Caries clinical trial of a remineralising toothpaste in radiation patients

Objectives: The purpose of this study was to determine the efficacy and safety of a specially formulated remineralising toothpaste in controlling caries in a high‐risk population: head and neck radiation patients. Design: The study compared the performance of the remineralising toothpaste with a conventional fluoride dentifrice using double‐blind randomisation. Materials and methods: Test products: The products compared contained equivalent quantities of fluoride (1100 p.p.m.). The dual‐phase remineralising toothpaste, Enamelon^®, also delivered soluble calcium and phosphate ions, essential components of teeth, from separate phases. Both groups had all caries restored at baseline and used a fluoride rinse daily. Subjects: Fifty‐seven subjects who received radiation to the head and neck causing saliva hypofunction, entered the study, while 44 completed the 10–12 month visit. Measurements: Examinations included coronal and root caries using the Pitts Diagnostic Criteria, salivary flow rate, plaque and gingival indices and microbiological counts over a 1‐year period. Results: The average net increment per year for root caries per subject was 0.04 (±.052) in subjects completing the study using the remineralising toothpaste and 1.65 (±0.51) for root caries in subjects completing the study using the conventional fluoride dentifrice. The difference was statistically significant (p = 0.03), suggesting lower net root surface increment/year for the remineralising toothpaste relative to the conventional toothpaste. No significant differences were noted on coronal surfaces. Conclusion: The results indicate that the remineralising toothpaste provides a significant benefit in preventing and remineralising root caries in high‐risk patients.     

Efficacy of chlorhexidine-thymol varnish (Cervitec) against plaque accumulation and gingival inflammation in a geriatric population

Objectives: To determine whether the 3‐monthly application of chlorhexidine (CHX)–thymol varnish is an effective method of controlling plaque and gingivitis in a group of institutionalised elderly as a complement to their usual oral hygiene practices. Design: A 6‐month double‐blind clinical trial. Setting: Two residential homes in Almería (Spain). Participants: Fifty‐six dentate subjects aged above 64 years who completed the 6‐month study. Intervention: The study subjects were randomly assigned to one of two groups (Cervitec^® or placebo). Varnishes were applied twice in the first week of the study and were applied again a month later and every 3 months until the end of the study. The patients continued with their usual oral hygiene practices throughout the study. Measurement: Plaque index and gingival index scores were determined at baseline and after 1, 3 and 6 months. Results: Treatment with Cervitec^® varnish had a statistically significant effect overtime on the gingival index score (p = 0.029), but not on the plaque index score (p = 0.651). The groups did not significantly differ in reductions in plaque or gingival index scores between baseline and 1, 3 or 6 months. Conclusion: According to these results, Cervitec^®, a CHX–thymol varnish, does not appear to reduce plaque and gingivitis by a 3‐monthly application in the institutionalised elderly with poor oral hygiene. Wider studies are required to investigate different varnishing protocols in geriatric populations.     

Stannous fluoride in dentifrice: an effective anti‐plaque agent in the elderly?

Objective: The aim of this study was to examine differences in plaque accumulation in elderly patients using two toothpastes, with either 0.2% sodium fluoride (NaF) or 0.4% stannous fluoride (SnF₂), but otherwise identical. Background data: The prevalence of denate elderly is increasing. Plaque both causes caries and is associated with an increased mortality rate in frail elderly patients with pneumonia. Therefore, the effective removal of plaque is important. Ingredients with an anti‐plaque effect, such as SnF₂, that can be used in toothpaste, are effective in plaque inhibition Materials and methods: Thirty‐two frail elderly women, 82–98 years of age (mean, 88 years) and living in a residential home, participated in a double‐blind crossover study. They brushed their teeth for 4 weeks with each toothpaste. Treatment outcome was a change in the plaque index (PI) on four anterior teeth and four molars. Results: anova showed statistically significant differences between the treatments (F = 4.21, p = 0.02). A post hoc test showed that SnF₂ produced a statistically significantly lower PI than did NaF. Conclusion: SnF₂ in toothpaste may be effective in inhibiting plaque accumulation in the elderly.     

