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Aims and Objectives: Use of herbal and natural extract as mouthwashes has several advantages and prevents emergence of drug resistance. Propolis and honey are two natural materials with biological and antimicrobial properties. Their effect depends on the location and time of harvest. In this study, we aimed to investigate the synergistic effect of Azarian honey and propolis on several oral pathogens to enhance antiseptic properties. Material and Methods: Growth of standard suspensions from six oral bacterial pathogens was investigated using dilutions of 25-0.0121 mg/mL of propolis and 50-1.56% of honey in a medium of trypticase Soy Broth to determine the minimum inhibitory concentration (MIC). One-way ANOVA was used for statistical analysis. Results: Staphylococcus aureus showed the lowest amount of honey MIC. MIC of honey for the Escherichia coli was significantly higher than that of all other bacteria (P < 0.05). Average MIC for Staphylococcus epidermidis was also significantly higher than that of S. aureus (P < 0.05). Minimum bactericidal concentrations for Streptococcus mutans, methicillin-resistant S. aureus, S. aureus, S. epidermidis, and Enterococcus faecalis were 0, 1.56, 0.78, 1.56, and 1.56, respectively. The combination of propolis and honey reduced MIC for all the bacteria. Conclusion: The MICs of the materials in the combined condition were less than the MIC independently, although this difference was not significant in the case of S. aureus for propolis. By mixing these two compounds in medicinal products, a more effective formulation and lower dilution of solvent (alcohol) can be achieved due a synergistic effect. In addition, the weak effect of propolis on Gram-negative bacteria can also be improved. [ABSTRACT FROM AUTHOR]

Purpose: Candidates and recipients of kidney transplants are at high risk for oral infections due to systemic co-morbidities, and disease and drug-induced immunosuppression. Developing oral infections while on the waiting list can jeopardize candidacy for receiving a kidney, and post-operatively increases the chance for organ rejection. Therefore, it is imperative to minimize oral disease risks in this population. A comprehensive, oral preventive care protocol is presented to guide dental professionals with patient management throughout the process of care. Proper dental and dental hygiene care can help to prevent oral infections, optimize oral health, and enhance overall health and quality of life for the renal transplant population. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases are chronic inflammatory diseases that affect a large segment of society. Coronary heart disease (CHD), the most common cardiovascular disease, progresses over several years and affects millions of people worldwide. Chronic infections may contribute to the systemic inflammation and enhance the risk for CHD. Periodontitis is one of the most common chronic infections that affects up to 50% of the adult population. Under inflammatory conditions the activation of endogenous degradation pathways mediated by immune responses leads to the release of destructive cellular molecules from both resident and immigrant cells. Matrix metalloproteinases (MMPs) and their regulators can activate each other and play an important role in immune response via degrading extracellular matrix components and modulating cytokines and chemokines. The action of MMPs is required for immigrant cell recruitment at the site of inflammation. Stimulated neutrophils represent the major pathogen-fighting immune cells that upregulate expression of several proteinases and oxidative enzymes, which can degrade extracellular matrix components (e.g. MMP-8, MMP-9 and neutrophil elastase). The activity of MMPs is regulated by endogenous inhibitors and/or candidate MMPs (e.g. MMP-7). The balance between MMPs and their inhibitors is thought to mirror the proteolytic burden. Thus, neutrophil-derived biomarkers, including myeloperoxidase, may activate proteolytic destructive cascades that are involved in subsequent immune-pathological events associated with both periodontitis and CHD. Here, we review the existing studies on the contribution of MMPs and their regulators to the infection-related pathology. Also, we discuss the possible proteolytic involvement and role of neutrophil-derived enzymes as an etiological link between chronic periodontitis and CHD. [ABSTRACT FROM AUTHOR]

Brain abscesses are rare but potentially deadly complications of odontogenic infections. This phenomenon has been described mainly in the form of case reports, as large-scale studies are difficult to perform. We compiled a total of 60 previously published cases of such a complication to investigate the predisposing factors, microbiology, and clinical outcomes of intracranial abscesses of odontogenic origin. A systematic review of the literature using the PubMed database was performed. Men accounted for 82.1% of cases, and the mean age was 42.1 years. Caries with periapical involvement and periodontitis were the two most common intra-oral sources, and wisdom tooth extraction was the most common preceding dental procedure. In 56.4% of cases, there were obvious signs of dental disease prior to development of intracranial infection. Commonly implicated microorganisms included Streptococcus viridans (especially the anginosus group), Actinomyces, Peptostreptococcus, Prevotella, Fusobacterium, Aggregatibacter actinomycetemcomitans and Eikenella corrodens. There was an 8.3% mortality rate. Intracranial abscesses can form anywhere within the brain, and appear unrelated to the side of dental involvement. This suggests that hematogenous spread is the most likely route of dissemination. [ABSTRACT FROM AUTHOR]

