Oral nitric oxide during plaque deposition

Dual Action Nitric Oxide and Fluoride Ion-Releasing Hydrogels for Combating Dental Caries

Demineralization and breakdown of tooth enamel are characterized by a condition called dental caries or tooth decay, which is caused by two main factors: (1) highly acidic food intake without proper oral hygiene and (2) overactive oral bacteria generating acidic metabolic byproducts. Fluoride treatments have been shown to help rebuild the hydroxyapatite structures that make up 98% of enamel but do not tackle the bacterial overload that continues to threaten future demineralization. Herein, we have created a dual-function Pluronic F127-alginate hydrogel with nitric oxide (NO)- and fluoride-releasing capabilities for the two-pronged treatment of dental caries. Analysis of the hydrogels demonstrated porous, shear-thinning behaviors with tunable mechanical properties. Varying the weight percent of the NO donor S-nitrosoglutathione (GSNO) within the hydrogel enabled physiologically actionable NO release over 4 h, with the fabricated gels demonstrating storage stability over 21 days. This NO-releasing capability resulted in a 97.59% reduction of viable Streptococcus mutans in the planktonic state over 4 h and reduced the preformed biofilm mass by 48.8% after 24 h. Delivery of fluoride ions was confirmed by a fluoride-sensitive electrode, with release levels resulting in the significant prevention of demineralization of hydroxyapatite discs after treatment with an acidic demineralization solution. Exposure to human gingival fibroblasts and human osteoblasts showed cytocompatibility of the hydrogel, demonstrating the potential for the successful treatment of dental caries in patients.

Role of nitric oxide in orthodontic tooth movement (Review)

Nitric oxide (NO) is an ubiquitous signaling molecule that mediates numerous cellular processes associated with cardiovascular, nervous and immune systems. NO also plays an essential role in bone homeostasis regulation. The present review article summarized the effects of NO on bone metabolism during orthodontic tooth movement in order to provide insight into the regulatory role of NO in orthodontic tooth movement. Orthodontic tooth movement is a process in which the periodontal tissue and alveolar bone are reconstructed due to the effect of orthodontic forces. Accumulating evidence has indicated that NO and its downstream signaling molecule, cyclic guanosine monophosphate (cGMP), mediate the mechanical signals during orthodontic-related bone remodeling, and exert complex effects on osteogenesis and osteoclastogenesis. NO has a regulatory effect on the cellular activities and functional states of osteoclasts, osteocytes and periodontal ligament fibroblasts involved in orthodontic tooth movement. Variations of NO synthase (NOS) expression levels and NO production in periodontal tissues or gingival crevicular fluid (GCF) have been found on the tension and compression sides during tooth movement in both orthodontic animal models and patients. Furthermore, NO precursor and NOS inhibitor administration increased and reduced the tooth movement in animal models, respectively. Further research is required in order to further elucidate the underlying mechanisms and the clinical application prospect of NO in orthodontic tooth movement.

Role of Poor Oral Hygiene in Causation of Oral Cancer-a Review of Literature

Oral squamous cell carcinomas (OSCC) are among the commonest cancers in South East Asia and more so in the Indian subcontinent. The role of tobacco and alcohol in the causation of these cancers is well-documented. Poor oral hygiene (POH) is often seen to co-exist in patients with OSCC. However, the role of poor oral hygiene in the etio-pathogenesis of these cancers is controversial. We decided to evaluate the available literature for evaluating the association of POH with OSCC. A thorough literature search of English-language articles in MEDLINE, PubMed, Cochrane Database of Systematic Reviews, and Web of Science databases was conducted, and 93 relevant articles were short-listed. We found that POH was strongly associated with oral cancers. It aids the carcinogenic potential of other known carcinogens like tobacco and alcohol. Even on adjusting for known confounding factors like tobacco, alcohol use, education, and socio-economic strata, presence of POH exhibits higher odds of developing oral cancer.

Influence of oral care on fractional exhaled nitric oxide

Background

Fractional exhaled nitric oxide (FeNO) is an indicator of bronchial inflammation in asthma patients. However, nitric oxide is also produced in the oral cavity, with production depending on the local anaerobic flora and intraoral acidity.

Objective

To evaluate the influence of oral care on measurement of FeNO, to investigate the influence of sleep when the oral environment changes dramatically, and to assess the impact of oral care on FeNO in the real clinical setting.

