The effect of tissue molecules on bacterial invasion of dentine

A macroscopic and histological analysis of radiographically well-defined deep and extremely deep carious lesions: carious lesion characteristics as indicators of the level of bacterial penetration and pulp response

AIM

To investigate the relationship between radiographically and macroscopically well-defined carious lesions and the dentine-pulp complex with regard to: (i) level of bacterial penetration; (ii) inflammatory status including the presence of hyperplastic pulp stroma; and (iii) formation of hard and/or ectopic connective tissue.

METHODOLOGY

The material comprised 68 untreated cavitated permanent teeth divided into well-defined radiographic categories based on the lesion penetration depth: (i) deep lesions ( ≥3/4 of the dentine thickness with a radio-dense zone separating the lesion from the pulp) and (ii) extremely deep lesions (the carious lesion penetrated the entire thickness of the dentine, without a radio-dense zone). After extraction, the teeth were processed for histology. The material was scored with regard to coronal breakdown, macroscopic variables describing caries activity and histological variables describing the dentine-pulp complex (bacteria, inflammatory infiltrate, partial pulp necrosis, hyperplastic changes and hard tissue/ectopic presence of connective tissue). Interrater agreement was assessed using Cohen's kappa. Associations between variables were assessed using Pearson's chi-squared or Fisher's exact test. The effect size was reported by odds ratio (OR) and associated 95% confidence interval (CI). Level of significance was set to 5%.

RESULTS

There were significant associations between a closed environment (1-2 surfaces involved) and the presence of biofilm, retrograde demineralization and light-coloured demineralized dentine. Whereas radiographically defined deep lesions tended to have bacteria only in the primary dentine (P < 0.001, OR = 20.55, 95% CI [4.44, 107.89]), extremely deep carious lesions tended to have bacteria in contact with the pulpal tissue (P = 0.007, OR = 6.84, 95% CI [2.00, 62.83]), presence of an inflammatory infiltrate (Fisher's exact; P < 0.001) and partial pulp necrosis. Hyperplastic pulps were seen only in extremely deep lesions.

CONCLUSIONS

Unlike deep lesions, extremely deep carious lesions were often associated with severe pulp inflammation and infection. A radiographic threshold between deep and extremely deep lesions is suggested as indicator of the bacterial penetration level and the severity of the pulpal response prior to intervention.

The effect of polyphenol-containing solutions on in situ biofilm formation on enamel and dentin

OBJECTIVES

To investigate the effects of Chinese gallnut extracts and pure tannic acid on in situ biofilm formation on enamel and dentin samples over 24 h.

METHODS

Bovine enamel and dentin samples were buccally fixed on maxillary splints. Six volunteers wore the splints for 24 h, and rinsed their mouths with tap water (control), 1% tannic acid- and 1% Chinese gallnut extracts-containing solution twice a day, 3 min after the splints were placed in the mouth and before night sleep. Live/dead staining was used for fluorescence microscopic (FM) visualization and quantification of bacteria viability of biofilms formed on enamel and dentin samples. Biofilm coverage was evaluated and recorded by FM and scanning electron microscopy (SEM). In addition, biofilms were analyzed by transmission electron microscopy (TEM). The Kruskal-Wallis test was used to analyze biofilm data.

RESULTS

Rinsing with tannic acid- and Chinese gallnut extracts-containing solutions significantly reduced in situ biofilm coverage on enamel and dentin samples (P < 0.05). The bacterial viability of biofilms formed on enamel samples was significantly reduced compared to the control (P < 0.05). TEM analysis revealed an increase in pellicle's electron density and thickness and only few or no bacteria adherent to the pellicle in the experimental samples.

CONCLUSIONS

Rinsing with tannic acid- and Chinese gallnut extracts-containing solutions can effectively inhibit in situ biofilm formation, modify the ultrastructure of biofilms on enamel and dentin surfaces and significantly reduce the bacterial viability of biofilm on enamel surfaces.

CLINICAL SIGNIFICANCE

Tannic acid- and Chinese gallnut extracts-containing solutions might be used for dental biofilm management.

