Phototargeting oral black-pigmented bacteria

Current perspective on dental black stain of bacterial origin: A narrative review

Dental black stain is a form of external discoloration appearing as a dark line or an incomplete coalescence of dark spots in the cervical third of the tooth. This review aims to provide an up-to-date clinical and biological summary of dental black stain of bacterial origin. Black stain is esthetically unwelcome to patients, and clinicians frequently attempt its removal. Dental black plaque has a prevalence rate of 2.4%-20% affecting both genders equally and may appear throughout the lifetime. Most studies investigating the microflora of black stain reveal that Actinomyces spp. are the most abundant species found. Most authors have found a correlation between black stain and a low caries incidence. Interestingly, individuals with black stain demonstrate higher salivary concentrations of iron, sodium, copper, and calcium/phosphate, higher pH, and lower salivary flow. Standard treatment involves repeated professional ultrasonic cleaning. Alternative treatments include photo-dynamic therapy, application of virgin coconut oil, peroxide therapy, lactoferrin, or oral probiotics. Our best interpretation of the causes implicates the involvement of oral bacteria, resulting in the deposition of iron ions in patients with altered salivary composition. The use of any treatments should be balanced against potential damage to the teeth as a result of the therapy.

Clinical and Microbiological Effectiveness of Diode Laser for Treating Patients with Stage II Grade A Periodontitis Patients: Split-Mouth Study

Objectives: This split-mouth randomized controlled clinical trial aimed to evaluate the efficacy of diode laser therapy as an adjunct to scaling and root planning (SRP) in the management of patients with stage II grade A periodontitis. Methods: Thirty participants were randomly assigned to receive either SRP alone (control group) or SRP and diode laser application (study group) on the contralateral side. Clinical parameters (plaque index, gingival index, probing depth, and clinical attachment level) and microbiological markers; Aggregatibacter actinomycetemcomitans (A actinomycetemcomitans), Porphyromonas gingivalis (P gingivalis), and Fusobacterium nucleatum (F nucleatum) were evaluated at baseline and at 4, 8, and 12 weeks post-treatment. Results: Both groups reported significant improvements in all clinical parameters over the follow-up period. The study group reported a significantly higher reduction in probing depth at 12 weeks than the SRP-alone group. Microbiological evaluation revealed significantly greater reductions in P gingivalis and F. nucleatum levels in the study group at later time points, whereas no significant alterations were observed for A actinomycetemcomitans. Conclusions: Our results suggest that the adjunctive use of diode laser therapy may improve the clinical and microbiological findings of nonsurgical periodontal management in patients with stage II grade A periodontitis.

Optical analysis for effective phototherapy in an LED oral care device

This paper investigates the advanced capabilities of light-emitting diodes (LEDs) in oral care devices, emphasizing their versatility in wavelength control and ability to reach complex areas within the oral cavity. While LEDs enable precise dosage control and adjustable penetration depths, existing oral care devices are often limited to single-wavelength designs, primarily targeting anterior teeth whitening or lateral surfaces, thereby failing to provide comprehensive oral coverage. To address these limitations, this study introduces a novel LED-based oral care device integrating three distinct wavelengths: blue for antibacterial effects, green for anti-inflammatory effects, and red for preventive and therapeutic applications. Using computed tomography (CT) data, upper and lower dental arch trajectories were acquired to design a flexible printed circuit board (FPCB) that conforms to the natural curvature of the dental arch. Strategically placed LEDs on the FPCB ensure uniform light distribution and optimized irradiance across the entire oral cavity. This research systematically determines the optimal design parameters and operating conditions necessary for achieving appropriate irradiance density, including LED placement, operating time, and power control through driving current and duty cycles. The findings demonstrate a practical and effective approach to overcoming the current limitations of LED oral care devices, significantly enhancing their performance and applicability in dental phototherapy.

Exploring heme and iron acquisition strategies of Porphyromonas gingivalis-current facts and hypotheses

Iron and heme are crucial for pathogenic bacteria living in the human host but are not available in free form due to their binding by iron- and heme-sequestering proteins. Porphyromonas gingivalis causes dysbiosis in the oral microbiome and is considered a keystone pathogen in the onset and progression of periodontal diseases. Its ability to infect and multiply in host cells and its presence in distant tissues and fluids highlights its pathogenic versatility and explains the relationship between periodontal diseases and systemic or neurodegenerative diseases. Porphyromonas gingivalis has evolved specialized mechanisms that allow it to thrive in the host under adverse nutrient-limited conditions. This review presents the updated summary of the mechanisms of iron and heme acquisition by P. gingivalis, with a central role played by gingipains and the unique Hmu system. The potential role of other iron and heme acquisition systems, such as Hus and Iht, indicates the importance of the partially conserved heme biosynthesis pathway, involving homologs of the HemN, HemG, and HemH proteins. In light of increasing antibiotic resistance, difficulties with diagnosis, and drug administration, targeting the mechanisms of heme and iron acquisition of P. gingivalis represents a promising target for developing diagnostic tests, preventive or therapeutic strategies.

Chromogenic bacterial staining of teeth: a scoping review

BACKGROUND

The purpose of this scoping review is to understand the etiological, clinical characteristics and treatment of chromogenic staining of teeth and the various management strategies reported in literature. This SR was performed in accordance with the PRISMA 2022 guidelines and was registered in the PROSPERO database (CRD42024565446).

METHODS

A systematic electronic search on databases like Scopus, Medline, EMBASE, CINAHL, ProQuest and Web of Science from inception to July 2024 was performed. Two independent reviewers ran the search strategy in the mentioned databases.

RESULTS

A total of 989 articles were obtained from various databases. 21 were included for data extraction of which 2 were case reports, 1 was case series and 18 were research articles. The prevalence of staining due to chromogenic bacteria reported from the included studies ranged from 3.1 to 18.5%. All these studies reported on the typical black color of staining of teeth.

CONCLUSION

This scoping review reveals sparsity in existing literature regarding the etiological, clinical characteristics and management of chromogenic staining of teeth. Though the role of peculiar oral microbiota is well established, evidence regarding the management strategies to combat these recalcitrant staining remains a strong research question.

Neutrophil response to Porphyromonas gingivalis is modulated by low-level laser application

OBJECTIVES

Neutrophil response is critical in inflammatory regulation and immune response to bacterial infections. During periodontal disease, pathogenic bacteria lead to exaggerated neutrophil responses. We hypothesized that low-level laser application (LLLT), therapeutic strategy for dampening inflammatory processes, will regulate neutrophil activity in response to periodontopathogens.

MATERIALS AND METHODS

The impact of LLLT on neutrophil responses was measured by light delivered at wavelength of 850 nm. The direct effect of LLLT on P. gingivalis A7436 was determined by flow cytometry using LIVE/DEADTM Cell Vitality kit. The phagocytosis of P. gingivalis A7436 by human neutrophils was measured using flow cytometry. Superoxide generation was measured by cytochrome-C-reduction in the presence of N-formyl-L-methionyl-L-leucyl-L-phenylalanine (fMLP; 1 mM). Cytokine release by neutrophils was measured by multiplex immunoassay.

RESULTS

The phagocytosis of P. gingivalis by primary human neutrophils was significantly reduced in response to LLLT (p < 0.05). While LLLT led to increased superoxide production in neutrophils that were not challenged by P. gingivalis, it dampened the increased superoxide and IL-6 release by the neutrophils in response to P. gingivalis. LLLT did not directly affect the viability of P. gingivalis.

CONCLUSION

These results suggested that LLLT can provide therapeutic strategy in periodontal disease, regulating the neutrophil response to P. gingivalis.

