Tuomas Waltimo

Antimicrobial Effect of Nanometric Bioactive Glass 45S5

Most recent advances in nanomaterials fabrication have given access to complex materials such as SiO2-Na2O-CaO-P2O5 bioactive glasses in the form of amorphous nanoparticles of 20- to 60-nm size. The clinically interesting antimicrobial properties of commercially available, micron-sized bioactive glass 45S5 have been attributed to the continuous liberation of alkaline species during application. Here, we tested the hypothesis that, based on its more than ten-fold higher specific surface area, nanometric bioactive glass releases more alkaline species, and consequently displays a stronger antimicrobial effect, than the currently applied micron-sized material. Ionic dissolution profiles were monitored in simulated body fluid. Antimicrobial efficacy was assessed against clinical isolates of enterococci from persisting root canal infections. The shift from micron- to nano-sized treatment materials afforded a ten-fold increase in silica release and solution pH elevation by more than three units. Furthermore, the killing efficacy was substantially higher with the new material against all tested strains.

Do bioactive glasses convey a disinfecting mechanism beyond a mere increase in pH

AIM To test whether bioactive glasses kill microbiota via mineralization or the release of ions other than sodium. METHODOLOGY Flame-spray synthesis was applied to produce nanometric glasses of different sodium content and constant Ca/P ratio: 28S5, 45S5 and 77S. Calcium hydroxide and nanometric tricalcium phosphate (TCP) were used as controls. Apatite induction was monitored by Raman spectroscopy. Bovine dentine disks with adherent Enterococcus faecalis cells were exposed to test and control suspensions or buffered solutions for 1 h, 1 day and 1 week. Colony-forming units were counted and disks were inspected using scanning electron microscopy. Suspension supernatants and solutions were analysed for their pH, osmolarity, calcium and silicon content. RESULTS Sodium containing glasses induced pH levels above 12, compared with less than pH 9 with sodium-free 77S. Calcium hydroxide, 45S5 and 28S5 killed all bacteria after 1 day and lysed them after 1 week. TCP caused the highest apatite induction and substantial calcification on bacteria adhering to dentine, but did not reduce viable counts. 77S achieved disinfection after 1 week without visible apatite formation, whilst the buffer solution at pH 9 caused only minimal reduction in counts. CONCLUSION Bioactive glasses have a directly and an indirectly pH-related antibacterial effect. The effect not directly linked to pH is because of ion release rather than mineralization.

Swallowing dysfunction in cancer patients

PurposeDysphagia (swallowing dysfunction) is a debilitating, depressing, and potentially life-threatening complication in cancer patients that is likely underreported. The present paper is aimed to review relevant dysphagia literature between 1990 and 2010 with a focus on assessment tools, prevalence, complications, and impact on quality of life in patients with a variety of different cancers, particularly in those treated with curative chemoradiation for head and neck cancer.MethodsThe literature search was limited to the English language and included both MEDLINE/PubMed and EMBASE. The search focused on papers reporting dysphagia as a side effect of cancer and cancer therapy. We identified relevant literature through the primary literature search and by articles identified in references.ResultsA wide range of assessment tools for dysphagia was identified. Dysphagia is related to a number of factors such as direct impact of the tumor, cancer resection, chemotherapy, and radiotherapy and to newer therapies such as epidermal growth factor receptor inhibitors. Concomitant oral complications such as xerostomia may exacerbate subjective dysphagia. Most literature focuses on head and neck cancer, but dysphagia is also common in other types of cancer.ConclusionsSwallowing impairment is a clinically relevant acute and long-term complication in patients with a wide variety of cancers. More prospective studies on the course of dysphagia and impact on quality of life from baseline to long-term follow-up after various treatment modalities, including targeted therapies, are needed.

Strategic considerations in treatment planning: Deciding when to treat, extract, or replace a questionable tooth

Prosthodontists face the difficult task of judging the influence and significance of multiple risk factors of periodontal, endodontic, or prosthetic origin that can affect the prognosis of an abutment tooth. The purpose of this review is to summarize the critical factors involved in deciding whether a questionable tooth should be treated and maintained, or extracted and possibly replaced by dental implants. A MEDLINE (PubMed) search of the English, peer-reviewed literature published from 1966 to August 2009 was conducted using different keyword combinations including treatment planning, in addition to decision making, periodontics, endodontics, dental implants, or prosthodontics. Further, bibliographies of all relevant papers and previous review articles were hand searched. Tooth maintenance and the acceptance of risks are suitable when: the tooth is not extensively diseased; the tooth has a high strategic value, particularly in patients with implant contraindications; the tooth is located in an intact arch; and the preservation of gingival structures is paramount. When complete-mouth restorations are planned, the strategic use of dental implants and smaller units (short-span fixed dental prostheses), either tooth- or implant-supported, as well as natural tooth abutments with good prognoses for long-span FDPs, is recommended to minimize the risk of failure of the entire restoration.