Crystal growth in dentinal tubules with bio-calcium carbonate-silica sourced from equisetum grass

BACKGROUND/PURPOSE

One effective way to deal with dentin hypersensitivity is to develop materials to seal the tubules. The porous bio-calcium carbonate-silica (BCCS) contained well-dispersed CaCO₃ would form calcium phosphates to seal the dentinal tubules when mixed with an acidic solution. The acidic hydrothermal treatment and calcination to isolate the BCCS from the agricultural waste like equisetum grass was used, which would be more environmentally friendly than chemically synthesized mesoporous biomaterials. The aim of this study was to develop mesoporous materials from natural resources to occlude the dentinal tubules which could be more environmentally-friendly.

METHODS

Dentin disc samples were prepared and treated with different methods as follows: (1) BCCS mixed with H₃PO₄; (2) BCCS mixed with KH₂PO₄; (3) Seal & Protect® was used as a comparison group. Sealing efficacy was evaluated by measuring the depths and percentages of precipitate occlusion in dentinal tubules with SEM.

RESULTS

The N₂ adsorption-desorption isotherm of the BCCS demonstrated a pore size of around 15.0 nm and a surface area of 61 m²g-1. From the results of occlusion percentage and depth, the BCCS treated with H₃PO₄ or KH₂PO₄ demonstrated promising sealing efficacy than the commercial product.

CONCLUSION

This synthetic process used the agricultural waste equisetum grass to produce bio-calcium carbonate-silica would be environmentally friendly, which has great potential in treating exposed dentin related diseases.

Microbiological aspects of traumatic injuries

After traumatic injuries to teeth, microorganisms may invade the compromised pulp tissue and initiate pulp infection and periapical inflammation. In addition to bone resorption that typically accompanies pulp necrosis, root resorption frequently occurs. Root resorption has several variants that may occur shortly after the trauma or at a later stage. The pathological changes seen after traumatic injuries to teeth are invariably linked to the presence of microbial irritants. The presence of bacterial biofilms in the dental pulp space can be treated with regenerative or therapeutic endodontic procedures. However, necrosis of periodontal ligament is usually terminal for the tooth involved. In this review, the sources of bacteria after traumatic injuries are discussed. The types and role of microorganisms involved in the pathogenesis of endodontic pathosis after traumatic injuries are presented, and contemporary approaches for the management of these conditions are reviewed. Contemporary antimicrobial strategies are discussed. The rationale for the use of systemic and topical antimicrobials is presented. Finally, novel approaches to the use of antimicrobial therapies, particularly in regenerative procedures, are reviewed.

Adhesion and invasion of gingival epithelial cells by Porphyromonas gulae

Porphyromonas gulae, an animal periodontal pathogen, possess fimbriae classified into three genotypes (A-C) based on the diversity of fimA genes encoding FimA. Accumulating evidence suggests that P. gulae strains with type C fimbriae are more virulent as compared to those with other types. The ability of these organisms to adhere to and invade gingival epithelial cells has yet to be examined. P. gulae showed the greatest levels of adhesion and invasion at a multiplicity of infection of 100 for 90 min. P. gulae type C and some type B strains invaded gingival epithelial cells at significantly greater levels than the other strains, at the same level of efficiency as P. gingivalis with type II fimbriae. Adhesion and invasion of gingival epithelial cells by P. gulae were inhibited by cytochalasin D and sodium azide, indicating the requirements of actin polymerization and energy metabolism for those activities. Invasion within gingival epithelial cells was blocked by staurosporine, whereas those inhibitors showed little effects on adhesion, while nocodazole and cycloheximide had negligible effects on either adhesion or invasion. P. gulae proteases were found to be essential for adhesion and invasion of gingival epithelial cells, while its DNA and RNA, and protein synthesis were unnecessary for those activities. Additionally, α5β1 integrin antibodies significantly inhibited adhesion and invasion by P. gulae. This is the first report to characterize P. gulae adhesion and invasion of human gingival epithelial cells.

Novel calcium encapsulated mesocellular siliceous foams for crystal growth in dentinal tubules

OBJECTIVES

The aim of this study was to investigate the novel mesocellular siliceous foams (MCF) containing CaCO₃ nanoparticles (denoted as CMCF) combined with phosphoric acid could occlude dentinal tubules through the formation of biomimetic crystal barrier.

METHODS

Ultrastructures of MCF and CMCF were examined by transmission electron microscopy (TEM). Elemental components were analyzed with energy dispersive X-ray spectrometry (EDX). CMCF was mixed with distilled water, 10%, 20% and 30% phosphoric acid then applied on dentine discs. Crystals were characterized by X-ray powder diffractometry (XRD). The sealing efficacy of the dentinal tubules was examined by scanning electron microscopy.

