Altair Antoninha Del Bel Cury

Development of Candida-associated denture stomatitis: new insights

Despite therapeutic progress, opportunistic oral fungal infectious diseases have increased in prevalence, especially in denture wearers. The combination of entrapment of yeast cells in irregularities in denture-base and denture-relining materials, poor oral hygiene and several systemic factors is the most probable cause for the onset of this infectious disease. Hence colonization and growth on prostheses by Candida species are of clinical importance. The purpose of this review is to critically discuss several key factors controlling the adhesion of Candida species which are relevant to denture-associated stomatitis. Although there is some consensus on the role of surface properties, studies on several other factors, as the use of denture liners, salivary properties and yeast-bacterial interactions, have shown contradictory findings. A comprehensive fundamental understanding is hampered by conflicting findings due to the large variations in experimental protocols, while other factors have never been thoroughly studied. Surface free energy and surface roughness control the initial adherence, but temporal changes have not been reported. Neither have in vivo studies shown if the substratum type is critical in dictating biofilm accumulation during longer periods in the oral environment. The contribution of saliva is unclear due to factors like variations in its collection and handling. Initial findings have disclosed that also bacteria are crucial for the successful establishment of Candida in biofilms, but the clinical significance of this observation is yet to be confirmed. In conclusion, there is a need to standardize experimental procedures, to bridge the gap between laboratory and in vivo methodologies and findings and – in general – to thoroughly investigate the factors that modulate the initial attachment and subsequent colonization of denture-base materials and the oral mucosa of patients subjected to Candida infections. Information on how these factors can be controlled is required and this may help to prevent the disease. The societal impact of such information is significant given the magnitude of the candidosis problem worldwide.

The effect of Streptococcus mutans and Candida glabrata on Candida albicans biofilms formed on different surfaces

Although Candida containing biofilms contribute to the development of oral candidosis, the characteristics of multi-species Candida biofilms and how oral bacteria modulate these biofilms is poorly understood. The aim of this study was to investigate interactions between Candida albicans and either Candida glabrata or Streptococcus mutans in biofilms grown on various surfaces, with or without saliva. Hydroxyapatite (HA), polymethylmetacrylate (PMMA) and soft denture liner (SL) discs were used as substratum. Counts of viable micro-organisms in the accumulating biofilm layer were determined and converted to colony forming units per unit surface area. Confocal laser scanning microscopy was used to characterize biofilms and to quantitate the number of hyphae in each condition tested. Viable counts of C. albicans and C. glabrata per mm(2) decreased in the order HA>PMMA>SL (p<0.05). Biofilms grown on saliva-coated specimens harboured fewer C. glabrata than uncoated specimens (p<0.05). Glucose and the presence of S. mutans suppressed C. albicans hyphal formation. Dual Candida species biofilms did not show competitive interaction between the two species. We conclude that Candida biofilms are significantly affected by saliva, substratum type and by the presence of other micro-organisms.

Improvement of XTT assay performance for studies involving Candida albicans biofilms

2, 3-bis (2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino) carbonyl]-2H-tetrazolium hydroxide (XTT) reduction assay has been used to study Candida biofilm formation. However, considering that the XTT reduction assay is dependent on cell activity, its use for evaluating mature biofilms may lead to inaccuracies since biofilm bottom cell layers tend to be relatively quiescent at later stages of biofilm formation. The aim of this study was to improve XTT reduction assay by adding glucose supplements to the standard XTT formulation. Candida albicans ATCC 90028 was used to form 24-, 48- and 72-h biofilms. The oxidative activity at 90, 180 and 270 min of incubation was evaluated. The control consisted of standard XTT formulation without glucose supplements, and was modified by the addition of 50, 100 and 200 mM of glucose. The XTT assay with 200 mM glucose showed more accurate and consistent readings correlating with biofilm development at 24, 48 and 72 h. Biofilm growth yield after 180 min incubation, when evaluated with the 200 mM glucose supplemented XTT, produced the most consistent readings on repetitive testing. It may be concluded that glucose supplementation of XTT could minimize variation and produce more accurate data for the XTT assay.

Effect of a denture cleanser on weight, surface roughness, and tensile bond strength of two resilient denture liners

