Shoji Takenaka

Residual Structure of Streptococcus mutans Biofilm following Complete Disinfection Favors Secondary Bacterial Adhesion and Biofilm Re-Development

Chemical disinfection of oral biofilms often leaves biofilm structures intact. This study aimed to examine whether the residual structure promotes secondary bacterial adhesion. Streptococcus mutans biofilms generated on resin-composite disks in a rotating disc reactor were disinfected completely with 70% isopropyl alcohol, and were again cultured in the same reactor after resupplying with the same bacterial solution. Specimens were subjected to fluorescence confocal laser scanning microscopy, viable cell counts and PCR-Invader assay in order to observe and quantify secondarily adhered cells. Fluorescence microscopic analysis, particularly after longitudinal cryosectioning, demonstrated stratified patterns of viable cells on the disinfected biofilm structure. Viable cell counts of test specimens were significantly higher than those of controls, and increased according to the amount of residual structure and culture period. Linear regression analysis exhibited a high correlation between viable and total cell counts. It was concluded that disinfected biofilm structures favored secondary bacterial adhesion.

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.

Impact of Streptococcus mutans on the generation of fluorescence from artificially induced enamel and dentin carious lesions in vitro

The purpose of this study was to examine whether Streptococcus mutans is implicated in the generation of fluorescence detected in carious lesions. Enamel surfaces and dentin cavities of extracted human teeth were subjected to artificial caries generation by exposing them either to a culture medium containing S. mutans or to a lactic acid buffer for 2 weeks. Fluorescence from the lesions was detected with confocal laser scanning microscopy or fluorescence microscopy at various excitation wavelengths, and maximum fluorescence radiance was computed using imageanalyzing software. Culture media of S. mutans were also examined for fluorescence generation. The results demonstrated that S. mutans-induced enamel and dentin lesions exhibited increased fluorescence in the red and green spectral regions, with the signal stronger in the red region. In the blue region, however, fluorescence signals in the corresponding area were below the background level. Significantly weaker or virtually no fluorescence was detected in lactic acid-demineralized lesions at all excitation wavelengths. Neither bacterial cells nor culture media generated any fluorescence. These results indicate that, although the presence of S. mutans may be a prerequisite for the emission of fluorescence from carious lesions, some interaction of S. mutans with exposed tooth matrix elements may also be required for the generation or unmasking of fluorophores.

Evidence-based strategy for dental biofilms: Current evidence of mouthwashes on dental biofilm and gingivitis

Summary Therapeutic mouthwash (MW) is an adjunctive tool along with a regular oral hygiene routine of daily tooth brushing and daily flossing. Previous systematic reviews have demonstrated that it is effective against dental biofilm and gingival inflammation, for prevention of dental caries, and for managing one’s bad breath condition according to the active ingredients. MWs prevent the microorganisms from bacterial adhesion that corresponds to the initial step in biofilm formation. This review summarized the current state of evidence such as anti-biofilm, anti-gingivitis and cariostatic properties of MWs by evaluating systematic reviews from the past six years. The anti-biofilm property has been proven to be effective, with strong evidence of three main clinical efficacies. The most commonly studied active agent was chlorhexidine gluconate (CHX), followed by essential oil (EO) and cetylpyridinium chloride. All the systematic reviews are in complete agreement that CHX and EO provide statistically significant improvements in terms of plaque and gingival indices. These effects have held up over the years as the number of studies has increased. While the use of fluoride MW is proven to be effective in improving the oral health of both children and adults, the quality of evidence is still regarded as low.

Adverse Influences of Antimicrobial Strategy against Mature Oral Biofilm

Antimicrobial measures, such as topical antiseptics and local drug delivery, have proven effective as complements to mechanical control. However, recent investigations have reported some adverse influences of antimicrobial strategy. One possible negative reaction is that residual structure may serve as a scaffold for redevelopment of biofilm. It is reported that no or little biofilm structure was removed when oral biofilms were treated with chemical compounds and that the secondary adhesion was promoted in the presence of residual structure. Second, residual structure may also act as pathogens. It is well known that various microbial components in the biofilm can play a role in disease pathogenesis, even if the microorganisms in the biofilm are completely killed. Third, low-dose antibiotics may promote bacterial biofilm formation. The short-time exposure of chemical agents will cause gradient of concentration inside biofilm. In this case, the cells in deeper area may be exposed to subminimal inhibitory concentrations (sub-MICs) of antimicrobial agents. Recent studies have demonstrated that a variety of antibiotics or antimicrobial agents at sub-MIC levels can induce biofilm formation in vitro, interfering with bacterial biofilm virulence expression. This chapter reviews studies demonstrating adverse influences of antimicrobial strategy against mature oral biofilm.