Fluoride inhibits the antimicrobial peroxidase systems in human whole saliva

The Significance of Lactoperoxidase System in Oral Health: Application and Efficacy in Oral Hygiene Products

Lactoperoxidase (LPO) present in saliva are an important element of the nonspecific immune response involved in maintaining oral health. The main role of this enzyme is to oxidize salivary thiocyanate ions (SCN^-) in the presence of hydrogen peroxide (H₂O₂) to products that exhibit antimicrobial activity. LPO derived from bovine milk has found an application in food, cosmetics, and medical industries due to its structural and functional similarity to the human enzyme. Oral hygiene products enriched with the LPO system constitute an alternative to the classic fluoride caries prophylaxis. This review describes the physiological role of human salivary lactoperoxidase and compares the results of clinical trials and in vitro studies of LPO alone and complex dentifrices enriched with bovine LPO. The role of reactivators and inhibitors of LPO is discussed together with the possibility of using nanoparticles to increase the stabilization and activity of this enzyme.

Effect of topical application of fluoride gel NaF 2% on enzymatic and non-enzymatic antioxidant parameters of saliva

OBJECTIVE

The aim of the study was to evaluate the effect of topical fluoride gel NaF 2% application on antioxidant parameters of whole saliva from children.

DESIGN

The saliva mechanically stimulated with parafilm was collected from 25 children (6-12 years) attending the Clinic of Paediatric Dentistry of Universidade Cruzeiro do Sul, São Paulo, Brazil, before (control group) and immediately after application of neutral fluoride gel NaF 2% (fluoride-gel group), according to the Standards for Research Using Human Subjects, Resolution 196/96 of the USA National Health Council of 10/10/1996. Afterwards, pre-post ferric-reducing antioxidant power (FRAP), trolox-equivalent antioxidant capacity (TEAC), uric acid, reduced/oxidised glutathione content (GSH/GSSG) and total peroxidase activity (TPO) were evaluated in whole saliva of both groups.

RESULTS

All non-enzymatic antioxidant parameters were augmented by fluoride-gel NaF 2% application, whereas a notable reduction (31%) of peroxidase activity was concomitantly observed in the children's saliva (p ≤ 0.05). Nevertheless, the reducing power of saliva was kept unaltered under these circumstances (p ≤ 0.05).

CONCLUSIONS

Despite the reduced activity of peroxidase (an important antimicrobial and antioxidant enzyme), the topical fluoride gel NaF 2% favourably stimulated the release of non-enzymatic antioxidant components of saliva, sustaining the reducing power of saliva and the natural defences of the oral cavity.

Inorganic chemistry of defensive peroxidases in the human oral cavity

The innate host response system is comprised of various mechanisms for orchestrating host response to microbial infection of the oral cavity. The heterogeneity of the oral cavity and the associated microenvironments that are produced give rise to different chemistries that affect the innate defense system. One focus of this review is on how these spatial differences influence the two major defensive peroxidases of the oral cavity, salivary peroxidase (SPO) and myeloperoxidase (MPO). With hydrogen peroxide (H(2)O(2)) as an oxidant, the defensive peroxidases use inorganic ions to produce antimicrobials that are generally more effective than H(2)O(2) itself. The concentrations of the inorganic substrates are different in saliva vs. gingival crevicular fluid (GCF). Thus, in the supragingival regime, SPO and MPO work in unison for the exclusive production of hypothiocyanite (OSCN(-), a reactive inorganic species), which constantly bathes nascent plaques. In contrast, MPO is introduced to the GCF during inflammatory response, and in that environment it is capable of producing hypochlorite (OCl(-)), a chemically more powerful oxidant that is implicated in host tissue damage. A second focus of this review is on inter-person variation that may contribute to different peroxidase function. Many of these differences are attributed to dietary or smoking practices that alter the concentrations of relevant inorganic species in the oral cavity (e.g.: fluoride, F(-); cyanide, CN(-); cyanate, OCN(-); thiocyanate, SCN(-); and nitrate, NO(3)(-)). Because of the complexity of the host and microflora biology and the associated chemistry, it is difficult to establish the significance of the human peroxidase systems during the pathogenesis of oral diseases. The problem is particularly complex with respect to the gingival sulcus and periodontal pockets (where the very different defensive stratagems of GCF and saliva co-mingle). Despite this complexity, intriguing in vitro and in vivo studies are reviewed here that reveal the interplay between peroxidase function and associated inorganic chemistry.