Methods

FeNO was measured before and after oral care in 14 subjects on awakening and at bedtime on 2 consecutive days to investigate variation of nitric oxide derived from the oral cavity. It was also measured before and after oral care in 62 outpatients with asthma to assess the clinical relevance of oral cavity nitric oxide.

Results

On both days, FeNO was significantly decreased by oral care on awakening (day 1: decrease = 10.6 ± 12.4 ppb, p = 0.0020; day 2: decrease = 11.6 ± 23.7 ppb, p = 0.0009), and the decrease was larger than at bedtime. In addition, FeNO was significantly reduced by oral care in asthma outpatients (decrease = 1.73 ± 0.95 ppb, p = 0.0090), and older age was significantly correlated with the decrease (p = 0.0261).

Conclusion

Oral care resulted in a decrease of FeNO, especially on awakening. While nitric oxide derived from the oral cavity generally has a limited impact in outpatients with asthma, its influence on measurement of FeNO may need to be considered, especially in elderly patients.

Production and physiological role of NO in the oral cavity

Nitric oxide (NO) is a free radical which is produced from a wide variety of cells and tissues in the human body. NO is involved in the regulation of many physiological processes, such as vascular relaxation, neurotransmission, immune regulation, and cell death. NO is generated by nitric oxide synthase (NOS), which has three identified isoforms: neuronal type NOS (nNOS), endothelial type NOS (eNOS), and inducible type NOS (iNOS). Different isoforms are expressed depending on the organs, tissues, and cells, and investigation of the types and functions of enzymes expressed in various tissues is underway. The oral cavity is a space in which marked changes have been detected in NO levels, and each tissue is constantly influenced by NO. NO is a component of saliva and is produced by oral bacteria in the oral cavity and released by NOS expressed in oral mucosa. NOS isoforms expressed under normal conditions differ among the oral organs. In addition, the overexpression of NOS was involved in carcinogenesis and tumor growth progression. This review summarized the expression of NOS and functions of NO in oral cavity organs, and their roles in diseases and the influences of treatments.

Kinetic-dependent Killing of Oral Pathogens with Nitric Oxide

Nitric oxide (NO)-releasing silica nanoparticles were synthesized via the co-condensation of tetramethyl orthosilicate with aminosilanes and subsequent conversion of secondary amines to N-diazeniumdiolate NO donors. A series of ~150 nm NO-releasing particles with different NO totals and release kinetics (i.e., half-lives) were achieved by altering both the identity and mol% composition of the aminosilane precursors. Independent of identical 2 h NO-release totals, enhanced antibacterial action was observed against the periodontopathogens Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis with extended NO-release kinetics at pH 7.4. Negligible bactericidal effect was observed against cariogenic Streptococcus mutans at pH 7.4, even when using NO-releasing silica particles with greater NO-release totals. However, antibacterial activity was observed against S. mutans at lower pH (6.4). This result was attributed to more rapid proton-initiated decomposition of the N-diazeniumdiolate NO donors and greater NO-release payloads. The data suggest a differential sensitivity to NO between cariogenic and periodontopathogenic bacteria with implications for the future development of NO-releasing oral care therapeutics.

Measurement of nitrite and nitrate in saliva of children with different caries activity

OBJECTIVE OF THE STUDY

Recently, there has been growing interest in the role of salivary nitrate and nitrite in caries protection. Nitrate is a natural compound found in fruits and vegetables and when secreted in saliva, is reduced to nitrite through bacterial respiration and subsequently reduced to nitric oxide in acidic condition. Nitric oxide takes part in oral non-specific immune system and prevents bacterial growth. The aim of present study was to determine the concentration of nitrite and nitrate in saliva of children with different caries activity.

MATERIALS AND METHODS

Ninety three children, 4 to 6 years old, enrolled in this case-control study and were divided into 3 groups; 31 caries free children, 31 with 5 <DFS ≤ 10 and 31 with DFS >10. Unstimulated saliva was collected and stored in 4°C. Measurement of nitrate and nitrite concentration was performed using Griess reaction. Data were analyzed by T-test, Chi-square, ANOVA and multiple comparisons using SPSS 18. p < 0.05 was considered significant.

RESULTS

Mean value of DFS in the first, second and third were 0, 7.12 and 12.61 respectively. Mean value of nitrite and nitrate in the third group was significantly higher than two others (p < 0.05), but the difference between first and second group was not significant.

CONCLUSION

Increase in DFS was associated by increase in salivary nitrite and nitrate concentration.

CLINICAL SIGNIFICANCE

High concentration of nitrate and nitrite is not enough for caries prevention.

