Denture plaque and adherence of Candida albicans to denture-base materials in vivo and in vitro

Current Drug Delivery Strategies for Buccal Cavity Ailments using Mouth Dissolving Wafer Technology: A Comprehensive Review on the Present State of the Art

BACKGROUND

Mouth-dissolving wafer is polymer-based matrice that incorporates various pharmaceutical agents for oral drug delivery. This polymeric wafer is ingenious in the way that it needs not be administered with water, like in conventional tablet dosage form. It has better compliance among the pediatric and geriatric groups owing to its ease of administration.

OBJECTIVE

The polymeric wafer dissolves quickly in the oral cavity and is highly effective for a targeted local effect in buccal-specific ailments. It is a safe, effective, and versatile drug delivery carrier for a range of drugs used to treat a plethora of oral cavity-specific ailments that inflict common people, like thrush, canker sores, periodontal disease, benign oral cavity tumors, buccal neoplasm, and malignancies. This review paper focuses thoroughly on the present state of the art in mouth-dissolving wafer technology for buccal drug delivery and targeting. Moreover, we have also addressed present-time limitations associated with wafer technology to aid researchers in future developments in the arena of buccal drug delivery.

CONCLUSION

This dynamic novel formulation has tremendous future implications for designing drug delivery systems to target pernicious ailments and diseases specific to the buccal mucosa. In a nutshell, this review paper aims to summarize the present state of the art in buccal targeted drug delivery.

Different Polymers for the Base of Removable Dentures? Part II: A Narrative Review of the Dynamics of Microbial Plaque Formation on Dentures

This review focuses on the current disparities and gaps in research on the characteristics of the oral ecosystem of denture wearers, making a unique contribution to the literature on this topic. We aimed to synthesize the literature on the state of current knowledge concerning the biological behavior of the different polymers used in prosthetics. Whichever polymer is used in the composition of the prosthetic base (poly methyl methacrylate acrylic (PMMA), polyamide (PA), or polyether ether ketone (PEEK)), the simple presence of a removable prosthesis in the oral cavity can disturb the balance of the oral microbiota. This phenomenon is aggravated by poor oral hygiene, resulting in an increased microbial load coupled with the reduced salivation that is associated with older patients. In 15-70% of patients, this imbalance leads to the appearance of inflammation under the prosthesis (denture stomatitis, DS). DS is dependent on the equilibrium-as well as on the reciprocal, fragile, and constantly dynamic conditions-between the host and the microbiome in the oral cavity. Several local and general parameters contribute to this balance. Locally, the formation of microbial plaque on dentures (DMP) depends on the phenomena of adhesion, aggregation, and accumulation of microorganisms. To limit DMP, apart from oral and lifestyle hygiene, the prosthesis must be polished and regularly immersed in a disinfectant bath. It can also be covered with an insulating coating. In the long term, relining and maintenance of the prosthesis must also be established to control microbial proliferation. On the other hand, several general conditions specific to the host (aging; heredity; allergies; diseases such as diabetes mellitus or cardiovascular, respiratory, or digestive diseases; and immunodeficiencies) can make the management of DS difficult. Thus, the second part of this review addresses the complexity of the management of DMP depending on the polymer used. The methodology followed in this review comprised the formulation of a search strategy, definition of the inclusion and exclusion criteria, and selection of studies for analysis. The PubMed database was searched independently for pertinent studies. A total of 213 titles were retrieved from the electronic databases, and after applying the exclusion criteria, we selected 84 articles on the possible microbial interactions between the prosthesis and the oral environment, with a particular emphasis on Candida albicans.

Evaluation of surface roughness of differently manufactured denture base materials

STATEMENT OF PROBLEM

The popularity of computer-aided design and computer-aided manufacturing (CAD-CAM) dentures has led to the introduction of new denture materials and resins. However, studies on the surface characteristics of these materials and how they compare to dentures fabricated by more traditional methods are lacking.

PURPOSE

The purpose of this cross-sectional study was to determine whether the surface roughness (Ra) of denture base materials differed based on manufacturing technique.

MATERIAL AND METHODS

Disks of Ø10×2-mm (n=10) were fabricated using 6 different manufacturing techniques, including compression molding (Lucitone 199), injection molding (Ivocap High Impact), Computer Numerical Control (CNC) milling (Ivotion Base), and additive manufacturing on the Carbon M2 (Lucitone Digital Print), the SprintRay Pro55 S (Dentca Denture Base II), and the Envision One (Flexcera Base) systems. An automatic, noncontact laser confocal microscope (VK-X1000 Series; KEYENCE) was used to analyze the Ra surface roughness of each specimen at ×5 magnification. The images were imported into a multifile analyzer, horizontal and vertical roughness profiles were inserted into each scan, and Ra values were calculated and averaged by following the International Organization for Standardization (ISO) 4287 standard. A 1-way analysis of variance (ANOVA) was performed to compare the effect of manufacturing technique on surface roughness, followed by the Tukey multiple comparisons test (α=.05).

RESULTS

The additively manufactured Dentca Denture Base II (AM-DB) exhibited a statistically significantly higher Ra when compared with the other test groups (P<.001). The additively manufactured Flexcera Base (AM-FB) showed a higher Ra mean value when compared with injection molding (IM) (P=.036). No statistically significant difference in surface roughness was found among the other tested materials representing the different processing methods (P>.05).

CONCLUSIONS

The manufacturing method influences the Ra of denture base materials with varying results. The injection molding method resulted in the smoothest surface compared with additively manufactured and CNC-milled denture base materials.

Strategies for Inhibition of Biofilm Formation on Silicone Rubber Voice Prostheses: A Systematic Review

BACKGROUND

Lifetime elongation of the silicone voice rubber prostheses by inhibition of biofilm formation is a primary objective in voice restoration of laryngectomized patients. This systematic review sought to explore the existing strategies in this direction.

MATERIALS

We conducted a systematic search of both in vitro and in vivo literature published in PubMed, Scopus, and Cochrane Central Register of Controlled Trials, until December 31, 2022, for published and unpublished trials assessing the strategies for inhibiting biofilm formation on silicone rubber voice prostheses, and appraised quality assessment with the modified Consolidated Standards of Reporting Trials tool. We analyzed the infection prevention capacity of the included antibacterial and antifungal agents.

RESULTS

The qualitative synthesis showed that both surface modification methods and prophylactic treatment of silicone rubber voice prostheses present adequate antibiofilm activity. Of note, the majority of the suggested prosthetic surfaces were not chronically exposed to both human fluids and biofilm-forming microorganisms.

CONCLUSION

Various experimental methods provide promising antibiofilm activity and, thus, possible lifespan elongation of silicone rubber voice prostheses.

Dispersion and Homogeneity of MgO and Ag Nanoparticles Mixed with Polymethylmethacrylate

This study aims to examine the impact of the direct and indirect mixing techniques on the dispersion and homogeneity of magnesium oxide (MgO) and silver (Ag) nanoparticles (NPs) mixed with polymethylmethacrylate (PMMA). NPs were mixed with PMMA powder directly (non-ethanol-assisted) and indirectly (ethanol-assisted) with the aid of ethanol as solvent. X-ray diffraction (XRD), energy-dispersive X-ray spectroscopy (EDX), and scanning electron microscope (SEM) were used to evaluate the dispersion and homogeneity of MgO and Ag NPs within the PMMA-NPs nanocomposite matrix. Prepared discs of PMMA-MgO and PMMA-Ag nanocomposite were analyzed for dispersion and agglomeration by Stereo microscope. XRD showed that the average crystallite size of NPs within PMMA-NP nanocomposite powder was smaller in the case of ethanol-assisted mixing compared to non-ethanol-assisted mixing. Furthermore, EDX and SEM revealed good dispersion and homogeneity of both NPs on PMMA particles with ethanol-assisted mixing compared to the non-ethanol-assisted one. Again, the PMMA-MgO and PMMA-Ag nanocomposite discs were found to have better dispersion and no agglomeration with ethanol-assisted mixing when compared to the non-ethanol-assisted mixing technique. Ethanol-assisted mixing of MgO and Ag NPs with PMMA powder obtained better dispersion, better homogeneity, and no agglomeration of NPs within the PMMA-NP matrix.

