Photodynamic therapy with Bixa orellana extract and LED for the reduction of halitosis: study protocol for a randomized, microbiological and clinical trial

Investigation on the effect of antimicrobial photodynamic therapy as an adjunct for management of deep caries lesions-study protocol for a randomized, parallel groups, controlled clinical trial

BACKGROUND

Alternatively to conventional treatments, chemo-mechanical caries removal agents can be used. A modality of treatment that has been increasing in dentistry is antimicrobial photodynamic therapy (aPDT). Bixa orellana is being researched for application in aPDT. This protocol aims to determine the effectiveness of aPDT with Bixa orellana extract in deep caries lesions.

METHODS

A total of 160 teeth with deep occlusal dental caries will be selected and divided into 4 groups: G1 - control group (Caries removal with a low-speed drill); G2 - Partial Caries Removal with Papacarie™ (Fórmula e Ação, São Paulo, SP, Brazil); G3 - Partial Caries Removal with Papacarie™ and application Bixa orellana extract (20%) (Fórmula e Ação, São Paulo, SP, Brazil); G4 - Partial Caries Removal with Papacarie™ and application Bixa orellana extract (20%) with LED (Valo Cordless Ultradent®, South Jordan, UT, USA) (aPDT). After treatment, all the teeth will be restored with glass ionomer cement and followed up clinically and radiographically, with evaluations at immediately, 1 week, and 1, 3, 6, and 12 months. Dentin samples before and after treatment will be analyzed microbiologically. The efficacy of treatments will be assessed with microbiological (colony-forming units, before and after carious tissue removal), radiographic (integrity of the periapical area and eventual changes in the radiolucent zones), and clinical examinations (retention of the restorative material in the cavity and occurrence of secondary caries), as well as with the time required for the procedures and the need for anesthesia during the procedures. In case data distribution is normal, analysis of variance (ANOVA) will be used for both the dependent and independent variables. In case the data distribution is not normal, the Friedman test will be used for the dependent variables. For independent variables, the Kruskal-Wallis test will be used.

DISCUSSION

Procedures using aPDT have been developed for the treatment of dental caries, but there are few controlled clinical trials in the literature confirming its efficacy.

TRIAL REGISTRATION

This protocol is registered at ClinicalTrials.gov under the number NCT05236205 and it was first posted on 01/21/2022 and last updated on 05/10/2022.

Photodynamic therapy with acai (Euterpe oleracea) and blue light in oral cells: A spectroscopic and cytotoxicity analysis

OBJECTIVE

To evaluate the potential of photodynamic therapy (PDT) with blue light-emitting diode (LED) 460 nm at 25, 50 and 100 J/cm² using three concentrations of acai extracts (100, 40, and 10 mg/ml), in the proliferation and viability of head and neck tumor lines (SCC9).

METHODS

Three groups of cells were analyzed for 3 days in an in vitro assay with MTT (3- (4,5-dimethylthiazol-2-yl) -2,5, -diphenyltetrazolium bromide) and crystal violet: cells in the absence of acai extract and PDT (control group); cells in the presence of acai extract and no light; and cells in the presence of acai extract and LED blue light (PDT groups).

RESULTS

When using acai as a PS combined with blue LED (460 nm, 0.7466 cm² , 1000 mW/cm² ) and irradiation at 25, 50, and 100 J/cm² , after 72 h, cell viability (p < 0.0001 vs. control, p = 0.0027 vs. 100 mg/ml açai group, p = 0.0039 vs. 40 mg/ml açai group, p = 0.0135 vs. 10 mg/ml açai group; One-Way ANOVA/Tukey) and proliferation (p < 0.05, One-Way ANOVA/Tukey) decreased.

CONCLUSION

The acai in question is a potential photosensitizer (PS), with blue light absorbance and efficacy against head and neck tumor lines (SCC9).

Natural Photosensitizers in Antimicrobial Photodynamic Therapy

Health problems and reduced treatment effectiveness due to antimicrobial resistance have become important global problems and are important factors that negatively affect life expectancy. Antimicrobial photodynamic therapy (APDT) is constantly evolving and can minimize this antimicrobial resistance problem. Reactive oxygen species produced when nontoxic photosensitizers are exposed to light are the main functional components of APDT responsible for microbial destruction; therefore, APDT has a broad spectrum of target pathogens, such as bacteria, fungi, and viruses. Various photosensitizers, including natural extracts, compounds, and their synthetic derivatives, are being investigated. The main limitations, such as weak antimicrobial activity against Gram-negative bacteria, solubility, specificity, and cost, encourage the exploration of new photosensitizer candidates. Many additional methods, such as cell surface engineering, cotreatment with membrane-damaging agents, nanotechnology, computational simulation, and sonodynamic therapy, are also being investigated to develop novel APDT methods with improved properties. In this review, we summarize APDT research, focusing on natural photosensitizers used in in vitro and in vivo experimental models. In addition, we describe the limitations observed for natural photosensitizers and the methods developed to counter those limitations with emerging technologies.

Comparative study between photodynamic therapy with urucum + Led and probiotics in halitosis reduction-protocol for a controlled clinical trial

Background

Halitosis is a term that defines any foul odor emanating from the oral cavity. The origin may be local or systemic. The aim of the proposed protocol is to determine whether treatment with antimicrobial photodynamic therapy (aPDT) and treatment with probiotics are effective at eliminating halitosis.