RESULTS

TEM images showed MCF presented a pore size of approximately 30.0 nm and CMCF contained abundant nano-CaCO₃. Sealing efficacy showed that CMCF, when reacted with 30% phosphoric acid, would form crystals in the dentinal tubules to a depth of 83.2 ± 17.6 μm at an occlusion percentage of 75.6 ± 12.8% on average; both occlusion percentage and depth were higher than those obtained with 10% or 20% phosphoric acid (p < 0.05). The results of XRD and EDS indicated that the crystal growth in the dentinal tubules could be transformed into the biomimetic crystals.

CONCLUSION

This study showed that the CMCF with 30% phosphoric acid could effectively occlude the dentinal tubules through the formation of biomimetic crystal barrier.

CLINICAL SIGNIFICANCE

The novel CMCF combined with phosphoric acid may have potential for the treatment of dentine hypersensitivity.

Evaluation of photosensitizer penetration into sound and decayed dentin: A photoacoustic spectroscopy study

BACKGROUND

Photodynamic therapy (PDT) may have topical indications. In those cases it is important for a topical photosensitizer to penetrate into the tissue to which it has been applied. This study aimed to compare the penetration of two different concentrations of erythrosine into intact and in vitro decayed dentin samples.

METHODS

This in vitro study evaluated erythrosine (0.3 and 5%) penetration into sound (intact) and decayed dentin. A total of 11 dentin discs were prepared and divided into two equal halves, in order to keep one half sound while the other half was submitted to sterilization and an in vitro demineralization model for 5 days. Before erythrosine application, the organic and inorganic composition of all samples was evaluated by Fourier Transform Raman spectroscopy, and after erythrosine application for 30 min, the penetration depth was determined by Photoacoustic spectroscopy technique.

RESULTS

The results indicated that 0.3% erythrosine showed a higher penetration depth into sound dentin (p = 0.002); and 5% erythrosine higher penetration into decayed dentin (p < 0.001). However considering clinical parameters, no statistically significant difference was found between any of the conditions tested.

CONCLUSIONS

Erythrosine demonstrated ability to penetrate into dentin, irrespective of sound or decayed condition. Photoacoustic spectroscopy can be considered a method for estimating the penetration into hard tissues, and in conjunction with Raman spectroscopy, these are effective methods for evaluating the spectral response of dentin. Considering that erythrosine is capable of penetrating into decayed dentin, clinical trials are needed to test the effectiveness of this photosensitizer in Photodynamic therapy and Antimicrobial Photodynamic therapy.

Green tea catechin inhibits the activity and neutrophil release of Matrix Metalloproteinase-9

Green tea (Camellia sinensis; 綠茶 lǜ chá) extracts have been shown to possess anti-oxidant and anti-inflammatory effects in various cell types. Green tea extract (GTX) has been shown to significantly inhibit the activity of collagenase-3 (matrix metalloproteinase-13 (MMP-13)) in vitro. MMPs, such as MMP-9, are known to be involved in many inflammatory diseases including periodontal disease. GTX and a major catechin, epigallocatechin-gallate (EGCG), were examined for their ability to inhibit purified MMP-9 activity and its release from stimulated neutrophils.

Methanol extract of Green tea and commercially purchased EGCG (>95 % purity) were tested in vitro for their ability to inhibit MMP-9 activity and/or its release from neutrophils using a β-casein cleavage assay and gelatin zymography, respectively. Statistical analysis was performed by Student's t-test.

GTX and EGCG at 0.1% (w/v) completely inhibited the activity of MMP-9. In addition, GTX and EGCG (0.1 %) significantly inhibited (p < 0.001) the release of MMP-9 from formyl-Met-Leu-Phe (FMLP)-stimulated human neutrophils by 62.01% ± 6.717 and 79.63% ± 1.308, respectively. The inhibitory effects of GTX and EGCG occurred in unstimulated neutrophils (52.42% ± 3.443 and 62.33% ± 5.809, respectively). When the inhibitory effect of EGCG was further characterized, it significantly inhibited the release of MMP-9 from the FMLP-stimulated human neutrophils in a dose-dependent manner.

The effects of GTX and EGCG on MMPs could be extrapolated to clinical/in vivo studies for the development of oral care products to prevent or treat chronic inflammatory diseases including periodontal diseases.

Assessment of dentinal tubule invasion capacity of Enterococcus faecalis under stress conditions ex vivo

AIM

To investigate the dentinal tubule invasion capacity of Enterococcus faecalis under alkaline and energy starvation stress conditions.

