casts and parallel placement result in higher accuracy for dental restorations.

Effect of Over-the-counter Whitening Toothpaste and Mouthwash in Orthodontics: A Literature Review

Aim

To summarize and analyze all the available literature on the use of over-the-counter toothpaste and mouthwashes with whitening agents and their possible effects on orthodontic treatment.

Background

Tooth color change frequently occurs during orthodontic treatment and represents a self-perceived need. According to the patient's perspective, there is a preference for the use of toothpaste and mouthwashes with some whitening effect.

Materials and methods

An electronic bibliographic search in English was carried out until June 2022, in PubMed, Scopus, and Web of Science databases. Randomized or nonrandomized clinical trials and experimental laboratory studies were included.

Review results

A total of 57 papers were obtained from an electronic search and 11 studies were included in the review. Outcomes such as strength force elastomeric, color stability, frictional resistance, ion release, shear bond strength (SBS), and adhesive remnant index (ARI) were evaluated.

Conclusion

Toothpaste and mouthwashes with whitening action did not have a favorable effect on most of the outcomes evaluated. In some cases regular toothpaste showed a better effect and in other cases, there were no differences with the control group. Only in the outcome release of ions from wires to whitening effect in teeth with or without attached brackets, they have a better performance.

Clinical significance

Due to the unfavorable effects of over-the-counter whitening toothpaste and mouthwashes on orthodontic materials and appliances, their use should be justified during treatment.

How to cite this article

Chinchay-Ruesta S, Ortiz-Pizarro M, Rodríguez-Díaz DR, et al. Effect of Over-the-counter Whitening Toothpaste and Mouthwash in Orthodontics: A Literature Review. Int J Clin Pediatr Dent 2023;16(S-3):S311-S316.

Using Catechol and Zwitterion-Functionalized Copolymers to Prevent Dental Bacterial Adhesion

In this manuscript, we report the synthesis of zwitterionic copolymers and their ability to form antifouling coatings on porous hydroxyapatite as a mimic of dental coatings. Specifically, we systematically investigated how altering the composition of copolymers of catechol methacrylate (Cat-MA or 2) and methacryloyloxyethyl phosphorylcholine (2-MPC) with varying catechol-to-zwitterion ratios impacted their adhesive and antifouling properties, allowing for the rational design of functional coatings. Characterization by ellipsometry, contact angle goniometry, and X-ray photoelectron spectroscopy revealed the presence of hydrophilic copolymer coatings of ∼10 nm thickness. Notably, these copolymers adhered to hydroxyapatite and reduced the level of attachment of both Gram-negative Escherichia coli and Gram-positive Streptococcus oralis. Additionally, in vitro experiments that mimicked the complex mouth environment (i.e., swallowing and using mouthwash) were employed to evaluate S. oralis adhesion, finding that the copolymer coatings reduced the quantity of adhered bacteria. We suggest that these copolymers provide insights into the design of antifouling coatings that are appropriate for use in oral care.

Development of a novel, entirely herbal-based mouthwash effective against common oral bacteria and SARS-CoV-2

BACKGROUND

Parallel to the growth of the oral healthcare market, there is a constantly increasing demand for natural products as well. Many customers prefer products that contain fewer toxic agents, therefore providing an environmentally friendly solution with the benefit of smaller risk to the user. Medieval and early modern medicinal knowledge might be useful when looking for natural, herbal-based components to develop modern products. Along with these considerations we created, tested, and compared an entirely natural mouthwash, named Herba Dei.

METHODS

The manufacturing procedure was standardized, and the created tincture was evaluated by GC/MS analysis for active compounds, experimentally tested in cell-based cytotoxicity, salivary protein integrity, cell-free antioxidant activity, anti-bacterial and anti-viral assays, and compared with three market-leading mouthwashes.

RESULTS

Our tincture did not show significant damage in the cytotoxicity assays to keratinocyte and Vero E6 cells and did not disrupt the low molecular weight salivary proteins. Its radical scavenging capacity surpassed that of two tested, partly natural, and synthetic mouthwashes, while its antibacterial activity was comparable to the tested products, or higher in the bacterial aerobic respiratory assay. The active compounds responsible for the effects include naturally occurring phenylpropanoids, terpenes, and terpenoids. Our mouthwash proved to be effective in vitro in lowering the copy number of SARS-CoV-2 in circumstances mimicking the salivary environment.

CONCLUSIONS

The developed product might be a useful tool to impede the transmission and spread of SARS-CoV-2 in interpersonal contact and aerosol-generating conditions. Our mouthwash can help reduce the oral bacterial flora and has an antioxidant activity that facilitates wound healing and prevents adverse effects of smoke in the oral cavity.