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Awareness of the increased prevalence of syphilis is essential for early diagnosis and treatment, and to prevent the spread of the disease. Although serological studies are the primary tool used to confirm the diagnosis of secondary syphilis, biopsy of unsuspected oral lesions is not uncommon in the routine oral pathology laboratory. In these cases, histopathological characteristics are likely to indicate the possibility of syphilis, and an immunohistochemical reaction can confirm it. The aim of the present study was to highlight the histological features and test the efficacy of immunohistochemistry in the detection of Treponema pallidum in oral lesions biopsied with the assumption of a non-syphilitic disease. Thirty-nine tissue samples from patients for whom the possibility of syphilis was suggested on the basis of histopathological findings, were retrieved from the surgical oral pathology service files and submitted to immunohistochemical staining for T. pallidum . The study was approved by the institutional ethics committee. Eighteen of the tissue samples were positive for T. pallidum . Following this, the contributing clinicians were contacted to check whether they had asked for serological examinations when the diagnostic report was received; for all 18 positive cases, the clinicians confirmed that the patients had tested positive at that time. This study shows the importance of clinical–pathological correlation and the value of immunohistochemistry in the diagnosis of unsuspected syphilis. [ABSTRACT FROM AUTHOR]

Medicinal plants are rich sources of valuable molecules with various profitable biological effects, including antimicrobial activity. The advantages of herbal products are their effectiveness, relative safety based on research or extended traditional use, and accessibility without prescription. Extensive and irrational usage of antibiotics since their discovery in 1928 has led to the increasing expiration of their effectiveness due to antibacterial resistance. Now, medical research is facing a big and challenging mission to find effective and safe antimicrobial therapies to replace inactive drugs. Over the years, one of the research fields that remained the most available is the area of natural products: medicinal plants and their metabolites, which could serve as active substances to fight against microbes or be considered as models in drug design. This review presents selected flavonoids (such as apigenin, quercetin, kaempferol, kurarinone, and morin) and tannins (including oligomeric proanthocyanidins, gallotannins, ellagitannins, catechins, and epigallocatechin gallate), but also medicinal plants rich in these compounds as potential therapeutic agents in oral infectious diseases based on traditional usages such as Agrimonia eupatoria L., Hamamelis virginiana L., Matricaria chamomilla L., Vaccinium myrtillus L., Quercus robur L., Rosa gallica L., Rubus idaeus L., or Potentilla erecta (L.). Some of the presented compounds and extracts are already successfully used to maintain oral health, as the main or additive ingredient of toothpastes or mouthwashes. Others are promising for further research or future applications.

The oral microbiome plays a major role in shaping oral health/disease state; thus, a main challenge for dental practitioners is to preserve or restore a balanced oral microbiome. Nonetheless, when pathogenic microorganisms install in the oral cavity and are incorporated into the oral biofilm, oral infections, such as gingivitis, dental caries, periodontitis, and peri-implantitis, can arise. Several prophylactic and treatment approaches are available nowadays, but most of them have been antibiotic-based. Given the actual context of antimicrobial resistance (AMR), antibiotic stewardship in dentistry would be a beneficial approach to optimize and avoid inappropriate or even unnecessary antibiotic use, representing a step towards precision medicine. Furthermore, the development of new effective treatment options to replace the need for antibiotics is being pursued, including the application of photodynamic therapy and the use of probiotics. In this review, we highlight the advances undergoing towards a better understanding of the oral microbiome and oral resistome. We also provide an updated overview of how dentists are adapting to better manage the treatment of oral infections given the problem of AMR.

Opportunistic oral infections caused by Candida albicans are frequent problems in immunocompromised patients. Management of such infections is limited due to the low number of antifungal drugs available, their relatively high toxicity and the emergence of antifungal resistance. Given these issues, our investigations have focused on novel derivatives of the antifungal antibiotic Nystatin A, generated by modifications at the amino group of this molecule. The aims of this study were to evaluate the antifungal effectiveness and host cell toxicity of these new compounds using an in vitro model of oral candidosis based on a reconstituted human oral epithelium (RHOE). Initial studies employing broth microdilution, revealed that against planktonic C. albicans, Nystatin A had lower minimal inhibitory concentration than novel derivatives. However, Nystatin A was also markedly more toxic against human keratinocyte cells. Interestingly, using live/dead staining to assess C. albicans and tissue cell viability after RHOE infection, Nystatin A derivatives were more active against Candida with lower toxicity to epithelial cells than the parent drug. Lactate dehydrogenase activity released by the RHOE indicated a fourfold reduction in tissue damage when certain Nystatin derivatives were used compared with Nystatin A. Furthermore, compared with Nystatin A, colonisation of the oral epithelium by C. albicans was notably reduced by the new polyenes. In the absence of antifungal agents, confocal laser scanning microscopy showed that C. albicans extensively invaded the RHOE. However, the presence of the novel derivatives greatly reduced or totally prevented this fungal invasion. [ABSTRACT FROM AUTHOR]

Introduction We aimed to investigate the relationship between blood profile and histologic findings in both apical periodontitis (AP) and periodontal disease (PD) associated with diabetes. Methods Wistar rats (N = 80) were assigned to the following 8 groups: control, AP, PD, AP associated with PD, diabetes, diabetes with AP, diabetes with PD, and diabetes with AP and PD. Diabetes mellitus (DM) was induced with streptozotocin, AP was induced by exposure to the oral environment, and PD was induced using periodontal ligature. After 30 days, blood samples were collected, and the rats were euthanized. Subsequently, the maxillae were processed for light microscopy. Hematologic examinations were conducted to determine the total number of erythrocytes and leukocytes, erythrocyte constant, and blood glucose level. One-way analysis of variance and Kruskal-Wallis tests were used for statistical analysis, and the significance was set at P < .05. Results A significant correlation was found between the histologic findings and blood parameters. Conclusions In conclusion, diabetes accelerated the development and progression of AP and PD in the rats and caused an increase in the average erythrocyte volume as well as the leukocyte and neutrophil counts. Oral infections increase the total number of leukocytes, the number of neutrophils and lymphocytes, and blood glucose concentrations in DM rats. [ABSTRACT FROM AUTHOR]

