Susceptibility of Streptococcus mutans and Streptococcus sobrinus to antimicrobial agents after short-term oral chlorhexidine treatments

Identification of the antibacterial action mechanism of diterpenoids through transcriptome profiling

Effective antibacterial substances of Aralia continentalis have anti-biofilm and bactericidal activity to the oral pathogen Streptococcus mutans. In this study, three compounds extracted from A. continentalis were identified as acanthoic acid, continentalic acid, and kaurenoic acid by NMR and were further investigated how these diterpenoids affect the physiology of the S. mutans. When S. mutans was exposed to individual or mixed fraction of diterpenoids, severe growth defects and unique morphology were observed. The proportion of unsaturated fatty acids in the cell membrane was increased compared to that of saturated fatty acids in the presence of diterpenoids. Genome-wide gene expression profiles with RNA-seq were compared to reveal the mode of action of diterpenoids. Streptococcus mutans commonly enhanced the expression of 176 genes in the presence of the individual diterpenoids, whereas the expression of 232 genes was considerably reduced. The diterpenoid treatment modulated the expression of genes or operon(s) involved in cell membrane synthesis, cell division, and carbohydrate metabolism of S. mutans. Collectively, these findings provide novel insights into the antibacterial effect of diterpenoids to control S. mutans infection, which causes human dental caries.

Phenotypic Adaptation to Antiseptics and Effects on Biofilm Formation Capacity and Antibiotic Resistance in Clinical Isolates of Early Colonizers in Dental Plaque

Despite the wide-spread use of antiseptics in dental practice and oral care products, there is little public awareness of potential risks associated with antiseptic resistance and potentially concomitant cross-resistance. Therefore, the aim of this study was to investigate potential phenotypic adaptation in 177 clinical isolates of early colonizers of dental plaque (Streptococcus, Actinomyces, Rothia and Veillonella spp.) upon repeated exposure to subinhibitory concentrations of chlorhexidine digluconate (CHX) or cetylpyridinium chloride (CPC) over 10 passages using a modified microdilution method. Stability of phenotypic adaptation was re-evaluated after culture in antiseptic-free nutrient broth for 24 or 72 h. Strains showing 8-fold minimal inhibitory concentration (MIC)-increase were further examined regarding their biofilm formation capacity, phenotypic antibiotic resistance and presence of antibiotic resistance genes (ARGs). Eight-fold MIC-increases to CHX were detected in four Streptococcus isolates. These strains mostly exhibited significantly increased biofilm formation capacity compared to their respective wild-type strains. Phenotypic antibiotic resistance was detected to tetracycline and erythromycin, consistent with the detected ARGs. In conclusion, this study shows that clinical isolates of early colonizers of dental plaque can phenotypically adapt toward antiseptics such as CHX upon repeated exposure. The underlying mechanisms at genomic and transcriptomic levels need to be investigated in future studies.

New Autonomous Water-Enabled Self-Healing Coating Material with Antibacterial-Agent-Releasing Properties

A new autonomous water-enabled self-healing coating with antibacterial-agent-releasing capability was developed for the first time by precipitating an aqueous solution of hydrogen-bonded tannic acid (TA) and polyethylene glycol (PEG) (TA: 5 mg/mL; PEG: 5 mg/mL with M_W = 100 kDa) to form a smooth, uniform coating layer with an average roughness of 0.688 nm and thickness of 22.3 μm on a polymethyl methacrylate (PMMA) substrate after 10 min of incubation. Our method is cost- and time-efficient, as the hydrophilic coating (water contact angle = 65.1°) forms rapidly, binding strongly to the PMMA substrate (adhesive energy = 83 mJ/m²), without the need for pretreatment or surface modification, and is capable of rapid self-repair (approximately 5 min) through hydrogen bonding in aqueous media. Furthermore, adding 0.5 mg/mL of chlorhexidine acetate (CHX), a commonly used antibacterial agent in dentistry, into the TA–PEG emulsion allowed the release of 2.89 μg/mL of the drug from the coating layer, which is promising for actively inhibiting the vitality and growth of bacteria around PMMA dental restorations. The use of CHX-loaded TA–PEG hydrogen-bonded complexes is highly favorable for the fabrication of an autonomous self-healing biocoating with active antibacterial-agent-releasing capability, which can be applied not only in dentistry but also in other medical fields.