Anti‐biofilm and bactericidal effects of magnolia bark‐derived magnolol and honokiol on Streptococcus mutans

Dental caries affects people of all ages and is a worldwide health concern. Streptococcus mutans is a major cariogenic bacterium because of its ability to form biofilm and induce an acidic environment. In this study, the antibacterial activities of magnolol and honokiol, the main constituents of the bark of magnolia plants, toward planktonic cell and biofilm of S. mutans were examined and compared with those of chlorhexidine. The minimal inhibitory concentrations of magnolol, honokiol and chlorhexidine for S. mutans were 10, 10 and 0.25 µg/mL, respectively. In addition, each agent showed bactericidal activity against S. mutans planktonic cells and inhibited biofilm formation in a dose‐ and time‐dependent manner. Magnolol (50 µg/mL) had greater bactericidal activity against S. mutans biofilm than honokiol (50 µg/mL) and chlorhexidine (500 µg/mL) at 5 min after exposure, while all showed scant activity against biofilm at 30 s. Furthermore; chlorhexidine (0.5–500 µg/mL) exhibited high cellular toxicity for the gingival epithelial cell line Ca9‐22 at 1 hr, whereas magnolol (50 µg/mL) and honokiol (50 µg/mL) did not. Thus; it was found that magnolol has antimicrobial activities against planktonic and biofilm cells of S. mutans. Magnolol may be a candidate for prevention and management of dental caries.     

An in vitro synergetic evaluation of the use of nisin and sodium fluoride or chlorhexidine against Streptococcus mutans

The objective of this study is to investigate the synergetic action between nisin and sodium fluoride or chlorhexidine against Streptococcus mutans, a primary cariogenic pathogen. In the antibacterial assay, a synergetic effect on S. mutans was found between nisin and sodium fluoride, but there was no interaction between nisin and chlorhexidine by the checkerboard, the fractional inhibitory concentration (FIC) and the fractional bactericidal concentration (FBC) tests. S. mutans survival rates showed a significant decline after treatment with a combination of nisin and sodium fluoride in a time-kill study. Scanning electron microscopy showed that the damage to S. mutans with the combined nisin and sodium fluoride treatment was the most severe among all of the different single and combined antimicrobial treatments. Furthermore, in the antibiofilm test, nisin in combination with sodium fluoride produced a stronger bactericidal effect on a S. mutans biofilm for 4 h and 16 h compared with sodium fluoride alone by confocal laser scanning microscopy. Nisin in combination with sodium fluoride exerted a high bactericidal effect on S. mutans and thereby has the potential to be used as an effective drug combination to prevent dental caries.     

Short‐term side effects of 0.2% alcohol‐free chlorhexidine mouthrinse in geriatric patients: a randomized,double‐blind,placebo‐controlled study

doi: 10.1111/j.1741‐2358.2012.00671.x Short‐term side effects of 0.2% alcohol‐free chlorhexidine mouthrinse in geriatric patients: a randomized, double‐blind, placebo‐controlled study Objective: To determine the effects of a 0.2% alcohol‐free chlorhexidine mouthwash applied twice a day during 30 days in patients over 65 years of age. Materials and methods: A randomized, double‐blind, placebo‐controlled study was made of 70 denture wearers over 65 years of age. The study subjects were randomly assigned to one of the two groups (chlorhexidine or placebo). The patients were instructed to complete a first whitening phase with a duration of 1 week, followed by a 30‐day treatment period. The following data were collected: Silness and Löe plaque index, gingival index, the number of colony‐forming units of Candida albicans at the start and end of treatment and the possible adverse effects of chlorhexidine. Results: Significant differences were observed in the evolution of the Silness and Löe plaque index and gingival index in the two groups, as well as in the number of colony‐forming units of C. albicans between the start and end of treatment. Conclusions: These results suggest that the clinical benefits of antiplaque, antigingivitis mouthrinses in both study groups.     