Aim To measure glycosylated haemoglobin ( Hb A1c) in a diabetic model as a means of investigating apical periodontitis and periodontal disease for their effects on both blood glucose concentrations and long-term glycaemic control. Methodology Wistar rats ( n = 80) were assigned to one of eight groups (10 animals/group): control ( G1), apical periodontitis ( G2), periodontal disease ( G3), apical periodontitis and periodontal disease ( G4), diabetic ( G5), diabetic with apical periodontitis ( G6), diabetic with periodontal disease ( G7) and diabetic with apical periodontitis and periodontal disease ( G8). A diabetic state was induced with streptozotocin. Apical periodontitis was induced by dental exposure to the oral environment. Periodontal disease was induced by periodontal ligature. Blood glucose concentrations were measured at 0, 6, 30 and 60 days. After euthanization, rat maxillae were excised and processed for histopathology and for measurement of Hb A1c levels by ion exchange chromatography. Data were tabulated and subject to statistical analysis ( P < 0.05). Results The inflammatory infiltrate and alveolar bone resorption were more severe in diabetic rats ( P < 0.05). Diabetic rats exhibited higher levels of Hb A1c independent of apical periodontitis or periodontal disease ( P < 0.05). However, the presence of oral infections in diabetic rats was associated with increased blood glucose concentrations ( P < 0.05). Conclusions Oral infections affect glycaemic conditions in diabetic rats and increase Hb A1c levels in normoglycaemic or diabetic rats. [ABSTRACT FROM AUTHOR]

Abstract: The potential of antimicrobial nanoparticles to control oral infections is reviewed. Such particles can be classified as having a size no greater than 100nm and are produced using traditional or more novel techniques. Exploitation of the toxic properties of nanoparticles to bacteria, fungi and viruses, in particular metals and metal oxides, as well as their incorporation into polymeric materials have increased markedly over the past decade. The potential of nanoparticles to control the formation of biofilms within the oral cavity, as a function of their biocidal, anti-adhesive and delivery capabilities, is now receiving close attention. Latest insights into the application of nanoparticles within this field, including their use in photodynamic therapy, will be reviewed. Possible approaches to alter biocompatibility and desired function will also be covered. [Copyright &y& Elsevier]

Background: Dental infections are frequent and have recently been implicated as a possible risk factor for Alzheimer's disease (AD). Despite a lack of studies investigating orofacial pain in this patient group, dental conditions are known to be a potential cause of pain and to affect quality of life and disease progression. Objectives: To evaluate oral status, mandibular function and orofacial pain in patients with mild AD versus healthy subjects matched for age and gender. Methods: Twenty-nine patients and 30 control subjects were evaluated. The protocol comprised a clinical questionnaire and dental exam, research diagnostic criteria for temporomandibular disorders, the McGill Pain Questionnaire, the decayed, missing, and filled teeth index, and included a full periodontal evaluation. AD signs and symptoms as well as associated factors were evaluated by a trained neurologist. Results: A higher prevalence of orofacial pain (20.7%, p < 0.001), articular abnormalities in temporomandibular joints (p < 0.05), and periodontal infections (p = 0.002) was observed in the study group compared to the control group. Conclusion: Orofacial pain and periodontal infections were more frequent in patients with mild AD than in healthy subjects. Orofacial pain screening and dental and oral exams should be routinely performed in AD patients in order to identify pathological conditions that need treatment thus improving quality of life compromised due to dementia. [ABSTRACT FROM AUTHOR]

The oral cancer survivors are a group of special individuals whose disease affect anatomical structures with a key role in identity and communication and a fundamental role in basic human functions such as speaking, eating, swallowing and breathing. Thus, quality of life of these individuals can be impaired by the consequences of disease and treatments, in particular surgery and radiotherapy. Among others, infectious conditions of any nature, bacterial, viral, fungal, are a frequent finding among oral cancer survivors. In fact, the peculiar systemic and local conditions of these subjects are known to significantly modify the microbiota, which, besides facilitating opportunistic infections, can affect the cancer microenvironment, as well as alter the effects of the anti-cancer therapies. Similarly, mouth infections can also affect the prognosis of oral cancer survivors. Among the opportunistic infections, fungal are the most common infections affecting these subjects, since neutropenia resulting from cancer, as well as chemotherapy and/or radiotherapy treatments, promote the shift from the carrier state of Candida species, to pathogen state. Treatment of oral candidiasis can be difficult in oral cancer survivors, and good evidence supports clotrimazole as the most effective for prevention, and fluconazole as the one with the best risk-benefit profile. Probiotics, although promising, need better evidence to be considered an effective treatment or preventive measure., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Pispero, Lombardi, Manfredi, Varoni, Sardella and Lodi.)