Glutamate is a key nutrient for Porphyromonas gingivalis growth and survival during intracellular autophagic life under nutritionally limited conditions

Porphyromonas gingivalis survives in special autophagic vacuoles that serve as major replicative habitats in human primary gingival epithelial cells (GECs). As an asaccharolytic strict anaerobe, P. gingivalis is dependent on amino acids and peptides for nutrient sources. However, it is largely unknown as to P. gingivalis' metabolic processing under the nutritionally limited intracellular environments such the vacuoles, especially the preferred amino acids and associated-metabolic machineries. Here we elucidate that a Glutamate (Glu) catabolic enzyme, glutamate dehydrogenase (GdhA) is highly enriched in the isolated P. gingivalis -containing vacuoles. Interestingly, we found that P. gingivalis induces conversion of intracellular glutamine pool to Glu determined by analyses of the P. gingivalis- containing vacuoles and the whole infected-GECs. Critically, exogenous Glu-Glu dipeptide, a simple precursor of Glu, significantly increases the size of isolated intact P. gingivalis containing-vacuoles and live wild-type P. gingivalis numbers in GECs. In contrast, the isogenic GdhA-deficient-strain, Δ gdhA displayed a significant growth defect with collapsed-vacuoles in GECs. Next, we confirmed that P. gingivalis uptakes 14 C-Glu and it preferentially utilizes Glu-Glu-dipeptide using a nutritionally reduced Tryptic-Soy-Broth (TSB) media supplemented with Glu-Glu. Contrary, Δ gdhA -strain showed no detectable growth especially in nutritionally reduced TSB media with Glu-Glu. Using Atomic-Force-Microscopy, we observed that, wild-type P. gingivalis but not Δ gdhA strain notably increased the cell volume upon Glu-Glu supplementation, an indicator of higher metabolism and growth. Utilization of a human gingiva-mimicking organoid-system further validated the importance of Glu as an essential nutrient for the intramucosal colonization of P. gingivalis via the protected replicative vacuoles in GECs.

Importance

This study reveals that P. gingivalis heavily depends on preferential utilization of Glutamate (Glu) for autophagic vacuolar growth and survival in human GECs. Several novel observations are made to support this: (i) GdhA of P. gingivalis is highly enriched in these vacuoles, (ii) P. gingivalis induces a large conversion of intracellular glutamine to Glu, (iii) size of vacuoles are significantly increased in the presence of Glu-Glu in P. gingivalis wild-type strain infection which is opposite in a Δ gdhA strain, (iv) P. gingivalis uptakes 14 C-Glu and preferentially utilizes Glu-Glu dipeptide, (v) similarly, wild-type strain shows growth increase in a nutritionally reduced bacterial culture media, and (vi) finally, Glu-Glu supplementation increases bacterial cell-volume of P. gingivalis wild-type but not Δ gdhA strain, an indicator of higher metabolism and growth. Taken together, this study highlights the pathophysiological importance of Glu for P. gingivalis growth-rate, biomass induction and survival in nutritionally limited host subcellular environments.

Photodynamic therapy empowered by nanotechnology for oral and dental science: Progress and perspectives

Photodynamic therapy (PDT), as a noninvasive therapeutic modality, has significantly revolutionized the contemporary management of oral and dental health. Recently, PDT has witnessed significant technological advancements, especially with the introduction of biomaterials and nanotechnologies, thus highlighting its potential as a multi-functional tool in therapeutics. In this review, our objective was to provide a comprehensive overview of the advancements in nanotechnology-enhanced PDT for the treatment of oral diseases, encompassing dental caries, root canal infection, periodontal disease, peri-implant inflammation, tooth staining, and whitening, as well as precancerous lesions and tumors. Furthermore, we extensively deliberated upon the persisting challenges and prospective avenues of nanotechnology-enhanced PDT in the realm of oral diseases, which will open up new possibilities for the application of nanotechnology-enhanced PDT in clinical implementation.

Effects of various light-emitting diode wavelengths on periodontopathic bacteria and gingival fibroblasts: An in vitro study

BACKGROUND

In recent years, light has been used for bacterial control of periodontal diseases. This in vitro study evaluated the effects of light-emitting diode (LED) irradiation at different wavelengths on both Porphyromonas gingivalis and human gingival fibroblasts (HGF-1).

METHODS

P. gingivalis suspension was irradiated with LEDs of 365, 405, 450, 470, 565, and 625 nm at 50, 100, 150, and 200 mW/cm2 for 3 min (radiant exposure: 9, 18, 27, 36 J/cm2, respectively). Treated samples were anaerobically cultured on agar plates, and the number of colony-forming units (CFUs) was determined. Reactive oxygen species (ROS) levels were measured after LED irradiation. The viability and damage of HGF-1 were measured through WST-8 and lactate dehydrogenase assays, respectively. Gene expression in P. gingivalis was evaluated through quantitative polymerase chain reaction.

RESULTS

The greatest reduction in P. gingivalis CFUs was observed on irradiation at 365 nm with 150 mW/cm2 for 3 min (27 J/cm2), followed by 450 and 470 nm under the same conditions. While 365-nm irradiation significantly decreased the viability of HGF-1 cells, the cytotoxic effects of 450- and 470-nm irradiation were comparatively low and not significant. Further, 450-nm irradiation indicated increased ROS production and downregulated the genes related to gingipain and fimbriae. The 565- and 625-nm wavelength groups exhibited no antibacterial effects; rather, they significantly activated HGF-1 proliferation.

CONCLUSIONS

The 450- and 470-nm blue LEDs showed high antibacterial activity with low cytotoxicity to host cells, suggesting promising bacterial control in periodontal therapy. Additionally, blue LEDs may attenuate the pathogenesis of P. gingivalis.

Application of Different Wavelengths of LED Lights in Antimicrobial Photodynamic Therapy for the Treatment of Periodontal Disease

Therapeutic light has been increasingly used in clinical dentistry for surgical ablation, disinfection, bio-stimulation, reduction in inflammation, and promotion of wound healing. Photodynamic therapy (PDT), a type of phototherapy, has been used to selectively destroy tumor cells. Antimicrobial PDT (a-PDT) is used to inactivate causative bacteria in infectious oral diseases, such as periodontitis. Several studies have reported that this minimally invasive technique has favorable therapeutic outcomes with a low probability of adverse effects. PDT is based on the photochemical reaction between light, a photosensitizer, and oxygen, which affects its efficacy. Low-power lasers have been predominantly used in phototherapy for periodontal treatments, while light-emitting diodes (LEDs) have received considerable attention as a novel light source in recent years. LEDs can emit broad wavelengths of light, from infrared to ultraviolet, and the lower directivity of LED light appears to be suitable for plaque control over large and complex surfaces. In addition, LED devices are small, lightweight, and less expensive than lasers. Although limited evidence exists on LED-based a-PDT for periodontitis, a-PDT using red or blue LED light could be effective in attenuating bacteria associated with periodontal diseases. LEDs have the potential to provide a new direction for light therapy in periodontics.

Evaluation of the antibacterial activity of cinnamon essential oil and its individual compounds on Aggregatibacter actinomycetemcomitans isolated from black extrinsic tooth stain: an in vitro study

AIM

Black extrinsic tooth stain (BETS) is a health challenge that commonly affects children. Aggregatibacter actinomycetemcomitans (Aa) presents in higher prevalence within the polymicrobial community of BETS. In this study, the anti-planktonic and anti-sessile activities of cinnamon essential oil (CEO) and its individual compounds against Aa were evaluated. The preventive effect of CEO and its active substances on BETS formation was also studied in vitro.

METHODS

Aa was isolated from a preschool child with BETS and was identified based on the morphological characteristics, MALDI-TOF mass spectroscopy and 16S rRNA sequencing. The effect of CEO and its individual compounds on the growth kinetics of planktonic and sessile Aa cells as well as their antibacterial efficacy and their rate of bacterial killing were examined. The preventive effect of CEO and its active substances on the formation of BETS was evaluated using an ex vivo model. The data were analysed using one-way analysis of variance (ANOVA) and the significance level was set at p < 0.05.