Double blind clinical trial of a remineralizing dentifrice in the prevention of caries in a radiation therapy population

Objectives: The purpose of this study is to determine the efficacy and safety of a specially formulated remineralizing toothpaste in controlling caries in a group of high risk, head and neck radiation patients. Design: The study compares the performance of the remineralizing toothpaste with a leading conventional fluoride dentifrice using double-blind randomization. Test Products The products compared both contain equivalent quantities of fluoride (1150ppm). The remineralizing toothpaste also delivers soluble calcium and phosphate ions, the essential components of teeth. Subjects: On completion, 50 subjects who received >50 Gy of radiation to the head and neck. Measurements: Examinations include coronal and root caries using the Pitts Diagnostic Criteria, salivary flow rate, plaque and gingival indices and microbiological counts over one year. Results: At this point subjects are enrolled in the study at various phases. However, the current average for the net increment per month per subject is −0.12 (±1.30) for coronal caries and 0.06 (±0.73) for root caries in subjects using the remineralizing toothpaste and 0.53 (±1.62) for coronal caries and 0.45 (±0.98) for root caries in subjects using the conventional fluoride dentifrice. Non-parametric analysis of rank scores for net root surface increments/month was statistically significant (p=0.02), suggesting lower net root surface increment/month for the remineralizing toothpaste relative to the conventional toothpaste. No significant differences were noted on coronal surfaces. Conclusions: The results to date indicate that the remineralizing toothpaste is significantly superior to the conventional fluoride dentifrice in preventing root caries in high risk patients.     

Prevention of Root Caries1

Primary prevention of root caries should focus on preventing periodontitis and the concomitant loss of gingival attachment. This requires a regimen of plaque control consisting of scrupulous oral hygiene, supplemented, if necessary, by antimicrobial agents. Once gingival recession has occurred, available data from human and animal studies indicate that to prevent root caries, patients should limit their dietary sucrose intake both in amount and frequency. The cornerstone of any preventive regimen for patients at high risk for caries is some mode of topical fluoride therapy. No controlled clinical data exist that show one agent (sodium fluoride versus stannous fluoride) or one vehicle (gel versus rinse) as more effective than another. When used daily at home, these topical fluoride agents reduce caries in patients with xerostomia. Some reports claiming efficacy are anecdotal, but ethical considerations preclude the use of an untreated control group. As no studies exist documenting an effect of topical fluoride in controlling root caries per se, current recommendations are based on extrapolation from studies of these xerostomic patients. Limited studies, both in humans and animals, indicate that drinking fluoridated water helps in reducing root caries. Progression of early root caries lesions can be arrested by a combination of mechanical/chemical therapy, recontouring and smoothing the roots, and applying topical fluoride to these surfaces.     

Fluoride exposure and factors affecting dental caries in preschool children living in two areas with different natural levels of fluorides

BackgroundSuccessful oral health interventions must be based on the specific needs of the population that they serve. Evaluation of habits related to dental caries development and estimation of fluoride exposure in a target group of young patients helps to plan effective and safe caries prevention strategies.ObjectivesThe study aimed to evaluate factors affecting dental caries experience and sources of fluoride exposure in preschool children living in two areas: with optimal and low natural content of fluoride in drinking water.Materials and methodsThe study included a group of 73 children of both sexes aged 4–7 years attending two kindergartens in Środa Wielkopolska and Turek (Wielkopolska Voivodeship, Poland), where the content of fluoride in drinking water according to data obtained in the sanitary station ranged from 0.68 to 0.74 mg/L (optimal concentration of fluoride) and from 0.19 to 0.30 mg/L (low concentration of fluoride), respectively. Parents of patients completed a survey about diet, hygiene, and dental care, taking into account the child's fluoride exposure. The calibrated dentist assessed the oral health condition using a mirror, a CPI probe, and a headlamp. Oral hygiene was recorded using the Silness and Löe plaque index, caries experience by calculating the numbers of decayed, missing, and filled primary, and permanent teeth (dmf and DMF, respectively) while caries frequency by calculating the percentage of children with caries experience above 0. In order to assess the fluoride concentrations in urine and drinking water, parents were asked to provide a urine sample collected on fasting and a tap water sample. Fluoride concentrations were assessed using a 09–37 (MARAT) fluoride ion-selective electrode and a RAE 111 silver-chloride reference electrode. Statistical analysis was conducted using the data analysis software system Statistica (version 12, StatSoft, Inc. 2014), assuming a statistical significance level p < 0.05.ResultsNo statistically significant differences were found between caries indices of the examined children in each kindergarten (p > 0.05). Urinary fluoride levels were higher in children who tended to swallow toothpaste or used fluoride rinses and positively correlated with fluoride concentrations in the drinking water. Dental caries experience in the examined children depended on the effectiveness and frequency of oral hygiene procedures and dietary habits.ConclusionsThe strategy aimed at improving the oral health of the examined group of children should include accomplishing oral hygiene, promoting a non-cariogenic diet, and, finally, controlling fluoride exposure from at-home fluoride products. Caries prevention program ought to be adjusted to individual characteristics of each child, taking into consideration oral hygiene practices, dietary habits and total fluoride intake.     