METHODOLOGY

The root canals from human single-rooted teeth (n = 40) were infected with E. faecalis under alkaline (pH 9, 10, 11 and 12) and energy starvation (no glucose, 0.05% glucose and 0.15% glucose) stress conditions. The root canals were prepared in a standard manner and treated to remove the smear layer before incubation. After 4 weeks of cultivation, the roots were split vertically into two halves: one half was processed for biofilm formation analysis using a scanning electron microscope; the other half was stained with fluorescent DNA-binding reagents, washed thoroughly and sectioned (100 μm thick), and the depth of tubule invasion by the microorganism was examined by confocal laser-scanning microscopy. The extent of dentine tubule invasion was analysed statistically.

RESULTS

The E. faecalis strain resulted in biofilm formation and dentine tubules invasion under all of the stress conditions, except for pH 11 and 12 conditions. However, the tubule penetration distance was markedly reduced in these stress conditions (P < 0.01) compared with in tryptic soy broth (TSB) or pH 7 medium. The invasion depth in the middle root dentine was significantly higher than in the apical sections in TSB and energy starvation medium (P < 0.01).

CONCLUSIONS

Ex vivo E. faecalis formed biofilms and colonized dentine under alkaline and glucose starvation stress conditions, but its ability to invade dentine tubules was significantly decreased.

Microbial invasion of dentinal tubules: a literature review and a new perspective

Various features of endodontic microbiology have been investigated using various methods. The aim of the present study was to review the existing literature on endodontic microbiology in dentinal tubules, and to present the features of two cases with endodontic pathology. An electronic search was performed with a search string created ad hoc. Ex vivo and in vitro studies were included, recording the method of detection and characteristics of analyzed teeth. Twenty studies fulfilled the inclusion criteria. Seven of them were in vitro laboratory studies on teeth inoculated after extraction, while 13 were ex vivo studies on extracted, infected teeth. Endodontic bacteria were detected in dentinal tubules, both as single units and as biofilm aggregates. Two similar in vitro cases presented here corroborate the latter findings. A number of techniques have been utilized to observe bacteria in the dentinal tubule ecosystem. Dentinal tubules are favorable niches for microbial survival, either in the form of monomicrobial or polymicrobial communities.

Supplementary sampling of obturation materials enhances microbial analysis of endodontic treatment failures: a proof of principle study

OBJECTIVES

Root canal treatment failures often correlate with persistent biomaterial-associated endodontic infections. The aim of the present study was to assess the impact of endodontic obturation material sampling from root canals with posttreatment apical periodontitis on improving standard study protocols.

MATERIALS AND METHODS

Samples from previously filled root canals and their corresponding endodontic filling materials were obtained from five root-filled teeth with posttreatment periradicular lesions. After cultivation, the isolated microorganisms were quantified and biochemically identified. Moreover, clone libraries were constructed after the amplification of bacterial 16S ribosomal DNA (rDNA) from the same samples. DNA from selected clones was sequenced to identify microbial species. Transmission electron microscopy (TEM) aided visualization of the detected bacteria.

RESULTS

Overall, 22 taxa of the phyla Firmicutes, Actinobacteria, and Bacteroidetes were detected in both obturation and root canal samples by culture-dependent and culture-independent methods. Root canal fillings sheltered 17 species (3.30-7.50 × 10(3) CFU/ml). Of these, nine were detected solely in the retrieved obturation materials. The reinfected root canals harbored 13 taxa (3.48-7.36 × 10(3) CFU/ml). Obligate and facultative anaerobic bacteria prevailed. The number of different species ranged from 1 to 5 within a single sample. Fungi were not detected.

CONCLUSIONS

Bacteria can colonize both root canals and endodontic fillings in vivo.

CLINICAL RELEVANCE

Integrating the sampling of obturation materials with standard root canal sample collection offers a clearer insight into the actual microbial flora of reinfected root canals and improves the study protocols of secondary/persistent endodontic infections.

Synergistic effect of microbubble emulsion and sonic or ultrasonic agitation on endodontic biofilm in vitro

INTRODUCTION

Irrigation dynamics and antibacterial activity determine the efficacy of root canal disinfection. Sonic or ultrasonic agitation of irrigants is expected to improve irrigation dynamics. This study examined the effects of microbubble emulsion (ME) combined with sonic or ultrasonic agitation on irrigation dynamics and reduction of biofilm bacteria within root canal models.