Effect of nano-ceramic coating on surface property and microbial adhesion to poly(methyl methacrylate)

To improve surface properties of poly(methyl methacrylate) (PMMA) using nano-ceramic coatings and assess microbial adherence after long-term use of a chemical cleanser. Thirty-six PMMA samples were fabricated, polished and coated with a nano-thin TiO₂ or mixed TiO₂ /ZrO₂ , with uncoated samples as controls. Six samples in each group (n = 12) were soaked in Polident denture cleaner 180 times for 30 min, while six were soaked in deionized water. Surface roughness of PMMA before and after being soaked in Polident was assessed. All samples were subsequently exposed to Candida albicans for 6 h and the adherent cells were determined by viable colony count. Two-way analysis of variance was performed for statistical analysis. No significant difference in surface roughness was noted between the uncoated and coated PMMA before soaking. After soaking, surface roughness of the uncoated PMMA increased from 0.164 to 0.532 μm (p < .05). No significant change was observed for TiO₂ -coated (0.105-0.143 μm) or TiO₂ /ZrO₂ -coated PMMA (0.104-0.141 μm). Attachment of C. albicans to PMMA soaked in water showed significantly less attachment to both TiO₂ -coated (1.4 × 10³ cfu/ml) and TiO₂ /ZrO₂ -coated PMMA (1.6 × 10³ cfu/ml) than to the uncoated PMMA (2.6 × 10³ cfu/ml). After soaking in Polident, the uncoated PMMA had significantly less C. albicans attachment than coated samples. Less attachment was noted on the TiO₂ /ZrO₂ -coated PMMA then the TiO₂ -coated samples (p < .05). Nano-ceramic TiO2₂ /ZrO₂ coating of PMMA denture base material alters surface properties thus reduces oral microbial adhesion. It represents a promising alternative to the chemical disinfection for PMMA denture materials.

Removal effect of Candida albicans biofilms from the PMMA resin surface by using a manganese oxide nanozyme-doped diatom microbubbler

To prevent oral candidiasis, removal of the Candida biofilms from dentures is important. However, common denture cleaners are insufficiently effective in removing biofilms. A manganese oxide (MnO₂) nanozyme-doped diatom microbubbler (DM) can generate oxygen gas microbubbles by a catalase-mimicking activity in hydrogen peroxide (H₂O₂). DM can invade and destroy biofilms with the driving force of continuously generated microbubbles. In this study, the Candida biofilm removal efficiency by co-treatment of DM and H₂O₂ was investigated. Diatom particles were reacted with (3-aminopropyl)triethoxysilane to prepare amine-substituted diatom particles. These particles were reacted with potassium permanganate to fabricate DMs. The morphology and components of DM were analyzed by using a scanning electron microscope (SEM). Four types of denture base resin specimens on which biofilms of Candida albicans were formed were treated with phosphate-buffered saline (PBS group), Polident 5-Minute (Polident group), 0.12% chlorhexidine gluconate (CHX group), 3% H₂O₂ (H₂O₂ group), and co-treatment of 3 mg/mL of DM and 3% H₂O₂ (DM group). The biofilm removal effect of each group was quantitatively analyzed by crystal violet assay, and the results were visually confirmed by SEM images. After each treatment, the remaining C. albicans were stained with Hoechst 33342/propidium iodide, and observed with confocal laser scanning microscopy (CLSM) to evaluate the viability. MnO₂ nanozyme sheets were successfully doped on the surface of the fabricated DM. Although biofilms were not effectively removed in the Polident and CHX groups, CLSM images showed that CHX was able to effectively kill C. albicans in the biofilms on all resin specimen types. According to the crystal violet analysis, the H₂O₂ groups removed the biofilms on heat-activated and 3D-printed resins (P < .01), but could not remove the biofilms on autopolymerizing and milled resins significantly (P = .1161 and P = .1401, respectively). The DM groups significantly removed C. albicans from all resin specimen types (P < .01).

Effect of Nano Ceramic Coating on Color Perceptibility and Acceptability of Polymethylmethacrylate: In Vitro and Clinical Study

The effect of a novel nano-ceramic coating (TiO₂) using an atomic layer deposition (ALD) technique on the surface of polymethyl methacrylate (PMMA) material was investigated. The patients' and clinicians' perception and acceptance of the PMMA color with TiO₂ coating were also examined. In vitro color measurement was performed on thirty specimens (light, original, and dark pink) before and after TiO₂ coating. Patients' and clinicians' perception and acceptance of color changes on PMMA were measured and compared. Descriptive and analytic statistics were analyzed (a = 0.05). TiO₂ films were successfully deposited on the PMMA specimen by the ALD technique. Color changes after TiO₂ coating were observed on all three PMMA shades, significantly higher than the established 50:50% perceptibility threshold, but below the established 50:50% acceptability threshold. The percentage of patients that perceived a color difference after TiO₂ coating were 83.3%, 63.9%, and 77.8% for light, original, and dark pink, respectively. The percentages of clinicians that were satisfied with the color difference were 96.4%, 80%, and 69.2% for light, original, and dark pink, respectively. Color changes after TiO₂ coating were observed, but below the acceptable threshold. The clinical survey demonstrated that a color difference was perceived but was clinically acceptable. In general, laypeople have lower perception and higher acceptance of changes in PMMA color than clinicians.

Evaluation of Effective Chloramine-T Concentration to Be Incorporated in Dental Stone for Antimicrobial Activity

Objective The objective of this study was to determine the antimicrobial activity of type III gypsum at three different chloramine-T concentrations and to ascertain the most effective concentration to be added for optimum inhibitory activity against Candida albicans. Method Ten discs of type III gypsum were fabricated for each group. Standard type III gypsum without any disinfectant was used for the control group. For the experimental group, an admixture of chloramine-T and standard dental stone was employed in varying w/w concentrations (0.1%, 0.25%, and 0.5%). Discs were placed in a petri dish containing Sabouraud dextrose agar lawned with Candida albicans culture and incubated for 24 hours. The zone of inhibition created around the discs was measured and evaluated. Result The mean zone of inhibition (mean ± standard deviation) in the control group was 0 mm; 0.70±1.05 mm in group 1 (0.1% w/w concentration), 2.70 ± 2.35 mm in group 2 (0.25% w/w concentration), and 20.80 ± 1.68 mm in group 3 (0.5% w/w concentration). A one-way ANOVA test showed that there was a significant difference in the inhibition zone created around all groups (p < 0.05), with the discs of group 3 yielding the most positive results. Conclusion The addition of 0.5% chloramine-T to type III gypsum showed the most promising result, out of the concentrations tested, as a self-disinfecting dental stone and could be used for further investigations.

The Use of Acrylate Polymers in Dentistry

The manuscript aimed to review the types of acrylate polymers used in dentistry, as well as their chemical, physical, mechanical, and biological properties. Regarding their consistency and purpose, dental acrylate polymers are divided into hard (brittle), which includes acrylates for the production of plate denture bases, obturator prostheses, epitheses and maxillofacial prostheses, their repairs and lining, and soft (flexible), which are used for lining denture bases in special indications. Concerning the composition and method of polymerization initiation, polymers for the production of denture bases are divided into four types: heat-, cold-, light-, and microwave-polymerized. CAD/CAM acrylate dentures are made from factory blocks of dental acrylates and show optimal mechanical and physical properties, undoubtedly better monomer polymerization and thus biocompatibility, and stability of the shape and colour of the base and dentures. Regardless of the number of advantages that these polymers have to offer, they also exhibit certain disadvantages. Technological development enables the enhancement of all acrylate properties to respond better to the demands of the profession. Special attention should be paid to improving the biological characteristics of acrylate polymers, due to reported adverse reactions of patients and dental staff to potentially toxic substances released during their preparation and use.

Adherence Of Candida Albicans to Five Long-Term Silicone-Based Denture Lining Materials Bonded to CAD-CAM Denture Base

PURPOSE

Knowledge about quantifying the number as well as the retention and adhesion of Candida albicans blastoconidia to silicone denture liners is limited. Thus, the aim of this in vitro study was to explore the adherence of Candida albicans to the surface of five long-term silicone-based soft denture lining materials, using artificial saliva.

