Natural products and caries prevention

Inhibition of pathogenic microbes in oral infectious diseases by natural products: Sources, mechanisms, and challenges

The maintenance of oral health is of utmost importance for an individual's holistic well-being and standard of living. Within the oral cavity, symbiotic microorganisms actively safeguard themselves against potential foreign diseases by upholding a multifaceted equilibrium. Nevertheless, the occurrence of an imbalance can give rise to a range of oral infectious ailments, such as dental caries, periodontitis, and oral candidiasis. Presently, clinical interventions encompass the physical elimination of pathogens and the administration of antibiotics to regulate bacterial and fungal infections. Given the limitations of various antimicrobial drugs frequently employed in dental practice, the rising incidence of oral inflammation, and the escalating bacterial resistance to antibiotics, it is imperative to explore alternative remedies that are dependable, efficacious, and affordable for the prevention and management of oral infectious ailments. There is an increasing interest in the creation of novel antimicrobial agents derived from natural sources, which possess attributes such as safety, cost-effectiveness, and minimal adverse effects. This review provides a comprehensive overview of the impact of natural products on the development and progression of oral infectious diseases. Specifically, these products exert their influences by mitigating dental biofilm formation, impeding the proliferation of oral pathogens, and hindering bacterial adhesion to tooth surfaces. The review also encompasses an examination of the various classes of natural products, their antimicrobial mechanisms, and their potential therapeutic applications and limitations in the context of oral infections. The insights garnered from this review can support the promising application of natural products as viable therapeutic options for managing oral infectious diseases.

Prevention of Dental Biofilm Formation with Polyphenols: A Systematic Review

Polyphenols are plant secondary products with health-promoting properties against various degenerative or infectious diseases, and thus may help in the prevention of oral diseases. The aim of the present systematic review was to investigate polyphenols as a possible adjuvant in inhibiting dental biofilm formation, which is an important precondition for the most prevalent oral disease - caries and periodontitis. A literature search was conducted using the databases PubMed, CENTRAL and Scopus. Only studies with oral healthy participants and plaque level as outcome were included. Data search and extraction was conducted by two authors independently. Of the 211 initially identified studies, only six met all inclusion criteria. Meta-analysis was performed with five studies using the random effect model. Treatment with polyphenols reduced the plaque level in comparison to a negative control, but not significantly. Strong evidence of heterogeneity was observed. The diversity and complexity of polyphenols and their preparation need to be considered. There is no clear evidence that clinical use of polyphenols can prevent dental biofilm formation. Additional research with more and larger randomized controlled trials are required.

A Chinese herb preparation, honokiol, inhibits Streptococcus mutans biofilm formation

OBJECTIVE

This study aimed to investigate the antibiofilm and anticariogenic effects of honokiol, a traditional Chinese medicine, on the cariogenic bacterium Streptococcus mutans (S. mutans).

DESIGN

The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of honokiol on S. mutans UA159 were measured. Then, S. mutans were treated with honokiol at concentrations of 1/2 MIC and 1/4 MIC. Extracellular polysaccharide (EPS) synthesis was assessed with confocal laser scanning microscopy (CLSM) and the anthrone-sulfuric method. Crystal violet staining and scanning electron microscopy (SEM) were used to demonstrate the characteristics and morphology of S. mutans biofilms. Colony-forming unit (CFU) assay was performed to observe the antibacterial effect of honokiol. Lactic acid production of 24-h biofilms was measured by the lactic acid assay. The expression level of caries-related genes (gtfB/C/D, comD/E and ldh) was identified by quantitative real-time PCR (qRTPCR) to explore the relevant mechanism. And the cytotoxic effect on human gingival fibroblasts (HGFs) was evaluated by the Cell Counting Kit-8 (CCK-8) assay.

RESULTS

The MIC and MBC of honokiol on S. mutans were 30 μg/mL and 60 μg/mL, respectively. Honokiol inhibited biofilm formation, EPS synthesis and lactic acid production. It also decreased the expression of glucosyltransferases (Gtfs) and quorum sensing (QS) system encoding genes. Moreover, honokiol showed favorable biocompatibility with HGFs.

CONCLUSIONS

Honokiol has an inhibitory effect on S. mutans and favorable biocompatibility, with application potential as a novel anticaries agent.

Dual protective effect of the association of plant extracts and fluoride against dentine erosion: In the presence and absence of salivary pellicle

OBJECTIVES

To verify the protective effect of plant extracts associated with fluoride against dental erosion of dentine, in the presence and absence of a salivary pellicle.