METHODS

Two experiments were conducted. First, high-speed imaging was used to characterize the bubble dynamics generated in ME by sonic or ultrasonic agitation within canals of polymer tooth models. Second, 5.25% NaOCl irrigation or ME was sonically or ultrasonically agitated in canals of extracted teeth with 7-day-grown Enterococcus faecalis biofilms. Dentinal shavings from canal walls were sampled at 1 mm and 3 mm from the apical terminus, and colony-forming units (CFUs) were enumerated. Mean log CFU/mL values were analyzed with analysis of variance and post hoc tests.

RESULTS

High-speed imaging demonstrated strongly oscillating and vaporizing bubbles generated within ME during ultrasonic but not sonic agitation. Compared with CFU counts in controls, NaOCl-sonic and NaOCl-ultrasonic yielded significantly lower counts (P < .05) at both measurement levels. ME-sonic yielded significantly lower counts (P = .002) at 3 mm, whereas ME-ultrasonic yielded highly significantly lower counts (P = .000) at both measurement levels. At 3 mm, ME-ultrasonic yielded significantly lower CFU counts (P = .000) than ME-sonic, NaOCl-sonic, and NaOCl-ultrasonic.

CONCLUSIONS

Enhanced bubble dynamics and reduced E. faecalis biofilm bacteria beyond the level achieved by sonic or ultrasonic agitation of NaOCl suggested a synergistic effect of ME combined with ultrasonic agitation.

Bacterial viability determination in a dentinal tubule infection model by confocal laser scanning microscopy

Dentinal tubule invasion protects bacteria from chemo-mechanical disinfection and frequently results in root canal treatment failures. Enterococcus faecalis is a primary causative agent, particularly in persistent, asymptomatic, and chronic apical periodontitis. In order to assess and compare the efficacies of endodontic antimicrobial agents and application strategies, we have developed a convenient and robust method to measure bacterial viability and assess distribution in an ex vivo tubule infection model. Following infection and antimicrobial treatment of prepared ex vivo roots, the tubule bacteria are exposed to nucleic acid-binding fluorescent stains (LIVE/DEAD BacLight stain), sectioned, and examined by confocal laser scanning microscopy. The proportion of red-fluorescing (dead) and green-fluorescing (live) bacteria is then visualized in situ and quantified with image analysis software.

Dentinal tubule invasion and adherence by Enterococcus faecalis

AIM

To investigate dentinal tubule invasion and the predilection of Enterococcus faecalis for dentinal tubule walls.

METHODOLOGY

The invasion of dentinal tubules in extracted human teeth by E. faecalis was measured ex vivo after 8 weeks of incubation. The canal walls of 16 root sections were either intact or instrumented with or without smear layer present. Extent and maximum depth of tubule invasion were assessed histologically and compared between groups. In the adherence study, 44 vertically split root samples were prepared to expose longitudinally aligned dentinal tubules and fractured orthodentine (OD). Surfaces were exposed to E. faecalis (erythromycin resistant strain, JH2-2 carrying plasmid pGh9:ISS1) and incubated aerobically for 2 h. Samples were processed for analysis using scanning electron microscopy. Bacterial adhesion to tubule walls versus fractured OD was calculated as number of cells per 100 microm(2).

RESULTS

The strain of E. faecalis used in this study showed moderate to heavy tubule invasion after 8 weeks. In the adhesion studies, significantly more bacteria adhered to fractured OD than to dentinal tubule walls (ANOVA, P < 0.001). With respect to the tubule wall, adherence was greater in inner versus outer dentine (P = 0.02) and greater when bacterial adhesion was tested in chemically defined medium than in phosphate-buffered saline (ANOVA, P < 0.001).

CONCLUSIONS

Although E. faecalis readily invaded tubules, it did not adhere preferentially to tubule walls. Initial colonization of dentinal tubules by E. faecalis may depend primarily on other factors.

Bacterial invasion of dentinal tubules beneath apparently intact but hypomineralized enamel in molar teeth with molar incisor hypomineralization

BACKGROUND

The most common problems for a patient with molar incisor hypomineralization (MIH) are the collapse of enamel and cavitations, loss of fillings, and secondary caries, but most of all, severe hypersensitivity.

OBJECTIVE

The aim of this paper was therefore to histologically study possible bacterial invasion of dentinal tubules beneath apparently intact, but hypomineralized enamel in permanent molars with MIH.