Prevalence of gingival overgrowth among elderly patients under amlodipine therapy at a large Indian teaching hospital

doi: 10.1111/j.1741‐2358.2011.00603.x
Prevalence of gingival overgrowth among elderly patients under amlodipine therapy at a large Indian teaching hospital Objectives: To determine the prevalence of amlodipine‐induced gingival overgrowth (GO) among elderly subjects attending an Indian teaching hospital and find any association with demographic factors, drug variables, oral hygiene status and gingival inflammation. Methods: A cross‐sectional pilot study included 157 dentate patients aged 60 years or more, taking Amlodipine for at least 3 months. Data were collected from past medical records and oral examination. Clinical assessment of GO was correlated with patient’s age, gender, drug dosage (2.5, 5 or 10 mg/day), duration of drug therapy (3–4, 4–6, 6–12, 12–24 and >24 months) and also with subjects’ plaque index and gingival index scores. Results: Eight patients (5.09%) had GO. No statistically significant relation was observed between age (p = 0.79), gender (p = 0.56), drug dosage (p = 0.25) and duration of drug intake (p = 0.62) and prevalence of GO. GO prevalence related highly significantly (p < 0.001) with plaque and gingival index scores. Conclusions: Prevalence of amlodipine‐associated GO in the sample of elderly Indian patients was noted higher than that previously reported. Plaque and gingival inflammation were highly correlated with this condition, while demographic characteristics and drug dosage did not relate significantly.     

Inhibitory Activity by Barley Coffee Components Towards Streptococcus Mutans Biofilm

It was shown that barley coffee (BC) interferes with Streptococcus mutans adsorption to hydroxyapatite. After BC component fractionation by dialysis and gel filtration chromatography (GFC), it was found that the low molecular mass (<1,000 Da) fraction (LMM fraction) containing polyphenols, zinc and fluoride ions and, above all, a high molecular mass (HMM > 1,000 kDa) melanoidin fraction display strong anti-adhesive properties towards S. mutans. In this study, we have further examined the potential of BC, BC LMM fraction and BC HMM melanoidin fraction as caries controlling agents by evaluating their anti-biofilm activity.The effects of BC and BC fractions on biofilm formation by S. mutans ATCC 25175 and its detachment from pre-developed biofilms were evaluated by microtiter plate assay. It was found that BC and its fractions, at concentrations ranging from 60 to 15 mg ml⁻¹ that are devoid of antimicrobial activity, inhibited S. mutans biofilm formation. An increase of S. mutans ATCC 25175 detachment from 24 h developed biofilm was observed at the highest tested concentrations. Interestingly, BC and BC fractions also showed anti-biofilm activity towards a variety of S. mutans clinical strains isolated from saliva, plaque and caries lesions of adult donors. In general, the HMM melanoidin fraction was more active than the LMM fraction. These findings, classifying BC LMM fraction and BC HMM melanoidin fractions as natural anti-biofilm agents, represent the basis for studying their possible use as anti-caries agents.     