Evaluation of alcohol-free mouthwash for studies of the oral microbiome

Oral bacteria play important roles in human health and disease. Oral samples collected using ethanol-containing mouthwash are widely used for oral microbiome studies. However, ethanol is flammable and not ideal for transportation/storage in large quantities, and some individuals may avoid ethanol due to the burning sensation or due to various personal, medical, religious, and/or cultural factors. Here, we compared ethanol-free and ethanol-containing mouthwashes using multiple microbiome metrics and assessed the stability of the mouthwash samples stored up to 10 days before processing. Forty volunteers provided oral wash samples collected using ethanol-free and ethanol-containing mouthwashes. From each sample, one aliquot was immediately frozen, one was stored at 4°C for 5 days and frozen, while the third aliquot was stored for 5 days at 4°C and 5 days at ambient temperature to mimic shipping delays and then frozen. DNA was extracted, the 16S rRNA gene V4 region was amplified and sequenced, and bioinformatic processing was performed using QIIME 2. Microbiome metrics measured in the two mouthwash types were very similar, with intraclass correlation coefficients (ICCs) for alpha and beta diversity metrics greater than 0.85. Relative abundances of some taxa were significantly different, but ICCs of the top four most abundant phyla and genera were high (> 0.75) for the comparability of the mouthwashes. Stability during delayed processing was also high for both mouthwashes based on alpha and beta diversity measures and relative abundances of the top four phyla and genera (ICCs ≥ 0.90). These results demonstrate ethanol-free mouthwash performs similarly to ethanol-containing mouthwash for microbial analyses, and both mouthwashes are stable for at least 10 days without freezing prior to laboratory processing. Ethanol-free mouthwash is suitable for collecting and shipping oral wash samples, and these results have important implications for planning future epidemiologic studies of the oral microbiome.

Six Spain Thymus essential oils composition analysis and their in vitro and in silico study against Streptococcus mutans

BACKGROUND

Streptococcus mutans is a well-known oral pathogen that plays a critical role in the development of dental caries. Many studies have been directed to discover the chemical compounds present in natural products to inhibit the growth and biofilm formation activity of S. mutans. Thymus essential oils exhibit good inhibition on the growth and pathogenesis of S. mutans. However, details about the active compounds in Thymus essential oil and the inhibition mechanism still remain unclear. The aim of this study was to investigate the antimicrobial activity of 6 Thymus species (Three samples of Thymus vulgaris, two samples of Thymus zygis, and one sample of Thymus satureioides essential oils) on S. mutans, to identify the potential active components, and to reveal the underlying mechanism.

METHODS

The composition of Thymus essential oils was analyzed by gas chromatography-mass spectrometry. And its antibacterial effect was evaluated based on the bacterial growth, acid production, biofilm formation and genetic expression of virulence factors by S. mutans. Potential active components of the Thymus essential oil were identified using molecular docking and correlation analysis.

RESULTS

GC-MS analysis showed that the major components in the 6 Spain Thymus essential oils were linalool, α-terpineol, p-cymene, thymol and carvacrol. MIC and MBC analysis showed that 3 Thymus essential oils showed very sensitive antimicrobial activity, and were chosen for further analysis. The 3 Thymus essential oil exhibited a significant inhibitory effect on acid production, adherence and biofilm formation of S. mutans and the expression of virulence genes, such as brpA, gbpB, gtfB, gtfC, gtfD, vicR, spaP and relA. Correlation analysis showed that phenolic components, such as carvacrol and thymol, were positively related to DIZ value, which suggests that they are the potential antimicrobial components. Molecular docking between the Thymus essential oil components and virulence proteins also found that carvacrol and thymol exhibited strong binding affinity with functional domains of virulence genes.

CONCLUSIONS

Thymus essential oil showed significant inhibition against the growth and pathogenesis of S. mutans depending on their composition and concentration. And phenolic compounds, such as carvacrol and thymol, are the major active components. Thymus essential oil could be used in oral healthcare products as a potential anti-caries ingredient.