RESULTS

Out of eight individual compounds of CEO, only eugenol, cinnamaldehyde and α-methyl cinnamaldehyde showed anti-Aa activities. The values of the minimum inhibitory concentrations (MICs) were in the following order: CEO (421.5 mg/ml) > α-methyl cinnamaldehyde (26.37 mg/ml) > cinnamaldehyde (0.209 mg/ml) > eugenol (0.052 mg/ml). CEO, eugenol, cinnamaldehyde and α-methyl cinnamaldehyde, respectively, exhibited two-, four-, four- and eightfold increase of sessile MIC compared to their planktonic MIC. The growth kinetics of both planktonic and sessile Aa in the presence of CEO, eugenol, cinnamaldehyde and α-methyl cinnamaldehyde revealed a complete inhibition at the MICs and 5.3%-37.4% biofilm inhibition at sub-MICs. The time-killing study demonstrated that CEO, eugenol and cinnamaldehyde were capable of reducing the survival rate of both planktonic and sessile Aa cells after 15-20 and 25-30 min, respectively. However, α-methyl cinnamaldehyde showed a superior anti-planktonic to anti-biofilm activity. The daily incorporation of CEO, eugenol and cinnamaldehyde at their MICs for 14 days totally prevented the formation of BETS in the ex vivo model; however, in the case of α-methyl cinnamaldehyde, BETS was visually detectable after 10 days.

CONCLUSION

CEO and its individual compounds have marked antibacterial activity against Aa. The effective results against planktonic and sessile Aa within reasonable time indicate that they can be used to prevent BETS.

Photoinactivation and Photoablation of Porphyromonas gingivalis

Several types of phototherapy target human pathogens and Porphyromonas gingivitis (Pg) in particular. The various approaches can be organized into five different treatment modes sorted by different power densities, interaction times, effective wavelengths and mechanisms of action. Mode 1: antimicrobial ultraviolet (aUV); mode 2: antimicrobial blue light (aBL); mode 3: antimicrobial selective photothermolysis (aSP); mode 4: antimicrobial vaporization; mode 5: antimicrobial photodynamic therapy (aPDT). This report reviews the literature to identify for each mode (a) the putative molecular mechanism of action; (b) the effective wavelength range and penetration depth; (c) selectivity; (d) in vitro outcomes; and (e) clinical trial/study outcomes as these elements apply to Porphyromonas gingivalis (Pg). The characteristics of each mode influence how each is translated into the clinic.

Blue light and skin: what is the intriguing link?

Blue light has garnered attention because of its ability to penetrate more deeply into the skin layers, and induce cellular dysfunction and DNA damage. Photoageing, hyperpigmentation and melasma are some of the cutaneous changes that develop on exposure to blue light. To date, the therapeutic roles of blue light have been evaluated in dermatological conditions like psoriasis, eczema, acne vulgaris, actinic keratosis and cutaneous malignancies, among others. In this review, we have attempted to present an evidence-based compilation of the effects of blue light on the skin.

Laboratory evaluation of the broad-spectrum antibacterial efficacy of a low-irradiance visible 405-nm light system for surface-simulated decontamination

Purpose

Lighting systems which use visible light blended with antimicrobial 405-nm violet-blue light have recently been developed for safe continuous decontamination of occupied healthcare environments. This paper characterises the optical output and antibacterial efficacy of a low irradiance 405-nm light system designed for environmental decontamination applications, under controlled laboratory conditions.

Methods

In the current study, the irradiance output of a ceiling-mounted 405-nm light source was profiled within a 3×3×2 m (18 m3) test area; with values ranging from 0.001-2.016 mWcm-2. To evaluate antibacterial efficacy of the light source for environmental surface decontamination, irradiance levels within this range (0.021-1 mWcm-2) at various angular (Δ ϴ=0-51.3) and linear (∆s=1.6-2.56 m) displacements from the source were used to generate inactivation kinetics, using the model organism, Staphylococcus aureus. Additionally, twelve bacterial species were surface-seeded and light-exposed at a fixed displacement below the source (1.5 m; 0.5 mWcm-2) to demonstrate broad-spectrum efficacy at heights typical of high touch surfaces within occupied settings.

Results

Results demonstrate that significant (P≤0.05) inactivation was successfully achieved at all irradiance values investigated, with spatial positioning from the source affecting inactivation, with greater times required for inactivation as irradiance decreased. Complete/near-complete (≥93.28%) inactivation of all bacteria was achieved following exposure to 0.5 mWcm-2 within exposure times realistic of those utilised practically for whole-room decontamination (2-16 h).

Conclusion

This study provides fundamental evidence of the efficacy, and energy efficiency, of low irradiance 405-nm light for bacterial inactivation within a controlled laboratory setting, further justifying its benefits for practical infection control applications.

Effects of blue-light LED toothbrush on reducing dental plaque and gingival inflammation in orthodontic patients with fixed appliances: a crossover randomized controlled trial

BACKGROUND

Patients with fixed orthodontic appliances have higher plaque accumulation and gingival inflammation. Our aim was to compare the effectiveness of a light emitting diode (LED) toothbrush with a manual toothbrush in reducing dental plaque and gingival inflammation in orthodontic patients with fixed appliances, and to investigate the effect of the LED toothbrush on Streptococcus mutans (S. mutans) biofilm in vitro.

METHODS

Twenty-four orthodontic patients were recruited and randomly assigned into 2 groups: (1) started with manual and (2) started with LED toothbrushes. After a 28-day usage and 28-day wash-out period, the patients switched to the other intervention. The plaque and gingival indices were determined at baseline and 28 days after each intervention. The patients' compliance and satisfaction scores were collected using questionnaires. For the in vitro experiments, S. mutans biofilm was divided into 5 groups (n = 6) with 15-, 30-, 60-, or 120-sec LED exposure, and without LED exposure as a control group.

RESULTS

There was no significant difference in the gingival index between the manual and LED toothbrush groups. The manual toothbrush was significantly more effective in reducing the plaque index in the proximal area on the bracket side (P = 0.031). However, no significant difference was found between the two groups in other areas around the brackets or on the non-bracket side. After LED exposure in vitro, the percentages of bacterial viability after LED exposure for 15-120 s were significantly lower compared with the control (P = 0.006).

CONCLUSION

Clinically, the LED toothbrush was not more effective in reducing dental plaque or gingival inflammation than the manual toothbrush in orthodontic patients with fixed appliances. However, the blue light from the LED toothbrush significantly reduced the number of S. mutans in biofilm when it was exposed to the light for at least 15 s in vitro.

CLINICAL TRIAL REGISTRATION

Thai Clinical Trials Registry (TCTR20210510004). Registered 10/05/2021.

Effect of curcumin-loaded photoactivatable polymeric nanoparticle on peri-implantitis-related biofilm

Curcumin has been used as a photosensitizer (PS) for antimicrobial photodynamic chemotherapy (PACT). However, its low solubility, instability, and poor bioavailability challenge its in vivo application. This study aimed to synthesize curcumin-loaded polymeric nanoparticles (curcumin-NP) and determine their antimicrobial and cytotoxic effects. Nanoparticles (NP) were synthesized using polycaprolactone (PCL) as a polymer by the nanoprecipitation method. Curcumin-NP was characterized by particle size, polydispersity index and zeta potential, scanning electron microscopy, and curcumin encapsulation efficiency (EE). Curcumin-NP was compared to free curcumin solubilized in 10% DMSO as photosensitizers for PACT in single and multispecies Porphyromonas gingivalis, Fusobacterium nucleatum, and Streptococcus oralis biofilms. Chlorhexidine 0.12% (CHX) and ultrapure water were used as positive and negative controls. The cytotoxic effect of curcumin-NP was evaluated on human periodontal ligament fibroblast cells (HPLF). Data were analyzed by ANOVA (α=0.05). Curcumin-NP exhibited homogeneity and stability in solution, small particle size, and 67.5% EE of curcumin. Curcumin-NP presented reduced antibiofilm activity at 500 µg/ml, although in planktonic cultures it showed inhibitory and bactericidal effect. Curcumin-NP and curcumin with and without photoactivation were not cytotoxic to HPLF cells. Curcumin-NP has antimicrobial and antibiofilm properties, with better effects when associated with blue light, being a promising therapy for preventing and treating peri-implant diseases.