METHODS

Dentine specimens (n = 270) were randomly distributed into 9 experimental groups (n = 30/group): GT (green tea extract); BE (blueberry extract); GSE (grape seed extract); NaF (sodium fluoride); GT+NaF (green tea extract and NaF); BE+NaF (blueberry extract and NaF); GSE+NaF (grape seed extract and NaF); negative control (deionized water); and a positive control (commercialized mouthrinse containing stannous and fluoride). Each group was further divided into two subgroups (n = 15), according to the presence (P) or absence (NP) of salivary pellicle. The specimens were submitted to 10 cycles: 30 min incubation in human saliva (P) or only in humid chamber (NP), 2 min immersion in experimental solutions, 60 min of incubation in saliva (P) or not (NP), and 1 min erosive challenge. Dentine surface loss (dSL-10 and dSL-total), amount of degraded collagen (dColl) and total calcium release (CaR) were evaluated. Data were analyzed with Kruskal-Wallis, Dunn's and Mann-Whitney U tests (p>0.05).

RESULTS

Overall, the negative control presented the highest values of dSL, dColl and CaR, and the plant extracts showed different degrees of dentine protection. For the subgroup NP, GSE showed the best protection of the extracts, and the presence of fluoride generally further improved the protection for all extracts. For the subgroup P, only BE provided protection, while the presence of fluoride had no impact on dSL and dColl, but lowered CaR. The protection of the positive control was more evident on CaR than on dColl.

CONCLUSION

We can conclude that the plant extracts showed a protective effect against dentine erosion, regardless of the presence of salivary pellicle, and that the fluoride seems to improve their protection.

Novel Dental Restorative Solutions for Natural Teeth and Implants

The long-term survival of restorations in the oral cavity has always been one of the most significant challenges in modern dental practice [...].

Pomegranate Extract Potentiates the Anti-Demineralizing, Anti-Biofilm, and Anti-Inflammatory Actions of Non-Alcoholic Mouthwash When Associated with Sodium-Fluoride Trimetaphosphate

This study investigated the anti-caries and anti-inflammatory effects of mouthwash formulations containing Punica granatum (pomegranate) peel extract (PPE), sodium-trimetaphosphate, and low concentrations of fluoride. PPE was characterized using high-performance liquid chromatography (ellagic acid and punicalagin). Total phenolics were quantified among formulations, and their stability was analyzed for 28 days. The formulation effects were evaluated as follows: (1) inorganic component concentration and reduced demineralization on bovine enamel blocks subjected to pH cycling; (2) anti-biofilm effect on dual-biofilms of Streptococcus mutans ATCC 25175 and Candida albicans ATCC 10231 treated for 1 and 10 min, respectively; and (3) cytotoxicity and production of inflammatory mediators (interleukin-6 and tumor necrosis factor-alpha). The formulation containing 3% PPE, 0.3% sodium-trimetaphosphate, and 225 ppm of fluoride resulted in a 34.5% surface hardness loss; a 13% (treated for 1 min) and 36% (treated for 10 min) biofilm reduction in S. mutans; a 26% (1 min) and 36% (10 min) biofilm reduction in C. albicans; absence of cytotoxicity; and anti-inflammatory activity confirmed by decreased interleukin-6 production in mouse macrophages. Thus, our results provide a promising prospect for the development of an alcohol-free commercial dental product with the health benefits of P. granatum that have been recognized for a millennium.

A Bibliometric Analysis of Electrospun Nanofibers for Dentistry

Electrospun nanofibers have been widely used in dentistry due to their excellent properties, such as high surface area and high porosity, this bibliometric study aimed to review the application fields, research status, and development trends of electrospun nanofibers in different fields of dentistry in recent years. All of the data were obtained from the Web of Science from 2004 to 2021. Origin, Microsoft Excel, VOSviewer, and Carrot² were used to process, analyze, and evaluate the publication year, countries/region, affiliations, authors, citations, keywords, and journal data. After being refined by the year of publication, document types and research fields, a total of 378 publications were included in this study, and an increasing number of publications was evident. Through linear regression calculations, it is predicted that the number of published articles in 2022 will be 66. The most published journal about electrospun dental materials is Materials Science & Engineering C-Materials for Biological Applications, among the six core journals identified, the percent of journals with Journal Citation Reports (JCR) Q1 was 60%. A total of 17.60% of the publications originated from China, and the most productive institution was the University of Sheffield. Among all the 1949 authors, the most productive author was Marco C. Bottino. Most electrospun dental nanofibers are used in periodontal regeneration, and Polycaprolactone (PCL) is the most frequently used material in all studies. With the global upsurge in research on electrospun dental materials, bone regeneration, tissue regeneration, and cell differentiation and proliferation will still be the research hotspots of electrospun dental materials in recent years. Extensive collaboration and citations among authors, institutions and countries will also reach a new level.