MATERIALS & METHODS

A total of 50 specimens (10 × 10 × 3 mm) of five long-term resilient liners (Molloplast-B; GC Reline Soft; Elite Soft Relining; Tokuyama Sofreliner S; Ufigel SC), bonded to a computer-aided design and computer-aided manufacturing denture base, were prepared. The specimens were inoculated and incubated in artificial saliva for 1h and 24h with a standardized (2.8 × 10⁶ cfu/ml) Candida albicans suspension. At the end of the incubation period, the specimens were stained with acridine orange and observed, using fluorescence microscopy.

RESULTS

After 1h and in 24h, Molloplast B demonstrated significantly earlier adherence of Candida albicans cells compared to the other chairside materials (p<0.001 and p<0.001, respectively), where the mean number of cells also increased in the frontal parts. Regarding the rate of Candida albicans proliferation from 1h to 24 hours within the materials, there was an increase in all materials (Molloplast B: p<0.001; GC Reline Soft: p = 0.220; Elite Soft Relining: p = 0.032; Tokuyama Sofreliner S: p = 0.001; Ufigel Sc: p = 0.001). The Ufigel Sc showed a significant 2.5-fold increase at 24h.

CONCLUSIONS

Long-term silicone denture liners accumulate a significant amount of Candida albicans blastoconidia and their coverage by them increases progressively over time. This article is protected by copyright. All rights reserved.

Effect of Candida albicans Suspension on the Mechanical Properties of Denture Base Acrylic Resin

Yeast-like fungi such as Candida albicans (C. albicans) are the primary pathogenic microorganism in the oral cavity of denture wearers. The research available so far, conducted according to a protocol based on the exposure of specimens to a C. albicans suspension and their cutting with water cooling, shows that hard polymethyl methacrylate (PMMA) prosthetic materials are not only surface colonized, but also penetrated by microorganisms in a short time. This justifies the hypothesis that exposure to a suspension of the C. albicans strain causes the changes in mechanical properties due to surface colonization and/or penetration of the samples. In the current study, the chosen mechanical properties (flexural strength, flexural modulus, tensile strength, impact strength, ball indentation hardness, and surface Vickers hardness at 300 g load) of the PMMA denture base material Vertex RS (Vertex-Dental, The Netherlands) exposed for 30, 60, and 90 days to a suspension of C. albicans were investigated. The potential penetration of yeast was examined on the fractured surfaces (interior of specimens) to eliminate the risk of the contamination of samples during cutting. There was no influence on the flexural strength, flexural modulus, tensile strength, impact strength, or ball indentation hardness, but a significant decrease in surface hardness was registered. Microscopic observations did not confirm the penetration of C. albicans. On the surface, blastospores and pseudohyphae were observed in crystallized structures and in traces after grinding, which indicates that in clinical conditions, it is not penetration but the deterioration of surface quality, which may lead to the formation of microareas that are difficult to disinfect, causing rapid recolonization.

Oral Microbiome: Getting to Know and Befriend Neighbors, a Biological Approach

The oral microbiome, forming a biofilm that covers the oral structures, contains a high number of microorganisms. Biofilm formation starts from the salivary pellicle that allows bacterial adhesion–colonization–proliferation, co-aggregation and biofilm maturation in a complex microbial community. There is a constant bidirectional crosstalk between human host and its oral microbiome. The paper presents the fundamentals regarding the oral microbiome and its relationship to modulator factors, oral and systemic health. The modern studies of oral microorganisms and relationships with the host benefits are based on genomics, transcriptomics, proteomics and metabolomics. Pharmaceuticals such as antimicrobials, prebiotics, probiotics, surface active or abrasive agents and plant-derived ingredients may influence the oral microbiome. Many studies found associations between oral dysbiosis and systemic disorders, including autoimmune diseases, cardiovascular, diabetes, cancers and neurodegenerative disorders. We outline the general and individual factors influencing the host–microbial balance and the possibility to use the analysis of the oral microbiome in prevention, diagnosis and treatment in personalized medicine. Future therapies should take in account the restoration of the normal symbiotic relation with the oral microbiome.

Hydrophobicity of denture base resins: A systematic review and meta-analysis

Objectives:

The aim of this article is to review the factors that attract Candida albicans to denture base resin (DBR) and to verify the influence of different surface treatments, chemical modification, or structural reinforcements on the properties of DBR.

Materials and Methods:

Searches were carried out in PubMed, Scopus, WOS, Google Scholar, EMBASE, and J-stage databases. The search included articles between 1999 and 2020. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The keywords used during the search were “Candida albicans,” “Denture base,” “PMMA,” “Acrylic resin,” “Surface properties,” “hydrophobicity/hydrophilicity,” “contact angle,” and “surface free energy.” English full-text articles involving in-vitro studies with different acrylic resin modifications were included, whereas abstracts, dissertations, reviews, and articles in languages other than English were excluded. A meta-analysis was performed where appropriate.

Results:

Out of the 287 articles, 21 articles conformed to inclusion criteria. Sixteen articles were subjected to meta-analysis using random-effects model at 95% confidence interval. Results showed that DBR coatings/plasma coatings were effective methods to modify surface properties with estimated contact angle (CA) of 59.37° [95% confidence interval (CI): 53.69, 65.04]/55.87° (95% CI: 50.68, 61.06) and surface roughness (R_a) of 0.55 µm (95% CI: 0.52, 0.58)/0.549 µm (95% CI: 0.5, 0.59), respectively. Antifungal particle incorporation into poly(methylmethacrylate) DBR also produced similar effects with an estimated R_a of 0.16 µm (95% CI: 0.134, 0.187).

Conclusion:

The three properties responsible for C. albicans adhesion to DBR were R_a, CA, and surface free energy in terms of hydrophobicity. Therefore, the correlations between the hydrophobicity of DBR and C. albicans adhesion should be considered during future investigations for Candida-related denture stomatitis.

Hydrogen peroxide potentiates antimicrobial photodynamic therapy in eliminating Candida albicans and Streptococcus mutans dual-species biofilm from denture base

BACKGROUND

Candida albicans (C.albicans) is the primary pathogen of denture biofilm. Moreover, it could establish a cross-kingdom relationship with bacteria to enhance its virulence and resistance to antifungal drugs. This study aimed to investigate the efficacy of antimicrobial photodynamic therapy (aPDT) in combination with hydrogen peroxide (H₂O₂) against C.albicans and Streptococcus mutans (S.mutans) dual-species biofilm formed on polymethyl methacrylate (PMMA) disk, and explore its involved mechanisms.

METHODS

C.albicans and S.mutans were grown on PMMA disk for 48 h to form biofilm and received different treatments. The treatments included:1) phosphate-buffered saline (PBS) group,2) 100 mM H₂O₂ group,3) aPDT group,4) aPDT+ H₂O₂ and 5) H₂O₂+aPDT group. Colony forming units (CFU), 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), and scanning electron microscope (SEM) were used to evaluate the antimicrobial effects. Extracellular polysaccharide substance (EPS) production and observation, cell permeability of biofilm, and uptake of toluidine blue O (TBO) by biofilm were assessed to investigate the involved mechanism.

RESULTS

There was no significant difference between PBS group and H₂O₂ group in viable microorganisms and metabolic activity of biofilm. The treatment protocols containing aPDT group reduced microorganism numbers and metabolic activity when compared to PBS group or H₂O₂ group (P<0.05). H₂O₂+aPDT treatment showed the highest antimicrobial efficacy in comparison with other treatments (P<0.05). Pretreatment with H₂O₂ could decrease EPS production and enhance cell permeability, leading to increased TBO uptake in biofilm.

CONCLUSION

Pretreatment with H₂O₂ improved aPDT efficiency in eliminating dual-species biofilm from PMMA disk by reducing EPS amount, enhancing cell permeability, and increasing TBO uptake.