MATERIAL AND METHODS

Five extracted permanent first molars diagnosed with MIH were fixated, demineralized, and sagittally serially sectioned in a bucco-lingual direction in a microtome with a thickness of 4-5 microm. Sections were stained with a modified Brown and Benn staining for bacteria, unstained sections were analysed in field emission SEM.

RESULTS

Stained sections from the cuspal areas, below the hypomineralized enamel, the staining indicated the presence of bacteria in the dentinal tubules. The HTX staining showed that the pulp in sections without any findings was normal and free from bacteria or infiltrates from inflammatory cells. In sections where bacteria were found in the cuspal areas or deeper in the dentin, a zone of reparative dentin was found, and in sections from one tooth, the coronal pulp showed an inflammatory reaction with inflammatory cells. In sections adjacent to those without any bacterial staining, the SEM analyses revealed empty dentinal tubules without any odontoblast processes or signs of bacteria. When odontoblast processes were found, the dentinal tubules were filled with bacteria located on the surface of the odontoblast processes. In some areas, a large number of tubules were found with bacteria. No bacteria were found close to the pulp. The odontoblast processes appeared larger in areas where bacteria were found.

CONCLUSIONS

The presence of bacteria in the dentinal tubules and inflammatory reactions in the pulp indicate that oral bacteria may penetrate through the hypomineralized enamel into the dentin, thus possibly contribute to hypersensitivity of teeth with MIH.

Innate Immune Responses of the Dental Pulp to Caries

Various cells and inflammatory mediators are involved in the initial pulpal responses to caries. This review focuses on the cellular, neuronal, and vascular components of pulpal innate responses to caries. Discussion will include dentinal fluid, odontoblasts, neuropeptides, and neurogenic inflammation, which are not classic immune components but actively participate in the inflammatory response as the caries progress pulpally. Summaries of innate immune cells as well as their cytokines and chemokines in healthy and reversible pulpitis tissues are presented.

Hemin nutritional stress inhibits bacterial invasion of radicular dentine by two endodontic anaerobes

AIM

To determine if anaerobic bacteria routinely found in infected dentine and root canals require the presence of heme in the environment in order for them to invade dentinal tubules.

METHODOLOGY

Noncarious, unrestored human teeth with single root canals were prepared for invasion experiments and soaked in either TSB-M supplemented with hemin (5 microg mL(-1)) (n = 12 roots), TSB-M media (n = 12 roots) or TSB-M media followed by hemin soak (n = 12 roots) for 2 days, then inoculated with either Prevotella intermedia ATCC 25611 or Peptostreptococcus micros ATCC 33270 and incubated anaerobically for 14 days. Roots were prepared for light microscopy, stained with Brown and Brenn or antisera raised to the bacteria, and invasion within tubules assessed using a tubule invasion index (TI). Data were analysed using Student's t-test and Mann-Whitney U-test.

RESULTS

Prevotella intermedia (TI = 0.7 +/- 0.04) and P. micros (TI = 0.96 +/- 0.08) showed low invasion when grown in the presence of hemin with cells generally restricted to the superficial 20 microm of the tubules, whilst neither bacteria invaded tubules (TI = 0) when hemin was absent from the growth media (P < 0.01).

CONCLUSIONS

Hemin was required in the growth medium for P. intermedia and P. micros to invade dentinal tubules.

The Pulpal Origin of Immunoglobulins in Dentin Beneath Caries: An Immunohistochemical Study

Immunoglobulins localized in uninfected dentin beneath caries are thought to be protective, but their origin remains controversial. We reasoned that the localization and dominance of serum IgG1 would support the pulpal origin of the immunoglobulins while a predominance of secretory component (SC) bearing IgA1 and IgA2 would support their salivary origin. The prevalence and staining intensity of IgG1, IgA1, IgA2, IgM, and SC in uninfected dentinal tubules beneath shallow, deep caries, and noncaries teeth were examined immunohistologically. SC was only localized in caries, and IgG1 was the predominant subclass in uninfected dentinal tubules beneath shallow and deep caries, followed by IgA1. In noncaries teeth, IgG1 was localized on the pulpal end. The intensity of IgG1 was significantly higher than either IgA1 or IgA2 in both shallow and deep caries. Our data support the serum origin of immunoglobulins in uninfected dentin beneath caries.

