Egle Patrizia Milia

The Use of Probiotic Strains in Caries Prevention: A Systematic Review

This paper aims to provide a systematic review of the caries-prevention effect of probiotics in human. The hypothesis was that the administration of probiotic strains might play a role in caries lesion prevention and in the control of caries-related risk factors. The main relevant databases (Medline, Embase) were searched. Quality of the Randomized Clinical Trials (RCTs) was classified using the “Consolidated Standards of Reporting Trials” (CONSORT) checklist and the Impact Factor (IF) value of each journal was recorded. Sixty-six papers were identified, and 23 fulfilled the inclusion criteria. Only three studies had caries lesion development as outcome, all the others reported caries risk factors as interim evaluation. Using the CONSORT Score, the papers were coded as 4 excellent, 9 good and 10 poor. The mean IF value recorded was 1.438. Probiotics may play a role as antagonistic agent on mutans streptococci (MS), acidogenic/aciduric bacteria that contributes to the caries process. In two-thirds of the selected papers, probiotics have demonstrated the capacity to reduce MS counts in saliva and/or plaque in short-term. The effect of probiotics on the development of caries lesion seems encouraging, but to date, RCTs on this topic are insufficient to provide scientific clinical evidence.

Xerostomia induced by radiotherapy: an overview of the physiopathology, clinical evidence, and management of the oral damage

Background The irradiation of head and neck cancer (HNC) often causes damage to the salivary glands. The resulting salivary gland hypofunction and xerostomia seriously reduce the patient’s quality of life. Purpose To analyze the literature of actual management strategies for radiation-induced hypofunction and xerostomia in HNC patients. Methods MEDLINE/PubMed and the Cochrane Library databases were electronically evaluated for articles published from January 1, 1970, to June 30, 2013. Two reviewers independently screened and included papers according to the predefined selection criteria. Results Sixty-one articles met the inclusion criteria. The systematic review of the literature suggests that the most suitable methods for managing the clinical and pathophysiological consequences of HNC radiotherapy might be the pharmacological approach, for example, through the use of cholinergic agonists when residual secretory capacity is still present, and the use of salivary substitutes. In addition, a modified diet and the patient’s motivation to enhance oral hygiene can lead to a significant improvement. Conclusion Radiation-induced xerostomia could be considered a multifactorial disease. It could depend on the type of cancer treatment and the cumulative radiation dose to the gland tissue. A preventive approach and the correct treatment of the particular radiotherapeutic patient can help to improve the condition of xerostomia.

A systematic review on fluoridated food in caries prevention.

Abstract Objective. This paper aims to provide a systematic review of the caries-prevention effect of fluoridated food, excluding water. The main aim of this review was to evaluate the presence of scientific evidence relating to the effects of fluoride intake via food on the occurrence of carious lesions. The outcome was defined as a clinical outcome, so only papers evaluating a decrease in caries indices were included. Materials and methods. Relevant databases (Medline®, Embase®, The Cochrane Library) were searched. The date range was set from 01.01.1966 to 03.31.2011. One hundred and thirty-nine reports were identified and assessed. Only three papers fulfilled the inclusion criteria and were discussed in detail. Results. No paper related to the use of fluoridated salt in caries prevention fulfilled the inclusion criteria. The use of milk as a vehicle for providing additional fluoride in a dental public health programme was evaluated in two papers. The consumption of fluoridated milk was an effective measure to prevent caries in the primary teeth. The use of fluoridated sugar demonstrated a reduction in caries increment in the permanent dentition in one paper. Conclusions. Literature on the effectiveness of fluoridation in foods in caries prevention is scant and almost all the studies have been conducted in children. There is low evidence that the use of milk fluoridation is effective in reducing the caries increment.

Nanomaterials for Tissue Engineering In Dentistry

The tissue engineering (TE) of dental oral tissue is facing significant changes in clinical treatments in dentistry. TE is based on a stem cell, signaling molecule, and scaffold triad that must be known and calibrated with attention to specific sectors in dentistry. This review article shows a summary of micro- and nanomorphological characteristics of dental tissues, of stem cells available in the oral region, of signaling molecules usable in TE, and of scaffolds available to guide partial or total reconstruction of hard, soft, periodontal, and bone tissues. Some scaffoldless techniques used in TE are also presented. Then actual and future roles of nanotechnologies about TE in dentistry are presented.