Phytochemical Profile of Antibacterial Agents from Red Betel Leaf (Piper crocatum Ruiz and Pav) against Bacteria in Dental Caries

Based on data from The Global Burden of Disease Study in 2016, dental and oral health problems, especially dental caries, are a disease experienced by almost half of the world’s population (3.58 billion people). One of the main causes of dental caries is the pathogenesis of Streptococcus mutans. Prevention can be achieved by controlling S. mutans using an antibacterial agent. The most commonly used antibacterial for the treatment of dental caries is chlorhexidine. However, long-term use of chlorhexidine has been reported to cause resistance and some side effects. Therefore, the discovery of a natural antibacterial agent is an urgent need. A natural antibacterial agent that can be used are herbal medicines derived from medicinal plants. Piper crocatum Ruiz and Pav has the potential to be used as a natural antibacterial agent for treating dental and oral health problems. Several studies reported that the leaves of P. crocatum Ruiz and Pav contain secondary metabolites such as essential oils, flavonoids, alkaloids, terpenoids, tannins, and phenolic compounds that are active against S. mutans. This review summarizes some information about P. crocatum Ruiz and Pav, various isolation methods, bioactivity, S. mutans bacteria that cause dental caries, biofilm formation mechanism, antibacterial properties, and the antibacterial mechanism of secondary metabolites in P. crocatum Ruiz and Pav.

The Effect of Toothpastes Containing Natural Extracts on Bacterial Species of a Microcosm Biofilm and on Enamel Caries Development

This study investigated the effects of herbal toothpaste on bacterial counts and enamel demineralization. Thirty-six bovine enamel samples were exposed to a microcosm biofilm using human saliva and McBain saliva (0.2% sucrose) for 5 days at 37 °C and first incubated anaerobically, then aerobically–capnophilically. The following experimental toothpaste slurries (2 × 2 min/day) were applied: (1) Vochysia tucanorum (10 mg/g); (2) Myrcia bella (5 mg/g); (3) Matricaria chamomilla (80 mg/g); (4) Myrrha and propolis toothpaste (commercial); (5) fluoride (F) and triclosan (1450 ppm F), 0.3% triclosan and sorbitol (Colgate^®, positive control); (6) placebo (negative control). The pH of the medium was measured, bacteria were analyzed using quantitative polymerase chain reaction, and enamel demineralization was quantified using transverse microradiography. The total bacterial count was reduced by toothpaste containing Myrcia bella, Matricaria chamomilla, fluoride, and triclosan (commercial) compared to the placebo. As far as assessable, Myrcia bella, Matricaria chamomilla, and Myrrha and propolis (commercial) inhibited the outgrowth of S. mutans, while Lactobacillus spp. were reduced/eliminated by all toothpastes except Vochysia tucanorum. Mineral loss and lesion depth were significantly reduced by all toothpastes (total: 1423.6 ± 115.2 vol% × μm; 57.3 ± 9.8 μm) compared to the placebo (2420.0 ± 626.0 vol% × μm; 108.9 ± 21.17 μm). Herbal toothpastes were able to reduce enamel demineralization.

A Potential “Vitaminic Strategy” against Caries and Halitosis

Streptococcus mutans and Fusobacterium nucleatum are two key bacteria of the oral microbiota. Due to their ability to form biofilms on oral tissues, they are both involved in the onset of the most common oral diseases. F. nucleatum is also the principal producer of hydrogen sulfide (H2S), causative of the awkward bad breath of halitosis. In this study, the oral product Vea® Oris, made by vitamin E and capric/caprylic acid only, was evaluated as a potential treatment for the most common oral diseases. Different concentrations of the product were tested against both S. mutans and F. nucleatum. The effect on planktonic and biofilm growth was investigated for both strains, and for F. nucleatum, the influence on H2S production was evaluated. From our data, the product did not relevantly reduce the planktonic growth of both strains, whereas it validly counteracted biofilm assemblage. Moreover, an interesting trend of H2S reduction was highlighted. Overall, these results suggested, on the one hand, a synergistic antimicrobial–antibiofilm action of two Vea® Oris components and, together, potential modulation activity on H2S production. However, the study should be implemented to confirm these only preliminary findings, certainly extending the panel of tested bacteria and using alternative methods of detection.

Physicochemical and microbiological assessment of a dental adhesive doped with cashew nut shell liquid

