Effects of Cupral® on the formation and persistence of microbial biofilms in vitro

Introduction: endodontic biofilm is a microbial community, enclosed in a polymeric matrix of polysaccharide origin where are frequently found pathogenic microorganisms, such as Gram+, Gram- and opportunistic fungi, belonging to Candida spp, responsible for several endodontic pathologies. As clinical importance is the fact that biofilm is extremely resistant to common intra-canal irrigants, antimicrobial drugs and host immune defenses. The aim of this in vitro study was to evaluate the efficacy of Cupral® on planktonic forms of some pathogens, as well as to assess its ability to prevent and affect the formation/persistence of microbial biofilms. Materials and Methods: ATCC strains of S. aureus, P. aeruginosa and C. albicans were exposed to various concentrations of Cupral® (an antiseptic compound based on calcium and copper hydroxide, used in endodoncy) to investigate its antimicrobial efficacy. This activity has been evaluated in terms of microbial growth and cellular doubling time (optical density, colony forming units and doubling time assays), inhibition/persistence (crystal violet staining), viability of microbial cells embedded in the biofilms (live/dead stain) and pyoverdine production (fluorimetric assay). Finally, the morphology of Cupral®-treated biofilms was investigated by optical/confocal microscopy analysis. Results: the addition of Cupral® to microbial cultures, influences, in a significantly and dose-dependent manner, the doubling time and growth of microbial cultures. Cupral® antimicrobial activity was also assessed on biofilms formation and persistence with meaningful decreases of residual biomass (observed reductions of 47-94% for S. aureus, 28-95% for P. aeruginosa and 27-75 % for C. albicans). Cupral®-treated biofilms analyzed by optical and confocal microscopy revealed loss of typical sessile structure, with few scattered microbial cells and a reduced thickness. Finally, the addition of Cupral® reduced both the number of embedded alive cells in the biofilms and the levels of pyoverdine in the culture supernatants. Discussion and Conclusions: this pilot in vitro study provided the first evidences on Cupral® efficacy against microbial biofilms. The wide range of action (vs Gram+, Gram- and fungi) of Cupral® strongly suggests its use as compound in the prevention and treatment of main oral biofilm-associated infections

Ultraviolet disinfection (UV-D) robots: bridging the gaps in dentistry

Maintaining a microbe-free environment in healthcare facilities has become increasingly crucial for minimizing virus transmission, especially in the wake of recent epidemics like COVID-19. To meet the urgent need for ongoing sterilization, autonomous ultraviolet disinfection (UV-D) robots have emerged as vital tools. These robots are gaining popularity due to their automated nature, cost advantages, and ability to instantly disinfect rooms and workspaces without relying on human labor. Integrating disinfection robots into medical facilities reduces infection risk, lowers conventional cleaning costs, and instills greater confidence in patient safety. However, UV-D robots should complement rather than replace routine manual cleaning. To optimize the functionality of UV-D robots in medical settings, additional hospital and device design modifications are necessary to address visibility challenges. Achieving seamless integration requires more technical advancements and clinical investigations across various institutions. This mini-review presents an overview of advanced applications that demand disinfection, highlighting their limitations and challenges. Despite their potential, little comprehensive research has been conducted on the sterilizing impact of disinfection robots in the dental industry. By serving as a starting point for future research, this review aims to bridge the gaps in knowledge and identify unresolved issues. Our objective is to provide an extensive guide to UV-D robots, encompassing design requirements, technological breakthroughs, and in-depth use in healthcare and dentistry facilities. Understanding the capabilities and limitations of UV-D robots will aid in harnessing their potential to revolutionize infection control practices in the medical and dental fields

Antibacterial Effects of MicroRepair®BIOMA-Based Toothpaste and Chewing Gum on Orthodontic Elastics Contaminated In Vitro with Saliva from Healthy Donors: A Pilot Study