Personalized Oral Healthcare has recently become the new trend word in medicine and dentistry. In this context, saliva diagnostics using various biomarkers seem to be the gateway to personalized dental diagnostics and therapy. But the terminology is not (yet) uniformly defined, furthermore it is unclear to what extent which salivary markers play a relevant role in the therapeutic decision making. In this Scoping Review, an electronic search was conducted in PubMed and Web of Science databases using medical subject headings (MESH terms) "saliva", "biomarker", "personality/persons", and "dentistry". Only human studies were included, in which repeated salivary measurements were performed to analyze monitoring effects with at least ten patients per group. PRISMA-ScR and Tricco guidelines were followed: (i) to examine what salivary biomarkers have been explored in terms of personalized oral healthcare and precision dentistry, (ii) to investigate the clinical relevance for oral health and its correlation to systemic health, and (iii) to summarize an outlook for future developments based on these results. Out of 899 studies, a total of 57 were included for data extraction in this Scoping Review, mainly focusing on periodontal therapy and patient monitoring. Salivary biomarkers have shown the potential to change the field of dentistry in all dental disciplines as a key for personalized workflows. The increasing interest in dental research is obvious, demonstrated by the growing number of publications in recent years. At this time, however, the predominant discipline is periodontology, which allows biomarker-based monitoring of the disease prevention and progression. The studies included showed heterogeneous methods using manifolds biomarkers. Therefore, no uniformly accepted concept can be presented today. Further clinical research with well-defined outcomes including standardized procedures is necessary., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Paqué, Hjerppe, Zuercher, Jung and Joda.)

Introduction: Oral infectious diseases are common chronic oral diseases characterized by a chronic inflammatory condition. We investigated chronic oral diseases as potential risk factors for systemic chronic diseases, diabetes mellitus, connective tissue diseases, seropositive rheumatoid arthritis, ulcerative colitis, and Crohn's disease, as well as severe psychotic and other severe mental disorders., Methods: The cohort comprised 68,273 patients aged ≥ 29 years with at least one dental visit to the Helsinki City Health Services between 2001 and 2002. The cohort was linked to the data on death (Statistics Finland), cancer (Finnish Cancer Registry), and drug reimbursement (Finnish Social Insurance Institution) and followed until death or the end of 2013. The outcomes of interest were the incidences of chronic diseases measured starting with special refund medication, which means Social Insurance Institution partly or fully reimburses medication costs. Outcomes of interest were diabetes mellitus, connective tissue diseases, seropositive rheumatoid arthritis, ulcerative colitis and Crohn's disease, and severe mental disorders., Results: The mean follow-up time was 9.8 years. About 25% of the study population had periodontitis, 17% caries, over 70% apical periodontitis, and 9% <24 teeth at the start of follow-up. Diabetes was the only chronic systemic condition associated with oral health variables. Having 24 to 27 teeth was associated with a higher incidence rate ratio (IRR) (1.21, 95% confidence interval 1.09-1.33) compared to having 28 or more teeth; the IRR for having 23 or less was 1.40 (1.22-1.60). Having periodontitis (1.10, 1.01-1.20), caries (1.12, 1.01-1.23), or apical periodontitis (1.16, 1.04-1.30) is also associated with a higher risk of diabetes., Conclusion: Our epidemiological 10 years follow-up study suggests that the association exists between chronic oral diseases and diabetes, warranting close collaboration among patient's healthcare professionals., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Heikkilä, Niskanen, But, Sorsa and Haukka.)

Several links between chronic liver disease and oral health have been described and are discussed in this narrative review. Oral manifestations such as lichen planus, ulcers, xerostomia, erosion and tongue abnormalities seem to be particularly prevalent among patients with chronic liver disease. These may be causal, coincidental, secondary to therapeutic interventions, or attributable to other factors commonly observed in liver disease patients. In addition, findings from both experimental and epidemiological studies suggest that periodontitis can induce liver injury and contribute to the progression of chronic liver disease through periodontitis-induced systemic inflammation, endotoxemia, and gut dysbiosis with increased intestinal translocation. This has brought forward the hypothesis of an oral-gut-liver axis. Preliminary clinical intervention studies indicate that local periodontal treatments may lead to beneficial liver effects, but more human studies are needed to clarify if treatment of periodontitis truly can halt or reverse progression of liver disease and improve liver-related outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate triglyceride and cholesterol levels in diabetic rats and their relationship with pulpal and periodontal diseases. Methods: Eighty male rats ( Rattus norvegicus albinus, Wistar) were divided into the following eight groups comprising ten animals each: normal rats (G1), rats with pulpal diseases (G2), rats with periodontal diseases (G3), rats with both pulpal and periodontal diseases (G4), diabetic rats (G5), diabetic rats with pulpal diseases (G6), diabetic rats with periodontal diseases (G7), and diabetic rats with both periodontal and pulpal diseases (G8). Diabetes was induced by injecting streptozotocin, periapical lesions were induced by exposing pulpal tissue to the oral environment, and periodontal diseases were induced by periodontal ligature. The animals were killed after 30 days, and lipid profile was enzymatically measured using Trinder's method. The total assessed values were statistically analyzed by analysis of variance and Tukey test ( p < 0.05). Results: The triglyceride levels of diabetic rats with periodontal disease and of diabetic rats with both periodontal and pulpal diseases were significantly higher than those of normal rats and nondiabetic group rats, respectively. The differences in the cholesterol levels among the groups were not significant. Conclusions: We found that the association of pulpal and periodontal diseases with diabetes increased triglyceride levels in rats. Clinical significance: Changes in lipid profile may be related to the presence of oral infections and diabetes. [ABSTRACT FROM AUTHOR]