Resistance of Bacteria toward 475 nm Blue Light Exposure and the Possible Role of the SOS Response

The increase in antibiotic resistance represents a major global challenge for our health systems and calls for alternative treatment options, such as antimicrobial light-based therapies. Blue light has shown promising results regarding the inactivation of a variety of microorganisms; however, most often, antimicrobial blue light (aBL) therapy is performed using wavelengths close to the UV range. Here we investigated whether inactivation was possible using blue light with a wavelength of 475 nm. Both Gram-positive and -negative bacterial strains were treated with blue light with fluences of 7.5-45 J/cm2. Interestingly, only some bacterial strains were susceptible to 475 nm blue light, which was associated with the lack of RecA, i.e., a fully functional DNA repair mechanism. We demonstrated that the insertion of the gene recA reduced the susceptibility of otherwise responsive bacterial strains, indicating a protective mechanism conveyed by the bacterial SOS response. However, mitigating this pathway via three known RecA inhibiting molecules (ZnAc, curcumin, and Fe(III)-PcTs) did not result in an increase in bactericidal action. Nonetheless, creating synergistic effects by combining a multitarget therapy, such as aBL, with an RecA targeting treatment could be a promising strategy to overcome the dilemma of antibiotic resistance in the future.

Light-emitting-diode-based antimicrobial photodynamic therapies in the treatment of periodontitis

The use of light-emitting diode (LED)-based photodynamic therapies in the treatment of periodontitis is increasing because these modalities are effective, safe, and painless. They are not subject to acquired drug resistance or environmental issues and are associated with no complications when used appropriately. These light sources have also been used in combination with pharmacological measures to synergize their effects and optimize therapeutic outcomes. This review focuses on optical devices used in treating periodontitis and delineates the current applications of various methods, including their utility and efficacy. The application of LEDs in periodontology is described.

A Narrative Review on Oral and Periodontal Bacteria Microbiota Photobiomodulation, through Visible and Near-Infrared Light: From the Origins to Modern Therapies

Photobiomodulation (PBM) consists of a photon energy transfer to the cell, employing non-ionizing light sources belonging to the visible and infrared spectrum. PBM acts on some intrinsic properties of molecules, energizing them through specific light wavelengths. During the evolution of life, semiconducting minerals were energized by sun radiation. The molecules that followed became photoacceptors and were expressed into the first proto-cells and prokaryote membranes. Afterward, the components of the mitochondria electron transport chain influenced the eukaryotic cell physiology. Therefore, although many organisms have not utilized light as an energy source, many of the molecules involved in their physiology have retained their primordial photoacceptive properties. Thus, in this review, we discuss how PBM can affect the oral microbiota through photo-energization and the non-thermal effect of light on photoacceptors (i.e., cytochromes, flavins, and iron-proteins). Sometimes, the interaction of photons with pigments of an endogenous nature is followed by thermal or photodynamic-like effects. However, the preliminary data do not allow determining reliable therapies but stress the need for further knowledge on light-bacteria interactions and microbiota management in the health and illness of patients through PBM.

Repeated irradiation by light-emitting diodes may impede the spontaneous progression of experimental periodontitis: a preclinical study

PURPOSE

We investigated whether repeated irradiation with light-emitting diodes (LEDs) at a combination of 470 nm and 525 nm could suppress the progression of experimental periodontitis.

METHODS

A experimental periodontitis model was established in the second, third, and fourth premolars of the mandible in beagle dogs for 2 months. The spontaneous progression of periodontitis was monitored under the specified treatment regimen for 3 months. During this period, the animals were subjected to treatments of either plaque control only (control) or plaque control with LED application (test) at 2-week intervals. The clinical parameters included the probing pocket depth (PPD), gingival recession (GR), and the clinical attachment level (CAL). Histomorphometric analysis was performed using measurements of the length of the junctional epithelium, connective tissue (CT) zone, and total soft tissue (ST).

RESULTS

There were significant differences in PPD between the control and test groups at baseline and 12 weeks. When the change in PPD was stratified based on time intervals, it was shown that greater differences occurred in the test group, with statistical significance for baseline to 12 weeks, 6 to 12 weeks, and baseline to 6 weeks. There was no significant difference in GR between the control and test groups at any time points. Likewise, no statistically significant differences were found in GR at any time intervals. CAL showed a statistically significant difference between the control and test groups at baseline only, although significant differences in CAL were observed between baseline and 12 weeks and between 6 and 12 weeks. The proportion of CT to ST was smaller for both buccal and lingual areas in the control group than in the test group.

CONCLUSIONS

Repeated LED irradiation with a combination of 470-nm and 525-nm wavelengths may help suppress the progression of periodontal disease.

Optical clearing of tissues: Issues of antimicrobial phototherapy and drug delivery

This review presents principles and novelties in the field of tissue optical clearing (TOC) technology, as well as application for optical monitoring of drug delivery and effective antimicrobial phototherapy. TOC is based on altering the optical properties of tissue through the introduction of immersion optical cleaning agents (OCA), which impregnate the tissue of interest. We also analyze various methods and kinetics of delivery of photodynamic agents, nanoantibiotics and their mixtures with OCAs into the tissue depth in the context of antimicrobial and antifungal phototherapy. In vitro and in vivo studies of antimicrobial phototherapies, such as photodynamic, photothermal plasmonic and photocatalytic, are summarized, and the prospects of a new TOC technology for effective killing of pathogens are discussed.

In vitro investigation of the antibacterial and anti-inflammatory effects of LED irradiation

PURPOSE

This study aimed to investigate the proper wavelengths for safe levels of light-emitting diode (LED) irradiation with bactericidal and photobiomodulation effects in vitro.

METHODS

Cell viability tests of fibroblasts and osteoblasts after LED irradiation at 470, 525, 590, 630, and 850 nm were performed using the thiazolyl blue tetrazolium bromide assay. The bactericidal effect of 470-nm LED irradiation was analyzed with Streptococcus gordonii, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Porphyromonas gingivalis, and Tannerella forsythia. Levels of nitric oxide, a proinflammatory mediator, were measured to identify the anti-inflammatory effect of LED irradiation on lipopolysaccharide-stimulated inflammation in RAW 264.7 macrophages.

RESULTS

LED irradiation at wavelengths of 470, 525, 590, 630, and 850 nm showed no cytotoxic effect on fibroblasts and osteoblasts. LED irradiation at 630 and 850 nm led to fibroblast proliferation compared to no LED irradiation. LED irradiation at 470 nm resulted in bactericidal effects on S. gordonii, A. actinomycetemcomitans, F. nucleatum, P. gingivalis, and T. forsythia. Lipopolysaccharide (LPS)-induced RAW 264.7 inflammation was reduced by irradiation with 525-nm LED before LPS treatment and irradiation with 630-nm LED after LPS treatment; however, the effects were limited.

CONCLUSIONS

LED irradiation at 470 nm showed bactericidal effects, while LED irradiation at 525 and 630 nm showed preventive and treatment effects on LPS-induced RAW 264.7 inflammation. The application of LED irradiation has potential as an adjuvant in periodontal therapy, although further investigations should be performed in vivo.

Phototherapy and optical waveguides for the treatment of infection

With rapid emergence of multi-drug resistant microbes, it is imperative to seek alternative means for infection control. Optical waveguides are an auspicious delivery method for precise administration of phototherapy. Studies have shown that phototherapy is promising in fighting against a myriad of infectious pathogens (i.e. viruses, bacteria, fungi, and protozoa) including biofilm-forming species and drug-resistant strains while evading treatment resistance. When administered via optical waveguides, phototherapy can treat both superficial and deep-tissue infections while minimizing off-site effects that afflict conventional phototherapy and pharmacotherapy. Despite great therapeutic potential, exact mechanisms, materials, and fabrication designs to optimize this promising treatment option are underexplored. This review outlines principles and applications of phototherapy and optical waveguides for infection control. Research advances, challenges, and outlook regarding this delivery system are rigorously discussed in a hope to inspire future developments of optical waveguide-mediated phototherapy for the management of infection and beyond.