Lichen Polyphenolic Compounds for the Eradication of Candida albicans Biofilms

Lichens, due to their symbiotic nature (association between fungi and algae), constitute a chemical factory of original compounds. Polyphenolic compounds (depsides and depsidones) are the main constituents of lichens and are exclusively biosynthesized by these organisms. A panel of 11 polyphenols was evaluated for their anti-biofilm activity against Candida albicans biofilms on the maturation phase (anti-maturation) (MMIC₅₀) as well as on preformed 24-h-old biofilm (anti-biofilm) (MBIC₅₀) using the XTT assay. Minimum inhibitory concentrations of compounds (MICs) against C. albicans planktonic yeast were also determined using a broth microdilution method. While none of the tested compounds were active against planktonic cells (IC₅₀ > 100 µg/ml), three depsides slowed the biofilm maturation (MMIC₅₀ ≤12.5 µg/ml after 48 h of contact with Candida cells). Evernic acid was able to both slow the maturation and reduce the already formed biofilms with MBIC₅₀ ≤12.5 µg/ml after 48 h of contact with the biofilm. This compound shows a weak toxicity against HeLa cells (22%) at the minimal active concentration and no hemolytic activity at 100 µg/ml. Microscopic observations of evernic acid and optimization of its solubility were performed to further study this compound. This work confirmed the anti-biofilm potential of depsides, especially evernic acid, and allows to establish the structure-activity relationships to better explain the anti-biofilm potential of these compounds.

Computational Drug Repurposing Resources and Approaches for Discovering Novel Antifungal Drugs against Candida albicans N-Myristoyl Transferase

Candida albicans is a yeast that is an opportunistic fungal pathogen and also identified as ubiquitous polymorphic species that is mainly linked with major fungal infections in humans, particularly in the immunocompromised patients including transplant recipients, chemotherapy patients, HIV-infected patients as well as in low-birth-weight infants. Systemic Candida infections have a high mortality rate of around 29 to 76%. For reducing its infection, limited drugs are existing such as caspofungin, fluconazole, terbinafine, and amphotericin B, etc. which contain unlikable side effects and also toxic. This review intends to utilize advanced bioinformatics technologies such as Molecular docking, Scaffold hopping, Virtual screening, Pharmacophore modeling, Molecular dynamics (MD) simulation for the development of potentially new drug candidates with a drug-repurpose approach against Candida albicans within a limited time frame and also cost reductive.

Retentive efficacy, antimicrobial and cytotoxicity comparisons between different types of commercial and experimental denture adhesives with antifungal action

The effect of the addition of nystatin and an alternative antifungal derived from pyrazoles in different commercial denture adhesives on their retentive efficacy, cytotoxicity and antimicrobial activity against Candida albicans was evaluated. Commercial denture adhesives were prepared with the inclusion of nystatin and 3,5-diaryl-4,5-dihydro-1H-pyrazole-1-carboximidamide (pyrazole) in three concentrations: 23.78 %w/w, 3.02 %w/w, and 0.31 %w/w (0.015 g, 0.0015 g, and 0.00015 g, respectively). The retentive efficacy was tested observing the influence of the medium, type of commercial denture type and the test condition (dipping). The antifungal action through disk diffusion and direct contact tests at 1, 4, 8 and 12 h and cytotoxic activity was evaluated in mouse fibroblasts (NIH/3T3) by the MTT reduction colorimetric assay. The addition of pyrazole and nystatin in commercial denture adhesives did not affect retentive efficacy rates and enhanced antifungal actions against Candida albicans. Results show a possibility of using denture adhesives as a delivery system for commercial antifungals (Nystatin) or pyrazole, with the second concentration (1,560 µg-3.02 %w/w) as the most efficient.

Denture-Soaking Solution Containing Piper betle Extract-Loaded Polymeric Micelles; Inhibition of Candida albicans, Clinical Study, and Effects on Denture Base Resin

Candida albicans is a common overgrowth in people wearing dentures. Long-term use of antifungal chemicals carries a risk of toxic side effects. This study focused on the edible Piper betle extract because of its safety. The broth dilution method was applied for antifungal determination of the ethyl acetate fractionated extract (fEA) and fEA-loaded polymeric micelles (PMF). The PMF was prepared by thin-film hydration using poloxamer 407 as a polymer base. The results found that the weight ratio of fEA to polymer is the main factor to obtain PMF system as a clear solution, nanoparticle sizes, narrow size distribution, negative zeta potential, and high entrapment efficiency. The activity of PMF against C. albicans is significantly higher than fEA alone, with a minimum fungicidal concentration of 1.5 mg/mL. PMF from 1:3 ratio of fEA to polymer is used to develop a denture-soaking solution contained 1.5 mg fEA/mL (PMFS). A clinical study on dentures of 15 volunteers demonstrated an 86.1 ± 9.2% reduction of C. albicans after soaking the dentures in PMFS daily for 14 days. Interestingly, PMFS did not change the hardness and roughness of the denture base resins. The developed PMFS may serve as a potential natural denture-soaking solution against candidiasis in denture wearers.

Oral prosthetic microbiology: aspects related to the oral microbiome, surface properties, and strategies for controlling biofilms

The oral cavity is an environment that allows for the development of complex ecosystems; the placement of prosthetic devices as a consequence of partial or total tooth loss may alter the diversity of microbial communities. Biofilms on the surface of materials used in dental prostheses can promote important changes in the mechanic and aesthetic properties of the material itself and may cause local and systemic diseases for the prosthetic wearer. This review presents the main features of the oral microbiome associated with complete or partial dentures and dental implants. The main diseases associated with microbial colonization of prosthetic surfaces, factors that may affect biofilm formation on prosthetic materials, as well as novel alternative therapies aiming to reduce biofilm formation and/or to eradicate biofilms formed on these materials are also explored.

Nanomaterials Application in Orthodontics

Nanotechnology has gained importance in recent years due to its ability to enhance material properties, including antimicrobial characteristics. Nanotechnology is applicable in various aspects of orthodontics. This scientific work focuses on the concept of nanotechnology and its applications in the field of orthodontics, including, among others, enhancement of antimicrobial characteristics of orthodontic resins, leading to reduction of enamel demineralization or control of friction force during orthodontic movement. The latter one enables effective orthodontic treatment while using less force. Emphasis is put on antimicrobial and mechanical characteristics of nanomaterials during orthodontic treatment. The manuscript sums up the current knowledge about nanomaterials' influence on orthodontic appliances.

Evaluation of flexural strength and antibacterial effect of orthodontic acrylic resins containing Galla chinensis extract

Objective:

To evaluate different concentrations of Galla chinensis extract (GCE) added to poly(methyl methacrylate) (PMMA), which is widely used for fabrication of removable orthodontic appliances, regarding the effectiveness of this herbal extract on antimicrobial effect and flexural strength of PMMA.

Methods:

Acrylic resin samples containing 0.4%, 0.8% and 1.6% GCE were prepared. Flexural strength was investigated via three-point flexural strength test for the 15 acrylic resin blocks of each concentration. Disk diffusion test was used to evaluate antibacterial effects of incorporating the same concentrations of GCE into acrylic resin. All these three groups were compared with the control group, with no added GCE, regarding flexural strength and antibacterial properties.

Results:

Comparison of flexural strength between the three study groups and the control group showed significant differences between the groups (P=0.018). However, there was no significant difference between the groups containing GCE. There were significant differences in antimicrobial activity between the four groups (P=0.026).

Conclusion:

Within the limitations of this study, it is suggested that incorporation of GCE into PMMA would be beneficial for antimicrobial activity and flexural strength of PMMA, but further studies on other physical properties and antimicrobial effects on other bacterial strain would be beneficial prior to clinical investigations.

Hyposalivation, oral health, and Candida colonization in independent dentate elders

Hyposalivation is an important problem in elders and could interfere with several oral functions and microbial ecology. While the number of independent elders who retain more natural teeth increases worldwide, few studies examined hyposalivation in this population. Thus, this study aims to examine relationships between hyposalivation, oral health conditions and oral Candida colonization in independent dentate elders and evaluate factors associated with salivary flow and Candida carriage. We conducted a cross-sectional study in fifty-three dentate elders (≥65 years old with at least 4 pairs of posterior occlusal contacts) with no, or well-controlled, systemic conditions. Participants were interviewed for medical history, subjective dry mouth symptoms, oral hygiene practices and denture information. Unstimulated and stimulated salivary flow rates, objective dry mouth signs, gingival, tongue-coating, and root-caries indices were recorded. Stimulated saliva was cultured on Sabouraud-dextrose agar for Candida counts. Candida species were identified using chromogenic Candida agar and polymerase chain reaction. Statistical significance level was set at p<0.05. The results showed that hyposalivation was associated with higher gingival and tongue-coating indices (p = 0.003 and 0.015, respectively), but not root-caries index. Hyposalivation was also associated with higher prevalence of oral Candida colonization (p = 0.010; adjusted OR = 4.36, 95% confidence interval = 1.29–14.72). These two indices and Candida load were negatively correlated with unstimulated and stimulated salivary flow rates. Interestingly, non-albicans Candida species were more prevalent in denture wearers (p = 0.017). Hence, hyposalivation is a risk factor for poorer oral health and oral Candida colonization in independent dentate elders. Because of its potential adverse effects on oral and systemic health, hyposalivation should be carefully monitored in elders.