Antibacterial efficacy of exogenous nitric oxide on periodontal pathogens

Current treatments for periodontitis (e.g., scaling/root planing and chlorhexidine) have limited efficacy since they fail to suppress microbial biofilms satisfactorily over time, and the use of adjunctive antimicrobials can promote the emergence of antibiotic-resistant organisms. Herein, we report the novel application of nitric oxide (NO)-releasing scaffolds (i.e., dendrimers and silica particles) as anti-periodontopathogenic agents. The effectiveness of macromolecular NO release was demonstrated by a 3-log reduction in periodontopathogenic Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis viability. In contrast, Streptococcus mutans and Streptococcus sanguinis, caries-associated organisms, were substantially less sensitive to NO treatment. Both dendrimer- and silica-based NO release exhibited substantially less toxicity to human gingival fibroblasts at concentrations necessary to eradicate periodontopathogens than did clinical concentrations of chlorhexidine. These results suggest the potential utility of macromolecular NO-release scaffolds as a novel platform for the development of periodontal disease therapeutics.

Nitric oxide modulates levels of salivary Lactobacilli

OBJECTIVE

Nitric Oxide (NO) is one of the most powerful antibacterial compounds. The aim of this study was to determine the association between salivary NO, dental caries and cariogenic bacteria.

MATERIALS AND METHODS

The salivary NO concentration of 257 Korean children was analyzed by the Griess colorimetric reaction method. Salivary mutans streptococci (MS) and Lactobacilli (LB) were counted using the Dentocult MS and Dentocult LB kit, respectively. Dental caries status was examined using the WHO criteria. Confounders were age, gender, salivary flow rate and salivary buffer capacity. Analysis of covariance (ANCOVA) was used to evaluate the association among NO, salivary MS level, salivary LB level and dental caries status after adjusting for the effects of confounders.

RESULTS

A significant decrease was found in salivary NO levels as the salivary LB count increased after controlling for confounders (p = 0.049). However, the MS level, caries experience and active caries status showed no significant association.

CONCLUSION

This result indicates that NO production might be a host defense mechanism against the growth of cariogenic bacteria.

[Examination of the oral cavities of patients with cancer: clinical evaluation and indirect measurement of the nitric oxide level]

This observational study aimed to verify the association between the clinical state of the oral cavity (based on the Index of Decayed, Missing, and Filled Teeth and the Simplified Oral Hygiene Index) and the indirectly determined nitric oxide level in patients with oncologic and hematologic diseases. This study included 20 hospitalized patients who were in the evaluation phase prior to starting chemotherapy and who had been diagnosed with leukemia (35%), lymphoma (50%) or myeloma (15%). Fifty percent of these patients had normal oral health (no injury or trauma), and most had satisfactory (35%) or typical (35%) hygiene, but 30% had poor or very poor hygiene. The indirectly measured levels of nitric oxide ranged from 13.34 to 257. The nitric oxide level was not associated with other parameters, and there was great variability in its level. Further studies are necessary given the potential of using this indicator in the early detection of oral diseases.

Would Nitric Oxide be an Effective Marker for Earlier Stages of Peri-Implant Disease? An Analysis in Human Peri-Implant Sulcular Fluid

Nitric oxide has an important effect on host immune response. However, little has been studied in relation to its potential as a possible diagnostic tool in peri-implant disease. The present study analyzed nitrite levels in the peri-implant sulcular fluid (PISF) of implants with mucositis and the correlation of these nitrite levels with clinical parameters using a simplified fluid collection methodology. Twenty-five partially edentulous patients showing peri-implant mucositis were evaluated, and the peri-implant status was determined based on current clinical parameters: probing depth (PD) and bleeding on probing (BOP). The sulcular fluid (SF) around teeth (control) and implants were collected, and the nitrite levels were evaluated using the Griess method. The mean probing depth (mm) was significantly higher (P &lt; .0001) in implants (2.852 ± 0.6484) than in control teeth (1.585 ± 0.3636). The mean total nitrite level (μM) was statistically higher (P = .0069) in implants with mucositis (14.34 ± 11.83) than in control teeth (9.316 ± 5.534). No correlation was observed between the total nitrite levels and the PD mean in the control group (P = .2558, r = −0.2361) or in the implant group (P = .1160, r = −0.3224), as well as the number of faces showing bleeding on probing (P = .8747, r = 0.0332). These results demonstrated that the nitrite levels were higher in inflamed areas. According to the methodology applied and results obtained, the higher nitrite levels in inflamed areas suggest that, in the future, nitrite could be used as a marker of peri-implant mucositis associated with clinical data to monitor the cure or evolution of the disease.