The Role of Environmental Changes on Monospecies Biofilm Formation on Root Canal Wall by Enterococcus faecalis

Biofilm mode of growth is a strategy in microorganisms to survive harsh growth conditions. Although previous studies have established the ability of Enterococcus faecalis to survive postendodontic environmental conditions, the effect of such conditions on the ultrastructural and physiochemical features of E. faecalis biofilm has received less attention. This study aims to evaluate the effect of different growth conditions on the characteristics of E. faecalis biofilm on root canal, and the penetration of E. faecalis into dentinal tubules. Forty-five intact noncarious human maxillary molars were experimented under nutrient-rich, nutrient-deprived, aerobic, and anaerobic conditions for a period of 21 days. Scanning Electron Microscopy with Energy Dispersive X-ray microanalysis, Laser Confocal Scanning Microscopy and Light microscopic examinations were carried out. The microscopic analysis highlighted a distinct variation in the ultrastructure of the biofilms formed under different experimental conditions. The EDX microanalysis showed a significant increase in the levels of Calcium (Ca) in the biofilm structures formed under anaerobic nutrient-deprived condition (p < 0.001). The depth of bacterial penetration was significantly greater in nutrient-rich condition (p < 0.001). This study demonstrated distinct ultrastructural and physiochemical properties of the biofilms formed and dentinal tubular penetration of E. faecalis under different conditions.

Growth at high pH increases Enterococcus faecalis adhesion to collagen

AIM

To evaluate the effect of growth at pH levels from 7.1 to 9.5 on the adherence of Enterococcus faecalis to bovine serum albumin (BSA) and collagen type I.

METHODOLOGY

Enterococcus faecalis strain A197A was grown in broth of adjusted pHs varying between 7.1 and 9.5. Aliquots of bacterial suspensions were added to wells coated either with BSA or with collagen type I. Bacteria adhering to the surfaces were stained with crystal violet. Spectrophotometric measurements of the dissolved stain were used to assess the number of bacteria adhering to the surfaces. The data obtained were analysed using the Kolmogorov-Smirnov test, Levene's test and Student's t-test, with alpha = 0.05 as the level for statistical significance.

RESULTS

The adhesion of E. faecalis to BSA-coated surfaces decreased inversely with alkalinity of the growth medium. The pH 7.1-grown bacteria bound to BSA significantly more than the other BSA groups. On the contrary, the adhesion to collagen type I-coated surfaces of bacteria grown at pH 8.0 and 8.5 was significantly greater than for those grown at pH 7.1.

CONCLUSIONS

A minor increase in pH up to 8.5, which may be a consequence of insufficient treatment with alkaline medicaments such as calcium hydroxide, increases the collagen-binding ability of E. faecalis, in vitro. This can be a critical mechanism by which E. faecalis predominates in persistent endodontic infections.

Virulence, phenotype and genotype characteristics of endodontic Enterococcus spp

BACKGROUND/AIMS

Enterococci have been implicated in persistent root canal infections but their role in the infection process remains unclear. This study investigated the virulence, phenotype and genotype of 33 endodontic enterococcal isolates.

METHODS

Phenotypic tests were conducted for antibiotic resistance, clumping response to pheromone, and production of gelatinase, hemolysin and bacteriocin. Genotype analysis involved polymerase chain reaction amplification of virulence determinants encoding aggregation substances asa and asa373, cytolysin activator cylA, gelatinase gelE, gelatinase-negative phenotype ef1841/fsrC, adherence factors esp and ace, and endocarditis antigen efaA. Physical DNA characterization involved pulsed-field gel electrophoresis of genomic DNA, and plasmid analysis.

RESULTS

Potential virulence traits expressed included production of gelatinase by Enterococcus faecalis (n=23), and response to pheromones in E. faecalis culture filtrate (n=16). Fourteen strains produced bacteriocin. Five strains were resistant to tetracycline and one to gentamicin, whereas all were susceptible to ampicillin, benzylpenicillin, chloramphenicol, erythromycin, fusidic acid, kanamycin, rifampin, streptomycin and vancomycin. Polymerase chain reaction products encoding efaA, ace, and asa were detected in all isolates; esp was detected in 20 isolates, cylA in six isolates, but asa373 was never detected. The gelatinase gene (gelE) was detected in all isolates of E. faecalis (n=31) but not in Enterococcus faecium (n=2); a 23.9 kb deletion sequence corresponding to the gelatinase-negative phenotype was detected in six of the eight E. faecalis isolates that did not produce gelatinase. Pulsed-field gel electrophoresis and plasmid analyses revealed genetic polymorphism with clonal types evident. Plasmid DNA was detected in 25 strains, with up to four plasmids per strain and a similar (5.1 kb) plasmid occurring in 16 isolates.