Evidence and Therapeutic Perspectives in the Relationship between the Oral Microbiome and Alzheimer's Disease: A Systematic Review

This review aims to clarify the nature of the link between Alzheimer’s disease and the oral microbiome on an epidemiological and pathophysiological level, as well as to highlight new therapeutic perspectives that contribute to the management of this disease. We performed a systematic review, following the Preferred Reporting Items for Systematic Reviews checklist, from January 2000 to July 2021. The terms “plaque,” “saliva,” and “mouth” were associated with the search term “oral diseases” and used in combination with the Boolean operator “AND”/“OR”. We included experimental or clinical studies and excluded conferences, abstracts, reviews, and editorials. A total of 27 articles were selected. Evidence for the impact of the oral microbiome on the pathophysiological and immunoinflammatory mechanisms of Alzheimer’s disease is accumulating. The impact of the oral microbiome on the development of AD opens the door to complementary therapies such as phototherapy and/or the use of prebiotic compounds and probiotic strains for global or targeted modulation of the oral microbiome in order to have a favourable influence on the evolution of this pathology in the future.

Inhibition of cathepsin-K and matrix metalloproteinase by photodynamic therapy

OBJECTIVES

The objective of this study was to determine the effects of antimicrobial photodynamic therapy (aPDT) with indocyanine green (ICG) and toluidine blue (TB) on protease activity (matrix-bound cathepsin K and matrix metalloproteinase (MMP) and dentin bond strength.

METHODS

Caries-free human third molars were assigned to five groups: 1-control group, 2-application of ICG with activation using an 810 nm diode (aPDT), 3-application of ICG, 4-application of TB with activation using a 660 nm diode (aPDT), and 5-application of TB. For the enzymatic investigation, dentin beams were incubated for either 3 days or 3 weeks. Aliquots of the incubation media were analyzed by ELISA for CTX (C-terminal cross-linked telopeptide of type I Collagen) and ICTP (cross-linked carboxy-terminal telopeptide of type I collagen). For microtensile bond strength testing (μTBS), composite resins were layered onto the tooth surface; the samples were then subjected to μTBS. Kruskall-Wallis and Mann-Whitney U tests were applied for statistical analysis of CTX and ICTP, one way-ANOVA and Tukey's test were applied for statistical analysis of μTBS.

RESULTS

Pretreating the dentin matrices with aPDT decreased the endogenous protease activity. ICG with laser activation resulted in the highest μTBS. Therefore, aPDT should be considered as a treatment method because it can reduce MMP-mediated dentin degradation and increase the μTBS.

SIGNIFICANCE

Inhibiting endogenous protease activity improves the stability of the dentin-adhesive bond and the durability of the bond strength.

Association of Graphene Silver Polymethyl Methacrylate (PMMA) with Photodynamic Therapy for Inactivation of Halitosis Responsible Bacteria in Denture Wearers

(1) Background: Poor hygiene and denture presence in the oral cavity are factors that favor bacterial accumulation, the cause of halitosis and of various oral and general diseases. Aim: This study aimed to evaluate the possibility of inactivating bacteria associated with halitosis in acrylic denture wearers using polymethyl methacrylate resin enhanced with graphene silver nanoparticles and the effect of the resin association with extra oral photodynamic therapy. (2) Methods: Graphene silver nanoparticles in 1 and 2 wt% were added to a commercial acrylic resin powder. Three study groups containing samples from the three different materials were established. The first group was not exposed to the light treatment, and the other two were exposed to red light (laser and light emitting diode) after photosensitizer placement on the disk’s surface. Samples were incubated with Porphyromonas gingivalis and Enterococcus faecalis. (3) Results: For both bacterial strains, inhibition zones were obtained, showing significant differences for the light-treated samples. (4) Conclusions: Denture resins with antibacterial properties associated with extra oral photodynamic therapy exhibited enhanced antibacterial effects. The procedure could be used as a safer and more efficient alternative technique against halitosis and oral infections in denture wearers.

Factors Determining the Susceptibility of Bacteria to Antibacterial Photodynamic Inactivation

Photodynamic inactivation of microorganisms (aPDI) is an excellent method to destroy antibiotic-resistant microbial isolates. The use of an exogenous photosensitizer or irradiation of microbial cells already equipped with endogenous photosensitizers makes aPDI a convenient tool for treating the infections whenever technical light delivery is possible. Currently, aPDI research carried out on a vast repertoire of depending on the photosensitizer used, the target microorganism, and the light delivery system shows efficacy mostly on in vitro models. The search for mechanisms underlying different responses to photodynamic inactivation of microorganisms is an essential issue in aPDI because one niche (e.g., infection site in a human body) may have bacterial subpopulations that will exhibit different susceptibility. Rapidly growing bacteria are probably more susceptible to aPDI than persister cells. Some subpopulations can produce more antioxidant enzymes or have better performance due to efficient efflux pumps. The ultimate goal was and still is to identify and characterize molecular features that drive the efficacy of antimicrobial photodynamic inactivation. To this end, we examined several genetic and biochemical characteristics, including the presence of individual genetic elements, protein activity, cell membrane content and its physical properties, the localization of the photosensitizer, with the result that some of them are important and others do not appear to play a crucial role in the process of aPDI. In the review, we would like to provide an overview of the factors studied so far in our group and others that contributed to the aPDI process at the cellular level. We want to challenge the question, is there a general pattern of molecular characterization of aPDI effectiveness? Or is it more likely that a photosensitizer-specific pattern of molecular characteristics of aPDI efficacy will occur?

Microbiologic Profiles of Patients with Dental Prosthetic Treatment and Periodontitis before and after Photoactivation Therapy-Randomized Clinical Trial

Fixed prosthodontic dental restorations can potentially affect the periodontal tissues and vice versa, the periodontium can influence the longevity and esthetic appearance of dental restorations. We proposed an investigation on total bacterial load, specific periodontal pathogens, and periodontal clinical parameters in patients with dental fixed prosthesis and different degrees of periodontal tissue loss that followed photoactivation therapy (PDT) adjunctive to scaling and root planing. The study was conducted on 160 subjects, which were randomly assigned to scaling and root planing (SRP) alone (52 subjects, 256 sites), SRP and chlorhexidine rinsing (58 subjects, 276 sites), and SRP plus PDT (50 subjects, 318 sites). Periodontal parameters (plaque index, bleeding on probing, probing depth, and clinical attachment loss), followed by total bacterial load and specific periodontal pathogens (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola) were examined in each patient at baseline, one and six months after. PDT exerted significant improvements both in clinical and microbiological load after one month, and these results were maintained 6 months after when compared to chlorhexidine rinsing or SRP alone, especially in severe periodontitis cases. Photoactivation therapy as an adjunctive periodontal therapeutic method was efficient in offering supplementary periodontal improvements in the clinical and microbiological parameters of patients with fixed dental prosthesis, particularly in severe periodontitis cases.

Rose bengal-mediated photodynamic inactivation against periodontopathogens in vitro

BACKGROUND

The main goal of periodontal therapy is to eliminate the spread of infection in the periodontium. Antimicrobial photodynamic therapy (aPDT) is a bactericidal method that has been recently introduced for controlling periodontal infection. The aim of this in vitro study was to evaluate the effect of aPDT using a combination of medium-power blue light-emitting diodes (LEDs) and rose bengal (RB) on selected key periodontopathogens.

METHODS

Porphyromonas gingivalis ATCC33277, Aggregatibacter actinomycetemcomitans ATCC29523 and Fusobacterium nucleatum ATCC10953 were used in the experiments. Each bacterial suspension was irradiated with a blue LED (BL) (450-470 nm, output power density of 1.2 W/cm²) for 20-60 s (6-18 J/cm²), treated with RB (1 min), or subjected to a combination of RB treatment and BL irradiation (40 s, 12 J/cm²). All bacterial suspensions were serially diluted, plated and incubated anaerobically or microaerobically, and the numbers of colony-forming units (CFUs) were counted on day 7. One-way analysis of variance (ANOVA) and Tukey's HSD tests were used for statistical analysis.