Nitrogen dioxide-dependent oxidation of uric acid in the human oral cavity under acidic conditions: implications for its occurrence in acidic dental plaque

The pH in dental plaque falls to below 5 after the ingestion of foods, and it may remain low if acid-tolerant bacteria grow in the plaque. Certain nitrate-reducing bacteria in the oral cavity can proliferate in dental plaque at low pH, and nitrite is detected in such plaque. In acidic dental plaque, NO(2) can be produced by self-decomposition of nitrous acid and also by peroxidase-catalyzed oxidation of nitrite, and it may oxidize uric acid, a major antioxidant in the oral cavity. Under experimental conditions that simulate oral cavity, the oxidation of uric acid by nitrite and by nitrite/peroxidase systems was much more rapid at pH 5 than at pH 7, suggesting the more rapid production of NO(2) in dental plaque at lower pH. We propose that if the pH of plaque developed in a dental crevice decreased, NO(2) and other nitrogen oxides produced in the plaque would diffuse into the adjoining gingival tissues. The results of this study seem to contribute to the understanding of the induction of periodontal diseases in the context of nitrite-dependent production of nitrogen oxides in acidic dental plaque.

Denitrification in human dental plaque

Background

Microbial denitrification is not considered important in human-associated microbial communities. Accordingly, metabolic investigations of the microbial biofilm communities of human dental plaque have focused on aerobic respiration and acid fermentation of carbohydrates, even though it is known that the oral habitat is constantly exposed to nitrate (NO₃^-) concentrations in the millimolar range and that dental plaque houses bacteria that can reduce this NO₃^- to nitrite (NO₂^-).

Results

We show that dental plaque mediates denitrification of NO₃^- to nitric oxide (NO), nitrous oxide (N₂O), and dinitrogen (N₂) using microsensor measurements, ¹⁵N isotopic labelling and molecular detection of denitrification genes. In vivo N₂O accumulation rates in the mouth depended on the presence of dental plaque and on salivary NO₃^- concentrations. NO and N₂O production by denitrification occurred under aerobic conditions and was regulated by plaque pH.

Conclusions

Increases of NO concentrations were in the range of effective concentrations for NO signalling to human host cells and, thus, may locally affect blood flow, signalling between nerves and inflammatory processes in the gum. This is specifically significant for the understanding of periodontal diseases, where NO has been shown to play a key role, but where gingival cells are believed to be the only source of NO. More generally, this study establishes denitrification by human-associated microbial communities as a significant metabolic pathway which, due to concurrent NO formation, provides a basis for symbiotic interactions.

Nitration of the salivary component 4-hydroxyphenylacetic acid in the human oral cavity: enhancement of nitration under acidic conditions

4-Hydroxyphenylacetic acid (HPA) and nitrite are present in human mixed whole saliva, and HPA can be nitrated by peroxidase/hydrogen peroxide (H(2)O(2))/nitrite systems in the oral cavity. Thus, the objectives of the present study were to estimate the concentrations of HPA, nitrated HPA [4-hydroxy-3-nitrophenylacetic acid (NO(2)HPA)], nitrite, and thiocyanate (SCN(-)) in saliva from 73 patients with periodontal diseases and to elucidate the conditions necessary to induce nitration of HPA. High concentrations of HPA, nitrite, and SCN(-) were found in the saliva of patients older than 50 yr of age. NO(2)HPA was detected in seven patients who were older than 60 yr of age. Nitrite-dependent formation of NO(2)HPA by a bacterial fraction prepared from mixed whole saliva was faster at pH 5.3 than at pH 7, and increased as the rate of H(2)O(2) formation increased. The formation of NO(2)HPA was inhibited by SCN(-) and by salivary antioxidants such as uric acid, ascorbic acid, and glutathione. These results suggest that nitration can proceed at an acidic site in the oral cavity where H(2)O(2) is produced under conditions of decreased concentrations of SCN(-) and of antioxidants.

Increased oral nitric oxide in obstructive sleep apnoea

BACKGROUND

Hypoxia and snoring-related mechanical trauma contribute to airway inflammation in obstructive sleep apnoea (OSA). Increased exhaled nitric oxide (FENO), an airway inflammation marker, has been reported in OSA patients. We propose the measure of NO in the oral cavity (oNO) as marker of oropharyngeal inflammation in OSA.