Abstract: The compounds 2′,6′-dihydroxy-4′-geranyloxyacetophenone (1) and 2′,6′-dihydroxy-4′-farnesyloxy‐acetophenone (2) are oxyprenylated secondary metabolites extracted from plants belonging to the Rutaceae family. In this study, 1 and 2 were synthesized and tested for their antimicrobial activity toward major oral pathogens. Compounds 1 and 2 were synthesized by selective prenylation of 2,4,6-trihydroxyacetophenone at the 4′ position with geranyl and farnesyl bromide, respectively. Compound 1 showed stronger antimicrobial activity than 2 against major oral pathogens, including Gram positive bacteria (Streptococcus mutans, Streptococcus sobrinus), Gram negative bacteria (Prevotella intermedia, Porphyromonas gingivalis) and Candida albicans. Evidences were obtained that the mode of action of 1 and 2 may be related to their iron-chelating property. This study suggests that 1 and 2 may represent potential natural molecules for the prevention/treatment of common oral infections, including dental caries, periodontal disease, and candidiasis. [Copyright &y& Elsevier]

Abstract: The role of Trichomonas tenax as a pathogen had been clearly implicated in various pathological processes that arise outside the boundaries of the mouth. Although a relationship between the increased occurrence of this protozoan and progression of periodontal disease has been demonstrated, the ability of T. tenax in causing oral infections and the precise mechanism of tissue damage is not well known. The present study aimed to investigate different isolates of T. tenax from individuals having oral infections. Plaques and/or calculi samples were collected from 70 individuals who were diagnosed as having periodontitis and/or gingivitis, then subjected to parasitological examination and culture on modified trypticase, yeast and iron medium (TYI-S-33). Isolates successfully maintained in culture were further subjected to analysis of protein profile of lysates by Sodium Dodecyl Sulfate–Polyacrylamide Gel Electrophoresis (SDS–PAGE) and analysis of proteinases by non-denaturing gelatin-SDS–PAGE. Comparison of growth kinetics of seven T. tenax isolates showed a wide variability in the growth characteristics. Protein profiles of the seven isolates revealed a total 53 bands ranged in molecular weight (MW) from 5 to 95kDa using 12% resolution gel. Also, T. tenax isolates were found to possess 19 proteinase bands ranged in MW from 14 to 66kDa. The proteolytic bands were intensified by a cysteine proteinase activator and totally disappeared by treatment with a cysteine proteinase inhibitor suggesting that the proteinases were of cysteine proteinases type. The high frequency of T. tenax detected (28.6%) along with the variability in protein profiling and proteolytic activity of the isolates supports the possible pathogenicity of T. tenax and clarifies a conclusion that different strains with possibility of variable pathogenic potential may exist. [Copyright &y& Elsevier]

Abstract: Oral infections with Candida albicans are very common diseases in even only mildly immunocompromised patients. By using genome-wide microarrays, in vitro infection models and samples from patients with pseudomembranous candidiasis, several genes have been identified which encode known and unknown fungal factors associated with oral infection. The expression of selected genes has been investigated via qRT-PCR in both in vitro models and in vivo samples from patients. Several lines of evidence suggest that fungal morphology plays a key role in adhesion to and invasion into oral epithelial cells and mutants lacking regulators of hyphal formation are attenuated in their ability to invade and damage epithelial cells. Adhesion is mediated by hyphal-associated factors such as Hwp1 and the Als adhesin family. Hyphal formation facilitates epithelial invasion via two routes: active penetration and induced endocytosis. While induced endocytosis is predominantly mediated by the adhesin and invasin Als3, active penetration seems to be supported by hydrolase activity and mechanical pressure. Expression profiles reflect the morphological switch and an adaptive response to neutral pH, non-glucose carbon sources, and nitrosative stress. [Copyright &y& Elsevier]

Background: Protective athletic mouthguards (PAM) produce oral mucosal injuries and may be associated with other systemic conditions.Hypothesis: With wear, PAM become contaminated by a range of microorganisms. The number of microorganisms in PAM can be reduced by daily use of an antimicrobial solution.Study Type: Case series.Study Design and Methods: Sixty-two division I football player volunteers were divided into 4 groups, using PAM for varying lengths of time before surrendering them for microbial analysis. One group had their PAM soaked in an antimicrobial solution between uses. The PAM were analyzed qualitatively and quantitatively for bacteria, yeasts, and fungi, using previously accepted methods.Results: The 62 football players surrendered a total of 81 PAM for microbial analysis. The PAM yielded 154 gram-positive cocci, 150 gram-positive bacilli, 21 gram-negative cocci, 31 gram-negative bacilli, 22 yeasts, and 107 molds. The most common species of gram-positive cocci were Staphylococcus spp. and Micrococcus spp. Only 3 PAM (4%) were positive for Staphylococcus aureus. The most common species of gram-positive bacilli were Brevibacterium spp. and Cellulomonas spp. The most common species of yeasts were Candida parapsilosis and Rhodotorula mucilaginosa, while the most common species of mold were Cochliobolus spp. and Penicillium chrysogenum. Soaking the PAM in an antimicrobial solution between uses substantially reduced the numbers of microorganisms.Conclusions: Substantial microbial contamination of PAM occurs with use. The microbial load can be reduced by soaking in an antimicrobial solution between uses.Clinical Relevance: PAM are contaminated by microorganisms that have the potential to produce oral and systemic diseases. They should be sanitized daily and changed when they become sharp and/or jagged. [ABSTRACT FROM AUTHOR]