Effect of Novel Cycloaliphatic Comonomer on Surface Roughness and Surface Hardness of Heat-cure Denture Base Resin

Background:

Polymethyl methacrylate (PMMA) is a widely used resin in the field of prosthodontics for fabricating myriad orofacial prostheses. Albeit several advantages, it possesses certain lacunae concerning physicomechanical properties.

Purpose:

This in vitro research aimed to evaluate the surface roughness (SR) and hardness (SH) of heat-cured PMMA processed with a cycloaliphatic monomer, tricyclodecane dimethanol diacrylate (TCDDMDA), in methyl methacrylate at various concentrations.

Materials and Methods:

Groups have been divided into control (SRC and SHC) and experimental groups (SR10 and 20; SH10 and 20). Forty-five PMMA disc specimens were prepared. SR was assessed using a nanomechanical testing machine and the arithmetic roughness (Ra) was recorded. The same specimens were then subjected to Vicker’s microhardness testing and Vicker’s hardness number (VHN) was obtained. Data were compared using one-way analysis of variance (ANOVA) and post hoc Bonferroni tests (α=0.05).

Results:

The mean (standard deviation [SD]) of SRC, SR10, and 20 groups were 111.415 nm (0.789), 62.666 nm (0.482), and 41.004 nm (0.561), respectively. The mean (SD) VHN of SHC, SH10, and 20 groups were 21.003 (0.252), 23.975 (0.207), and 34.622 (0.079), respectively.

Conclusion:

The addition of TCDDMDA markedly decreased the SR and increased the SH of the experimental groups.

In vitro Candida albicans biofilm formation on different titanium surface topographies

Objectives

To investigate if differences in titanium implant surface topography influence Candida albicans biofilm formation.

Materials and Methods

Titanium discs were prepared and characterized using a profilometer: Group A (R_a 0.15 µm, smooth), Group B (R_a 0.64 µm, minimally rough) and Group C (R_a 1.3 µm, moderately rough). Contact angle and surface free energy (SFE) were determined for each group. Non-preconditioned titanium discs were incubated with C. albicans for 24 h. In additional experiments, the titanium discs were initially coated with human saliva, bovine serum albumin or phosphate-buffered saline for 2 h before incubation with C. albicans for 24 h. The amount of fungal biofilm formation was quantified using a colorimetric assay.

Results

C. albicans biofilm formation was significantly lower (p < 0.05) on the minimally rough titanium surface compared to smooth and moderately rough surfaces. The titanium surface displaying the lowest SFE (Group B) was associated with significantly lower (p < 0.05) C. albicans biofilm formation than the other two groups. Salivary coating resulted in greater adherence of C. albicans with increased surface roughness.

Conclusions

The minimally rough titanium discs displayed lowest SFE compared to smooth and moderately rough surfaces and showed the least C. albicans biofilm formation. This study demonstrated that C. albicans biofilm formation increased in a SFE-dependent manner. These findings suggest that SFE might be a more explanatory factor for C. albicans biofilm formation on titanium surfaces than roughness. The presence of a pellicle coating may negate the impact of SFE on C. albicans biofilm formation on titanium surfaces.

Biocompatible silver nanoparticles incorporated in acrylic resin for dental application inhibit Candida albicans biofilm

BACKGROUND

Although silver nanoparticles (SNP) have proven antimicrobial activity against different types of microorganisms, the effect of SNP incorporation into acrylic resin to control Candida albicans biofilm formation aiming at the prevention of Candida-associated denture stomatitis has not yet been fully elucidated.

OBJECTIVES

This study aimed to evaluate the antimicrobial effect of an acrylic resin containing SNP on C. albicans biofilm growth, the flexural strength of this material and tissue reaction in the subcutaneous connective tissue of rats to SNP.

METHOD

SNP were synthesized through silver nitrate reduction by sodium citrate. Transmission electron microscopy (TEM) and scanning electron microscopy (SEM) were used to verify the size and colloidal stability. SNP were added to acrylic resin monomer (Lucitone 550) at 0.05, 0.5 and 5 vol%. The antimicrobial effect against C. albicans (ATCC 10231) was investigated by the enumeration of colony-forming units (CFUs) and SEM. The three-point bending test was performed to analyze the flexural strength. Tissue reaction was evaluated after 7 and 60 days of implantation in the connective tissue of Wistar rats.

RESULTS

Spherical particles of 5 and 10 nm were obtained. SNP at 0.05 and 0.5% incorporated into acrylic resin was effective in reducing C. albicans biofilm growth (p < .001). SEM revealed that the material was able to disrupt C. albicans biofilm formation and did not reduce the flexural strength compared to control (p > .05). The inflammatory response observed 60 days after implantation SNP in the subcutaneous tissue was similar to control.

CONCLUSION

It was concluded that SNP addition at 0.05 and 0.5% into acrylic resin exhibited antimicrobial effects against C. albicans biofilm, did not interfere in the flexural strength and may be considered biocompatible.

Impact of various finishing and polishing techniques and composite materials on Candida albicans biofilm formation

Candida albicans biofilms are commonly associated with severe oral infections. In dentistry, prosthetic and restorative materials are potential structures for the adhesion of C. albicans facilitating the formation of Candida biofilm and infection. Three composite resins (Charisma Classic, Sonic Fill, Estelite ∑ Quick) and two finishing-polishing systems (Biscover LV, Dental Finishing Disc) were evaluated for Candida biofilm formation. A Candida biofilm assay showed that both the resin and the finishing/polishing procedures affect Candida biofilm formation. Specifically, Candida biofilm formation was significantly lower in Sonic Fill resin than both Charisma Classic and Estelite ∑ Quick (P = .021). The type of finishing and polishing procedure also significantly affected the Candida biofilm formation to composite material (P < .001). Candida biofilm formation was more advanced after Biscover LV procedure than Dental Finishing Disc procedure.

In vitro adherence of Candida albicans to zirconia surfaces

OBJECTIVES

This study aimed to characterize surface properties such as roughness (Ra) and surface-free energy (SFE) of glazed and polished yttria-stabilized zirconia and to evaluate in vitro adherence of fungus Candida albicans and salivary bacteria, Staphylococcus epidermidis, mixed with C. albicans to these substrata. Additionally, the influence of salivary proteins (albumin, mucin and α-amylase) on yeast adhesion was studied.

MATERIAL AND METHODS

Ra and SFE of glazed and polished zirconia discs were measured. Specimens were wetted with saliva and salivary proteins prior to incubation with C. albicans and mixed suspension of C. albicans and S. epidermidis for 24 hr, respectively. Microbial adhesion was quantified by counting colony-forming units (CFU). Differences in physicochemical properties were proved by t test. "Linear mixed model" with the factors "type of surface" and "wetting media" was applied to analyse the effects on fungal adhesion (p < .05).

RESULTS

SFE and Ra of glazed specimens were significantly higher than corresponding values of polished ones. The wetting media significantly changed the fungal binding (p = .0016). Significantly higher quantities of adhering fungi were found after mucin incubation compared to saliva (p = .004). For the factor "surface" as well as the interaction between "surface" and "wetting media," no statistically significant differences have been found. In mixed suspension, the growth of Candida was completely prevented.

CONCLUSIONS

Glazed and polished zirconia differs in terms of physicochemical surface properties. These differences appear to be modulated by pellicle coating affecting the biomass of adhered Candida. Mucin seems to be good binding sites for adhesion of C. albicans.