To evaluate i) the inhibitory and bactericidal activity of cashew nut shell liquid (CNSL) and its isolated compounds (anacardic acid and cardol) against oral bacteria; ii) the biofilm formation inhibition, resin-dentin bond strength and physicochemical properties of a dental adhesive incorporated with these substances. The antibacterial effect of CNSL, anacardic acid, and cardol were assessed by determining the minimum inhibitory (MIC) and minimum bactericidal (MBC) concentrations. Effect in inhibiting biofilm formation of the adhesive incorporated with the substances (15 μg/ml) against a mixed-species biofilm of Streptococcus mutans and Candida Albicans and was determined by direct contact test. Additional Analysis included microtensile bond strength (μTBS) test, elastic modulus (EM), flexural strength (FS), degree of conversion (DC), water sorption (WS) and solubility (SL). The data were submitted to statistical analysis by one-way ANOVA and Tukey's test (p < 0.05). CNSL, anacardic acid and cardol showed antibacterial activity for all strains tested, with MIC and MBC values ranging from 3.12 to 25 μg/ml. There was no growth of colonies forming units in the adhesives incorporated with the substances. EM increased in the adhesive incorporated with anacardic acid, decreased after incorporation of cardol and it was not affected by incorporation of CNSL. The substances tested showed no effect in FS, DC, WS, SL and μTBS. In conclusion, the CNSL, anacardic acid and cardol showed antibacterial effects against oral bacteria and, the incorporation of substances did not reduce the performance of the adhesive.

Virtual Screening and Biological Evaluation of Anti-Biofilm Agents Targeting LuxS in the Quorum Sensing System

Biofilm formation is considered as a crucial factor in various oral diseases, such as dental caries. The quorum sensing (QS) signaling system was proved to have a crucial role in the microbial dental plaque biofilm formation of Streptococcus mutans ( S. mutans). LuxS was critical to regulating the QS system and survival of the bacterium, and, therefore, compounds which target LuxS may be a potential therapy for dental caries. The binding activities of 37,170 natural compounds to LuxS were virtually screened in this study. Baicalein and paeonol were chosen for further research of the binding mode and ΔG values with LuxS. Both baicalein and paeonol inhibited the biofilm formation without influence on the growth of S. mutans. Baicalein also distinctly reduced the production of both rhamnolipids and acids. The results provide us with a new approach to combat dental caries instead of the traditional use of antibacterial chemicals.

The Effect of Solutions Containing Extracts of Vochysia tucanorum Mart., Myrcia bellaCambess., Matricaria chamomilla L. and Malva sylvestris L. on Cariogenic Bacterial Species and Enamel Caries Development

This study evaluated the effect of experimental solutions containing plant extracts on bacterial species and enamel caries prevention. Microcosm biofilm was produced from human saliva mixed with McBain saliva (0.2% sucrose) on bovine enamel for 5 days (3 days under anaerobiosis and 2 days under aerobiosis) at 37°C. From the 2nd day, the following treatments were applied (1 × 60 s/day): Vochysia tucanorum (10 mg/mL); Myrcia bella (5 mg/mL); Matricaria chamomilla (80 mg/mL); Malva sylvestris, fluoride, and xylitol (Malvatricin Plus®); 0.12% chlorhexidine (CHX, PerioGard®); and PBS (negative control). The medium pH was measured. Quantitative polymerase chain reaction was performed for the detection of Streptococcus mutans and Lactobacillus spp. Enamel demineralization was measured by spectral-domain optical coherence tomography. The data were compared by means of the Kruskal-Wallis/Dunn, two-way ANOVA/Bonferroni, and ANOVA/Tukey tests (p < 0.05). The pH decreased after sucrose exposure; only CHX reestablished pH >5.5 by the last day. CHX also eliminated Lactobacillusspp., but the other treatments did not differ significantly from PBS. Malvatricin Plus® and CHX eliminated S. mutans, but the other treatments did not differ from PBS. Similar results were seen concerning the reduction of lesion depth and reflectivity. The experimental natural-extract solutions were ineffective against cariogenic bacteria and in preventing the development of enamel caries.

Inhibition of Streptococcus mutans biofilm formation by strategies targeting the metabolism of exopolysaccharides

Dental caries is one of the most prevalent and costly biofilm-associated infectious diseases affecting most of the world's population. In particular, dental caries is driven by dysbiosis of the dental biofilm adherent to the enamel surface. Specific types of acid-producing bacteria, especially Streptococcus mutans, colonize the dental surface and cause damage to the hard tooth structure in the presence of fermentable carbohydrates. Streptococcus mutans has been established as the major cariogenic pathogen responsible for human dental caries, with a high ability to form biofilms. The exopolysaccharide (EPS) matrix, mainly contributed by S. mutans, has been considered as a virulence determinant of cariogenic biofilm. As EPS is an important virulence factor, targeting EPS metabolism could be useful in preventing cariogenic biofilm formation. This review summarizes plausible strategies targeting S. mutans biofilms by degrading EPS structure, inhibiting EPS production, and disturbing the EPS metabolism-related gene expression and regulatory systems.