Several new products with innovative formulations are being proposed to facilitate oral care. Here, we evaluated the effects of a commercially available product, a toothpaste and chewing gum named Biorepair Peribioma, on oral microorganisms of healthy subjects. Saliva from six volunteers was collected during 20 min of mastication of a traditional gum (gum A) and the Biorepair Peribioma gum (gum P). Orthodontic elastics (OE) were in vitro contaminated with salivary samples, both A and P, and subsequently exposed or not to a Biorepair Peribioma toothpaste-conditioned supernatant (Tp-SUP). The salivary samples were tested for initial microbial load; hence, the contaminated OE were assessed for microbial growth, adhesion, biofilm formation and persistence; moreover, species identification was assessed. We found that the salivary samples A and P had similar microbial load; upon contamination, microbial adhesion onto the OE was detected to a lower extent when using saliva P with respect to saliva A. Microbial growth and biofilm formation, assessed at 24 h, remained at lower levels in OE exposed to saliva P, compared to saliva A. This difference between salivary samples A and P was confirmed when measuring biofilm persistence (48 h), while it was lost in terms of microbial re-growth (48 h). The Tp-SUP treatment drastically affected microbial load at 24 h and strongly impaired biofilm formation/persistence, in OE exposed to both salivary samples A and P. Finally, such treatment resulted in consistent overgrowth of Lactobacilli, bacterial species originally present both in the Biorepair Peribioma toothpaste and gum. In conclusion, by an in vitro pilot study, we show that the Biorepair Peribioma toothpaste and gum deeply affect oral microorganisms’ behavior, drastically impairing their ability to contaminate and produce plaque onto orthodontic devices

Diagnostic Accuracy of Pulp Vitality Tests and Pulp Sensibility Tests for Assessing Pulpal Health in Permanent Teeth: A Systematic Review and Meta-Analysis

he current systematic review and meta-analysis was carried out to compare the diagnostic accuracy of pulp vitality and pulp sensibility tests in assessing pulpal health. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Google Scholar and Open Grey databases were searched and after assessing eligibility criteria the data were extracted. True-positive, false-positive, true-negative, false-negative, sensitivity and specificity values were extracted or calculated if not presented. Quality of studies was evaluated based on the QUADAS 2 tool. Metaanalysis was performed in MetaDTA (v2.0; Shinyapps, RStudio PBC, Boston, MA, USA) and Review Manager 5.3 (RevMan web; The Cochrane Collaboration, London, UK). Ten articles were included for qualitative synthesis and five for meta-analysis. The pooled diagnostic odds ratio for pulse oximeter (PO), electric pulp tester (EPT), cold test (CT) and heat test (HT) was 628.5, 10.75, 17.24 and 3.47, respectively. Pairwise comparison demonstrated a higher pooled mean sensitivity and specificity with PO compared with EPT. Comparison between PO and CT and between PO and HT also demonstrated a higher pooled mean sensitivity and specificity for PO. Summary points on receiver operating characteristic curves confirmed the ability of PO to correctly screen negatives in presenting patients as compared to EPT, CT and HT but no study was rated as good on quality assessment. PO can be considered as the most accurate diagnostic method as compared to EPT, CT and HT. This review provides information about the reliability and diagnostic accuracy of using pulp vitality and sensibility tests for assessing pulp status

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe

Propolis Affects Pseudomonas aeruginosa Growth, Biofilm Formation, eDNA Release and Phenazine Production: Potential Involvement of Polyphenols