Applying the Host-Microbe Damage Response Framework to Candida Pathogenesis: Current and Prospective Strategies to Reduce Damage

Disease is a complex outcome that can occur as a result of pathogen-mediated damage, host-mediated damage or both. This has led to the revolutionary concept of the damage response framework (DRF) that defines microbial virulence as a function of host immunity. The DRF outlines six scenarios (classes) of host damage or beneficial outcomes, depending on the microbe and the strength of the immune response. Candida albicans is uniquely adapted to its human host and can exist as either a commensal, colonizing various anatomical sites without causing notable damage, or as a pathogen, with the ability to cause a diverse array of diseases, ranging from mucosal to invasive systemic infections that result in varying levels of microbe-mediated and/or host-mediated damage. We recently categorized six different forms of candidiasis (oropharyngeal, hematogenous, intra-abdominal, gastrointestinal, denture stomatitis, and vulvovaginitis) into independent DRF classes, supporting a contemporary view of unique mechanisms of pathogenesis for these Candida infections. In this review, we summarize the evidence for the pathogenesis of these various forms of candidiasis in the context of the DRF with the further intent to provide insights into strategies to achieve a level of host response or outcome otherwise, that limits host damage.

Activity of chitosan antifungal denture adhesive against common Candida species and Candida albicans adherence on denture base acrylic resin

STATEMENT OF PROBLEM

Candida adherence to the denture base is an important cause of denture stomatitis. In addition, infections with drug-resistant Candida have become more prevalent, especially among elderly and immunocompromised patients. Thus, alternative safe antifungal agents for oral applications are needed.

PURPOSE

The purpose of this in vitro study was to investigate the activity of chitosan, a natural biopolymer, against common oral Candida species and its efficacy in inhibiting C albicans adherence to denture-base acrylic resin.

MATERIAL AND METHODS

The minimum fungicidal concentrations (MFCs) of 5 types of chitosan against 6 species of Candida and 10 C albicans clinical isolates were determined by broth and agar dilution, respectively. N-succinyl chitosan (NSC), low- and high-molecular-weight water-soluble chitosan (LMWC and HMWC), and oligomer and polymer shrimp-chitosan were examined. NSC and HMWC, as pure gel and as a mixture with carboxymethylcellulose (CMC), were applied to acrylic resin disks, incubated with C albicans for 24 hours, and washed, and adherent cells were collected for colony count. The effects of HMWC on human gingival fibroblasts after 1 and 24 hours of treatment were measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The retention force of HMWC gel was measured by using a universal testing machine. The Kruskal-Wallis and Mann-Whitney U tests were used to compare the antiadherence activity (α=.05).

RESULTS

HMWC had the highest antifungal activity against most Candida species tested and C albicans clinical isolates. HMWC gel completely inhibited C albicans adherence to denture base acrylic resin (P<.001). CMC denture adhesive significantly increased C albicans adherence (P<.001), but adding 2×MFC HMWC into CMC reduced the adherence, although this was not statistically significant (P=.06). HMWC at 1×MFC and 2×MFC showed no toxic effect on gingival fibroblast viability and proliferation. Moreover, the retention force provided by HMWC gel was sufficient for use as a denture adhesive (>5000 Pa).

CONCLUSIONS

High-molecular-weight, water-soluble chitosan is a biocompatible biopolymer that could inhibit C albicans adherence and that showed properties suitable for development into an antifungal denture adhesive.

Candida glabrata Has No Enhancing Role in the Pathogenesis of Candida-Associated Denture Stomatitis in a Rat Model

Many denture wearers suffer from Candida-associated denture stomatitis (DS), a fungal infection of the hard palate in contact with dentures. Biofilm formation by Candida albicans on denture/palate surfaces is considered a central process in the infection onset. Although Candida glabrata is frequently coisolated with C. albicans, its role in DS pathogenesis is unknown. We show here, using a contemporary rat model that employed a patented intraoral denture system, that C. glabrata established stable colonization on the denture/palate. However, in contrast to C. albicans inoculated rats, rats inoculated with C. glabrata exhibited minimal changes in weight gain or palatal tissue damage. Likewise, coinoculation with the two Candida species resulted in no exacerbation of C. albicans-induced DS pathology. Together, our findings indicate that C. glabrata has no inducing/enhancing role in DS pathogenesis.

Denture stomatitis (DS) is a condition characterized by inflammation of the oral mucosa in direct contact with dentures and affects a significant number of otherwise healthy denture wearers. Candida-associated DS is predominantly caused by Candida albicans, a dimorphic fungus that readily colonizes and forms biofilms on denture materials. Previous studies showed a requirement for Candida biofilm formation on both palate and dentures in infection and identified fungal morphogenic transcription factors, Efg1 and Bcr1, as key players in DS pathogenesis. While both C. albicans and Candida glabrata are frequently coisolated in mucosal candidiasis, a pathogenic role for C. glabrata in DS remains unknown. Using an established rat model of DS, we sought to determine whether C. glabrata alone or coinoculation with C. albicans establishes colonization and causes palatal tissue damage and inflammation. Rats fitted with custom dentures were inoculated with C. albicans and/or C. glabrata and monitored over a 4-week period for fungal burden (denture/palate), changes in body weight, and tissue damage via lactate dehydrogenase (LDH) release as well as palatal staining by hematoxylin and eosin (H&E) and immunohistochemistry for myeloperoxidase (MPO) as measures of inflammation. C. glabrata colonized the denture/palate similarly to C. albicans. In contrast to C. albicans, colonization by C. glabrata resulted in minimal changes in body weight, palatal LDH release, and MPO expression. Coinoculation with both species had no obvious modulation of C. albicans-mediated pathogenic effects. These data suggest that C. glabrata readily establishes colonization on denture and palate but has no apparent role for inducing/enhancing C. albicans pathogenesis in DS.

IMPORTANCE Many denture wearers suffer from Candida-associated denture stomatitis (DS), a fungal infection of the hard palate in contact with dentures. Biofilm formation by Candida albicans on denture/palate surfaces is considered a central process in the infection onset. Although Candida glabrata is frequently coisolated with C. albicans, its role in DS pathogenesis is unknown. We show here, using a contemporary rat model that employed a patented intraoral denture system, that C. glabrata established stable colonization on the denture/palate. However, in contrast to C. albicans inoculated rats, rats inoculated with C. glabrata exhibited minimal changes in weight gain or palatal tissue damage. Likewise, coinoculation with the two Candida species resulted in no exacerbation of C. albicans-induced DS pathology. Together, our findings indicate that C. glabrata has no inducing/enhancing role in DS pathogenesis.

Denture Liners: A Systematic Review Relative to Adhesion and Mechanical Properties

Purpose

The objective of this systematic review is to compare results concerning the properties of adhesion, roughness, and hardness of dental liners obtained in the last ten years.

Methods

Searches on the databases LILACS, PubMed/Medline, Web of Science, and Cochrane Database of Systematic Reviews were supplemented with manual searches conducted between February and April of 2018. The inclusion criteria included experimental in vitro and in vivo, clinical, and laboratory studies on resilient and/or hard liners, assessment of hardness, roughness, and/or adhesion to the denture base, and physical/mechanical changes resulting from the disinfection process and changes in liners' composition or application.

Results

A total of 406 articles were identified and, from those, 44 are discussed. Twenty-four studies examined the bond strength, 13 surface roughness, and 19 the hardness. Of these 44 studies, 12 evaluated more than one property. Different substances were used in the attempt to improve adhesion. Considering roughness and hardness, the benefits of sealants have been tested, and the changes resulting from antimicrobial agents' incorporation have been assessed.

Conclusion

Adhesion to the prosthesis base is improved with surface treatments. Rough surfaces and changes in hardness compromise the material's serviceability.

Improving Polymethyl Methacrylate Resin Using a Novel Titanium Dioxide Coating

PURPOSE

The objective of this study was to improve the surface characteristics of poly (methyl methacrylate) (PMMA) by developing a novel, thin film coating process and to characterize the resulting coated surface.

MATERIALS AND METHODS

An atomic layer deposition (ALD) technique was developed to deposit a titanium dioxide (TiO₂ ) nano-thin film on PMMA. The surface wettability for both coated and uncoated PMMA was determined by measuring water contact angle. Wear resistance was assessed using a mechanical tooth-brushing device with a 50 g load for 6000 strokes after 5 months of water storage. A denture cleanser challenge test was performed by using sonication in 3.8% sodium perborate for 1 hour with aged specimens. X-ray photoelectron spectroscopy (XPS) was used before and after the brushing test and challenge test to analyze the PMMA surface chemical composition. The mechanical strength of coated and uncoated PMMA was measured using a three-point bending test. Surface microbial interactions were also evaluated by assessing Candida albicans biofilm attachment.