A Novel Small Molecule, LCG-N25, Inhibits Oral Streptococcal Biofilm

Dental caries is a chronic oral infectious disease caused by cariogenic biofilm adhered on the tooth surface. Our previous study demonstrated that a repurposed natural compound napabucasin (NAP) showed good antimicrobial activity against oral streptococcal biofilms. The current study designed a novel small molecule, namely LCG-N25, using NAP as a lead compound, and aimed to investigate its potential as an antimicrobial agent in the control of dental caries. LCG-N25 was designed and synthesized with reference to the structure of NAP. The minimal inhibitory concentrations and the minimal bactericidal concentrations of LCG-N25 against Streptococcus mutans, Streptococcus sanguinis, and Streptococcus gordonii were evaluated by microdilution method. The antimicrobial activity of LCG-N25 was further evaluated by crystal violet staining, colony forming units counting, biofilm metabolism assay, dead/live fluorescent staining, and scanning electron microscopy. The effect of LCG-N25 on the extracellular polysaccharides of biofilms was determined by both anthrone-sulfuric acid method and fluorescent staining. The microbial composition of streptococcal biofilms after LCG-N25 treatment was further visualized and quantified by fluorescence in situ hybridization. Besides, the cytotoxicity of LCG-N25 was evaluated by Cell Counting Kit-8 assay, and repeated exposure of S. mutans to LCG-N25 treatment was performed to assess if this novel compound could induce drug resistance of this cariogenic bacterium. We found that LCG-N25 exhibited a good antibacterial activity, low-cytotoxicity, and did not induce drug resistance of cariogenic S. mutans. These findings suggest that LCG-N25 may represent a promising antimicrobial agent that can be used as an adjuvant to the management of dental caries.

Evaluation of Anti-Biofilm Activity of Mouthrinses Containing Tannic Acid or Chitosan on Dentin In Situ

In contrast to enamel, dentin surfaces have been rarely used as substrates for studies evaluating the effects of experimental rinsing solutions on oral biofilm formation. The aim of the present in situ study was to investigate the effects of tannic acid and chitosan on 48-h biofilm formation on dentin surfaces. Biofilm was formed intraorally on dentin specimens, while six subjects rinsed with experimental solutions containing tannic acid, chitosan and water as negative or chlorhexidine as positive control. After 48 h of biofilm formation, specimens were evaluated for biofilm coverage and for viability of bacteria by fluorescence and scanning electron microscopy. In addition, saliva samples were collected after rinsing and analyzed by fluorescence (five subjects) and transmission electron microscopy (two subjects) in order to investigate the antibacterial effect on bacteria in a planktonic state and to visualize effects of the rinsing agents on salivary proteins. After rinsing with water, dentin specimens were covered by a multiple-layered biofilm with predominantly vital bacteria. In contrast, chlorhexidine led to dentin surfaces covered only by few and avital bacteria. By rinsing with tannic acid both strong anti-adherent and antibacterial effects were observed, but the effects declined in a time-dependent manner. Transmission electron micrographs of salivary samples indicated that aggregation of proteins and bacteria might explain the antiadhesion effects of tannic acid. Chitosan showed antibacterial effects on bacteria in saliva, while biofilm viability was only slightly reduced and no effects on bacterial adherence on dentin were observed, despite proteins being aggregated in saliva after rinsing with chitosan. Tannic acid is a promising anti-biofilm agent even on dentin surfaces, while rinsing with chitosan could not sufficiently prevent biofilm formation on dentin.

Inhibitory effects of flavedo, albedo, fruits, and leaves of Citrus unshiu extracts on Streptococcus mutans

OBJECTVES

Citrus unshiu has been shown to exhibit antimicrobial effects against citrus diseases. In the present study, C. unshiu was divided into flavedo, albedo, fruits, and leaves; the inhibitory effects of these extracts on Streptococcus mutans, a major pathogen of dental caries, were investigated.

DESIGN

C. unshiu specimens were separated into flavedo, albedo, fruits, and leaves. First, pH values and polyphenol amounts in Citrus extracts were measured. In addition, Citrus extract was added to the bacterial suspensions of S. mutans MT8148, and inhibitory effects of C. unshiu extracts on MT8148 for antimicrobial activity, bacterial growth, and biofilm formation were analyzed. These assays were also performed using C. sinensis extracts.

RESULTS

Among these extracts, albedo exhibited a pH value closest to neutral, while the fruits exhibited the most acidic pH value; the pH values significantly differed between these extracts (P < 0.05). In addition, the amounts of polyphenols were significantly higher in albedo than in other extracts (P < 0.001). All extracts showed inhibitory effects on MT8148 for antimicrobial activity, bacterial growth and biofilm formation. These inhibitory effects were significantly stronger in flavedo, albedo, and fruits, compared with leaves (P < 0.05). Furthermore, extracts of Citrus sinensis also showed inhibitory effects on S. mutans, although these effects were weaker than the effects of C. unshiu.

CONCLUSION

These results suggest that extracts from C. unshiu fruits exhibit inhibitory effects on S. mutans, among which albedo may be especially useful for dental caries prevention due to its neutral pH and abundant polyphenols, in addition to its inhibitory effects.