RESULTS

Treatment with BL irradiation from 6 to 18 J/cm² did not significantly reduce the number of CFUs, whereas treatment with RB alone induced a low-to-high reduction in the bacterial CFUs in a dye concentration-dependent manner. Furthermore, the difference in the effects obtained with 16 μg/mL and 160 μg/mL RB was not statistically significant. Treatment with the BL at 12 J/cm² combined with 160 μg/mL RB yielded maximal log reductions of 3.03, 4.2 and 2.23 in P. gingivalis, A. actinomycetemcomitans and F. nucleatum CFUs, respectively.

CONCLUSION

Within the limits of this study, the three periodontal pathogens, especially A. actinomycetemcomitans, were susceptible to photodynamic inactivation by the combination of the BL and RB. RB-mediated aPDT may offer a viable alternative tool for periodontal pathogen treatment, especially for A. actinomycetemcomitans eradication. aPDT may be a valuable tool for the treatment of periodontal diseases, particularly those in which A. actinomycetemcomitans is a dominating pathogen.

Cavity Disinfection With a 445 nm Diode Laser Within the Scope of Restorative Therapy - A Pilot Study

Introduction: Cavity disinfection is necessary to prevent a progressive infection of the crown dentin and pulp. Increasing intolerance and resistance to antiseptics and antibiotics as well as the controversy over the effects of those on the dental hard tissue and composite have prompted the investigation of alternative treatment options. The objective of this pilot study is to evaluate the antibacterial potential of a diode laser with a wavelength of 445 nm in the cavity preparation using the bacterium Streptococcus salivarius associated with caries in conjunction with the characteristics and influences of dentin on light transmission. Methods: The bactericidal effect of the laser irradiation was determined in culture experiments by using caries-free human dentin samples on bacteria-inoculated agar. For this, dentin discs (horizontally cut coronal dentin) of 500 µm and 1000 µm thicknesses were produced and irradiated with the laser with irradiation parameters of 0.7-1 W in a cw-mode and exposure times of between 5-30 s. Based on the different sample thicknesses, the penetration depth effect of the irradiation was ascertained after the subsequent incubation of the bacteria-inoculated agar. Additional influential parameters on the irradiation transmission were investigated, including surface moisture, tooth color as well as the presence of a smear layer on the dentin surface. Results: The optical transmission values of the laser radiation for dentin were significantly dependent on the sample thickness (P = 0.006) as well as its moisture content (P = 0.013) and were independent of the presence of a smear layer. There was a 40% reduction in bacteria after the radiography of the 500-µm-thick dentin samples, which was shown as the lowest laser dose (443 J/cm²). Conclusion: These findings indicate that the diode laser with light emission at a wavelength of 445 nm is interesting for the supportive cavity disinfection within the scope of caries therapy and show potential for clinical applications.

Light-based technologies for management of COVID-19 pandemic crisis

The global dissemination of the novel coronavirus disease (COVID-19) has accelerated the need for the implementation of effective antimicrobial strategies to target the causative agent SARS-CoV-2. Light-based technologies have a demonstrable broad range of activity over standard chemotherapeutic antimicrobials and conventional disinfectants, negligible emergence of resistance, and the capability to modulate the host immune response. This perspective article identifies the benefits, challenges, and pitfalls of repurposing light-based strategies to combat the emergence of COVID-19 pandemic.

Black stain and dental caries in primary teeth of Tunisian preschool children

AIM

To assess the prevalence of black tooth stains and to investigate its correlation with caries experience in the primary dentition of 3-5-year-old children in the region of Monastir, Tunisia.

METHODS

It was a descriptive cross-sectional study involving children in preschool establishments in Monastir, Tunisia. It consisted of an oral examination of 393 children and data collection through a questionnaire completed by parents. ANOVA test and Pearson Chi-square test were used to assess the prevalence of black stains and its association with dental caries.

RESULTS

The overall mean decayed, missing, and filled teeth (dmft) index was 1.42 ± 0.1. Caries prevalence was 49.9%. Of all the children involved, 6.1% had black stains. A statistically significant relationship was found between black stain and the prevalence of early childhood caries (p = 0.047). However, the association with the dmft index was not statistically significant (p = 0.08).

CONCLUSION

Preschool children with black tooth stain had lower dental caries experience. The results of the present study suggest that black stains are a protective factor for early childhood caries. More studies are needed to explore the risk factors of black stains.

Antimicrobial effect of photodynamic therapy using sinoporphyrin sodium and 390-400 nm light-emitting diode on Porphyromonas gingivalis in vitro

This study aims to investigate the effect of antimicrobial photodynamic therapy (a-PDT) using a novel combination of sinoporphyrin sodium (DVDMS) and light-emitting diode (LED) with a wavelength of 390-400 nm on Porphyromonas gingivalis in vitro. Absorption spectrum of DVDMS was determined by spectrometer for selecting suitable wavelength light source. The uptake of DVDMS by P. gingivalis was evaluated according to fluorescence intensity detected by a spectrometer. Then effects of DVDMS alone, 390-400 nm LED alone, and photodynamic therapy produced by 10, 20, 40, and 80 μg/mL DVDMS and 390-400 nm LED on the suspension of P. gingivalis were evaluated by counting the number of colony forming units (CFU) after incubation. In the experiment, the LED illumination time was 30, 60, 90, 120, 180, 240, and 360 s, respectively, and the corresponding energy density was 1, 2, 3, 4, 6, 8, and 12 J/cm², respectively. According to the absorption spectrum of DVDMS, the 390-400-nm light emitted by the LED was selected as the light source. The fluorescence intensity of DVDMS on P. gingivalis increased significantly at 5 min, and with the extension of time, it decreased at 30 min. DVDMS alone did not produce a significant toxicity on P. gingivalis compared with PBS (p = 0.979). While 390-400 nm LED alone had a certain bactericidal effect on P. gingivalis, the bactericidal effect was more obvious as the light dose increased (p < 0.001). The effect of a-PDT produced by 20, 40, and 80 μg/mL DVDMS and 390-400 nm LED were significantly better than that of 390-400 nm LED alone (p < 0.05). Both DVDMS concentration and light dose could enchance the bactericidal effect. The strongest photo-killing effect was generated by 80 μg/mL DVDMS with 360 s illumination (energy density is 12 J/cm²), and the log reduction of bacteria was 5.69 ± 1.70. a-PDT using the combination of DVDMS with 390-400 nm LED shows promise as a new treatment modality for pathogens elimination in periodontal therapy.

Dual-light photodynamic therapy administered daily provides a sustained antibacterial effect on biofilm and prevents Streptococcus mutans adaptation

Antibacterial photodynamic therapy (aPDT) and antibacterial blue light (aBL) are emerging treatment methods auxiliary to mechanical debridement for periodontitis. APDT provided with near-infrared (NIR) light in conjunction with an indocyanine green (ICG) photosensitizer has shown efficacy in several dental in-office-treatment protocols. In this study, we tested Streptococcus mutans biofilm sensitivity to either aPDT, aBL or their combination dual-light aPDT (simultaneous aPDT and aBL) exposure. Biofilm was cultured by pipetting diluted Streptococcus mutans suspension with growth medium on the bottom of well plates. Either aPDT (810 nm) or aBL (405 nm) or a dual-light aPDT (simultaneous 810 nm aPDT and 405 nm aBL) was applied with an ICG photosensitizer in cases of aPDT or dual-light, while keeping the total given radiant exposure constant at 100 J/cm2. Single-dose light exposures were given after one-day or four-day biofilm incubations. Also, a model of daily treatment was provided by repeating the same light dose daily on four-day and fourteen-day biofilm incubations. Finally, the antibacterial action of the dual-light aPDT with different energy ratios of 810 nm and 405 nm of light were examined on the single-day and four-day biofilm protocols. At the end of each experiment the bacterial viability was assessed by colony-forming unit method. Separate samples were prepared for confocal 3D biofilm imaging. On a one-day biofilm, the dual-light aPDT was significantly more efficient than aBL or aPDT, although all modalities were bactericidal. On a four-day biofilm, a single exposure of aPDT or dual-light aPDT was more efficient than aBL, resulting in a four logarithmic scale reduction in bacterial counts. Surprisingly, when the same amount of aPDT was repeated daily on a four-day or a fourteen-day biofilm, bacterial viability improved significantly. A similar improvement in bacterial viability was observed after repetitive aBL application. This viability improvement was eliminated when dual-light aPDT was applied. By changing the 405 nm to 810 nm radiant exposure ratio in dual-light aPDT, the increase in aBL improved the antibacterial action when the biofilm was older. In conclusion, when aPDT is administered repeatedly to S. mutans biofilm, a single wavelength-based aBL or aPDT leads to a significant biofilm adaptation and increased S. mutans viability. The combined use of aBL light in synchrony with aPDT arrests the adaptation and provides significantly improved and sustained antibacterial efficacy.

