The role of biotics as a therapeutic strategy for oral mucositis - a systematic review

Objectives: Oral mucositis (OM) is an acute and highly prevalent side effect of cancer treatments. Currently, there is no effective strategy for its prevention or treatment. This systematic review aimed to assess the effectiveness of biotics used as a therapeutic strategy for the management of OM. Materials and Methods: The PRISMA checklist was followed and PubMed, Web of Science, and Scopus were screened for clinical and pre-clinical studies assessing the potential effects of biotics in OM. Inclusion criteria included in vivo studies related to oral mucositis evaluating the effect of biotics, and written in Portuguese, English, French, Spanish, or Dutch. The following exclusion criteria were used: systematic reviews and meta-analyses, reviews, case reports, opinion papers or comments, conference papers, letters without results, articles not related to oral therapy-induced mucositis or biotics, or in vitro articles that do not simulate oral mucositis. Results: From a total of 1250 articles retrieved, 9 were included in this systematic review. Four clinical studies reported a reduction in oral mucositis occurrence with Lactobacillus species (Lactobacillus casei and Lactobacillus brevis CD2) and Bacillus clausii UBBC07. In pre-clinical studies, Lactococcus lactis genetically modified and Lactobacillus reuteri reduced the severity of OM and Streptococcus salivarius K12 also decreased the size of the ulcers. Conclusion: The findings of this systematic review suggest that probiotic supplementation may potentially reduce the incidence of therapy-induced OM and decrease its severity in patients undergoing cancer treatment. However, the available evidence is marred by significant heterogeneity across studies.info:eu-repo/semantics/publishedVersio

Antimicrobial susceptibility of Staphylococcus aureus and coagulase-negative staphylococci in oral and nasal cavities

Staphylococcus infections are becoming increasingly difficult to treat due to the growing number of resistant strains to old and new antibiotics. Staphylococcus aureus is referenced as the most clinically relevant but other species, known as coagulase-negative staphylococci (CoNS), have emerged as major causes of serious infections. Although nostrils are considered Staphylococcus preferred host habitat, the oral cavity has also been appointed as a relevant reservoir. Thus, this study aimed to evaluate the antibiotic susceptibility (AS) of nasal and oral staphylococci isolates. Therefore, AS was determined to 102 nasal and 90 oral isolates, previously recovered from dentistry students, by disc diffusion agar for amoxicillin, cefoxitin, ciprofloxacin, chloramphenicol, clindamycin, erythromycin, gentamicin, quinupristin-dalfopristin, tetracycline, and trimethoprim+sulfamethoxazole following the EUCAST/CLSI guidelines. In either nasal (N) or oral (O) cavities, the Staphylococcus isolates included 22% of S. aureus and 78% of CoNS isolates, namely S. epidermidis (41%-N,37%-O), S. warneri (15%-N,16%-O), S. capitis (10%-N,4%-O), S. saprophyticus (9%-N,6%-O), S. pasteuri (7%-O), S. lugdunensis (3%-O), and other (S. haemolyticus, S. hominis, S. sciuri, S. cohnii, and S. condimenti/S. carnosus). All S. aureus isolates presented resistance to at least one antibiotic, and 36% in oral and 25% in nasal cavities presented multidrug resistance (MDR). Among CoNS 65% in oral and 49% in nasal cavities presented resistance to at least one antibiotic, and ~5% presented MDR, namely isolates of S. epidermidis, S. pasteuri, S. haemolyticus, and S. hominis. In conclusion, this study revealed the relevance of the oral cavity as a colonization site for Staphylococcus, including S. aureus, and as a potential source/reservoir of antibiotic resistance, which has been widely neglected so far, highlighting the need for oral cavity inclusion in the Staphylococcus carriage and antibiotic screening.info:eu-repo/semantics/publishedVersio

Caries in Portuguese children with Down syndrome

OBJECTIVES: Oral health in Down syndrome children has some peculiar aspects that must be considered in the follow-up of these patients. This study focuses on characterizing the environmental and host factors associated with dental caries in Portuguese children with and without Down syndrome. METHODS: A sibling-matched, population-based, cross-sectional survey was performed. RESULTS: Down syndrome children presented a significantly greater percentage of children without caries, 78% vs. 58% of non-Down syndrome siblings. This difference in the DMFT index (number of decayed, missing and filled teeth) essentially reflects data obtained from treated teeth, for which 91% of children with Down syndrome had never had a tooth treated vs. 67% of siblings. This result was statistically significant, whereas results for decayed and lost teeth did not differ between Down syndrome children and their unaffected siblings. Additionally, in Down syndrome children, a delayed eruption of the second molar occurs. Down syndrome children and their siblings have similar oral hygiene habits, but a higher percentage of Down syndrome children visit a dentist before the age of three years, in comparison to their siblings. Bruxism was also more common in Down syndrome children compared to their siblings. CONCLUSIONS: Our results show that Portuguese children with Down syndrome have lower caries rates than children without Down syndrome. This reduced prevalence may be associated with the parents' greater concern about oral health care in Down syndrome children, resulting in their taking them sooner to visit a dentist, as well as to a higher bruxism prevalence and delayed tooth eruption

Peritoneal microbiome in end-stage renal disease patients and the impact of peritoneal dialysis therapy