Materials and methods

Eighty-eight patients, from 18 to 25 years old with a diagnosis of halitosis (H₂S≥112 ppb, determined by gas chromatography) will be randomly allocated to four groups (n = 22) that will receive different treatments: Group 1 –treatment with teeth brushing, dental floss and tongue scraper; Group 2 –brushing, dental floss and aPDT; Group 3 –brushing, dental floss and probiotics; Group 4 –brushing, flossing, aPDT and probiotics. The results of the halimetry will be compared before, immediately after, seven days and thirty days after treatment. The microbiological analysis of the coated tongue will be performed at these same times. The normality of the data will be determined using the Shapiro-Wilk test. Data with normal distribution will be analyzed using analysis of variance (ANOVA). Non-parametric data will be analyzed using the Kruskal-Wallis test. The Wilcoxon test will be used to analyze the results of each treatment at the different evaluation periods.

Clinical trail registration

NCT03996044.

Antimicrobial photodynamic therapy against Propionibacterium acnes biofilms using hypericin (Hypericum perforatum) photosensitizer: in vitro study

Acne vulgaris is the most recurring skin condition in the world, causing great harm to the physical and psychological well-being of many patients. Antimicrobial photodynamic therapy (aPDT) has broad therapeutic applicability. The purpose was to evaluate in vitro the photodynamic inactivation against Propionibacterium acnes (P. acnes) biofilms by using different concentrations of hypericin (Hypericum perforatum) photosensitizer associated with different energies of low-level laser. The biofilms were placed in 96-well microplates with a 6.4-mm diameter surface, by using standard suspensions (2 × 10⁷ CFU/mL) and grown in brain heart infusion broth (BHI) for 48 h in anaerobic chamber. Subsequently, the control group received application of 0.9% sterile saline solution for 3 min; the photosensitising groups received hypericin at concentrations of 5 and 15 μg/mL for 3 min; the laser groups received irradiation of energies of 3 and 5 J (660 nm, continuous output, 100 mW, 30 and 50 s and 100 J/cm² and 166 J/cm², respectively); the aPDT groups received 5 and 15 μg/mL concentrations of hypericin associated with energies of 3 and 5 J of low-level laser irradiation. After the biofilms were broken up and seeded for CFU counting. The results showed a reduction in P. acnes biofilms after aPDT emphasising that 15 μg/mL hypericin associated with 3 and 5 J laser irradiation reduced biofilms by 14.1 and 27.9%, respectively. In addition, all groups of aPDT demostrated statistically significant reductions. In vitro photodynamic inactivation against P. acnes biofilms using different concentration of hypericin photosensitizer associated with different energies of low-level laser promoted effective antimicrobial action.

Antimicrobial photodynamic therapy with Bixa orellana extract and blue LED in the reduction of halitosis-A randomized, controlled clinical trial

BACKGROUND

This study aimed to evaluate the reduction of halitosis when using antimicrobial photodynamic therapy (aPDT) with Bixa orellana extract and blue light-emitting diode (LED).

METHODS

Forty-four UNINOVE students or employees with a diagnosis of sulfide (H2S) ≥ 112 ppb in gas chromatography were selected. The patients were randomly divided in groups: Group 1 (n = 15): aPDT with annatto and LED; Group 2 (n = 14): tongue scraping; Group 3 (n = 15): tongue scraping and aPDT. For aPDT, a wasBixa orellana extract used in a concentration of 20 % w/v (Fórmula e Ação®, São Paulo, Brazil) on the tongue for 2 min, associated with a blue-violet LED (Valo Cordless Ultradent® Products, Inc., South Jordan, UT, USA) (395-480 nm). Six points were irradiated on the back of the tongue, at wavelength 395-480 nm for 20 s, energy of 9.6 J and radiant energy of 6.37 J/cm² per point. The results were compared before, immediately after treatment and 7 days after. The Friedman test was used for the intragroup analysis and the Kruskal Wallis test for the intergroup analysis.

RESULTS

In all groups, there was a difference between baseline and the value immediately after the treatment. In Groups 1 and 3, there was no difference between the baseline and the 7 days control.

CONCLUSION

There was an immediate reduction of halitosis, but the reduction was not maintained after 7days.

Therapeutic effect of laser on pediatric oral soft tissue problems: a systematic literature review

In recent years, extensive evidence has been published about usage of laser in oral lesions. The aim of the present study was to review the effectiveness of laser radiation in the treatment of pediatric oral soft tissue problems. The relevant keywords were searched in EBSCO, Medline (via Ovid), PubMed, Scopus, and Web of Science (WOS) databases. Then, eligible case series and controlled clinical trial studies, which published up to the end of 2018, were extracted and scrutinized. In this study, the age range of ≤ 21 years or the average age of ≤ 21 years was considered as the pediatric group. After limiting the search results, removing duplicate titles and eligibility evaluation, 17 papers were enrolled to the study (seven controlled clinical trials and ten case series). Er:YAG (2940 nm), CO₂ (10,600 nm), Er,Cr:YSGG (2780 nm), and diode (650, 660, and 975 nm) lasers indicated successful clinical results on mucocele excision, frenectomy, gingival incision and re-contouring, and treatment of vascular malformations. In addition, 660-nm diode laser radiation was an effective adjuvant treatment for halitosis and gingivitis induced by multi-bracket appliances. Reduction or absence of pain and bleeding, suitable homeostasis, reduction of operation time, less analgesic consumption, and antibacterial effect were among the advantages of the laser radiation in the studies. Laser as a main or adjuvant tool can have an effective role in surgical and non-surgical treatments of pediatric oral soft tissue problems. Conducting further randomized controlled trial studies on different soft tissue lesions can contribute to drawing better conclusions.