Visible Light as an Antimicrobial Strategy for Inactivation of Pseudomonas fluorescens and Staphylococcus epidermidis Biofilms

The increase of antimicrobial resistance is challenging the scientific community to find solutions to eradicate bacteria, specifically biofilms. Light-Emitting Diodes (LED) represent an alternative way to tackle this problem in the presence of endogenous or exogenous photosensitizers. This work adds to a growing body of research on photodynamic inactivation using visible light against biofilms. Violet (400 nm), blue (420 nm), green (570 nm), yellow (584 nm) and red (698 nm) LEDs were used against Pseudomonas fluorescens and Staphylococcus epidermidis. Biofilms, grown on a polystyrene surface, were irradiated for 4 h. Different irradiance levels were investigated (2.5%, 25%, 50% and 100% of the maximum irradiance). Surviving cells were quantified and the inactivation kinetic parameters were estimated. Violet light could successfully inactivate P. fluorescens and S. epidermidis (up to 6.80 and 3.69 log10 reduction, respectively), while blue light was effective only against P. fluorescens (100% of maximum irradiance). Green, yellow and red irradiation neither increased nor reduced the biofilm cell density. This is the first research to test five different wavelengths (each with three intensities) in the visible spectrum against Gram-positive and Gram-negative biofilms. It provides a detailed study of the potential of visible light against biofilms of a different Gram-nature.

Simultaneous photoablative and photodynamic 810-nm diode laser therapy as an adjunct to non-surgical periodontal treatment: an in-vitro study

BACKGROUND

The use of lasers at different wavelengths has been proposed in combination with conventional non-surgical periodontal treatment in order to improve the clinical outcome of periodontal disease. However, the clinical use of laser photonic energy is still the subject of research and debate because the antibacterial activity of the laser is dependent upon method, laser parameters, quantity of bacteria, species selected and photosensitizers used.

METHODS

We evaluated the in-vitro bactericidal activity of 810 nm diode-laser irradiation in simultaneous photoablative and photodynamic mode against the major pathogenic bacterial organisms associated with periodontal inflammation and disease. We used indocyanine green as photosensitizer and the high-energy density of 161.7 J/cm2 or 215.0 J/cm2 for the photoablative-photodynamic irradiation.

RESULTS

The bacteria were drastically affected by the 215.0 J/cm2 irradiation in the presence of indocyanine green. In fact, the number of Porphyromonas gingivalis and Prevotella intermedia was reduced by 99.9% (P<0.001), while the number of Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, Tannerella forsythia and Actinomyces viscosus decremented by 83.3% (P<0.01), 86.8% (P<0.05), 75% (P<0.01) and 78.7% (P<0.001), respectively. P. gingivalis and P. intermedia were the only bacteria that were sensitive to the treatment with indocyanine green dye and 161.7 J/cm2 of laser irradiation (P<0.001).

CONCLUSIONS

Our preliminary in-vitro data suggest that simultaneous photoablative-photodynamic irradiation could be a promising therapy against a wide range of bacteria involved in periodontal disease. We believe that further additional in-vivo investigation is necessary, to enable a more complete picture of effectiveness within a clinical setting to be established. In addition, the use of a simultaneous photoablative-photodynamic therapy is suggested to reduce treatment time, without compromising the efficacy against the periodontal pathogens.

In vitro inhibitory effect of two commercial probiotics on chromogenic actinomycetes

PURPOSE

Black extrinsic discoloration is a common clinical and aesthetic problem. This study aims to evaluate the potential in vitro antagonistic activity of two commercial probiotics, Streptococcus salivarius M18 and Lactobacillus reuteri ProDentis, against microorganisms associated with black stains.

METHODS

Streptococcus salivarius M18 and Lactobacillus reuteri were tested against Aggregatibacter actinomycetemcomitans and Actinomyces naeslundiiusing their cell-free fermentative broth in a planktonic growth inhibition test.

RESULTS

Both probiotic cell-free supernatants showed the ability to reduce the pathogenic bacteria growth in a dose-dependent way. Streptococcus salivarius M18 showed a stronger antimicrobial activity than Lactobacillus reuteri ProDentis against the two indicator strains used. A. naeslundi was less susceptible to the probiotic activity of both S. salivarius and L. reuteri compared to A. actinomycetemcomitans.

CONCLUSIONS

The obtained results demonstrate a potent antagonistic ability of probiotics to reduce the growth of microorganisms associated with black tooth stains. Therefore, these strains could be evaluated for a therapeutic use against dental pigmentations.

Antimicrobial blue light for decontamination of platelets during storage

Platelet (PLT) storage is currently limited to 5 days in clinics in the United States, in part, due to an increasing risk for microbial contamination over time. In light of well-documented antimicrobial activity of blue light (405-470 nm), we investigated potentials to decontaminate microbes during PLT storage by antimicrobial blue light (aBL). We found that PLTs produced no detectable levels of porphyrins or their derivatives, the chromophores that specifically absorb blue light, in marked contrast to microbes that generated porphyrins abundantly. The difference formed a basis with which aBL selectively inactivated contaminated microbes prior to and during the storage, without incurring any harm to PLTs. In accordance with this, when contamination with representative microbes was simulated in PLT concentrates supplemented with 65% of PLT additive solution in a standard storage bag, all "contaminated" microbes tested were completely inactivated after exposure of the bag to 405 nm aBL at 75 J/cm2 only once. While killing microbes efficiently, this dose of aBL irradiation exerted no adverse effects on the viability, activation or aggregation of PLTs ex vivo and could be used repeatedly during PLT storage. PLT survival in vivo was also unaltered by aBL irradiation after infusion of aBL-irradiated mouse PLTs into mice. The study provides proof-of-concept evidence for a potential of aBL to decontaminate PLTs during storage.

Photonic Therapy in Periodontal Diseases an Overview with Appraisal of the Literature and Reasoned Treatment Recommendations

Recent reviews and meta-analyses of the literature over the past quarter-century have failed to provide enough evidence to prove or disprove the actual utility of photonic therapy in periodontitis, alone or adjunctive to conventional approaches. This apparent paradox has been explained by the many physical, molecular, biological, anatomical, and technical variables of photonic treatments, which can differ in light-emitting devices (laser or LED), wavelengths, irradiation power and modes, clinical objectives, follow-up times, disease grading, and assessment methods. This multi-faceted, controversial scenario has led practitioners to underestimate the actual potential of photonic therapy in periodontal diseases. In this critical appraisal of the literature, we have briefly summarized the main photonic therapies and instruments used in Periodontology, highlighting their main characteristics and limitations. Then, we have tried to identify and discuss the key methodological issues which can have an impact on the outcome of photonic therapies. Our main goal was to identify the best parameters, settings, and methodologies to perform effective periodontal photonic treatments and to extrapolate some recommendations for clinical use. Should these recommendations find a consensus among periodontologists and be adopted in future clinical studies, they will hopefully contribute to dissipate the present confusion and uncertainty on this complex matter.