METHODS

We compared oNO and FENO of 39 OSA patients with those of 26 mild asthmatics (ASTHMA), 15 patients with chronic rhinitis or rhinosinusitis (CRS) and 24 healthy subjects. A special device was used for oNO measurement. Apnoea/hypopnoea index (AHI), oxygen desaturation index, mean and nadir SaO2 were calculated from the polysomnography.

RESULTS

oNO was significantly increased in OSA (104.2 95%CI 80.2-135.5ppb) as compared to ASTHMA (71.9 95%CI 56.3-91.9ppb; p=0.015), CRS (54.4 95%CI 40.2-73.7ppb; p=0.009) and healthy subjects (63.6 95%CI 59-73ppb; p<0.001). oNO was directly related to AHI (r=0.466, p=0.003) and to minutes slept with SaO2 <90% (r=0.471, p=0.011) and it was inversely related to nadirSaO2 (r=-0.393, p=0.018). FENO was highest in asthmatics (40.3 95%CI 32.5-50.1ppb) and only slightly elevated in OSA (23.1 95%CI 19,8-28.3ppb) and CRS (22.8 95%CI 16.8-32.5ppb).

CONCLUSIONS

The finding that oral NO is increased in OSA and is related to upper airway obstructive episodes and to hypoxemia severity, strengthens the clinical and pathogenic role of oral inflammation in OSA.

Production of nitric oxide-derived reactive nitrogen species in human oral cavity and their scavenging by salivary redox components

Nitrite is reduced to nitric oxide (NO) in the oral cavity. The NO generated can react with molecular oxygen producing reactive nitrogen species. In this study, reduction of nitrite to NO was observed in bacterial fractions of saliva and whole saliva. Formation of reactive nitrogen species from NO was detected by measuring the transformation of 4,5-diaminofluorescein (DAF-2) to triazolfluorescein (DAF-2T). The transformation was fast in bacterial fractions but slow in whole saliva. Salivary components such as ascorbate, glutathione, uric acid and thiocyanate inhibited the transformation of DAF-2 to DAF-2T in bacterial fractions without affecting nitrite-dependent NO production. The inhibition was deduced to be due to scavenging of reactive nitrogen species, which were formed from NO, by the above reagents. The transformation of DAF-2 to DAF-2T was faster in bacterial fractions and whole saliva which were prepared 1-4 h after tooth brushing than those prepared immediately after toothbrushing. Increase in the rate as a function of time after toothbrushing seemed to be due to the increase in population of bacteria which could reduce nitrite to NO. The results obtained in this study suggest that reactive nitrogen species derived from NO are continuously formed in the oral cavity and that the reactive nitrogen species are effectively scavenged by salivary redox components in saliva but the scavenging is not complete.

Nitric oxide levels in saliva increase with severity of chronic periodontitis

The aims of this study were to compare nitric oxide (NO) levels in stimulated whole saliva from individuals with and without generalized chronic periodontitis (GCP), and to evaluate correlations between these levels with a clinical diagnostic parameter. According to specific criteria, 30 individuals were divided into three groups: one comprising individuals without periodontitis (GC), a second comprising individuals with moderate GCP (GM), and a third comprising individuals with advanced GCP (GA). Samples were collected and NO levels measured. NO in the GCP group (GM: 7.78 microM; GA: 15.79 microM) was higher than in the GC group (5.86 microM). NO levels in the GA group were significantly higher (P < 0.0001) than in the GC group, and could also differentiate (P < 0.0001) the moderate and advanced forms of the disease. In addition, positive correlations between NO level and the number of teeth with a probing depth of > or = 4 mm (r = 0.54) and > or = 7 mm (r = 0.68) were observed. In conclusion, NO levels are elevated in individuals with GPC and are correlated with a periodontal clinical parameter. These results reveal that this form of periodontal disease and its severity are related to salivary nitrite concentration, indicating that NO may serve as a potential biological marker for detection and/or monitoring of GCP.

Nitrite reductase in Streptoccocus mutans plays a critical role in the survival of this pathogen in oral cavity

BACKGROUND/AIMS

The mechanisms of nitric oxide (NO) production by bacteria in the oral cavity are still not clearly defined but salivary streptococci have been reported to generate NO. The aim of this study was to clarify the mechanism of nitrite metabolism and generation of NO by Streptococcus mutans, a major pathogen of dental caries.