STATEMENT OF PROBLEM Denture cleansers used in clinical practice can damage resilient denture lining materials. PURPOSE This study evaluated the effects of a denture cleanser on weight change, roughness, and tensile bond strength on 2 denture resilient lining materials. MATERIAL AND METHODS Forty specimens of microwave acrylic resin (Onda-Cryl), 30 mm in diameter and 4 mm thick, were prepared to verify weight change and surface roughness. The specimens were divided into 4 groups consisting of 10 specimens each, relined with a resilient liner (Coe Soft or Dentusoft), and treated (Polident or tap water). To evaluate tensile bond strength, 12 specimens were used for each group. All specimens were stored in artificial saliva for 15 days, immersed once a day in Polident or tap water, and evaluated at 0 hours and after 24 hours and 7 and 15 days. Roughness was evaluated by use of a profilometer. Weight changes were recorded in milligrams and expressed as the percentage of weight difference between the periods of evaluation. Tensile bond strength was determined with a universal testing machine. The specimens were placed under tension until failure by a cross-speed of 5 mm/min with a 500 Kg load cell. The type of failure was determined by use of stereoscopic microscopy at original magnification x8. The data were submitted to analysis of variance and compared by Tukeys test (alpha=.05). RESULTS Specimens immersed in Polident showed higher and significant (P<.05) weight changes (%) than those immersed in water between 24 hours and 7 days (Coe Soft-Polident: 0.48 +/- 0.09; Coe Soft-water: 0.28 +/- 0.09; Dentusoft-Polident: 0.44 +/- 0.16; Dentusoft-water: 0.22 +/- 0.15) and between 7 and 15 days (Coe Soft-Polident: 0.08 +/- 0.04; Coe Soft-water: -0.17 +/- 0.05; Dentusoft-Polident: 0.01 +/- 0.04; Dentusoft-water: - 0.24 +/- 0.03). There was significant difference (P<.05) in roughness (in micrometers), between treatments after 7 days (Coe Soft-water: 4.07 +/- 0.22; Coe Soft-Polident: 3.36 +/- 0.52; Dentusoft-water: 3.68 +/- 0.72; Dentusoft-Polident: 3.26 +/- 0.41) and 15 days (Coe Soft-water: 4.88 +/- 0.29; Coe Soft-Polident:3.53 +/- 0.61; Dentusoft-water: 4.42 +/- 1.12; Dentusoft-Polident: 3.68 +/- 0.37). Tensile bond strength was highest (P<.05) after 15 days (Coe Soft-water: 5.19 +/- 0.93; Coe Soft-Polident: 4.40 +/- 0.38; Dentusoft-water: 4.42 +/- 1.15; Dentusoft-Polident: 4.84 +/- 1.14). Most failures were cohesive (Coe Soft: 76.04% and Dentusoft: 82.29%). CONCLUSION Within the limitations of this in vitro study, specimens immersed in Polident demonstrated increased weight changes of resilient liners when compared with tap water, but surface roughness and tensile bond strength were unaffected.

Effect of starch on the cariogenic potential of sucrose

Since in vitro and animal studies suggest that the combination of starch with sucrose may be more cariogenic than sucrose alone, the study assessed in situ the effects of this association applied in vitro on the acidogenicity, biochemical and microbiological composition of dental biofilm, as well as on enamel demineralization. During two phases of 14 d each, fifteen volunteers wore palatal appliances containing blocks of human deciduous enamel, which were extra-orally submitted to four groups of treatments: water (negative control, T1); 2 % starch (T2); 10 % sucrose (T3); and 2 % starch+10 % sucrose (T4). The solutions were dripped onto the blocks eight times per day. The biofilm formed on the blocks was analysed with regard to amylase activity, acidogenicity, and biochemical and microbiological composition. Demineralization was determined on enamel by cross-sectional microhardness. The greatest mineral loss was observed for the association starch+sucrose (P<0.05). Also, this association resulted in the highest lactobacillus count in the biofilm formed (P<0.05). In conclusion, the findings suggest that a small amount of added starch increases the cariogenic potential of sucrose.

O papel da odontologia na equipe interdisciplinar: contribuindo para a atenção integral ao idoso

This literature review focuses on dentistrys role in comprehensive health care for the elderly. The authors discuss the need for an interdisciplinary approach. They begin by analyzing the current situation in geriatric dentistry and related problems in Brazil, relating primarily to the lack of specific studies and human resources with training in geriatrics and gerontology. The authors emphasize interactions between dentistry and other health professions for health promotion, specific prevention, and rehabilitation of elderly patients, with special attention to the importance of communication and information exchange.

Efficacy of denture cleansers on Candida spp. biofilm formed on polyamide and polymethyl methacrylate resins

STATEMENT OF PROBLEM Although new materials have emerged as options to fabricate removable dental prostheses, the development of Candida biofilms on these materials and the effectiveness of methods to control these pathogenic biofilms are poorly understood. PURPOSE The purpose of this study was to evaluate the efficacy of denture cleansers on Candida single- and dual-species biofilms formed on polyamide resin. MATERIAL AND METHODS Polymethyl methacrylate (PMMA) resin (Acron MC) and polyamide resin (Flexite M.P.) specimens (n=116) were prepared, and their surface roughness was standardized (0.34 ±0.02 μm). Surface free energy (SFE) was measured for some specimens (n=20 per resin), while the remainder were randomly divided by lottery into 24 groups (n=8) for biofilm assay. C. albicans and/or C. glabrata biofilm was formed for 72 hours, and then specimens were treated with an enzymatic cleanser solution (Polident 3 Minutes), a cleanser solution (Corega Tabs), or 0.5% sodium hypochlorite (NaOCl) solution. Water served as the negative control. Remaining adherent microorganisms were removed from the treated specimens by ultrasonic waves, and colony-forming units (CFU) of each microorganism were calculated. SFE data were analyzed by 1-way ANOVA, and Candida species data were analyzed by 3-way ANOVA followed by the Tukey-Kramer test (P=.05). RESULTS All tested biofilms displayed significantly higher growth on polyamide resin (P<.001), which presented the lowest SFE. Denture cleansers significantly decreased Candida levels; however, the 0.5% NaOCl solution was the only effective cleanser. C. glabrata revealed significantly higher CFU counts under all experimental conditions (P<.001). CONCLUSIONS The highest Candida spp. biofilm growth was shown to occur on polyamide resin when compared with PMMA. Denture cleansers were able to remove Candida spp. biofilm formed on both denture base resins.