The specific aim of this work was to prepare mucoadhesive patches containing tetracycline hydrochloride and carvacrol in an attempt to develop a novel oral drug delivery system for the treatment of mouth infections. The bilayered patches were prepared using ethyl cellulose as a backing layer and carbopol 934 as a matrix mucoadhesive layer. Patches were prepared with different loading amounts of tetracycline hydrochloride and carvacrol. The antimicrobial activity was assessed for the prepared patches using the disc-diffusion method against the yeast Candida albicans and five bacterial strains, including Pseudomonas aeruginosa, Escherichia coli, Bacillus cereus, Staphylococcus aureus, and Bacillus bronchispti. In this work, we highlighted the possibility of occurrence of a synergistic action between carvacrol and tetracycline. The best formulation was selected based on microbiological tests, drug release, ex-vivo mucoadhesive performance, and swelling index. Physical characteristics of the selected formulations were determined. These included pH, patch thickness, weight uniformity, content uniformity, folding endurance, and patch stability. [ABSTRACT FROM AUTHOR]

Archaea, organisms that make up the third domain of cellular life are members of the human oral microflora. They are strikingly less diverse than oral bacteria and appear to be relatively rare with respect to their numerical abundance. Since they have been exclusively found in association with oral infections such as periodontitis and apical periodontitis and given their unique physiology and energy metabolism, it is highly plausible that they are more than just secondary colonizers of infected areas, but instead are actively involved in the overall poly-microbial infection process. Conversely, it is a highly challenging task to clearly demonstrate their possible active participation — mostly due to the difficulty to grow them in routine microbiology laboratories. This current review points out the importance for understanding the medical impact of methanogens and aims at devising strategies for elucidating the true function of archaea in the oral ecosystem. [ABSTRACT FROM AUTHOR]

Background: Protective athletic mouthguards (PAMs) have been worn in competitive sports for more than 100 years. Today, participants in contact and noncontact sports wear PAMs.Hypothesis: Wearing a PAM produces oral injury.Study Type: Case series.Study Design and Methods: Sixty-two Division I football players voluntarily participated in the study. Before the beginning of the season, each player underwent a thorough oral examination, and all abnormal oral findings were photographed (hyperkeratosis, erythema, ulceration, and combinations thereof). At midseason, 14 players were given complete oral examinations, with all abnormal oral findings documented. At season end, all remaining players (n = 53) had complete oral examinations and photographs taken of abnormal oral findings.Results: The preseason examination of 62 players found a total of 85 lesions (1.4 lesions per player) on the gingiva (n = 17), buccal mucosa (n = 60), and palate (n = 8). The 14 midseason players had 28 lesions (2.0 lesions per player) on gingiva (n = 8), buccal mucosa (n = 16), and tongue (n = 4). At season end, the 53 remaining players had 198 lesions (3.7 per player) on the gingiva (n = 96), buccal mucosa (n = 79), tongue (n = 18), and palate (n = 5). In addition, the lesion intensity scores progressively increased over the season. Because the palate did not come into direct contact with the PAM, it was used as an internal control.Conclusion: The wearing of a PAM may increase the number and intensity of oral mucosal injuries, which may cause localized soft tissue reactions such as hyperkeratosis, erythema, and ulceration.Clinical Relevance: Because the PAM reduces tooth injury but may cause oral lesions, it should be sanitized daily and changed regularly and replaced whenever it becomes sharp and jagged or when the athlete develops an irritation in the mouth. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to microbiologically analyze oral mucosal samples collected during 2 years from patients with oral mucosal complaints. Materials and methods: Mucosal scraping samples were taken from 297 patients and semiquantified by culture for detection of opportunistic microorganisms e.g. Staphylococcus aureus, enterococci, aerobic Gram-negative bacilli (AGNB) and yeasts. Antibiotic susceptibility test was performed. Results: Altogether 297 patients were sampled (mean age 56.8 ± 20.7). Among the 110 patients with known medical condition, 48 were systemically immunocompromised, 35 had systemic diseases, and 27 had only local oral complaints. Opportunists in moderate growth or more were present commonly in all three groups and most frequent in the immunocompromised patients (66.7%). Candida species were the most frequent opportunist (68.8%), however, their level was low and combinations with bacterial opportunists were common (39.6%). All bacterial opportunists tested were antibiotic multiresistant. Follow-up samples were collected in 23 cases out of which seven showed still presence of opportunists in heavy growth despite repeated treatment with ciprofloxacin. Conclusions: This study showed a frequent presence of bacterial and fungal opportunists in patients with oral mucosal complaints, which were most common in immunocompromised individuals, however, also frequent in patients with local oral complaints only. Systematic evaluation of different treatment strategies is needed. [ABSTRACT FROM AUTHOR]