METHODS

We searched the genomic database of oral pathogens for nitrite reductase and used a polymerase chain reaction (PCR) to clone the nirJ gene from S. mutans GS5. His-tagged recombinant NirJ protein was expressed in Escherichia coli BL21 and characterized. We constructed a nirJ gene-disrupted mutant strain of S. mutans (DeltanirJ) to analyze the physiological significance of nirJ.

RESULTS

S. mutans generates NO from nitrite, probably as a result of the possession of nitrite reductase. We cloned the nirJ gene from S. mutans GS5 by PCR. The recombinant NirJ protein catalyzed the reduction of nitrite with a K(m) value of 3.37 microM and a specific activity of 2.5 micromol/min/mg of protein at 37 degrees C. Biochemical analysis revealed that the nitrite-reducing activity of the mutant (DeltanirJ) strain was significantly lower than that of the wild-type strain. The growth of the mutant strain, but not of the wild-type strain, was strongly suppressed by the presence of physiological levels of nitrite ( approximately 0.2 mM) in saliva.

CONCLUSION

These observations suggest that the elimination of nitrite and/or the generation of NO are important for the survival of S. mutans in the oral cavity.

Chlorogenic acid in coffee can prevent the formation of dinitrogen trioxide by scavenging nitrogen dioxide generated in the human oral cavity

Coffee contains antioxidants like chlorogenic acid and its isomers. In this report, effects of coffee on the nitrite-induced N2O3 formation were studied using whole saliva and bacterial fraction prepared from the saliva. The formation of N2O3 was measured by fluorescence increase due to the transformation of 4,5-diaminofluorescein to triazolfluorescein. Coffee inhibited the nitrite-induced fluorescence increase, and 50% inhibition was observed at several microg of coffee/mL in bacterial fraction of saliva as well as whole saliva. During the inhibition of the fluorescence increase, concentration of chlorogenic acid and its isomers decreased. It is discussed that the reduction of NO2 by chlorogenic acid and its isomers contributed to the coffee-dependent inhibition of the fluorescence increase as N2O3 is formed from NO and NO2. When coffee was added to whole saliva, chlorogenic acid and its isomers bound to cells in the saliva. The rate of the fluorescence increase in bacterial fraction, which was prepared at defined periods after the ingestion of coffee, was increased to the rate before the ingestion of coffee with a half-time of about 1 h. This result suggests that chlorogenic acid and its isomers remained in the oral cavity for a few hours after ingestion of coffee. The significance of coffee drinking and rinsing of the mouth with coffee for the health of the oral cavity is proposed.

Bioanalytical profile of the L-arginine/nitric oxide pathway and its evaluation by capillary electrophoresis

This review briefly summarizes recent progress in fundamental understanding and analytical profiling of the L-arginine/nitric oxide (NO) pathway. It focuses on key analytical references of NO actions and the experimental acquisition of these references in vivo, with capillary electrophoresis (CE) and high-performance capillary electrophoresis (HPCE) comprising one of the most flexible and technologically promising analytical platform for comprehensive high-resolution profiling of NO-related metabolites. Another aim of this review is to express demands and bridge efforts of experimental biologists, medical professionals and chemical analysis-oriented scientists who strive to understand evolution and physiological roles of NO and to develop analytical methods for use in biology and medicine.

Thiocyanate Cannot Inhibit the Formation of Reactive Nitrogen Species in the Human Oral Cavity in the Presence of High Concentrations of Nitrite: Detection of Reactive Nitrogen Species with 4,5-Diaminofluorescein

In the human oral cavity, nitrite is reduced to nitric oxide (NO) by certain bacteria. 4,5-Diaminofluorescein (DAF-2) was transformed to a fluorescent component triazolfluorescein (DAF-2T) in a bacterial fraction of saliva in the presence of nitrite. No detectable consumption of DAF-2 and formation of DAF-2T were observed in bacterial fraction in the absence of nitrite. The nitrite-dependent transformation of DAF-2 to DAF-2T was inhibited by catalase, SCN(-), and CN(-) suggesting the participation of peroxidases in saliva in the transformation. The formation of DAF-2T, which was observed by the addition of an NO generating reagent (+/-)-(E)-4-ethyl-2-[(E)-hydroxyimino]-5-nitro-3-hexenamide (NOR 3) to bacterial fraction, was also inhibited by catalase, SCN(-), and CN(-). The degree of the inhibition by SCN(-) decreased as the concentration of nitrite or NOR 3 was increased. Superoxide dismutase (SOD) enhanced nitrite- and NOR 3-induced fluorescence increase in the bacterial fraction, and the degree of the enhancement decreased as the concentrations of nitrite and NOR 3 were increased. In whole saliva filtrate, the inhibitory effects of SCN(-) on the fluorescence increase decreased as the concentration of nitrite was increased, but the enhancement by SOD was not significantly affected by the increase in the concentration of nitrite. As salivary bacteria produce O(2)(-), H(2)O(2), and NO and as peroxidase/H(2)O(2)/nitrite systems in saliva produce NO(2), the effects of SCN(-) are discussed taking SCN(-)-dependent inhibition of NO(2) formation by peroxidases in saliva into consideration and the effects of SOD are discussed taking O(2)(-)-dependent consumption of NO into consideration. It is concluded that when the rate of the formation of NO is high, SCN(-) is not effective enough to inhibit the formation of N(2)O(3) in the oral cavity.