CONCLUSIONS

Phenotypic and genotypic evidence of potential virulence factors were identified in endodontic Enterococcus spp., specifically production of gelatinase and response to pheromones.

Single species biofilm-forming ability of root canal isolates on gutta-percha points

The participation of bacterial biofilms in the over-filled gutta-percha points associated with refractory periapical periodontitis has recently been reported. This study investigated the initial biofilm-forming ability of root canal isolates (Enterococcus faecalis, Streptococcus sanguis, Strep. intermedius, Strep. pyogenes, Staphylococcus aureus, Fusobacterium nucleatum, Propionibacterium acnes, Porphyromonas gingivalis and Prevotella intermedia) on gutta-percha points in vitro. Each bacterial strain was suspended in 100% cell culture medium or in culture medium containing 4.5, 45 or 90% (vol/vol) serum. The bacterial suspensions were then co-incubated anaerobically with gutta-percha points for 7 d. The gutta-percha points were processed for scanning electron microscopic observation and examined for biofilm presence and thickness. E. faecalis, Strep. sanguis, Strep. intermedius, Strep. pyogenes and Staph. aureus biofilms were generated on the surfaces of the specimens incubated in culture medium supplemented with 45 or 90% (vol/vol) serum. The E. faecalis and Strep. sanguis biofilms were significantly thicker than those of Strep. intermedius, Strep. pyogenes and Staph. aureus. No biofilms were detected on the specimens incubated with F. nucleatum, Prop. acnes, Porph. gingivalis and Prev. intermedia. These findings suggest that Gram-positive facultative anaerobes have the ability to colonize and form extracellular matrices on gutta-percha points, while serum plays a crucial role in biofilm formation.

Human salivary aggregation in Streptococcus intermedius type g strains: relationship with IgA

Bacterial aggregation is an important step in elimination from the human body to protect against infection. Streptococcus intermedius K1K aggregates in human saliva. In this study, the salivary agglutinin was identified. The aggregation level was very strong in sonic-treated saliva and 1-microm filtrate. Preincubation of human saliva with anti-human alpha chain serum or anti-human whole saliva serum completely inhibited aggregation, but preincubation with anti-human micro chain serum or anti-Fc fragment of human IgG serum had no effect. Agglutinin of human saliva that could aggregate the strain K1K was purified using DEAE-Sepharose CL-6B, Phenyl-Sepharose CL-4B and Sephacryl S200HR gel filtration. Purified salivary agglutinin was characterized with electrophoresis and immunological techniques, indicating that purified material was IgA. Bacterial aggregation was dependent on the presence of calcium. Saliva filtrate specimens from eight healthy men and eight women showed different aggregation activities. Three men and one woman had little activity. These data show that the present bacterial aggregation was an immunoreaction between IgA in saliva and the bacteria dependent on the levels of calcium. In addition, the IgA in human saliva related with possible calcium-dependent antigen(s) on the surface of strain K1K.

Bacterial adhesins--their role in tubule invasion and endodontic disease

Bacterial invasion of dentinal tubules is critical to the progression of dental caries and the development of pulp and periapical disease, and may also influence the progression of periodontal disease. However, little is known about the host or bacterial mechanisms involved in tubule invasion. Recent work has demonstrated that bacterial interactions with dentine, and salivary and tissue molecules influence invasion. Salivary molecules such as mucin and immunoglobulin G (IgG) co-aggregate with bacterial cells, which inhibits dentine invasion, while deposition of dentinal tubule fluid molecules e.g. albumin, IgG, or fibrinogen within dentinal tubules also inhibits invasion. Dentine invasion by streptococci has been shown to be associated with a bacterial growth response and adhesion to unmineralized collagen, which are mediated by streptococcal cell-surface antigen I/II polypeptides. These adhesins possess diverse binding properties including binding to salivary glycoprotein, other bacteria, and to collagen. Additionally, some antigen I/II polypeptides facilitate species-specific co-invasion between streptococci and obligate anaerobes that lack the ability to invade by themselves. An understanding of the mechanisms involved in bacterial invasion of dentine should allow development of new control strategies.