Effect of local antimicrobial agents on excisional palatal wound healing: a clinical and histomorphometric study in rats

AIM

To assess the effect of topically applied antimicrobial agents on palatal excisional wound in rats.

MATERIALS AND METHODS

Excisional wounds, 5 mm in diameter, were made in the centre of the palate of 125 Wistar male rats. In four experimental groups, chlorhexidine digluconate (CHX) 0.12% solution, 1% CHX gel, phenolic compounds solution (Listerine), amine/stannous fluoride solution (Meridol) and saline solution as a control group were applied daily for 1 min. The wound area was measured photographically and the epithelialization rate was determined histologically at 3, 7, 14 and 21 days post-surgery.

RESULTS

The mean wound area and mean distance between the epithelial margins decreased significantly with time (p<0.001) in experimental and control groups, with the greatest wound area reduction and rate of epithelialization on day 14. A significantly superior rate of wound epithelialization (p=0.03) was presented following use of 1% CHX gel and Listerine and a comparatively inferior one when the Meridol solution was applied.

CONCLUSIONS

Each tested antimicrobial agent when applied on an excisional wound with epithelial and connective tissue deficiency did not have a negative effect on the rate of wound closure. The best results were achieved with 1%CHX gel and Listerine.

Selective sensitization of bacteria to peroxide damage associated with fluoride inhibition of catalase and pseudocatalase

Fluoride and sulfide are known inhibitors of heme catalases in acid environments. Staphylococcus aureus H cells were found to be sensitized by fluoride or sulfide to H2O2 killing at acid pH values in the range of 3.5 to 4.0, and catalase activity was reduced concomitantly. In contrast, fluoride had little effect on H2O2 killing of Streptococcus mutans GS-5, which has fluoride-insensitive peroxidase activity, but still is more sensitive to H2O2 than is S. aureus in the absence of fluoride. Fluoride but not sulfide was inhibitory also for the Mn-containing, non-heme pseudocatalase of Lactobacillus plantarum ATCC 14431 over a wide pH range, and this inhibitory effect was reflected in enhanced H2O2 killing in the presence of fluoride. In addition, we found that catalase-positive S. aureus or Neisseria sicca could protect catalase-negative S. mutans against killing by H2O2 in mixed suspensions, but protection was compromised by fluoride or sulfide under acid conditions. Thus, catalase-positive organisms could protect a catalase-negative organism against peroxide damage, but inhibition of catalase reduced protection. These findings are pertinent to the widespread use of fluoride and peroxide in oral health care products.

Short exposure of polymorphonuclear leucocytes to sodium fluoride suppresses the response to fMLP

Fluoridated dental care products are used to prevent dental decay. Up to now, there are no data available on whether the fluoride (F-) component of these products affects the bactericidal activity of salivary polymorpho-nuclear leucocytes, which are involved in the protection of the oral mucosa against infection. Therefore, after determining the concentration/time profile of F- in mixed saliva of healthy subjects after topical application of 0.5 g of a 1.25% F- containing gel, unstimulated and fMLP-stimulated polymorphonuclear leucocytes (PMNs) were shortly exposed to these F- concentrations and the generation of superoxide and hypochloric acid were measured, as well as the liberation of lysomal enzymes, and correlated with the cellular Ca2+ and cAMP-levels. The results show that F-, at concentrations as retained in saliva, did not activate the oxidative burst in unstimulated PMNs. In fMLP-activated PMNs, F-suppressed the receptor-mediated increase in the oxidative burst and the liberation of fl-glucuronidase by reduction of the availability of extracellular Ca2+ and, thus, the influx of Ca2+ necessary to couple completely the fMLP signal to effector pathways. These F- concentrations neither altered the liberation of Ca2+ from internal stores nor induced a rise in cAMP. The possible clinical consequences of these results for xerostomic patients with respect to the generation of HOSCN/OSCN/SCN in saliva an important non-immune factor for oral health, are dicussed.