Quercetin-dependent scavenging of reactive nitrogen species derived from nitric oxide and nitrite in the human oral cavity: interaction of quercetin with salivary redox components

In the human oral cavity, nitrite is reduced to nitric oxide (NO) by certain bacteria. The NO formed reacts with O2 to generate NO2 and then with NO2 producing N2O3. In this study, N2O3 produced by the reaction between NO and NO2 was detected by fluorescence increase due to the transformation of 4,5-diaminofluorescein to fluorescent triazolfluorescein. Nitrite-induced fluorescence increase in the bacterial fraction of saliva was completely inhibited by 1muM quercetin and the complete inhibition continued until almost all quercetin had been oxidized. Nitrite-induced fluorescence increase was also observed in the saliva which contained salivary redox components. Quercetin effectively inhibited the fluorescence increase. During the inhibition of the fluorescence increases by quercetin, the flavonol was oxidized. NO2 seemed to participate in the oxidation. The main oxidation product was 2-(3,4-dihydroxybenzoyl)-2,4,6-trihydroxy-3(2H)-benzofurane. Thiocyanate inhibited the fluorescence increase in bacterial fraction and duration of the complete inhibition by quercetin was prolonged by SCN-. The inhibition and the prolongation are discussed to be due to SCN--dependent inhibition of oxidation of nitrite to NO2 by salivary peroxidase. Quercetin cooperated with ascorbate to inhibit the fluorescence increase. From the results obtained in this study, it is deduced (1) that quercetin can protect human oral cavity from damages induced by reactive nitrogen species and (2) that the protective function of quercetin may be significant when antioxidant capacity of saliva is decreased by periodontal diseases.

Tooth loss and obstructive sleep apnoea

BACKGROUND

Complete tooth loss (edentulism) produces anatomical changes that may impair upper airway size and function. The aim of this study was to evaluate whether edentulism favours the occurrence of obstructive sleep apnoea (OSA).

METHODS

Polysomnography was performed in 48 edentulous subjects on two consecutive nights, one slept with and the other without dentures. Upper airway size was assessed by cephalometry and by recording forced mid-inspiratory airflow rate (FIF50). Exhaled nitric oxide (eNO) and oral NO (oNO), were measured as markers of airway and oropharyngeal inflammation.

RESULTS

The apnoea/hypopnoea index (AHI) without dentures was significantly higher than with dentures (17.4 +/- 3.6 versus 11.0 +/- 2.3. p = 0.002), and was inversely related to FIF50 (p = 0.017) and directly related to eNO (p = 0.042). Sleeping with dentures, 23 subjects (48%) had an AHI over 5, consistent with OSA, but sleeping without dentures the number of subjects with abnormal AHI rose to 34 (71%). At cephalometry, removing dentures produced a significant decrease in retropharyngeal space (from 1.522 +/- 0.33 cm to 1.27 +/- 0.42 cm, p = 0.006). Both morning eNO and oNO were higher after the night slept without dentures (eNO 46.1 +/- 8.2 ppb versus 33.7 +/- 6.3 ppb, p = 0.035, oNO 84.6 +/- 13.7 ppb versus 59.2 +/- 17.4 ppb, p = 0.001).

CONCLUSION

These findings suggest that complete tooth loss favours upper airway obstruction during sleep. This untoward effect seems to be due to decrease in retropharyngeal space and is associated with increased oral and exhaled NO concentration.