A New Antibacterial Agent-Releasing Polydimethylsiloxane Coating for Polymethyl Methacrylate Dental Restorations

Chlorhexidine (CHX) has been incorporated into the composition of polymethyl methacrylate (PMMA) dental restorations to enhance their antimicrobial performance. However, the controlled delivery of CHX remains a challenge. Although previous findings with pure silica or polymer coatings demonstrated the resistance to bacterial adhesion, they did not provide antibacterial activity beyond the coated surface. Polydimethylsiloxane (PDMS) and mesoporous silica nanoparticles (MSNs) are widely used in biomedical science as a transfer medium in drug delivery systems. Here, the MSNs are used to encapsulate CHX, and the combination is added to PDMS. A thin coating film is formed on the PMMA, using oxygen plasma and thermal treatment. The liquid chromatography analysis shows that the coating film has high encapsulation efficiency and loading capacity, with a slow and stable release rate of CHX. The cytotoxicity tests also show that the coating does not affect the proinflammatory cytokines, cellular mitotic activity, or apoptotic cell death. The ability of the coating to release CHX indicates that the coating may even be effective against bacteria that are not directly in contact with the surface. This antibacterial protective film is expected to be a novel method to inhibit bacterial activity distal to the coated surfaces of PMMA restorations.

Development of antiseptic adaptation and cross-adapatation in selected oral pathogens in vitro

There is evidence that pathogenic bacteria can adapt to antiseptics upon repeated exposure. More alarming is the concomitant increase in antibiotic resistance that has been described for some pathogens. Unfortunately, effects of adaptation and cross-adaptation are hardly known for oral pathogens, which are very frequently exposed to antiseptics. Therefore, this study aimed to determine the in vitro increase in minimum inhibitory concentrations (MICs) in oral pathogens after repeated exposure to chlorhexidine or cetylpyridinium chloride, to examine if (cross-)adaptation to antiseptics/antibiotics occurs, if (cross-)adaptation is reversible and what the potential underlying mechanisms are. When the pathogens were exposed to antiseptics, their MICs significantly increased. This increase was in general at least partially conserved after regrowth without antiseptics. Some of the adapted species also showed cross-adaptation, as shown by increased MICs of antibiotics and the other antiseptic. In most antiseptic-adapted bacteria, cell-surface hydrophobicity was increased and mass-spectrometry analysis revealed changes in expression of proteins involved in a wide range of functional domains. These in vitro data shows the adaptation and cross-adaptation of oral pathogens to antiseptics and antibiotics. This was related to changes in cell surface hydrophobicity and in expression of proteins involved in membrane transport, virulence, oxidative stress protection and metabolism.

Effectiveness of probiotic, chlorhexidine and fluoride mouthwash against Streptococcus mutans - Randomized, single-blind, in vivo study

Aim:

To determine the short-term efficiency of probiotic, chlorhexidine, and fluoride mouthwashes on plaque Streptococcus mutans level at four periodic intervals.

Materials and Methods:

This was a single-blind, randomized control study in which each subject was tested with only one mouthwash regimen. Fifty-two healthy qualified adult patients were selected randomly for the study and were divided into the following groups: group 1- 10 ml of distilled water, group 2- 10 ml of 0.2% chlorhexidine mouthwash, group 3- 10 ml of 500 ppm F/400 ml sodium fluoride mouthwash, and group 4- 10 ml of probiotic mouthwash. Plaque samples were collected from the buccal surface of premolars and molars in the maxillary quadrant. Sampling procedure was carried out by a single examiner after 7 days, 14 days, and 30 days, respectively, after the use of the mouthwash. All the samples were subjected to microbiological analysis and statistically analyzed with one-way analysis of variance (ANOVA) and post-hoc test.

Results:

One-way ANOVA comparison among groups 2, 3, and 4 showed no statistical significance, whereas group 1 showed statistically significant difference when compared with groups 2, 3, and 4 at 7^th, 14^th, and 30^th day.