Background: Plasma antibody measurements of antibody levels to periodontal pathogens may be used to support diagnosis, disease activity, classification, and prognosis of periodontitis. Objective: The aim of this study was to investigate the long-term stability of plasma antibody levels against Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis. Design: Plasma immunoglobulin G (IgG) antibody levels against the pathogens were analyzed annually during 15 years from 21 voluntary subjects, whose periodontal status was not known at the point of selection. The total number of plasma samples was 315. In connection of the last sampling, the clinical and radiographic periodontal status was examined. Pooled bacterial samples from periodontal pockets, as well as salivary samples were collected for A. actinomycetemcomitans and P. gingivalis detection, and antibody determinations, respectively. According to the clinical status, six subjects had periodontitis, whereas 15 did not. Results: Plasma IgG-class antibody levels to periodontal pathogens remained extremely stable during the 15-year period and no significant (p>0.05) intra-individual variations were observed. Retrospectively, the average plasma IgG antibody levels against A. actinomycetemcomitans and P. gingivalis were 1.6-2.3 (p<0.05) and 1.4-1.7 (p<0.05) fold higher in the subjects with periodontitis than those without, respectively, during the whole 15-year tracking. As expected, at the time of the periodontal examination the plasma and salivary IgG antibody levels were associated both with periodontitis and bacterium-positivity. Conclusions: Plasma IgG levels against A. actinomycetemcomitans and P. gingivalis are extremely stable during 15 years both in subjects with and without periodontitis. [ABSTRACT FROM AUTHOR]

The oral cavity is an intricate environment subjected to various chemical, physical, and thermal injuries. The effectiveness of the local and systemically administered drugs is limited mainly due to their toxicities and poor oral bioavailability that leads to the limited effectiveness of the drugs in the target tissues. To address these issues, nanoparticle drug delivery systems based on metals, liposomes, polymeric particles, and core shells have been developed in recent years. Nano drug delivery systems have applications in the treatment of patients suffering from temporomandibular joint disorders such as preventing degeneration of cartilage in patients suffering from rheumatoid arthritis and osteoarthritis and alleviating the pain along with it. The antibacterial dental applications of nano-drug delivery systems such as silver and copper-based nanoparticles include these agents used to arrest dental caries, multiple steps in root canal treatment, and patients suffering from periodontitis. Nanoparticles have been used in adjunct with antifungals to treat oral fungal infections such as candida albicans in denture wearers. Acyclovir being the most commonly used antiviral has been used in combination with nanoparticles against an array of viral infections such as the herpes simplex virus. Nanoparticles based combination agents offer more favorable drug release in a controlled manner along with efficient delivery at the site of action. This review presents an updated overview of the recently developed nanoparticles delivery systems for the management of temporomandibular joint disorders along with the treatment of different oral infections. [ABSTRACT FROM AUTHOR]

Background and Objective: Dietary manipulation, including caloric restriction, has been shown to impact host response capabilities significantly, particularly in association with aging. This investigation compared systemic inflammatory and immune-response molecules in rhesus monkeys ( Macaca mulatta). Material and Methods: Monkeys on continuous long-term calorie-restricted diets and a matched group of animals on a control ad libitum diet, were examined for systemic response profiles including the effects of both gender and aging. Results: The results demonstrated that haptoglobin and α1-antiglycoprotein levels were elevated in the serum of male monkeys. Serum IgG responses to Campylobacter rectus, Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis were significantly elevated in female monkeys. While only the antibody to Fusobacterium nucleatum was significantly affected by the calorie-restricted diet in female monkeys, antibody levels to Prevotella intermedia, C. rectus and Treponema denticola demonstrated a similar trend. Conclusion: In this investigation, only certain serum antibody levels were influenced by the age of male animals, which was seemingly related to increasing clinical disease in this gender. More generally, analytes were modulated by gender and/or diet in this oral model system of mucosal microbial challenge. [ABSTRACT FROM AUTHOR]

Abstract: At this time in the USA there are no antimicrobials with specific indications for oral infections, and many of those currently used have limited efficacy against oral anaerobic strains. We tested the activity of azithromycin against a broad range of anaerobic oral pathogens and, at pH 8, found it to be effective against 98% of strains, including all fusobacteria and β-lactamase-producing strains of Prevotella spp. All strains of Eikenella corrodens were also susceptible to azithromycin but resistant to erythromycin, clindamycin, metronidazole and cefalexin. Other comparator agents were penicillin, amoxicillin/clavulanic acid, tetracycline, levofloxacin and ciprofloxacin. Minimum inhibitory concentrations obtained on agar adjusted to pH 8 were generally one dilution lower than those obtained on agar at pH 7. [Copyright &y& Elsevier]