Yeasts in Apical Periodontitis

Microbiological reports of apical periodontitis have revealed that yeasts can be isolated from approximately 5-20% of infected root canals. They occur either in pure cultures or together with bacteria. Almost all isolated yeasts belong to the genus Candida, and the predominant species is C. albicans. Pheno- and genotypic profiles of C. albicans isolates show heterogeneity comparable with those of isolates from other oral sites. C. albicans expresses several virulence factors that are capable of infecting the dentin-pulp complex, including dentinal tubules. This causes, consequentially, an inflammatory response around the root apex, which suggests a pathogenic role for this organism in apical periodontitis. Yeasts are particularly associated with persistent root canal infections that do not respond favorably to conservative root canal therapy. This may be due to the resistance of all oral Candida species against a commonly used topical medicament, calcium hydroxide. However, other antimicrobial agents may offer alternative therapeutic approaches and improve the treatment of these persistent cases of apical periodontitis.

Impact of Growth Conditions on Susceptibility of Five Microbial Species to Alkaline Stress

The effects of different growth conditions on the susceptibility of five taxa to alkaline stress were investigated. Enterococcus faecalis ATCC 29212, Streptococcus sobrinus OMZ 176, Candida albicans ATCC 90028, Actinomyces naeslundii ATCC 12104, and Fusobacterium nucleatum ATCC 10953 were grown as planktonic cells, allowed to adhere to dentin for 24 hours, grown as monospecies or multispecies biofilms on dentin under anaerobic conditions with a serum-enriched nutrient supply at 37 degrees C for 5 days. In addition, suspended biofilm microorganisms and 5-day old planktonic multispecies cultures were used. Microbial recovery upon direct exposure to saturated calcium hydroxide solution (pH 12.5) for 10 and 100 minutes was compared with control exposure to physiologic saline. Planktonic microorganisms were most susceptible; only E. faecalis and C. albicans survived in saturated solution for 10 minutes, the latter also for 100 minutes. Dentin adhesion was the major factor in improving the resistance of E. faecalis and A. naeslundii to calcium hydroxide, whereas the multispecies context in a biofilm was the major factor in promoting resistance of S. sobrinus to the disinfectant. In contrast, the C. albicans response to calcium hydroxide was not influenced by the growth condition. Adherence to dentin and interspecies interactions in a biofilm appear to differentially affect the sensitivity of microbial species to calcium hydroxide.

Tissue-dissolution capacity and dentin-disinfecting potential of calcium hydroxide mixed with irrigating solutions

OBJECTIVE The goal of this study was to compare the tissue-dissolution potential and antibacterial effectiveness of a conventional Ca(OH)(2)/saline paste with equivalent Ca(OH)(2)/NaOCl and Ca(OH)(2)/chlorhexidine digluconate medications. STUDY DESIGN Tissue specimens were obtained from freshly dissected pig palates. Tissue pieces of similar form and weight were incubated in air-tight containers with Ca(OH)(2) pastes or solutions proper for up to 7 days. Antimicrobial testing was performed in dentin blocks infected with Enterococcus faecalis. Medicated, sealed dentin specimens were incubated for 1 and 5 days, and bacterial growth was tested at different dentin depths. RESULTS Up to day 4, the Ca(OH)(2)/irrigating solution mixtures dissolved tissue more effectively than the conventional Ca(OH)(2)/saline paste. After 7 days, however, no statistically significant differences were found between the saline and hypochlorite mixtures, but the Ca(OH)(2)/chlorhexidine medication was significantly less effective. Dentin block disinfection was quicker and more thorough with the Ca(OH)(2)/chlorhexidine or the Ca(OH)(2)/NaOCl than with the Ca(OH)(2)/saline paste. CONCLUSION Ca(OH)(2)/irrigant mixtures under investigation appear more advantageous than the conventional Ca(OH)(2)/saline mixture, and merit further investigation in a clinical study.