Pseudomonas aeruginosa (P. aeruginosa) is an opportunistic pathogen responsible for a wide range of clinical conditions, from mild infections to life-threatening nosocomial biofilm-associated diseases, which are particularly severe in susceptible individuals. The aim of this in vitro study was to assess the effects of an Albanian propolis on several virulence-related factors of P. aeruginosa, such as growth ability, biofilm formation, extracellular DNA (eDNA) release and phenazine production. To this end, propolis was processed using three different solvents and the extracted polyphenolic compounds were identified by means of high performance liquid chromatography coupled to electrospray ionization mass spectrometry (HPLC-ESI-MS) analysis. As assessed by a bioluminescence-based assay, among the three propolis extracts, the ethanol (EtOH) extract was the most effective in inhibiting both microbial growth and biofilm formation, followed by propylene glycol (PG) and polyethylene glycol 400 (PEG 400) propolis extracts. Furthermore, Pseudomonas exposure to propolis EtOH extract caused a decrease in eDNA release and phenazine production. Finally, caffeic acid phenethyl ester (CAPE) and quercetin decreased upon propolis EtOH extract exposure to bacteria. Overall, our data add new insights on the anti-microbial properties of a natural compound, such as propolis against P. aeruginosa. The potential implications of these findings will be discussed

Approcci innovativi per studi sui patogeni del cavo orale: modelli di studio in vitro ed ex vivo