Conclusion:

Chlorhexidine, sodium fluoride, and probiotic mouthwashes reduce plaque S. mutans levels. Probiotic mouthwash is effective and equivalent to chlorhexidine and sodium fluoride mouthwashes. Thus, probiotic mouthwash can also be considered as an effective oral hygiene regimen.

Antimicrobial activity of alexidine, chlorhexidine and cetrimide against Streptococcus mutans biofilm

Background

The use of antimicrobial solutions has been recommended to disinfect demineralized dentin prior to placing the filling material. The aim of this study was to evaluate the ability of several antimicrobials in controlling Streptococcus mutans (SM) biofilm formed in dentin.

Methods

Antimicrobial activity of 0.2% and 2% chlorhexidine (CHX), 0.2% cetrimide (CTR) and 0.2%, 0.5%, 1% and 2% alexidine (ALX) was assayed on 1-week SM biofilm formed on standardized coronal dentin blocks. Results of SM biofilm antimicrobial activity by different protocols were expressed as the kill percentage of biofilm and the term “eradication” was used to denote the kill of 100% of the bacterial population. To compare the efficacies of the different protocols the Student t test was used, previously subjecting data to the Anscombe transformation.

Results

All ALX concentrations tested and 0.2% CTR achieved a kill percentage higher than 99%, followed by 2% CHX with percentages above 96% (no statistically significant difference among them). Whereas 2% ALX and 0.2% CTR respectively showed eradication in 10 and 9 of the twelve specimens, 0.2% CHX did not produce eradication in any case.

Conclusions

The present study shows that, when used for one minute, 2% and 1% alexidine, and 0.2% cetrimide, achieve eradication of Streptococcus mutans biofilm in most specimens when applied to a dentin-volumetric model.

Effect of chlorhexidine gluconate, Clearfil Protect Bond, and KTP laser on microleakage under metal orthodontic brackets with thermocycling

OBJECTIVE

The purpose of this study was to evaluate the effects of antimicrobial pretreatments [chlorhexidine gluconate (CHX), Clearfil Protect Bond (CPB), and potassium-titanyl-phosphate (KTP) laser] on microleakage under metal orthodontic brackets.

MATERIALS AND METHODS

Sixty freshly-extracted human premolars were randomly assigned to four equal groups: group 1, 37% phosphoric acid; group 2, 37% phosphoric acid + 2% CHX; group 3, 37% phosphoric acid + KTP laser; and group 4, CPB. The teeth were kept in distilled water for 24 h, and thereafter subjected to 500 thermal cycles. Then specimens were sealed with nail varnish, stained with 0.5% basic fuchsin for 24 h, sectioned, and evaluated under a stereomicroscope. Microleakage was scored with regard to the adhesive-tooth interface and the bracket-adhesive interface at both incisal and gingival margins by the same person. Statistical analysis was accomplished by one-way ANOVA and the Kruskal-Wallis test, with significance set at p = 0.05.

RESULTS

Microleakage was observed in all groups. No statistically significant difference was observed among all groups in terms of microleakage when bracket-adhesive and bracket-enamel interface along both gingival and incisal margins was evaluated (p > 0.05).

CONCLUSIONS

The lowest microleakage scores were observed in the control group. CPB, KTP, and CHX groups did not show significant differences with the control group (p > 0.05), but the mean scores of the CHX group were higher than those of the other two experimental groups.

Microleakage in Resin Composite Restorations After Antimicrobial Pre-treatments: Effect of KTP Laser, Chlorhexidine Gluconate and Clearfil Protect Bond

Although none of the procedures tested in this study completely eliminated microleakage, KTP laser irradiation exhibited the lowest microleakage scores for both enamel and gingival margins.