Antimicrobial peptides for the prevention and treatment of dental caries: A concise review

The objective of this study was to perform a comprehensive review of the use of antimicrobial peptides for the prevention and treatment of dental caries. The study included publications in the English language that addressed the use of antimicrobial peptides in the prevention and treatment of caries. These publications were also searchable on PubMed, Web of Science, Embase, Scopus, the Collection of Anti-Microbial Peptides and the Antimicrobial Peptide Database. A total of 3,436 publications were identified, and 67 publications were included. Eight publications reported seven natural human antimicrobial peptides as bactericidal to Streptococcus mutans. Fifty-nine publications reported 43 synthetic antimicrobial peptides developed to mimic natural antimicrobial peptides, fusing peptides with functional sequences and implementing new designs. The 43 synthetic antimicrobial peptides were effective against Streptococcus mutans, and nine peptides specifically targeted Streptococcus mutans. Ten antimicrobial peptides had an affinity for hydroxyapatite to prevent bacterial adhesion. Six antimicrobial peptides were also antifungal. Four antimicrobial peptides promoted remineralisation or prevented the demineralisation of teeth by binding calcium to hydroxyapatite. In conclusion, this study identified 67 works in the literature that reported seven natural and 43 synthetic antimicrobial peptides for the prevention and treatment of caries. Most of the antimicrobial peptides were bactericidal, and some prevented bacterial adhesion. A few antimicrobial peptides displayed remineralising properties with hydroxyapatite.

Comparison of the Remineralizing Effect of Brushing with Aloe vera versus Fluoride Toothpaste

Objectives  The aim of the present in vitro study is to compare the remineralization brushing effect of three toothpastes and Aloe vera (AV) gel.

Materials and Methods  Forty sound extracted teeth were placed in a demineralizing solution for 4 days and randomly assigned to four groups: group A: 1,450-ppm fluoride toothpaste; group B: AV nonfluoridated toothpaste; group C: AV 1,000-ppm fluoridated toothpaste; and group D: AV gel. A 3-minute pH cycling was performed twice a day for each group for 12 days. Specimens were analyzed before and after by scanning electron microscope—energy dispersive X-ray.

Statistical Analysis  The outcomes were analyzed by Kolmogorov–Smirnov’s tests, repeated-measures analyses of variance followed by univariate analyses, and Bonferroni’s multiple comparisons tests to compare the calcium-to-phosphorus (Ca:P) ratio within time among toothpaste groups.

Results  Following remineralization, the Ca:P ratio increased in all groups. The difference of the Ca:P ratio was not significant between groups C, D, and A. The mean ratio was significantly lower in group B ( p -value = 0.026).

Conclusions  The AV gel demonstrated a remineralization capacity equal to that of the 1,450-ppm fluoride toothpaste. In contrast, fluoride-free AV toothpaste showed a lower remineralization efficiency. Further studies are required to understand its mechanism.

Polyphenols in Dental Applications

(1) Background: polyphenols are a broad class of molecules extracted from plants and have a large repertoire of biological activities. Biomimetic inspiration from the effects of tea or red wine on the surface of cups or glass lead to the emergence of versatile surface chemistry with polyphenols. Owing to their hydrogen bonding abilities, coordination chemistry with metallic cations and redox properties, polyphenols are able to interact, covalently or not, with a large repertoire of chemical moieties, and can hence be used to modify the surface chemistry of almost all classes of materials. (2) Methods: the use of polyphenols to modify the surface properties of dental materials, mostly enamel and dentin, to afford them with better adhesion to resins and improved biological properties, such as antimicrobial activity, started more than 20 years ago, but no general overview has been written to our knowledge. (3) Results: the present review is aimed to show that molecules from all the major classes of polyphenolics allow for low coast improvements of dental materials and engineering of dental tissues.

Products of Dental Use Containing Copaiba Oil-resin: Technological Prospecting Based on Patents

BACKGROUND

Copaiba oil-resin has been widely used and is especially found in neotropical regions, for which several pharmacological activities have been documented over the years. Prospective studies in intellectual property banks are important to increase competitiveness and thus generate new products in various research areas.

OBJECTIVE

A prospective study was carried out on patents of products containing copaiba oil-resin for dental use in intellectual property banks.

METHODS

The research was conducted with patent searches in six intellectual property banks of the world. Relevant information about the invention in the patent document was collected, processed and described.

RESULTS

The search found 9 patents using copaiba resin oil-resin in dental products. The National Institute of Industrial Property (INPI-Brazil) had the highest number of deposits (5), followed by Espacenet (2) and Free Patents (2). C. Langsdorffii was highlighted as the most widely used species in the products and deposits of vehicles in formulations (3). All the patents in the search are A61K code for medical, dental or hygienic purposes.