Negli ultimi anni, sono stati proposti nuovi composti/strumenti per mantenere la salute orale e/o per trattare diversi problemi dentali/parodontali. Come è noto, la carie dentale si pone tra le infezioni più diffuse ed una sua gestione impropria comporta lo sviluppo di malattie rilevanti ed eventualmente all'estrazione dell’elemento dentale. Una vasta letteratura documenta il ruolo patogenetico di diversi microorganismi che sono in grado di persistere nel cavo orale, in quanto capaci di organizzandosi come comunità microbica eterogenea (comprendente batteri, virus e funghi), adesa alle diverse superfici, strettamente racchiusa in una matrice polimerica di origine polisaccaridica. Tale comunità sessile, che se adesa ai denti è detta placca dentale, è notoriamente refrattaria non solo alle comuni procedure di pulizia con collutori e dentifrici/spazzolini, ma anche ai farmaci antimicrobici e alle difese immunitarie dell'ospite. Questo scenario si complica ulteriormente considerando che l’ampio uso di attacchi fissi o rimovibili nei trattamenti ortodontici espande la problematica e la conseguente sfida clinica, essendo tali dispositivi un ulteriore habitat utile per l'adesione microbica, la crescita e la formazione di biofilm. In misura simile, i pazienti con impianti dentali possono sviluppare localmente malattie legate alla produzione di biofilm impianto-associato, consentendo la progressione clinica verso quadri di perimucosite o perimplantite infettiva. Da qui, sorge la necessità di strumenti/composti innovativi per facilitare la rimozione di microrganismi potenzialmente patogeni e il mantenimento dell'omeostasi del cavo orale. Oltre ai patogeni orali più noti, tra cui il gruppo Streptococcus mutans e il "complesso rosso" dei bacilli anaerobi Gram-negativi, anche Candida albicans (C. albicans), Staphylococcus aureus (S. aureus) e Pseudomonas aeruginosa (P. aeruginosa) possono essere agenti eziologici di malattie orali. Il primo germe, spesso ospitato come commensale delle mucose sane, è il principale patogeno fungino coinvolto nella mucosite orale. Gli altri due sono patogeni molto subdoli, responsabili di malattie ad ampio spettro; considerati i loro numerosi fattori di virulenza e l’ampia farmaco-resistenza, S. aureus e P. aeruginosa sono ampiamente utilizzati per studi in vitro come preziosi prototipi di patogeni Gram-positivi e Gram-negativi. Lo scopo della presente tesi era di valutare in vitro ed ex vivo l'efficacia antimicrobica e antibiofilm di approcci innovativi contro i patogeni orali. Questa tesi ha fornito prove in vitro ed ex vivo sull'efficacia antimicrobica di composti nuovi e tradizionali per la cura e l’igiene del cavo orale, da cui possono derivare in prospettiva scelte più razionali e consapevoli. Ad esempio, un nuovo utilizzo del prodotto endodontico Cupral potrebbe essere proposto nelle pratiche di igiene quotidiana, così come potrebbe essere privilegiato il trattamento delle peri-implantiti con il sistema Bic-40, vista la sua particolare efficacia nella pulizia e nella decontaminazione di superfici lisce e ruvide in titanio, senza influire sulla vitalità delle cellule staminali dell’ospite. Inoltre, il nostro lavoro ha aggiunto nuove conoscenze sulle proprietà antimicrobiche di un composto naturale come la propoli e sui suoi possibili meccanismi d'azione, offrendo nuove opportunità nella ricerca di molecole antimicrobiche alternative. Infine, abbiamo dimostrato che il dentifricio e la gomma Biorepair Peribioma possono influenzare profondamente il comportamento dei microorganismi del cavo orale, a favore di condizioni utili al mantenimento dello stato di salute di questo distretto anatomico. Questo lavoro ha fornito nuove evidenze su come contrastare i patogeni, particolarmente se produttori di biofilm; facilitando il disegno di strategie mirate per la prevenzione e/o il trattamento delle infezioni dentali e orali associate al biofilm.During recent years, novel compounds/tools are being proposed to maintain oral health and/or to treat dental/periodontal problems. As well known, dental caries are among the most diffused infections and their improper management turns towards relevant disease(s) and eventually tooth extraction. Extensive literature documents the pathogenic role of certain microorganisms and their ability to persist in the oral cavity, as a complex microbial community, including bacteria, viruses and fungi, tightly enclosed in a polymeric matrix of polysaccharide origin. Such sessile community, and particularly dental plaque, the first deeply studied human-associated biofilm, is notoriously refractory not only to common cleaning procedures by mouthwashes and tooth-pastes/brushes, but also to antimicrobial drugs and host immune defenses. This scenario becomes further complicated considering that the widely diffused orthodontic treatments, with fixed or removal brackets, extend the clinical challenge, being such devices an additional good habitat for microbial adhesion, growth and biofilm formation. To a similar extent, patients with dental implants may locally develop biofilm-related diseases, allowing clinical progression toward pathogen-related peri-mucositis or peri-implantitis. From here, the need arises for innovative tools/compounds to facilitate microbial removal and maintenance of oral cavity homeostasis. Besides the most investigated oral pathogens, including Streptococcus mutans-group and the “red complex” Gram-negative anaerobe bacilli, also Candida albicans (C. albicans), Staphylococcus aureus (S. aureus) and Pseudomonas aeruginosa (P. aeruginosa) may occur as causative agent of oral diseases. The first, often harbored as commensal of healthy mucosae, is the main fungal pathogen involved in oral mucositis. The latter two are subtle pathogens, responsible of wide-spectrum diseases; they are being extensively used for in vitro studies, because of their numerous virulence factors and wide-spectrum antimicrobial resistance. The aim of the present thesis was to evaluate in vitro and ex vivo, the antimicrobial and antibiofilm efficacy of innovative approaches against oral pathogens. Our data provided in vitro and ex vivo evidence on the antimicrobial efficacy of several dental-care compounds. A novel use of the endodontic product Cupral could be proposed in daily hygiene practices. The Bic-40 treatment was shown as the best approach in cleaning smooth and rough titanium surfaces (without altering their properties); importantly, its device-decontamination efficacy did not affect the biological properties of reparative stem cells. Furthermore, our work added new insights on the anti-microbial properties of a natural compound, such as propolis, and on its possible mechanisms of action. At last, we showed that the Biorepair Peribioma toothpaste and gum deeply affected oral microorganisms’ behavior, drastically impairing their ability to contaminate and produce plaque onto orthodontic devices; interestingly, replacement by beneficial microorganisms was observed. The overall take-home message from this research is that basic science may greatly increase our knowledge on how to counteract biofilm-producing pathogens; in turn, this will facilitate prevention and/or treatment of dental and oral biofilm-associated infections, making a huge difference in terms of health promotion