RESULTS

Nano-TiO₂ coating (30 nm thick) was successfully deposited on PMMA at 65°C. After coating, water contact angle decreased from 70° to less than 5°. After brushing test, the coating remained intact. XPS analysis revealed no loss of TiO₂ from coated specimens following brushing and denture cleanser sonication for 1 hour. There was no statistically significant difference in mechanical strength (MPa) (mean ± SD) between PMMA (139.4 ± 11.3) and TiO₂ -PMMA (160.7 ± 37.1) (p = 0.0995). C. albicans attachment decreased by 63% to 77% on the coated PMMA surface.

CONCLUSIONS

ALD is a promising technique to modify surface properties of PMMA and resulted in a stable adherent thin film. By depositing a TiO₂ coating, PMMA surface properties may lead to significantly reduced microorganism adhesion and easier pathogen removal from PMMA. For patients who wear dentures, reducing the oral microbial biofilm burden using a TiO₂ -coated PMMA surface could positively impact their oral and systemic health.

In vitro assessment of the antifungal effects of neem powder added to polymethyl methacrylate denture base material

Background

Denture with antimicrobial activities is desirable to prevent Candida albican adhesion subsequently decreasing the susceptibility of denture stomatitis incidence. Azadirachta Indica, commonly known as Neem powder has antimicrobial effect but the effect of its addition to acrylic denture base on C. albicans adhesion has not been investigated. The aim of this study was determine whether adding neem powder to acrylic denture base materials could reduce Candida albicansadhesion.

Material and Methods

One hundred and twenty acrylic resin denture specimens were fabricated and divided into heat-polymerized (n=60) and auto-polymerized (n=60) groups. Each group was further divided into 6 groups (n=10) based on the neem concentration: 0, 0.5, 1, 1.5, 2 and 2.5 wt% of the polymer. After polymerization, the specimens were polished, stored in distilled water, sonicated, sterilized, submerged in artificial saliva containing C. albicans, and finally, placed in an incubator at 37°C. Slide counting and direct culture methods were used to assess the antifungal effects of the neem addition. An analysis of variance and post hoc Tukey’s test were performed for the data analysis (p≤0.05 was statistically significant).

Results

Based on the results, the neem addition significantly decreased the C. albicans count when compared to the control group (p≤0.05). Moreover, the count decreased as the neem concentration increased (lowest count with 2.5 wt%).

Conclusions

The results suggest that adding neem powder to acrylic resin denture base materials reduces the adhesion of C. albicans; therefore, the incorporation of neem could be a possible denture stomatitis prevention method.

Key words:Denture stomatitis, Candida albicans, Azadirachta indica, neem powder, denture base.

Candida Interactions with the Oral Bacterial Microbiota

The human oral cavity is normally colonized by a wide range of microorganisms, including bacteria, fungi, Archaea, viruses, and protozoa. Within the different oral microenvironments these organisms are often found as part of highly organized microbial communities termed biofilms, which display consortial behavior. Formation and maintenance of these biofilms are highly dependent on the direct interactions between the different members of the microbiota, as well as on the released factors that influence the surrounding microbial populations. These complex biofilm dynamics influence oral health and disease. In the latest years there has been an increased recognition of the important role that interkingdom interactions, in particular those between fungi and bacteria, play within the oral cavity. Candida spp., and in particular C. albicans, are among the most important fungi colonizing the oral cavity of humans and have been found to participate in these complex microbial oral biofilms. C. albicans has been reported to interact with individual members of the oral bacterial microbiota, leading to either synergistic or antagonistic relationships. In this review we describe some of the better characterized interactions between Candida spp. and oral bacteria.

Surface roughness implant-retained mandibular bar and ball joint overdentures and adherence of microorganisms

Objective:

The aim of this study is to assess the surface roughness of the implant-retained mandibular bar overdenture (BOD) and the implant-retained mandibular ball joint overdenture (BJOD) in jaw and its relation with the adhesion of molds and yeasts and mesophyll aerobe, in time 30 and 180 days in mouth.

Materials and Methods:

Five-systems titanium bar CARES^® and synOcta^® Straumann^® Dental Implant System, Holding AG Inc., Basel, Switzerland (BOD), and five-systems joint ball Klockner^® Implant System; Soadco Inc., Escaldes-Engordany; Andorra (BJOD), were used in two parallel groups of five participants, in an essay to simple blind person. To 30 and 180 days, the overdentures were withdrawn and evaluated the Ra: ųm. SJ-301^® Mitutoyo Corporation Inc., Kanagawa, Japan, and the adhesion of microorganisms (colony-forming unit/ml).

Results:

The results were as follows: the R_a: Um (30^th and 180^th): BOD, 0.965–1.351; BJOD, 1.325–2.384. Adhesion: Molds and yeasts, BOD, 2.6 × 10² and 4.6 × 10³; BJOD, 3.0 × 10² and 5.3 × 10⁴. Adhesion: Mesophyll aerobe, BOD, 3.8 × 10⁶ and 5.8 × 10⁶; BJOD, 4.3 × 10⁶ and 7.1 × 10⁷.

Conclusions:

At 30 days (P = 0.489), there were no differences in BOD and BJOD for adhesion of molds and yeasts and mesophyll aerobe between both overdentures. At 180 days (P = 0.723), there were differences in the adhesion of mold and yeast and mesophyll aerobe, being greater in BJOD.

Cytokine gene polymorphism in denture stomatitis patients: A clinical study

OBJECTIVE

This clinical study investigated the association between cytokine gene polymorphism and Candida growth in denture stomatitis (DS) patients.

SUBJECTS AND METHODS

Saliva and blood samples of 160 complete denture wearers (80 healthy controls and 80 with DS) were collected for mycological and gene polymorphism testing, respectively. Salivary Candida growth and TNF-α, TGF-β, IL-6, and IL-10 genotypes were investigated. Data were analyzed using Student's t test, Mann-Whitney U test, chi-square analysis, and continuity (yates) correction tests (p < .05).

RESULTS

Candida albicans colony counts in saliva were significantly higher in the DS group and in the TNF-α GG genotype (p < .05). TGF-β TC GG and TGF-β CC GG haplotypes were significantly higher in DS and control groups, respectively (p < .05). C. albicans colony counts were significantly higher in control group in the TGF-β TC GG haplotype (p < .05). Candida glabrata colony counts were significantly higher in the DS group than the control group in IL-6 GG genotype (p < .05). The difference between DS types in IL-6 genotypes was significant with lower expression level in DS type 3 than DS type 1 and also type 2 (p ≤ .01).

CONCLUSION

The significant differences in some genotypes of the TNF-α, TGF-β, and IL-6 in DS patients are promising in understanding the host defense in DS.

Examination of 2-methacryloyloxyethyl phosphorylcholine polymer coated acrylic resin denture base material: surface characteristics and Candida albicans adhesion

The aim of this study is to evaluate the effects of 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer coating with various concentrations onto acrylic resin denture base material on surface characteristics such as contact angle and surface roughness and on Candida albicans adhesion which is the major factor of denture stomatitis. Specimens, prepared from heat-polymerized acrylic denture base material, were divided into control and three test groups, randomly. Surfaces of the specimens in test groups were coated with poly(MPC) (PMPC) by graft polymerization of MPC in different concentrations (0.25 mol/L; 0.50 mol/L and 0.75 mol/L), while no surface treatment was applied to the control group. Contact angles and surface roughness were examined, and chemical composition of the surfaces was analyzed by Attenuated Total Reflectance-Fourier Transform Infrared Spectroscopy (FTIR) to verify the presence of PMPC coatings. Then, specimens were incubated with C. albicans for 18 h and the number of adhered cells was determined. Upon PMPC coating, the contact angle values statistically decreased, but no difference was found in surface roughness values. A statistically significant decrease was observed in C. albicans adhesion in parallel with the increase in the MPC polymer concentration. There was no significant difference between 0.50 mol/L and 0.75 mol/L groups in terms of adhesion. These findings indicated that graft polymerization of MPC on acrylic denture base material reduces the adhesion of C. albicans, and may be evaluated as a coating for prevention of denture stomatitis.