CONCLUSION

Most of the found patents are related to the area of Microbiology, specifically with application in Cariology. Brazil is represented by the INPI and presented the highest number of patent applications when compared to other intellectual property banks.

Novel Approaches to the Control of Oral Microbial Biofilms

Effective management of biofilm-related oral infectious diseases is a global challenge. Oral biofilm presents increased resistance to antimicrobial agents and elevated virulence compared with planktonic bacteria. Antimicrobial agents, such as chlorhexidine, have proven effective in the disruption/inhibition of oral biofilm. However, the challenge of precisely and continuously eliminating the specific pathogens without disturbing the microbial ecology still exists, which is a major factor in determining the virulence of a multispecies microbial consortium and the consequent development of oral infectious diseases. Therefore, several novel approaches are being developed to inhibit biofilm virulence without necessarily inducing microbial dysbiosis of the oral cavity. Nanoparticles, such as pH-responsive enzyme-mimic nanoparticles, have been developed to specifically target the acidic niches within the oral biofilm where tooth demineralization readily occurs, in effect controlling dental caries. Quaternary ammonium salts (QAS) such as dimethylaminododecyl methacrylate (DMADDM), when incorporated into dental adhesives or resin composite, have also shown excellent and durable antimicrobial activity and thus could effectively inhibit the occurrence of secondary caries. In addition, custom-designed small molecules, natural products and their derivatives, as well as basic amino acids such as arginine, have demonstrated ecological effects by modulating the virulence of the oral biofilm without universally killing the commensal bacteria, indicating a promising approach to the management of oral infectious diseases such as dental caries and periodontal diseases. This article aims to introduce these novel approaches that have shown potential in the control of oral biofilm. These methods may be utilized in the near future to effectively promote the clinical management of oral infectious diseases and thus benefit oral health.

State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management

The principles of minimally invasive dentistry clearly dictate the need for clinically effective measures to remineralize early enamel caries lesions. While fluoride-mediated remineralization is the cornerstone of current caries management philosophies, a number of new remineralization strategies have been commercialized or are under development that claim to promote deeper remineralization of lesions, reduce the potential risks associated with high-fluoride oral care products, and facilitate caries control over a lifetime. These non-fluoride remineralizing systems can be broadly categorized into biomimetic enamel regenerative technologies and the approaches that repair caries lesions by enhancing fluoride efficacy. This paper discusses the rationale for non-fluoride remineralization and the mechanism of action, challenges, and evidence behind some of the most promising advances in enamel remineralization therapies.

Oral health in China: from vision to action

Chinese president Xi Jinping made clear at the National Health and Wellness Conference that health is the prerequisite for people's all-around development and a precondition for the sustainable development of China. Oral health is an indispensable component of overall health in humans. However, the long neglect of oral health in overall health agendas has made oral diseases an increasing concern. With this perspective, we described the global challenges of oral diseases, with an emphasis on the challenges faced by China. We also described and analyzed the recently released health policies of the Chinese government, which aim to guide mid-term and long-term oral health promotion in China. More importantly, we called for specific actions to fulfill the larger goal of oral health for the nation. The implementation of primordial prevention efforts against oral diseases, the integration of oral health into the promotion of overall health, and the management of oral diseases in conjunction with other chronic non-communicable diseases with shared risk factors were highly recommended. In addition, we suggested the reform of standard clinical residency training, the development of domestic manufacturing of dental equipment and materials, the revitalization traditional Chinese medicine for the prevention and treatment of oral diseases, and integration of oral health promotion into the Belt and Road Initiative. We look forward to seeing a joint effort from all aspects of the society to fulfill the goal of Healthy China 2030 and ensure the oral health of the nation.

Ecological Approaches to Dental Caries Prevention: Paradigm Shift or Shibboleth?

Contemporary paradigms of dental caries aetiology focus on the ecology of the dental plaque biofilm and how local environmental factors can modulate this to cause disease. The crucial role that a healthy oral microbiome plays in preventing caries and promoting oral health is also being increasingly recognized. Based on these concepts, several ecological preventive approaches have been developed that could potentially broaden the arsenal of currently available caries-preventive measures. Many of these ecological approaches aim for long-term caries control by either disrupting cariogenic virulence factors without affecting bacterial viability, or include measures that can enhance the growth of health-associated, microbially diverse communities in the oral microbiome. This paper argues for the need to develop ecological preventive measures that go beyond conventional caries-preventive methods, and discusses whether these ecological approaches can be effective in reducing the severity of caries by promoting stable, health-associated oral biofilm communities.