Killing mechanism of bacteria within multi-species biofilm by blue light

Objectives: The aim of the study was to characterize the immediate and delayed effects of non-coherent blue-light treatment on the composition and viability of an in vitro biofilm composed of anaerobic multispecies, as well as the mechanisms involved. Methods: A multispecies biofilm was constructed of Streptococcus sanguinis, Actinomyces naeslundii, Porphyromonas gingivalis and Fusobacterium nucleatum, test groups were exposed to blue light. The multispecies biofilm was explored with a newly developed method based on flow cytometry and confocal microscopy. The involvement of the paracrine pathway in the phototoxic mechanism was investigated by a crossover of the supernatants between mono-species P. gingivalis and F. nucleatum biofilms. Results: Blue light led to a reduction of about 50% in the viable pathogenic bacteria P. gingivalis and F. nucleatum, vs that in the non-exposed biofilm. Biofilm thickness was also reduced by 50%. The phototoxic effect of blue light on mono-species biofilm was observed in P. gingivalis, whereas F. nucleatum biofilm was unaffected. A lethal effect was obtained when the supernatant of P. gingivalis biofilm previously exposed to blue light was added to the F. nucleatum biofilm. The effect was circumvented by the addition of reactive oxygen species (ROS) scavengers to the supernatant. Conclusion: Blue-light has an impact on the bacterial composition and viability of the multispecies biofilm. The phototoxic effect of blue light on P. gingivalis in biofilm was induced directly and on F. nucleatum via ROS mediators of the paracrine pathway. This phenomenon may lead to a novel approach for 'replacement therapy,' resulting in a less periodonto-pathogenic biofilm.

Bacteroides fragilis requires the ferrous-iron transporter FeoAB and the CobN-like proteins BtuS1 and BtuS2 for assimilation of iron released from heme

The intestinal commensal and opportunistic anaerobic pathogen Bacteroides fragilis has an essential requirement for both heme and free iron to support growth in extraintestinal infections. In the absence of free iron, B. fragilis can utilize heme as the sole source of iron. However, the mechanisms to remove iron from heme are not completely understood. In this study, we show that the inner membrane ferrous iron transporter ∆feoAB mutant strain is no longer able to grow with heme as the sole source of iron. Genetic complementation with the feoAB gene operon completely restored growth. Our data indicate that iron is removed from heme in the periplasmic space, and the released iron is transported by the FeoAB system. Interestingly, when B. fragilis utilizes iron from heme, it releases heme-derived porphyrins by a dechelatase activity which is upregulated under low iron conditions. This is supported by the findings showing that formation of heme-derived porphyrins in the ∆feoAB mutant and the parent strain increased 30-fold and fivefold (respectively) under low iron conditions compared to iron replete conditions. Moreover, the btuS1 btuS2 double-mutant strain (lacking the predicted periplasmic, membrane anchored CobN-like proteins) also showed growth defect with heme as the sole source of iron, suggesting that BtuS1 and BtuS2 are involved in heme-iron assimilation. Though the dechelatase mechanism remains uncharacterized, assays performed in bacterial crude extracts show that BtuS1 and BtuS2 affect the regulation of the dechelatase-specific activities in an iron-dependent manner. These findings suggest that the mechanism to extract iron from heme in Bacteroides requires a group of proteins, which spans the periplasmic space to make iron available for cellular functions.

Can light-based approaches overcome antimicrobial resistance?

The relentless rise of antibiotic resistance is considered one of the most serious problems facing mankind. This mini-review will cover three cutting-edge approaches that use light-based techniques to kill antibiotic-resistant microbial species, and treat localized infections. First, we will discuss antimicrobial photodynamic inactivation using rationally designed photosensitizes combined with visible light, with the added possibility of strong potentiation by inorganic salts such as potassium iodide. Second, the use of blue and violet light alone that activates endogenous photoactive porphyrins within the microbial cells. Third, it is used for "safe UVC" at wavelengths between 200 nm and 230 nm that can kill microbial cells without damaging host mammalian cells. We have gained evidence that all these approaches can kill multidrug resistant bacteria in vitro, and they do not induce themselves any resistance, and moreover can treat animal models of localized infections caused by resistant species that can be monitored by noninvasive bioluminescence imaging. Light-based antimicrobial approaches are becoming a growing translational part of anti-infective treatments in the current age of resistance.

Photosensitizers in antibacterial photodynamic therapy: an overview

Antibacterial Photodynamic therapy (APDT) is a process utilizing light and light sensitive agents (named photosensitizer (PS)) and is usually applied in an oxygen-rich environment. The energy of the photons is absorbed by the photosensitizer and subsequently transferred to surrounding molecules. Consequently, reactive oxygen species and free radicals are formed. These oxidative molecules can damage bacterial macromolecules such as proteins, lipids and nucleic acids and may result in bacterial killing. Unlike antibiotics, APDT as a novel technique does not lead to the selection of mutant resistant strains, hence it has appealed to researchers in this field. The type of PS used in APDT is a major determinant regarding outcome. In this review, various types of PS that are used in antimicrobial Photodynamic therapy will be discussed. PSs are classified based on their chemical structure and origin. Synthetic dyes such as methylene blue and toluidine blue are the most commonly used photosensitizers in Antibacterial Photodynamic therapy (APDT). Other photosensitizers including natural PSs (e.g. curcumin and hypericin) and tetra-pyrrole structures like phthalocyanines and porphyrins have also been studied. Furthermore, nanostructures and their probable contribution to APDT will be discussed.

Antimicrobial photodynamic therapy alone or in combination with antibiotic local administration against biofilms of Fusobacterium nucleatum and Porphyromonas gingivalis

Antimicrobial photodynamic therapy (aPDT) kills several planktonic pathogens. However, the susceptibility of biofilm-derived anaerobic bacteria to aPDT is poorly characterized. Here, we evaluated the effect of Photodithazine (PDZ)-mediated aPDT on Fusobacterium nucleatum and Porphyromonas gingivalis biofilms. In addition, aPDT was tested with metronidazole (MTZ) to explore the potential antimicrobial effect of the treatment. The minimum inhibitory concentration (MIC) of MTZ was defined for each bacterial species. Single-species biofilms of each species were grown on polystyrene plates under anaerobic conditions for five days. aPDT was performed by applying PDZ at concentrations of 50, 75 and 100 mg/L, followed by exposure to 50 J/cm² LED light (660 nm) with or without MTZ. aPDT exhibited a significant reduction in bacterial viability at a PDZ concentration of 100 mg/L, with 1.12 log₁₀ and 2.66 log₁₀ reductions for F. nucleatum and P. gingivalis in biofilms, respectively. However, the antimicrobial effect against F. nucleatum was achieved only when aPDT was combined with MTZ at 100× MIC. Regarding P. gingivalis, the combination of PDZ-mediated aPDT at 100 mg/L with MTZ 100× MIC resulted in a 5 log₁₀ reduction in the bacterial population. The potential antimicrobial effects of aPDT in combination with MTZ for both single pathogenic biofilms were confirmed by live/dead staining. These results suggest that localized antibiotic administration may be an adjuvant to aPDT to control F. nucleatum and P. gingivalis biofilms.

Fluorescence change of Fusobacterium nucleatum due to Porphyromonas gingivalis

The aim of this study was to measure changes in the fluorescence of Fusobacterium nucleatum interacting with Porphyromonas gingivalis for excitation with blue light at 405-nm. P. gingivalis was mono- and co-cultivated in close proximity with F. nucleatum. The fluorescence of the bacterial colonies was photographed using a QLF-D (Quantitative Light-induced Fluorescence-Digital) Biluminator camera system with a 405 nm light source and a specific filter. The red, green and blue intensities of fluorescence images were analyzed using the image analysis software. A fluorescence spectrometer was used to detect porphyrin synthesized by each bacterium. F. nucleatum, which emitted green fluorescence in single cultures, showed intense red fluorescence when it was grown in close proximity with P. gingivalis. F. nucleatum co-cultivated with P. gingivalis showed the same pattern of fluorescence peaks as for protoporphyrin IX in the red part of the spectrum. We conclude that the green fluorescence of F. nucleatum can change to red fluorescence in the presence of adjacent co-cultured with P. gingivalis, indicating that the fluorescence character of each bacterium might depend on the presence of other bacteria.