Antifungal Efficacy and the Mechanical Properties of Soft Liners against Candida albicans after the Incorporation of Garlic and Neem: An In vitro Study

Objectives:

To evaluate the in vitro growth inhibition of Candida albicans, in the soft-liner material and Shore A hardness from resin-based denture soft lining materials modified by neem or garlic incorporation.

Materials and Methods:

Resin discs were prepared with poly methyl methacrylate (PMMA) and soft liners incorporated with varying concentrations of neem or garlic. For antifungal activity, resin discs were placed on agar plates inoculated with C. albicans and were evaluated after 2, 4, and 7 days using the streaking method. The hardness of the PMMA was evaluated with the use of Shore A at 2, 4, and 7 days. Data were statistically processed by SPSS software (IBM Company, Chicago, USA) using Kruskal–Wallis test, and post hoc comparisons were done using Dunn's test. P <0.05 was considered statistically significant.

Results:

Neem and garlic added to PMMA soft liner had an inhibitory effect on C. albicans. Both the neem and garlic when added showed positive results against C. albicans when compared to the control group. The soft liner hardness increased statistically by time but not for the different plant extract concentrations.

Conclusions:

Within the limitations of this in vitro study, it was found that neem and garlic can be used as an additive to tissue conditioner to reduce the adherence of C. albicans without significantly affecting the hardness of the heat-polymerized acrylic resin.

Salivary polypeptide/hyaluronic acid multilayer coatings act as "fungal repellents" and prevent biofilm formation on biomaterials

Candida-associated denture stomatitis (CADS) is a common, recurring clinical complication in denture wearers that can lead to serious oral and systemic health problems. Current management strategies are not satisfactory due to their short-acting and ineffective therapeutic effects. Here, we describe a new fungal biofilm controlling strategy using the polyelectrolyte layer-by-layer (LBL) self-assembly technology on denture materials. Conventional poly(methyl methacrylate) (PMMA) denture material discs were functionalized with negatively charged poly(methacrylic acid) (PMAA) via plasma-initiated surface grafting, followed by repetitive alternating coating with the salivary antimicrobial polypeptide histatin 5 (H-5; cationic polymer) and hyaluronic acid (HA; anionic polymer). On the other hand, the H-5/HA LBL coatings (i.e., the outermost layer was H-5) inhibited fungal attachment/adhesion, significantly reduced fungal biofilm formation, and showed synergistic effects with the antifungal drug miconazole. LBL surface hydrophilicity was not the key mechanism in controlling Candida biofilm formation. The current approach demonstrates the utility of a new design principle for fabricating anticandidal denture materials, as well as potentially other related medical devices, for controlling fungal biofilm formation and combating insidious infections.

Fungicidal PMMA-Undecylenic Acid Composites

Undecylenic acid (UA), known as antifungal agent, still cannot be used to efficiently modify commercial dental materials in such a way that this affects Candida. Actually, issues with Candida infections and fungal resistance compromise the use of Poly(methyl-methacrylate) (PMMA) as dental material. The challenge remains to turn PMMA into an antifugal material, which can ideally affect both sessile (attached) and planktonic (free-floating) Candida cells. We aimed to tackle this challenge by designing PMMA-UA composites with different UA concentrations (3-12%). We studied their physico-chemical properties, the antifungal effect on Candida and the cytotoxicity toward human cells. We found that UA changes the PMMA surface into a more hydrophilic one. Mainly, as-preparation composites with ≥6% UA reduced sessile Candida for >90%. After six days, the composites were still efficiently reducing the sessile Candida cells (for ~70% for composites with ≥6% UA). Similar results were recorded for planktonic Candida. Moreover, the inhibition zone increased along with the UA concentration. The antifungal effect of UA was also examined at the surface of an UA-loaded agar and the minimal inhibitory concentration (MIC90) was below the lowest-studied 0.0125% UA. Furthermore, the embedded filamentation test after 24 h and 48 h showed complete inhibition of the Candida growth at 0.4% UA.

Recent advances in delivery of antifungal agents for therapeutic management of candidiasis

Candidiasis is a fungal infection caused by yeasts that belong to the genus Candida. There are over twenty species of Candida yeasts that can cause infection in humans, the most common of which is Candida albicans. Candida yeasts normally reside in the intestinal tract and can be found on mucous membranes and skin without causing infection; however, overgrowth of these organisms can cause symptoms to develop. Presence of other diseases that compromises the patient's immunity makes it more difficult to treat. Candidiasis is majorly divided into superficial infections (oral or vaginal) and systemic infections, also known as invasive candidiasis. The conventional therapeutic modalities used to treat candidiasis are associated with several side effects that limits the dose and dosing frequency. Development of novel drug delivery systems for reduction in dose and alleviation of side effects is an important strategy to improve the clinical efficacy and patient acceptability. This review gives a bird's eye view of the classification and current therapeutic regime of candidiasis. It presents the varied types of drug delivery systems that have been exploited for delivery of antifungal agents with measurable benefits. It also touches upon echinocandins a relatively new class of drugs that are amenable for translation into novel dosage forms with application against biofilm producing and fluconazole resistant strains contributing to a better therapeutic management of candidiasis.

The Physicochemical Characteristics of Prosthetic Materials and Their Influence on Their Clinical Properties

The use of elastic materials favours degradation of their surface. The period of their clinical usefulness is then shortened, and their further utilisation in the oral cavity may have the reverse effect. The surface properties of such material as well as the influence of the humidity on their surface are very important as they determine the prosthetic materials behavior in the mouth. The surface of such material should be resistant to water. Inverse gas chromatography is an accurate, sensitive technique for studying surface properties. Thanks to using a unique equipment specially designed for IGC technique, Surface Energy Analyzer, it was possible to characterize the surface at 0 and 80% of humidity. Our results show that increased humidity does not affect surface properties of studied prosthetic materials. Their ability to dispersive and specific interactions change in very limited degree. IGC experiment was also applied for the estimation of Hansen solubility parameters that indicate ability of a material to dispersive, polar, and hydrogen-bonding interactions. Relation between the surface characteristics and practical use of soft lining materials with implications for their clinical usefulness is also discussed.

The influence of polishing techniques on pre-polymerized CAD\CAM acrylic resin denture bases

Background

Lately, computer-aided design and computer-aided manufacturing (CAD/CAM) has broadly been successfully employed in dentistry. The CAD/CAM systems have recently become commercially available for fabrication of complete dentures, and are considered as an alternative technique to conventionally processed acrylic resin bases. However, they have not yet been fully investigated.

Objective

The purpose of this study was to inspect the effects of mechanical polishing and chemical polishing on the surface roughness (Ra) and contact angle (wettability) of heat-cured, auto-cured and CAD/CAM denture base acrylic resins.

Methods

This study was conducted at the Advanced Dental Research Laboratory Center of King Abdulaziz University from March to June 2017. Three denture base materials were selected: heat cure poly-methylmethacrylate resin, thermoplastic (polyamide resin) and (CAD\CAM) denture base resin. Sixty specimens were prepared and divided into three groups, twenty in each. Each group was divided according to the polishing techniques into (Mech P) and (Chem P), ten specimens in each; surface roughness and wettability were investigated. Data were analyzed by SPSS version 22, using one-way ANOVA and Pearson coefficient.

Results

One-way analysis of variance (ANOVA) and post hoc tests were used for comparing the surface roughness values between three groups which revealed a statistical significant difference between them (p₁<0.001). Heat-cured denture base material of (Group I) in both methods, showed the highest mean surface roughness value (2.44±0.07, 2.72±0.09, Mech P and Chem P respectively); while CAD\CAM denture base material (group III) showed the least mean values (1.08±0.23, 1.39±0.31, Mech P and Chem P respectively). CAD/CAM showed the least contact angle in both polishing methods, which were statistically significant at 5% level (p=0.034 and p<0.001).

Conclusion

Mechanical polishing produced lower surface roughness of CAD\CAM denture base resin with superior smooth surface compared to chemical polishing. Mechanical polishing is considered the best effective polishing technique. CAD/CAM denture base material should be considered as the material of choice for complete denture construction in the near future, especially for older dental patients with changed salivary functions, because of its wettability.