Inhibition of cultivable bacteria by chlorhexidine treatment of dentin lesions treated with the ART technique

The aim of this study was to examine the changes in the cultivable microflora of carious dentin before and after atraumatic restorative treatment (ART) and investigate the inhibitory effect of chlorhexidine-gluconate-based cavity disinfectant in the microflora. Using a split mouth design, 35 primary molar pairs with class II carious lesions in 35 patients (mean age 7.31+/-0.47 years) were selected. The total viable counts (TVC), Streptococcus mutans and lactobacilli were first measured in the center of the infected demineralized lesion and then from the hard dentine after caries removal by the ART technique. Chlorhexidine-gluconate (2%)-based cavity disinfectant was applied to one of the molar pairs and the other molar received no disinfectant treatment. Thereafter, all of the teeth were restored with glass ionomer cement (GIC). Cavities were reassessed after 6 months and again dentine samples were microbiologically investigated. Removal of carious dentine by ART significantly reduced TVC, S. mutans and lactobacilli. After 6 months, application of chlorhexidine exhibited a greater significant reduction in TVC (p=0.013), and a significant reduction in S. mutans compared to the nondisinfected group (p<0.001). A significant reduction in lactobacilli counts was observed in both groups after 6 months, but the difference between the disinfected and nondisinfected groups was not significant (p=0.056). ART was found to be effective in reducing the cultivable microflora and chlorhexidine-gluconate-based cavity disinfectant might serve as a suitable additional agent in inhibiting the residual bacteria in the dentine.

Growth-Inhibitory Effect of Antibacterial Self-Etching Primer on Mutans Streptococci Obtained from Arrested Carious Lesions

BACKGROUND

An antibacterial self-etching primer has been developed to inhibit bacterial attachment and plaque accumulation on the tooth surfaces. The purpose of this study was to evaluate the growth-inhibitory effect of an antibacterial self-etching primer on mutans streptococci obtained from arrested carious lesions.

MATERIALS AND METHODS

Softened dentin specimens were obtained from arrested carious lesions with an excavator or a round steel bur. The effect of a commercial antibacterial self-etching primer and a commercial self-etching primer on the total streptococci on Mitis-Salivarius (MS) agar plates and on Streptococcus mutans on MS agar plates containing 0.02 M bacitracin (MSB) was evaluated. Specimens with no primer were used as controls. The number of colonies of both total streptococci and S. mutans were compared statistically with two-way analysis of variance and Fisher's Protected Least Squares Differences (PLSD) test (p < .05).

RESULTS

The number of colonies of total streptococci (CFU/mL) for the two methods (excavator and round steel bur) were as follows: for the control, 5.0 x 10(6) and 5.0 x 10(6); for the self-etching primer, 1.0 x 10(5) and 1.0 x 10(5); and for the antibacterial self-etching primer, 0 and 0. The number of colonies of S. mutans for the two methods (excavator and round steel bur) were as follows: for the control, 5.0 x 10(6) and 1.8 x 10(5); for the self-etching primer, 3.5 x 10(4) and 5.0 x 10(3); and for the antibacterial self-etching primer, 0 and 0. Regardless of the method of softened dentin removal, the antibacterial effect was significantly higher for the group that had antibacterial self-etching primer compared with that of the control group and the group that had commercial self-etching primer (p < .05).

CLINICAL SIGNIFICANCE

The antibacterial self-etching primer showed a high level of antibacterial activity against mutans streptococci obtained from the arrested carious lesions.

Antiplaque biocides and bacterial resistance: a review

Modern dentistry emphasizes the importance of dental plaque control to improve oral health. The use of oral care formulations with antiplaque biocides plays a crucial role in patient-directed approaches for plaque control. The antiplaque efficacies of these formulations have been extensively studied in many long-term clinical studies designed in accordance with well-accepted guidelines. The results from these studies conclusively demonstrate that long-term use of oral care formulations with well-known antiplaque biocides such as chlorhexidine and triclosan reduce supragingival plaque and gingivitis. This review summarizes microbiological results from clinical studies conducted with oral care formulations containing antiplaque biocides. Results from a number of long-term clinical studies conducted under real-life use conditions indicate no adverse alterations in the bacteria found in dental plaque or emergent microbial resistance. Additionally, microbial sampling of dental plaque subsequent to extended use of antiplaque biocides reveals no increase in resistant microflora. Large numbers of common oral bacteria isolated from patients using chlorhexidine indicate no increase in microbial resistance to chlorhexidine or to commonly used antibiotics. The effects of antiplaque biocides containing oral care formulations on dental plaque that exists naturally as a biofilm are examined. These formulations contain biocide, surfactants, polymers and other components that are effective against the biofilm. In summary, the results of studies on the real-life use of oral care formulations with antiplaque biocides show no emergence of resistant microflora or alterations of the oral microbiota, while such formulations have been found to provide the benefits of reducing plaque and gingivitis.