Effect of oral hygiene education and motivation on removable partial denture wearers: longitudinal study

Objectives: The purpose of this study was to determine the effect of two different preventive oral hygiene education and motivation programmes on the plaque and gingival index, as well as denture hygiene of patients provided with removable partial denture (RPD) during a 12‐month follow‐up. Material and methods: A total of 53 partially edentulous patients were recruited for this study. The presence or absence of plaque and gingival bleeding by gentle probing was scored on all tooth surfaces at the preliminary visit. The plaque and gingival indexes were measured using the Löe index. Following treatment, the patients were randomly divided into three groups. In Control Group I, subjects were instructed to continue their personal oral hygiene routine. In Group II, participants were given verbal instructions and a self‐educational manual on oral hygiene without illustrations. In Group III, oral hygiene guidance was delivered using a combination of verbal instructions and a self‐teaching manual. To evaluate the effect of the different modes of instruction, the presence or absence of plaque and gingival bleeding was scored on all tooth surfaces (day zero examination) and re‐examined 7, 15 and 30 days, 3, 6 and 12 months following RPD placement. The state of denture hygiene was evaluated 7, 15 and 30 days and 3, 6 and 12 months following rehabilitation. Parametric statistics was applied to dental plaque and gingival indexes. For accumulation of plaque and calculus on the RPD, non‐parametric statistic was applied. Results: The frequency of plaque found during the preliminary visit was higher than that found in the other periods. With regard to gingival index, significant difference was found between the preliminary visit examination and other periods. There was a significant difference in the plaque accumulation on the denture surface between groups I and III. Conclusion: The different methods of oral hygiene instruction used in this study indicate that the type of education was not of significant importance.     

Oral health in institutionalised elderly people in Oslo, Norway and its relationship with dependence and cognitive impairment

doi: 10.1111/j.1741‐2358.2011.00490.x
Oral health in institutionalised elderly people in Oslo, Norway and its relationship with dependence and cognitive impairment Objective: Investigating oral health’s relationship with dependency and cognitive state. Background: Oral hygiene is poor in the institutionalised elderly. There are problems regarding the oral care of residents having poor mobility or cognitive impairment. Material and methods: Cross‐sectional study involving 135 participants (mean age 85.7, SD 8.8 years) in two categories: nurses doing tooth cleaning and residents doing tooth cleaning. Those cleaned by nurses were categorised as co‐operative or unco‐operative. The oral hygiene status, presence of caries, retained roots and denture‐related stomatitis were recorded. Results: Of the participants, 70% had only natural teeth. The prevalence of caries was 28%. A significant correlation showed that having more teeth gave a poorer Simplified Oral Hygiene Index (OHI‐S) (p = 0.018). The number of retained roots increased with the severity of cognitive impairment (p < 0.05). Significant differences were found between nurses or residents doing the tooth cleaning on the OHI‐S (p = 0.05) and percentage of dental plaque (p = 0.003). Unco‐operative residents had poorer oral hygiene (p = 0.028), more caries (p = 0.008) and were more often moderate–severe cognitive impaired (p = 0.016). Conclusions: A high percentage of participants had unacceptable oral hygiene. Residents whose teeth were cleaned by the nurses had poorer oral hygiene. Unco‐operative residents had the worst oral hygiene and more caries.     

Streptococcus mutans and dental caries in humans: a bacteriological and immunological study

Plaque samples from caries-active subjects showed a higher incidence of S. mutans than plaque samples from caries-free subjects. This was especially evident in approximal incisor plaque. S. mutans serotype d was almost exclusively present in approximal plaque obtained from caries-active subjects. Tooth surfaces infected with S. mutans still harbored this micro-organism 10 months later, while uninfected tooth surfaces remained free of S. mutans.Caries development predominantly occurs on those tooth surfaces which harbor relatively high percentages of S. mutans (> 5%). It is unlikely that serum or saliva antibodies against S. mutans play a major role in the protection against dental caries in these caries-free subjects since subjects with the greatest number of decayed surfaces showed the highest antibody titre as measured by haemagglutination or by the enzyme-linked immuno sorbent assay (ELISA).The present investigation shows that serum or salivary antibodies against S. mutans do not seem to play a role in caries resistance in young adults. However, this does not preclude a role of antibodies, prior to infection with S. mutans, in man.     