Adsorption of salivary and serum proteins, and bacterial adherence on titanium and zirconia ceramic surfaces

OBJECTIVES The aim of this study was to determine the pattern of salivary and serum proteins present in pellicles formed on titanium (Ti) and zirconia ceramic (ZrO(2)) surfaces, and the ability of bacterial cells to adhere to the experimental pellicles. In addition, the protein profiles and bacterial binding properties of pellicles on Ti and ZrO(2) were compared to those formed on hydroxyapatite (HA) surface. METHODS The pellicles were formed in vitro by incubating the materials with whole saliva, serum or saliva+serum. Protein composition in each of the pellicles was investigated by SDS-PAGE and immunodetection. The adherence of radiolabeled Streptococcus mutans and Actinomyces naeslundii to uncoated surfaces and experimental pellicles was determined by means of scintillation counting. Statistical analyses were done using ANOVA and Tukeys test at significance level at P<0.05. In general, the electrophoretic analysis of the pellicles formed on HA, Ti and ZrO(2) revealed few qualitative differences of the composition of proteins of the pellicles formed on HA, Ti and ZrO(2) surfaces. Pellicle components identified included amylase, IgA, IgG, albumin, fibronectin and fibrinogen. The number of S. mutans cells adhered to uncoated Ti and ZrO(2) was significantly higher than those adhered to HA (P<0.05). In contrast, lower number of A. naeslundii cells adhered to uncoated Ti and ZrO(2) than to HA (P<0.05). However, the presence of saliva and saliva+serum pellicles greatly reduced the number of S. mutans cells bound to each of the surfaces. The data showed that Ti and ZrO(2) display similar pellicle protein composition and bacterial binding properties; however, significant differences were observed when both materials were compared to HA.

Preload loss and bacterial penetration on different implant-abutment connection systems

Preload loss can favor the occurrence of implant-abutment interface misfit, and bacterial colonization at this interface may lead to implant failure. The aim of this study was to evaluate the preload loss and bacterial penetration through the implant-abutment interface of conical and external hexagon connection systems subjected to thermal cycling and mechanical fatigue (TM). Four different implant-abutment connection systems were evaluated (n=6): external hexagon with universal post, Morse taper with universal post, Morse taper with universal post through bolt, and locking taper with standard abutment. The assemblies (implant-abutment) were subjected to a thermal cycling regimen (1,000 cycles of 5 degrees C and 55 degrees C) and to mechanical fatigue (1.0 million cycles, 1.0 Hz, 120 N). The assemblies were immersed in Tryptic Soy + Yeast Extract broth containing Streptococcus sanguinis and incubated at 37 degrees C and 10% CO(2) for 72 h. Detorque values were recorded. The bacterial penetration was assessed and the abutments were observed by scanning electron microscopy. The preload data were analyzed statistically by two-way ANOVA and Tukeys test at 5% significance level. All screw abutment systems showed significantly higher (p<0.05) detorque values when subjected to TM and all conical systems presented bacterial penetration. The results show no relationship between the preload loss and the bacterial penetration.

Long-term efficacy of denture cleansers in preventing Candida spp. biofilm recolonization on liner surface

This study evaluated the long-term efficacy of denture cleansers against Candida spp. biofilm recolonization on liner surface. Specimens were fabricated of a poly(methyl methacrylate)-based denture liner and had their surface roughness evaluated at baseline and after cleansing treatments. C. albicans or C. glabrata biofilms were formed on liner surface for 48 h, and then the specimens were randomly assigned to one of cleaning treatments: two alkaline peroxides (soaking for 3 or 15 min), 0.5% sodium hypochlorite (10 min) or distilled water (control; 15 min). After the treatments, the specimens were sonicated to disrupt the biofilm, and residual cells were counted (cell/mL). Long-term effectiveness of the cleaning processes was determined by submitting a set of cleaned specimens to biofilm growth conditions for 48 h followed by estimation of cell counts. The topography of specimens after cleaning treatments was analyzed by SEM. Data were analyzed by ANOVA and Tukeys test (α; = 0.05). Results of cell count estimation showed significant differences in cleanliness among the treatments (p < 0.001), and it could be observed by SEM. However, no significant difference (p > 0.05) was observed among the Candida species regarding the recolonization condition. Alkaline denture cleansers showed similar cleaning performance and both differed from the control (p < 0.001). Sodium hypochlorite was the only treatment that removed biofilm efficiently, since no viable cells were found after its use. In conclusion, alkaline peroxide denture cleansers were not effective in removing Candida spp. biofilm from denture liner surfaces and preventing biofilm recolonization.