Osteogenesis from Dental Pulp Derived Stem Cells: A Novel Conditioned Medium Including Melatonin within a Mixture of Hyaluronic, Butyric, and Retinoic Acids

Human dental pulp stem cells (hDPSCs) have shown relevant potential for cell therapy in the orthopedic and odontoiatric fields. The optimization of their osteogenic potential is currently a major challenge. Vascular endothelial growth factor A (VEGF A) has been recently reported to act as a major conductor of osteogenesis in vitro and in vivo. Here, we attempted to prime endogenous VEGF A expression without the need for viral vector mediated gene transfer technologies. We show that hDPSCs exposure to a mixture of hyaluronic, butyric, and retinoic acids (HA + BU + RA) induced the transcription of a gene program of osteogenesis and the acquirement of an osteogenic lineage. Such response was also elicited by cell exposure to melatonin, a pleiotropic agent that recently emerged as a remarkable osteogenic inducer. Interestingly, the commitment to the osteogenic fate was synergistically enhanced by the combinatorial exposure to a conditioned medium containing both melatonin and HA + BU + RA. These in vitro results suggest that in vivo osteogenesis might be improved and further studies are needed.

Short-term response of three resin-based materials as desensitizing agents under oral environmental exposure

Abstract Objective. This paper focuses on clinical responses after 7 days of oral exposure to two resin-based materials as desensitizing agents compared to a fluoride varnish and on morphological and analytical study as a means to elucidate the mechanism of action. Materials and methods. The elemental composition of Vertise™ Flow (VF), Universal Dentine Sealant (UDS) and Flor-Opal® Varnish (FOV) were investigated by using an X-ray energy dispersive spectrometer (EDX) in conjunction with a scanning electron microscope (SEM). SEM morphology of the material-treated dentine surfaces and pain reduction ability according to the Visual Analogue Scale (VAS) were evaluated in selected hypersensitive teeth. Post treatments and 7 day controls were recorded with SEM and VAS measurements. Clinical data was analysed with the Students t-test for paired data, with a 5% significance level. Results. Silicon, ytterbium and alumina were the most present elements in VF, whilst calcium, chloride, silicon and alumina were highest in UDS. Within a 7 day oral environment all the tested materials modified the treated-dentine surfaces showing tubular occlusion of different morphology. Clinically, the efficacy of all materials was similar after a 7-day examination. However, VAS scores were significantly reduced if compared with the baseline (p < 0.05). Conclusions. Within the limits of this study, data indicate that both resins are effective in sealing tubules and reducing VAS. A resin-related effect on the dentines morphology was observed, which may influence the long-term response of the resins in the treatment of dental hypersensitivity, which requires further investigation.

Thymus essential oil extraction, characterization and incorporation in phospholipid vesicles for the antioxidant/antibacterial treatment of oral cavity diseases

The aim of the work was to extract, characterize, and formulate Thymus capitatus (Tymbra capitata) essential oil in phospholipid vesicles: liposomes, glycerosomes and Penetration Enhancer-containing Vesicles (PEVs). The steam-distilled essential oil was mainly composed of carvacrol. The oil was mixed with lecithin and water to produce liposomes, or different ratios of water/glycerol or water/propylene glycol (PG) to produce glycerosomes and PG-PEVs, respectively. Cryo-TEM showed the formation of unilamellar, spherical vesicles, and light scattering disclosed that their size increased in the presence of glycerol or PG, which improved long-term stability. The formulations were highly biocompatible, and capable of counteracting oxidative stress and favouring wound repair in keratinocytes, thanks to enhanced uptake. The antibacterial activity of the oil was demonstrated against cariogenic Streptococcus mutans, Lactobacillus acidophilus, and commensal Streptococcus sanguinis. The combination of antioxidant and antibacterial activities of Thymus essential oil formulations may be useful for the treatment of oral cavity diseases.

Effectiveness of two self-etchings bonded clinically in caries affected dentin with homogeneous smear layer

Aim. To examine the interface of two self-etchings in carious affected dentin (CAD), under clinical conditions. Materials and Methods. Class I cavities were prepared in 21 carious premolars, refining them by the use of a fine diamond bur in order to create similar smear layer interference. The mild self-etching Clearfil SE Bond (CSE), pH = 2.0, and the strong Tyrian SPE-One Step Plus (TSO), pH = 0.5, were applied followed by a composite. Teeth were extracted and processed for TEM. The primers osmolarity of the self-etchings was also calculated using a microosmometer. Results. CSE hybrid layer retained smear layer residues and scattered crystallites as an effect of the mild acidity. A high presence of hydroxyapatite still protected the affected fibres within the hybrid layer. CSE primer demonstrated values of 3220 mOsm/kg. TSO interdiffusion showed strong demineralization. Resin tags were not formed in the dentinal tubules which remained obstructed by crystals. However, dissolution of peritubular dentin and porosities were observed in the intertubular regions. The osmolarity of TSO was 8200 mOsm/kg. Conclusion. Increasing the acidity and osmolarity of the self-etchings increases interference in the homogeneous reinforcement of CAD, which may predispose the hybrid layer to instability and hydrolytic degradation overtime.