Buffering effect of a prophylactic gel on dental plaque in institutionalised elderly

Objectives: The effect of multiple daily applications of a prophylactic gel, with buffering substances, on plaque acidogenicity in elderly institutionalised individuals was evaluated. Background: Many elderly suffer from reduced salivary flow, poor oral hygiene and increased levels of cariogenic bacteria and are considered to be at an increased risk for coronal and root caries. Reinforcing the buffering capacity of dental plaque by the addition of substances such as bicarbonate and phosphates may decrease their caries activity. Materials and methods: Fourteen elderly, with subjective dry mouth, were treated for 16‐day‐periods at random with: (i) Profylin fluoride gel with buffering components; (ii) Profylin fluoride gel without buffering components and (iii) rinsing with water. Applications were made four times a day and each period was followed by a 2‐week wash‐out period. The plaque pH was registered after a carbohydrate challenge and the following were recorded before and after each test period: stimulated salivary secretion rate, buffer capacity, number Colony Farming Units (CFU) mutans streptococci, lactobacilli and a sample of Candida albicans on oral mucosa. Results: Eleven participants (mean age 76.6 years) fulfilled the study. Changes in plaque pH measurements, when calculated as area under the curve (AUC_6.2 and AUC_5.7) values (pH × min), before and after each of the three treatments, showed no significant differences. A tendency to a higher plaque acidogenicity and amount of cariogenic microorganisms was found after the gel treatments. C. albicans was found in low levels. Conclusion: Frequent applications of the gel did not result in an improved neutralising effect in the elderly. This may be caused by a combination of several factors, such as the level of oral dryness of the individuals and low solubility, release and retention of the gel substances in plaque. Instead, an increased plaque acidogenicity was noted.     

Oral hygiene care status of elderly with dementia and in residential aged care facilities

doi: 10.1111/j.1741‐2358.2011.00472.x
Oral hygiene care status of elderly with dementia and in residential aged care facilities Objective: To explore the effectiveness of oral hygiene care on plaque and gingival status of residents with dementia. Background: Oral hygiene and oral hygiene care has been reported to be poor among the institutionalised elderly with dementia. The severity of oral diseases has been shown to increase with the severity of physical and cognitive impairment related with dementia. Little research has been carried out on plaque and gingival status of elderly with dementia and the impact of disability related with dementia on oral health in residential aged care facilities (RACF). Materials and methods: A cross‐sectional study of 205 elderly residing in RACF in Perth. Results: Forty‐one percent of the residents in RACF had dementia. Sixty percent of the residents with dementia and 75% of the residents with an Activities of Daily Living Oral Health score of D were assisted with oral care. Mean plaques scores and extent of gingival inflammation were higher for residents in the DD and D subgroups and resident with dementia. Residents assisted with brushing had higher mean plaque score and more moderate gingival inflammation. Conclusion: Oral hygiene care status in residents with dementia was poor despite the fact that oral care assistance was being provided.     

A lemon myrtle extract inhibits glucosyltransferases activity of Streptococcus mutans

Streptococcus mutans is a bacterium found in human oral biofilms (dental plaques) that is associated with the development of dental caries. Glucosyltransferases (GTFs) are key enzymes involved in dental plaque formation, and compounds that inhibit their activities may prevent dental caries. We developed a screening system for GTF-inhibitory activities, and used it to profile 44 types of herbal tea extracts. Lemon myrtle (Backhousia citriodora) extract exhibited the highest GTF-inhibitory activity, with an IC₅₀ for GTF in solution of 0.14 mg mL^?1. Furthermore, lemon myrtle extracts had the third-highest polyphenol content of all tested extracts, and strongly inhibited S. mutans biofilm. Interestingly, lemon myrtle extracts did not inhibit cell growth.     