In vitro yeast infection of human dentin.

An in vitro model was developed for investigation of Candida albicans penetration into human dentinal tubules. The model consisted of a dentin disc mounted between two cuvettes that each had a circular opening facing the disc. The cuvettes were filled with Tryptic-Soy-Broth, and the pulpal side cuvette was inoculated with C. albicans and incubated at 37 degrees C in air until growth occurred in the uninoculated cuvette or up to 30 days. The system was also used with Enterococcus faecalis. Completely glue-covered dentin specimens served as negative controls. Brown & Brenn-stained histological preparations of the specimens were examined with light microscopy. The time needed before growth occurred in the uninoculated cuvette showed great variation with C. albicans, whereas E. faecalis penetrated within 1 to 5 days of incubation. Slight penetration both by hyphae and yeast cells was observed in specimens inoculated with C. albicans, whereas specimens inoculated with E. faecalis showed deep and effective penetration. This study demonstrates the penetration of dentin as a possible pathway of infection by C. albicans. However, dentin penetration by C. albicans was slow and limited in comparison with E. faecalis.

Antimicrobial activity of Streptococcus salivarius K12 on bacteria involved in oral malodour

OBJECTIVE To investigate the antimicrobial activity of the bacteriocin-producing strain Streptococcus salivarius K12 against several bacteria involved in halitosis. DESIGN The inhibitory activity of S. salivarius K12 against Solobacterium moorei CCUG39336, four clinical S. moorei isolates, Atopobium parvulum ATCC33793 and Eubacterium sulci ATCC35585 was examined by a deferred antagonism test. Eubacterium saburreum ATCC33271 and Parvimonas micra ATCC33270, which have been tested in previous studies, served as positive controls, and the Gram-negative strain Bacteroides fragilis ZIB2800 served as a negative control. Additionally, the occurrence of resistance in S. moorei CCUG39336 to S. salivarius K12 was analysed by either direct plating or by passage of S. moorei CCUG39336 on chloroform-inactived S. salivarius K12-containing agar plates. RESULTS S. salivarius K12 suppressed the growth of all Gram-positive bacteria tested, but the extent to which the bacteria were inhibited varied. E. sulci ATCC35585 was the most sensitive strain, while all five S. moorei isolates were inhibited to a lesser extent. Natural resistance seems to be very low in S. moorei CCUG39336, and there was only a slight decrease in sensitivity after exposure to S. salivarius K12 over 10 passages. CONCLUSION Our studies demonstrate that S. salivarius K12 has antimicrobial activity against bacteria involved in halitosis. This strain might be an interesting and valuable candidate for the development of an antimicrobial therapy for halitosis.

The antimicrobial activity of alpha-bisabolol and tea tree oil against Solobacterium moorei, a Gram-positive bacterium associated with halitosis

OBJECTIVE To investigate the antimicrobial effect of alpha-bisabolol and tea tree oil alone and in combination against the halitosis-associated Gram-positive bacillus Solobacterium moorei. DESIGN The inhibitory activity of alpha-bisabolol and tea tree oil against the reference strain S. moorei CCUG39336 and four clinical S. moorei isolates was investigated by a direct exposure test. Additionally, the ability of alpha-bisabolol to increase the sensitivity of S. moorei was tested by pretreating the bacteria with sublethal concentrations prior to the administration of tea tree oil. RESULTS A dose-dependent killing was observed for the antimicrobial agents in a direct exposure test with the reference strain S. moorei CCUG39336. Concentrations of ≥0.5% tea tree oil caused decreases in viability of >5 log colony forming units/ml even after short incubation periods, while bacterial viability was less affected by alpha-bisabolol. The combination of 0.1% alpha-bisabolol plus 0.05% tea tree oil showed a synergistic effect on S. moorei strain CCUG39336 and on two of the four clinical S. moorei isolates tested. However, incubation of S. moorei with a sublethal concentration of 0.1% alpha-bisabolol for three days prior to the administration of 0.05% tea tree oil did not enhance the antibacterial effect of tea tree oil. CONCLUSION Halitosis-associated bacterium S. moorei is susceptible to the antimicrobial agents tea tree oil and alpha-bisabolol, suggesting that these compounds might be beneficial in oral healthcare products.