Surface Modification of Silica Particles with Adhesive Functional Groups or Their Coating with Chitosan to Improve the Retention of Toothpastes in the Mouth

Silica is widely used in the oral care formulations to act as an abrasive and to give the products its distinct physical properties. In this study, silica particles were synthesized using a co-condensation of tetraethyl orthosilicate with a series of functional silane compounds [(3-mercaptopropyl)trimethoxysilane, (3-glycidyloxypropyl)trimethoxysilane, and (3-acryloxypropyl)trimethoxysilane)]. The surface of the particles based on tetraethyl orthosilicate and (3-glycidyloxypropyl)trimethoxysilane was then further modified with 3-aminophenylboronic acid. Commercial Aerosil R972 Pharma silica particles were also coated with chitosan. Additionally, commercially available (3-maleimido)propyl-functionalized silica particles were used in this study. All these functionalized silica particles were incorporated into toothpaste formulations, and their retentive properties were tested on ex vivo sheep tongue mucosa models using fluorescent microscopy-based flow-through techniques. Those surfaces with chitosan, phenylboronic acid, and acryloyl groups were shown to provide a significant improvement in the retention of the oral care formulations during the retention testing. The retention of toothpastes containing silica functionalized with maleimide and thiol groups was also superior compared to that of unmodified silica particles. This study synthesized and tested a range of silica particles and demonstrated that the functionalized silica incorporated into toothpastes can significantly improve the retention of these formulations on oral mucosal surfaces.

Gels containing statherin-derived peptide protect against enamel and dentin erosive tooth wear in vitro

The effect of gels containing a statherin-derived peptide (Stn) on the protection against enamel and dentin erosive tooth wear (ETW) in vitro was evaluated. Bovine enamel and dentin specimens were divided into 2 groups (n = 15 and 18/group for enamel and dentin, respectively) that were treated with Chitosan or Carboxymethylcellulose (CMC) gels containing Stn15pSpS at 1.88 × 10-5 M or 3.76 × 10-5 M. Chitosan or CMC gels without active ingredients served as negative controls, while chitosan gel containing 1.23% F (as NaF) and acidulated phosphate fluoride gel (1.23% F) served as positive controls. The gels were applied on the specimens for 4 min. Stimulated saliva was collected from 3 donors and used to form a 2-h acquired pellicle on the specimens. Then, the specimens were submitted to an erosive pH cycling protocol 4 times/day for 7 days (0.01 M HCl pH 2.0/45 s, artificial saliva/2 h, and artificial saliva overnight). The gels were applied again during pH cycling, 2 times/day for 4 min after the first and last erosive challenges. Enamel and dentin loss (μm) were assessed by contact profilometry. Scanning electron microscopy (SEM) was analyzed using a cold field emission. Data were analyzed by two-way ANOVA (for chitosan and CMC gels, separately) and Tukey's multiple comparison test. SEM images showed changes to enamel topography after application oft the gels containing Stn or F. Regarding CMC-based gels, for enamel, none of the treatments significantly reduced ETW in comparison with placebo; for dentin, however, gels containing Stn, regardless the concentration, significantly reduced the ETW. Moreover, Chitosan-based gels, regardless the Stn concentration, were able to protect enamel and dentin against ETW. Gels containing Stn might be a new approach to protect against ETW.

Effect of experimental and commercial artificial saliva formulations on the activity and viability of microcosm biofilm and on enamel demineralization for irradiated patients with head and neck cancer (HNC)

The effect of different artificial saliva formulations on biofilm activity and viability, and on enamel demineralization for head and neck cancer (HNC) patients was evaluated. Irradiated enamel samples were treated (1 min) with BioXtra® or with experimental formulations containing carboxymethylcellulose plus inorganic constituents alone (AS) or containing 0.1 mg mL^-1 CaneCPI-5 (AS + Cane), 1.0 mg mL^-1 hemoglobin (AS + Hb) or combination of both (AS + Cane + Hb). Phosphate-buffered-saline and chlorhexidine (0.12%) were negative and positive control, respectively. Biofilm was produced from the saliva of five male HNC patients, under 0.2% sucrose exposure for 5 days, and daily treated with the formulations (1 min). No significant effects were observed for the different experimental treatments. BioXtra^® significantly reduced lactobacilli, demonstrating antibacterial potential for this group. Chlorhexidine was an effective treatment to significantly reduce all parameters, being an important antimicrobial and anticaries agent. Future in vitro studies must be performed using a new approach for the design of the experimental formulations.