Resistance to mercury and antimicrobial agents in Streptococcus mutans isolates from human subjects in relation to exposure to dental amalgam fillings

Resistance to cefuroxime, penicillin, tetracycline, and mercury is reported for 839 Streptococcus mutans isolates from 209 human study subjects. The MICs of these drugs did not differ for isolates from one dental amalgam group and two nonamalgam subsets: a group with no known exposure to amalgam and a group whose members had their amalgam fillings removed.

The effect of monitored chlorhexidine gel treatment on mutans streptococci in margins of restorations

OBJECTIVES

The objective of this study was to compare the effect of a monitored chlorhexidine (CHX) gel treatment with a conventional two-day CHX treatment in subjects with well-restored dentitions and high numbers of salivary mutans streptococci (MS).

METHODS

In the test group (n = 8), the effect of the CHX gel applications was monitored in margins of restorations and in saliva during a period of 12 weeks. Strip Mutans was used for monitoring and whenever a sample revealed growth of MS, the subject received a 3 x 5 min 1% CHX gel treatment at the clinic. Nine subjects (control group) were only given the baseline (conventional) treatment with CHX gel 3 x 5 min on two consecutive days.

RESULTS

The monitored treatment in the test group resulted in a more pronounced reduction of MS both in margins of restorations and in saliva than the conventional treatment. The difference between the level of MS in the margins in the two groups was, however, only significant at the 20-week examination. There was a large individual variation in the effect of the CHX treatment, and three to nine extra CHX gel applications were needed in the test group to keep MS below a detectable level during the 12 weeks.

CONCLUSIONS

Our findings illustrate the difficulties to obtain a long-lasting reduction of MS in subjects with a large number of restorations and a high number of MS by antimicrobial treatment only. The results indicate the necessity to combine antimicrobial treatment with, for example, sucrose restriction, in order to keep MS at a low level for a longer period of time.

Effects of chlorhexidine on the bacterial colonization and degradation of dentin and completely demineralized dentin in situ

The effects of 0.2% chlorhexidine on selected plaque microorganisms were studied in an intraoral dentin caries model. In 8 individuals wearing partial dentures, sound and completely demineralized dentin specimens were placed consecutively in 2 periods of 4 weeks, respectively. Throughout the experimental period, the specimens were treated 2 x daily with 0.2% chlorhexidine; control specimens were treated with water. Plaque accumulation on the specimens was left undisturbed. No protection against demineralization of the dentin or degradation of the dentin collagen by the chlorhexidine treatment was observed. The chlorhexidine treatment did not result in a reduction of the total cultivable flora when compared with the control specimens. A significant reduction of mutans streptococci and total streptococci recovered from completely demineralized dentin treated with chlorhexidine was observed, but the proportions of Actinomyces and lactobacilli were not affected significantly. It is speculated that areas of exposed roots, which are difficult to reach by oral hygiene measurements, such as approximal surfaces, will not be protected by a 0.2% chlorhexidine mouthrinse against the caries process.

Oral pathoses caused by Candida albicans during chemotherapy: update on development mechanisms

Oral candidiasis occurs at a high frequency among immunocompromised hosts. The development mechanisms of oral pathoses associated with Candida are complex and certainly multifactorial. In immunocompromised patients, they include the evolution of the buccal flora associated with the influence of antineoplastic treatments and immunosuppression. They also include adherence of Candida to epithelial cells of the oral cavity as a function of host cell-related and yeast-related factors. Interaction and cooperation between Candida and bacteria could be a third influence in the development of oral candidiasis. It seems important to determine these mechanisms more precisely so as to improve preventive and therapeutic measures.