Failure of nitric oxide production by macrophages and decrease in CD4+ T cells in oral paracoccidioidomycosis: possible mechanisms that permit local fungal multiplication

Paracoccidioidomycosis is a chronic granulomatous disease that induces a specific inflammatory and immune response. The participation of nitric oxide (NO), a product of the inducible nitric oxide synthase enzyme (iNOS), as an important fungicidal molecule against Paracoccidioides brasiliensis has been demonstrated. In order to further characterize the Oral Paracoccidioidomycosis (OP), we undertook an immunohistochemical study of iNOS+, CD45RO+, CD3+, CD8+, CD20+, CD68+ cells and mast cells. The samples were distributed in groups according to the number of viable fungi per mm². Our results showed weak immunolabeling for iNOS in the multinucleated giant cells (MNGC) and in most of the mononuclear (MN) cells, and the proportion of iNOS+ MN/MNGC cells in the OP were comparable to Control (clinically healthy oral tissues). Additionally, our analysis revealed a similarity in the number of CD4+ cells between the Control and the OP groups with higher numbers of fungi. These findings suggest that a low expression of iNOS and a decrease in the CD4+ T cells in OP may represent possible mechanisms that permit the local fungal multiplication and maintenance of active oral lesions.

Quercetin-dependent inhibition of nitration induced by peroxidase/H2O2/nitrite systems in human saliva and characterization of an oxidation product of quercetin formed during the inhibition

Local pH in the oral cavity can decrease to below 7 at the site where acid-producing bacteria are proliferating. Effects of pH on nitration of 4-hydroxyphenylacetic acid were studied using dialyzed human saliva. Dialyzed saliva nitrated 4-hydroxyphenylacetic acid to 4-hydroxy-3-nitrophenylacetic acid in the presence of nitrite and H(2)O(2). The rate of the nitration was dependent on pH, and the maximal rate was observed between pH 5.5 and 7.2. The optimum pH seemed to reflect rates of formation of nitrogen dioxide and 4-hydroxyphenylacetic acid radicals. Quercetin inhibited the nitration. The quercetin-dependent inhibition might be due to scavenging of nitrogen dioxide and 4-hydroxyphenylacetic acid radicals, which were formed by salivary peroxidase-dependent oxidation of nitrite and 4-hydroxyphenylacetic acid, respectively, and competition with nitrite and 4-hydroxyphenylacetic acid for peroxidase in saliva. An oxidation product of quercetin was formed during inhibition of the nitration by quercetin. The oxidation product was identified as 2-(3,4-dihydroxybenzoyl)-2,4,6-trihydroxy-3(2H)-benzofuranone. This component could also be oxidized by salivary peroxidase and nitrogen dioxide radicals. The oxidation products were 2,4,6-trihydroxyphenylglyoxylic and 3,4-dihydroxybenzoic acids. On the basis of the results, the significance of quercetin for inhibition of nitrogen dioxide formation and for scavenging of nitrogen dioxide radicals in the oral cavity is discussed.

Nitric oxide formation in the oropharyngeal tract: possible influence of cigarette smoking

Cigarette smoking reduces the level of nitric oxide (NO) in exhaled air by an unknown mechanism. The view that part of the effect of cigarette smoking on NO production should occur in the oropharyngeal tract is supported by several studies. We have therefore compared smokers and non-smokers regarding non-enzymatic formation of NO from nitrite in the oral cavity since this is a primary candidate target for cigarette smoke. We have also looked at NO synthase-dependent NO formation in the mucosa of the oropharyngeal tract as an alternative target for the inhibitory effect induced by cigarette smoke. Smokers exhaled 67% lower levels of NO than controls (p<0.01, n=15 each group). We could not detect any significant difference in salivary nitrite, nitrate or ascorbate between smokers and non-smokers. Mouthwash with the antibacterial agent chlorhexidine reduced salivary nitrite (-65%) and exhaled NO levels (-10%) similarly in the two groups. Immunohistochemical techniques revealed dense expression of inducible (but not endothelial or neuronal) NO synthase in the squamous epithelium of non-inflamed tonsillar and gingival tissue biopsies. In the same biopsies, significant Ca2+ -independent citrulline-forming activity was detected. We found no difference between smoking and non-smoking subjects regarding NO-synthase expression and in vitro activity. In another group of non-smoking subjects (n=10), spraying the oropharyngeal tract with the NO-synthase inhibitor NG-monomethyl-L-arginine (250 mg) significantly reduced exhaled NO levels for at least 30 min (-18%, p<0.01). Our data suggest that cigarette smoking does not affect non-enzymatic NO formation from nitrite in saliva. However, NO is also formed by inducible NO synthase in the squamous epithelium of the normal oropharyngeal tract. We suggest that cigarette smoking may down-regulate enzymatic NO formation in the oropharyngeal compartment as well as in the bronchial compartment.