Beneficial effects of specific natural substances on oral health

Substances that are consumed daily or occasionally may influence an individual’s oral health. Some substances, such as alcohol, tobacco, and areca nut, adversely affect the oral region. However, some other substances, such as honey and green tea, which have antimicrobial properties, and berries, which have anticarcinogenic potential, exhibit beneficial effects on oral health. The effectiveness of synthetic drugs in maintaining oral health cannot be ignored; however, the benefits of synthetic drugs are associated with adverse effects and high costs. By contrast, the medicinal use of natural substances is associated with safety, affordability, and long-term benefits. In this paper, we review various natural substances that are potentially beneficial to oral health.

Galla chinensis Compounds Remineralize Enamel Caries Lesions in a Rat Model

OBJECTIVES

To investigate the effect of Galla chinensis chemical compounds on enamel caries remineralization in rats.

METHODS

A total of 40 rats were inoculated with Streptococcus sobrinus 6715 and fed a cariogenic diet (Keyes 2000). The rats were randomly divided into 4 groups and treated topically twice a day with each of the following extracts (or control) for 5 weeks: distilled and deionized water (DDW, negative control); 1,000 ppm NaF (positive control); 4,000 ppm G. chinensis crude aqueous extract (GCE), or 4,000 ppm gallic acid (GA). After the experimental period, Keyes' caries diagnosis and scoring technique was applied as a preliminary evaluation on the molar teeth. For more accurate remineralization data, the residual enamel volume of the first molar and the mineral density (MD) of the enamel were further analyzed by micro-CT.

RESULTS

The severity of molar enamel caries decreased in the following order of treatment groups: DDW > GA > GCE > NaF (p < 0.05). In addition, the residual first molar enamel volume and MD values increased in the order of DDW, GA, GCE and NaF treatment groups (p < 0.05). In most molars, remineralization layers were observed on the surface of lesions.

CONCLUSION

G. chinensis compounds remineralize enamel caries lesions in a rat model.

Self-perceived mouthfeel and physico-chemical surface effects after chewing gums containing sorbitol and Magnolia bark extract

The European Food Safety Authority recognizes the contribution of sugar-free chewing gum to oral health through increased salivation, clearance of food debris, and neutralization of biofilm pH. Magnolia bark extract is a gum additive shown to reduce the prevalence of bad-breath bacteria but its effects on self-perceived mouthfeel are unknown. This paper aims to relate the effects of sorbitol-containing chewing gum, with and without Magnolia bark extract, on tooth-surface hydrophobicity and salivary-film composition with self-perceived mouthfeel. In a crossover clinical trial, volunteers chewed sorbitol-containing gum, with or without Magnolia bark extract added, three times daily during a 4-wk time period. A subset of volunteers also chewed Parafilm as a mastication control. Oral moistness and tooth smoothness were assessed using questionnaires, and intra-oral water-contact angles were measured before, immediately after, and 60 min after, chewing. Simultaneously, saliva samples were collected, placed on glass slides, and the compositions of the adsorbed film were measured using X-ray photoelectron spectroscopy. Chewing of gum, regardless of whether or not it contained Magnolia bark extract, improved self-perceived mouthfeel up to 60 min, concurrent with a more hydrophilic tooth surface and an increased amount of O_1s electrons bound at 532.6 eV in salivary films. Chewing of Parafilm affected neither tooth-surface hydrophobicity nor salivary-film composition. Accordingly, adsorption of sorbitol, rather than the presence of Magnolia bark extract or increased salivation, is responsible for improved self-perceived mouthfeel.

Anti-Caries Effects of Dental Adhesives Containing Quaternary Ammonium Methacrylates with Different Chain Lengths

The objectives of this study were to investigate the effects of dental adhesives containing quaternary ammonium methacrylates (QAMs) with different alkyl chain lengths (CL) on ecological caries prevention in vitro. Five QAMs were synthesized with a CL = 3, 6, 9, 12, and 16 and incorporated into adhesives. Micro-tensile bond strength and surface charge density were used to measure the physical properties of the adhesives. The proportion change in three-species biofilms consisting of Streptococcus mutans, Streptococcus sanguinis, and Streptococcus gordonii was tested using the TaqMan real-time polymerase chain reaction. Lactic acid assay, MTT [3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay, exopolysaccharide staining, live/dead staining, scanning electron microscopy (SEM), and transverse microradiography (TMR) were performed to study the anti-biofilm and anti-demineralization effects of the dental adhesives. The results showed that incorporating QAMs with different alkyl chain lengths into the adhesives had no obvious effect on the dentin bond strength. The adhesives containing QAMs with a longer alkyl chain developed healthier biofilms. The surface charge density, anti-biofilm, and anti-demineralization effects of the adhesives increased with a CL of the QAMs from 3 to 12, but decreased slightly with a CL from 12 to 16. In conclusion, adhesives containing QAMs with a tailored chain length are promising for preventing secondary caries in an “ecological way”.