Natural Products for the Prevention and Treatment of Oral Mucositis-A Review

Cancer, a major world public health problem, is associated with chemotherapy treatments whose administration leads to secondary concerns, such as oral mucositis (OM). The OM disorder is characterized by the presence of ulcers in the oral mucosa that cause pain, bleeding, and difficulty in ingesting fluids and solids, or speaking. Bioactive compounds from natural sources have arisen as an effective approach for OM. This review aims to summarize the new potential application of different natural products in the prevention and treatment of OM in comparison to conventional ones, also providing a deep insight into the most recent clinical studies. Natural products, such as Aloe vera, Glycyrrhiza glabra, Camellia sinensis, Calendula officinalis, or honeybee crops, constitute examples of sources of bioactive compounds with pharmacological interest due to their well-reported activities (e.g., antimicrobial, antiviral, anti-inflammatory, analgesic, or wound healing). These activities are associated with the bioactive compounds present in their matrix (such as flavonoids), which are associated with in vivo biological activities and minimal or absent toxicity. Finally, encapsulation has arisen as a future opportunity to preserve the chemical stability and the drug bioa vailability of bioactive compounds and, most importantly, to improve the buccal retention period and the therapeutic effects.

Colloidal dynamics of emulsion droplets in mouth

The interaction of emulsions with the tongue is key to the sensory appeal of food and can potentially be exploited for oral/buccal pharmaceutical delivery. Whilst there is good understanding of the different mucoadhesive forces governing emulsion interaction with the tongue, their relative importance is not well understood. In addition, the physical location of emulsions within the saliva papillae on the tongue is not understood at all. A combination of ex vivo salivary film, and in vivo oral coating experiments were used to determine the importance of different mucoadhesive forces. Mucoadhesion of cationic emulsions was largely driven by electrostatic complexation. SDS-PAGE of the in vivo saliva coating highlighted that mucins were largely responsible for cationic emulsion mucoadhesion. Anionic emulsions were bound via hydrophobic/steric interactions to small salivary proteins typically located away from the mucin anchor points. The physical location and clustering of emulsions relative to the salivary film/papillae was probed via the invention of a fluorescent oral microscope. Cationic emulsions were densely clustered close to the papillae whilst anionic emulsions were suspended in the salivary film above the papillae. Interestingly, non-ionic emulsions were also trapped within the salivary film above the papillae as individual droplets. These findings highlight that whilst electrostatic complexation with saliva is a powerful mucoadhesive force, hydrophobic and steric interactions also act to induce oral retention of emulsions. The differences in physical location and clustering of emulsions within the salivary film hint at the 3D locations of the different salivary proteins driving each mucoadhesive interaction. This novel understanding of emulsion saliva/papillae interactions has potential to aid efficacy of buccal pharmaceutical delivery and the reduction of astringency in plant-based foods.

Role of mucoadhesive polymers in retention of toothpaste in the oral cavity

Retention of active ingredients of toothpastes in the mouth following brushing determines the efficiency of these oral care formulations. In this study, new in vitro methodologies for the observation and measurement of toothpaste retention in the oral cavity were developed and used to evaluate the efficiency of formulations containing different mucoadhesive hydrophilic polymers. The findings suggest that using Carbopol ETD 2020 and Carbopol Ultrez 10 as binders in toothpaste prolongs the retention time of these formulations in the oral cavity. The in vitro methodologies tested, coupled with texture analysis, were able to accurately characterise the behaviour of the toothpaste and produce detailed images showing how it is retained in the oral cavity. This study has not only produced a new method for studying the behaviour of toothpaste and other formulations in the oral cavity but is also the first to investigate how different types of mucoadhesive binders can be used to improve toothpaste retention.

Oral Health Related Behaviors in Relation to DMFT Indexes of Teenagers in an Urban Area of North-West Poland-Dental Caries Is Still a Common Problem

Caries has a negative influence on health and is still a public health problem among children and adolescents in Poland. The aim of this study was to analyze the association of dietary habits, oral hygiene behaviors and the frequency of usage of dental services with the dental caries index in teenagers in North-West Poland. The study enrolled 264 children (147M/117F) aged 15. Participants filled out a questionnaire regarding age, sex, frequency of visits to the dentist, dietary habits and oral hygiene behaviors, and the Decayed Missing Filled Teeth Index (DMFT) was calculated. Caries was found in 88.6% of subjects. The lower or no caries experience group (DMFT ≤ 5) comprised of 180 subjects, while higher caries experience (DMFT > 5) was found in 84 teenagers and was significantly inversely associated with tooth brushing after the last meal (OR = 0.45; 95% CI:0.21–0.97; p = 0.04) and the daily use of dental floss (OR = 0.12; 95% CI:0.01–0.92; p = 0.04). There is an emerging need for the implementation of effective caries prevention and recovery programs in Poland. Health promotion focusing on oral hygiene behaviors should be disseminated more widely because lower caries experience was demonstrated in teenagers declaring healthy oral habits. Another important need is the development of multi-sectorial actions aiming at the improvement of dietary habits.