Combined inhibitory effect of fluoride and hypothiocyanite on the viability and glucose metabolism of Streptococcus mutans, serotype c

The separate and combined effects of peroxidase-generated hypothiocyanite (HOSCN/OSCN-) and F- ions on glucose uptake and growth of Streptococcus mutans ATCC 25175 were investigated. S. mutans cells were grown to late exponential or stationary growth phase, harvested, washed and suspended in 2.0 ml of sterilized human whole saliva supplemented with 10 mM D-glucose. This saliva-bacteria mixture was supplemented with 5-150 microM H2O2 at pH 5.0 or 6.5. At pH 5.0, up to 103 +/- 21 microM HOSCN/OSCN- was generated. After 20 h of incubation at 37 degrees C, the saliva-bacteria suspension exposed to HOSCN/OSCN- were plated on mitis salivarius agar plates and incubated anaerobically for 2 days. Identical experiments were made with F- ions (0.5, 1.0 and 5.0 mM). Both HOSCN/OSCN- and F- caused a significant dose-dependent growth inhibition at pH 5.0, whereas no inhibition was observed at pH 6.5. When F- and HOSCN/OSCN- were added simultaneously at pH 5.0, an additive effect of growth inhibition was observed. In glucose incorporation experiments the bacteria-saliva mixture was exposed to 1 microM HOSCN/OSCN-, 0.5 mM F- or both. F-, HOSCN/OSCN- or their combination in sterilized whole saliva at pH 5.0 caused 14.2, 67.8 and 74.2% inhibition, respectively. These observations indicate that F- and HOSCN/OSCN- ions have an additive inhibitory effect on S. mutans and therefore their combination is likely to be more antibacterial than either agent alone.

Antimicrobial actions of fluoride for oral bacteria

Fluoride is widely used as a highly effective anticaries agent. Although it is felt that its anticaries action is related mainly to effects on mineral phases of teeth and on the process of remineralization, fluoride also has important effects on the bacteria of dental plaque, which are responsible for the acidification of plaque that results in demineralization. The results of recent studies have shown that fluoride can affect bacterial metabolism through a set of actions with fundamentally different mechanisms. It can act directly as an enzyme inhibitor, for example for the glycolytic enzyme enolase, which is inhibited in a quasi-irreversible manner. Direct action seems also to occur in inhibition of heme-based peroxidases with binding of fluoride to heme. The flavin-based peroxidases of many oral bacteria are insensitive to fluoride. Another mode of action involves formation of metal-fluoride complexes, most commonly AlF4-. These complexes are responsible for fluoride inhibition of proton-translocating F-ATPases and are thought to act by mimicking phosphate to form complexes with ADP at reaction centers of the enzymes. However, the actions of fluoride that are most pertinent to reducing the cariogenicity of dental plaque are those related to its weak-acid character. Fluoride acts to enhance membrane permeabilities to protons and compromises the functioning of F-ATPases in exporting protons, thereby inducing cytoplasmic acidification and acid inhibition of glycolytic enzymes. Basically, fluoride acts to reduce the acid tolerance of the bacteria. It is most effective at acid pH values. In the acidic conditions of cariogenic plaque, fluoride at levels as low as 0.1 mM can cause complete arrest of glycolysis by intact cells of Streptococcus mutans. Overall, the anticaries actions of fluoride appear to be complex, involving effects both on bacteria and on mineral phases. The antibacterial actions of fluoride appear themselves to be complex but to be dominated by weak-acid effects.

The influence of different fluoride salts on fluoride-mediated inhibition of peroxidase activity in human saliva

Fluoride-mediated inhibition of peroxidase potential activity in human saliva was investigated using NaF, NH4F, CaF2, Na2PO3F (MFP), SnF2 and TiF4. At pH 5.5 and for a 20 mM F concentration, the inhibition percentages increased from 2% for MFP and 5% for CaF2 to 61% for NaF and 65% for NH4F, while a 100% inhibition was observed at 10 mM for TiF4 and at 5 mM for SnF2. The inhibition was enhanced at acid pH and removed at pH 7. The inhibition could be attributed to ionized F-, except for SnF2 and TiF4, in which part of the inhibition could be imputed to the cations.