Influence of fluoride on the bacterial composition of a dual-species biofilm composed of Streptococcus mutans and Streptococcus oralis

Despite the widespread use of fluoride for the prevention of dental caries, few studies have demonstrated the effects of fluoride on the bacterial composition of dental biofilms. This study investigated whether fluoride affects the proportion of Streptococcus mutans and S. oralis in mono- and dual-species biofilm models, via microbiological, biochemical, and confocal fluorescence microscope studies. Fluoride did not affect the bacterial count and bio-volume of S. mutans and S. oralis in mono-species biofilms, except for the 24-h-old S. mutans biofilms. However, fluoride reduced the proportion and bio-volume of S. mutans but did not decrease those of S. oralis during both S. oralis and S. mutans dual-species biofilm formation, which may be related to the decrease in extracellular polysaccharide formation by fluoride. These results suggest that fluoride may prevent the shift in the microbial proportion to cariogenic bacteria in dental biofilms, subsequently inhibiting the cariogenic bacteria dominant biofilm formation.     

The efficacy of three formulations of Lippia sidoides Cham. essential oil in the reduction of salivary Streptococcus mutans in children with caries: A randomized,double-blind,controlled study

Essential oils of many plants have been previously tested in the treatment of oral diseases and other infections. This study was a randomized, double-blind, in parallel with an active control study, which aimed to evaluate the efficacy of three formulations of the Lippia sidoides Cham. essential oil (LSO) in the reduction of salivary Streptococcus mutans in children with caries. 81 volunteers, aged 6–12 years, both genders, with caries, were recruited to participate in this study, and randomly assigned to either one of five different groups. Each group received topical treatment with either 1.4% LSO toothpaste, 1.4% LSO gel, 0.8% LSO mouthwash, 1% chlorhexidine gel, or 0.12% chlorhexidine mouthwash. A 5-ml volume of each gel was placed inside disposable trays, and applied for 1 min, every 24 h, for 5 consecutive days. The mouthwash groups used 5-ml volume of a mouthwash inside disposable syringes. In the toothpaste group, children brushed their teeth for 1 min, once a day for 5 days. Saliva was collected before and after treatment. MS colonies were counted, isolated and confirmed through biochemical tests. Differences in MS levels measured in different days within the same treatment group was only verified with LSO toothpaste, chlorhexidine gel and chlorhexidine mouthwash. Comparison between groups of LSO mouthwash, toothpaste and gel showed that the toothpaste group expressed significantly lower MS levels than the mouthwash and gel groups at day-30. Chlorhexidine significantly reduced MS levels after 5 days of treatment, but these levels returned to baseline in other periods of the study. LSO toothpaste reduced MS levels after 5 days of treatment, and MS levels remained low and did not return to baseline during subsequent analysis. Hence, LSO toothpaste demonstrated the most long-lasting MS reduction in saliva, whereas other LSO formulations did not effectively reduce MS levels in children with dental caries.     

Effect of neovestitol–vestitol containing Brazilian red propolis on accumulation of biofilm in vitro and development of dental caries in vivo

The present study examined the influences of the neovestitol–vestitol (NV) containing fraction isolated from Brazilian red propolis on the development of biofilm and expression of virulence factors by Streptococcus mutans using saliva-coated surfaces of hydroxyapatite. In addition, NV was tested in a rodent model of dental caries to assess its potential effectiveness in vivo. Topical applications of NV (800 μg ml^?1) significantly impaired the accumulation of biofilms of S. mutans by largely disrupting the synthesis of glucosyltransferase-derived exopolysaccharides and the expression of genes associated with the adaptive stress response, such as copYAZ and sloA. Of even greater impact, NV was as effective as fluoride (positive control) in reducing the development of carious lesions in vivo. NV is a promising natural anti-biofilm agent that targets essential virulence traits in S. mutans, which are associated with the formation of cariogenic biofilm and the subsequent onset of dental caries disease.