Summary: Background: Malaria is an important disease in the tropics, and its role as a predisposing factor or co morbidity has been investigated in many diseases including HIV infection and tuberculosis. There are very few studies, which have investigated its role in oral and dental diseases. Our study aimed to demonstrate the possible role of malaria in predisposing to pericoronitis, an infection affecting impacted third molars predominantly. Patients and methods: Thirty-eight patients presenting with pericoronitis were tested for malaria parasites and results compared with that obtained from controls that were equally susceptible to pericoronitis but did not have the infection. Results: 19.7% of the study group compared to 6.6% of control group had malaria parasite in their blood. This difference was statistically significant, P=0.018 (Fisher''s exact). The odds ratio was 4.3 (95% CI=1.2–17.0). Conclusions: Malaria appears to be a predisposing factor to pericoronitis in this study. There is a need for further studies on the possible role of malaria in oral and dental diseases. [Copyright &y& Elsevier]

Arthritis may be triggered by microbial constituents, more specifically, bacterial cell wall fragments, or bacterial DNA. The aim of this study was to analyze the amount of oral bacterial DNA in synovial fluids (SF) of arthritis patients. SF from 15 rheumatoid arthritis (RA) patients, 15 arthritides (non-RA) patients and 9 osteoarthritis (control) patients were extracted for oral bacterial DNA. DNA was used in a checkerboard DNA–DNA hybridization set-up, in order to identify 40 different species. The mean number&PlusMinus;standard deviation (SD) of bacterial species in SF was 22.7 (5.6) in the RA group and 13.1 (3.9) in the control group (p=0.001). The mean number of species found in non-RA SF was 19.7 (7.8), (p=0.033). The qualitative differences in species between the groups were most notable for Actinobacillus actinomycetemcomitans, Eubacterium saburreum, Streptococcus anginosus, Actinomyces israelii, Streptococcus intermedius, Tannerella forsythensis, Prevotella melaninogenica and Prevotella intermedia. DNAs from these species were exclusively detected in RA SF and in non-RA SF. In RA SF, 33% of the species were found in high (=10 6 cells per 100 µl) concentrations compared with 13.4% in the control group (p=0.001). In non-RA SF, 38.3% of the species were found in high concentrations (p<0.0001). Oral bacterial DNA is a common finding in SF of arthritis patients. These data provide evidence of differences in concentration and assortment of oral bacterial DNAs in SF, between different arthritides and controls, and may indicate a connection between oral infections and joint inflammation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of antimicrobial therapy in oral odontogenic infections using estimated pharmacokinetic/pharmacodynamic parameters or efficacy indices, and to compare pharmacokinetic/pharmacodynamic breakpoints with National Committee for Clinical Laboratory Standards' (NCCLS) breakpoints.Study Design: Retrospective literature search to obtain minimum inhibitory concentration (MIC) values, pharmacokinetic parameters of antimicrobials and NCCLS breakpoints. Pharmacokinetic simulations were carried out using WinNonlin software (Pharsight Corporation, Mountain View, CA, USA).Methods: For antimicrobials with time-dependent activity, the time that the plasma drug concentration exceeds the MIC as the percentage of dose interval at steady state was calculated. For antimicrobials with concentration-dependent activity, the total area under the plasma concentration-time curve over 24 hours at steady state divided by the MIC was calculated. Pharmacokinetic/pharmacodynamic breakpoints were calculated according to these parameters.Results: Only amoxicillin/clavulanic acid and clindamycin showed adequate efficacy indices against the most commonly isolated bacteria in odontogenic infections. Metronidazole reached good indices against anaerobes only. Pharmacokinetic/pharmacodynamic susceptibility breakpoints do not coincide exactly with NCCLS breakpoints.Conclusion: Owing to the scarcity of double-blind, clinical trials on the use of antimicrobials in endodontics, this study may be useful in determining the best antimicrobial treatment in these infections. However, as we have not used concentration data in infected tissue to determine pharmacokinetic/pharmacodynamic indices, it would be necessary to design clinical trials in order to confirm these results. [ABSTRACT FROM AUTHOR]

The oral cavity is a complex ecosystem in which several hundred microbial species normally cohabit harmoniously. However, under certain special conditions, the growth of some micro-organisms with a pathogenic potential is promoted, leading to infections such as dental caries, periodontal disease, and stomatitis. The physiology and pathogenic properties of micro-organisms are influenced by modifications in environmental conditions that lead to the synthesis of specific proteins known as the heat-shock proteins (HSPs). HSPs are families of highly conserved proteins whose main role is to allow micro-organisms to survive under stress conditions. HSPs act as molecular chaperones in the assembly and folding of proteins, and as proteases when damaged or toxic proteins have to be degraded. Several pathological functions have been associated with these proteins. Many HSPs of oral micro-organisms, particularly periodontopathogens, have been identified, and some of their properties-including location, cytotoxicity, and amino acid sequence homology with other HSPs-have been reported. Since these proteins are immunodominant antigens in many human pathogens, studies have recently focused on the potential contributions of HSPs to oral diseases. The cytotoxicity of some bacterial HSPs may contribute to tissue destruction, whereas the presence of common epitopes in host proteins and microbial HSPs may lead to autoimmune responses. Here, we review the current knowledge regarding HSPs produced by oral micro-organisms and discuss their possible contributions to the pathogenesis of oral infections. [ABSTRACT FROM AUTHOR]