The following are available online at http://www.mdpi.com/2076-2607/8/2/173/s1, Figure S1 (Rarefaction curves), Figure S2 (Relative proportion taxa for class, order, genus, and species), Figure S3 (Abundances of the genera and families between the ESRD-PD and ESRD-nonPD), Figure S4 (Alpha diversity of the peritoneum microbiome community at phylum, class, order, family, genus, species and OUT taxonomic levels calculated with Observed, Chao1, Shannon, Simpson, and Inverse Simpson indexes), Figure S5 (Beta-diversity of the peritoneum microbiome community at OTU level with Bray-Curtis, Jaccard, unweighted Unifrac, and Weighted Unifrac) and Figure S6 (Non-metric multidimensional scaling of blood and peritoneum microbiomes of non-PD and PD patients).Factors influencing the occurrence of peritoneal dialysis (PD)-related infections are still far from fully understood. Recent studies described the existence of specific microbiomes in body sites previously considered microbiome-free, unravelling new microbial pathways in the human body. In the present study, we analyzed the peritoneum of end-stage kidney disease (ESKD) patients to determine if they harbored a specific microbiome and if it is altered in patients on PD therapy. We conducted a cross-sectional study where the peritoneal microbiomes from ESKD patients with intact peritoneal cavities (ESKD non-PD, n = 11) and ESKD patients undergoing PD therapy (ESKD PD, n = 9) were analyzed with a 16S rRNA approach. Peritoneal tissue of ESKD patients contained characteristically low-abundance microbiomes dominated by Proteobacteria, Firmicutes, Actinobacteria, and Bacteroidetes. Patients undergoing PD therapy presented lower species richness, with dominance by the Pseudomonadaceae and Prevotelaceae families. This study provides the first characterization of the peritoneal microbiome in ESKD patients, bringing new insight to the human microbiome. Additionally, PD therapy may induce changes in this unique microbiome. The clinical relevance of these observations should be further explored to uncover the role of the peritoneal microbiome as a key element in the onset or aggravation of infection in ESKD patients, especially those undergoing PD.This research was funded by FEDER—Fundo Europeu de Desenvolvimento Regional funds through the COMPETE 2020—Operacional Programme for Competitiveness and Internationalisation (POCI), Portugal 2020, and by Portuguese funds through FCT/MCTES in the framework of the project MicroMOB “POCI-01-0145-FEDER-029777 / PTDC/MEC-MCI/29777/2017”; and by a Research Grant 2014 by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) to I.S.-S. L.S.-S was supported by SFRH/BD/84837/2012 and I.S.-S was supported by SFRH/BPD/101016/2014 from FCT/QREN–POPH/FSE

Oral yeast colonization throughout pregnancy

Recent studies suggest that placenta may harbour a unique microbiome that may have origin in maternal oral microbiome. Although the major physiological and hormonal adjustments observed in pregnant women lead to biochemical and microbiological modifications of the oral environment, very few studies evaluated the changes suffered by the oral microbiota throughout pregnancy. So, the aim of our study was to evaluate oral yeast colonization throughout pregnancy and to compare it with non-pregnant women. The oral yeast colonization was assessed in saliva of 30 pregnant and non-pregnant women longitudinally over a 6-months period. Demographic information was collected, a non-invasive intra-oral examination was performed and saliva flow and pH were determined. Pregnant and non-pregnant groups were similar regarding age and level of education. Saliva flow rate did not differ, but saliva pH was lower in pregnant than in non-pregnant women. Oral yeast prevalence was higher in pregnant than in non-pregnant women, either in the first or in the third trimester, but did not attain statistical significance. In individuals colonized with yeast, the total yeast quantification (Log10CFU/mL) increase from the 1st to the 3rd trimester in pregnant women, but not in non-pregnant women. Pregnancy may favour oral yeast growth that may be associated with an acidic oral environment

Reduced salivary flow and colonization by mutans streptococci in children with Down syndrome

OBJECTIVES: Although individuals with Down syndrome have considerable oral disease, the prevalence of dental caries in this group is low. The present study aimed to compare known risk factors for dental caries development in children with Down syndrome and a matched population (siblings). In both populations, the number of acidogenic microorganisms, such as mutans streptococci, lactobacilli and Candida species, and the paraffin-stimulated pH, flow rate and IgA concentration in whole saliva were evaluated and compared. METHOD: Saliva was collected, and the caries index was evaluated in 45 sibling pairs aged between 6 and 18 years old. The salivary IgA concentration was determined by immunoturbidimetry. Salivary mutans streptococci, lactobacilli and Candida species were quantified on mitis salivarius agar containing bacitracin and 20% sucrose, rogosa agar supplemented with glacial acetic acid and sabouraud agar supplemented with chloramphenicol, respectively. RESULTS: Down syndrome children had a higher caries-free rate (p<0.05) and lower salivary mutans streptococci counts (p<0.03) compared to their siblings. Similar numbers of lactobacilli and Candida species were found in both groups. Salivary flow rates were 36% lower in Down syndrome children compared to their siblings (p<0.05). The salivary pH did not differ between Down syndrome children and controls. The Down syndrome children had an IgA secretion rate 29% lower than that of their siblings, but this difference was not statistically significant. CONCLUSIONS: In conclusion, the lower number of mutans streptococci in the saliva may be one of the factors contributing to the lower caries rate observed in Down syndrome children, despite evidence of hyposalivation

Effect of denture-related stomatitis fluconazole treatment on oral Candida albicans susceptibility profile and genotypic variability

Denture-related stomatitis (DRS) is the most common condition affecting removable-denture wearers, and Candida albicans the most frequent pathogenic agent. Systemic antifungal treatment is indicated but recurrences are frequent. The aim of this study was to characterize the oral load, fluconazole susceptibility profile and genotypic variability of oral C. albicans isolates from patients with DRS before (T0), immediately after fluconazole treatment (Tat) and after 6-months follow-up (T6m). Eighteen patients presenting DRS and treated with fluconazole were followed at the Faculty of Dentistry of Oporto University. Seventy C. albicans isolates were obtained and identified using standard cultural and biochemical multi-testing. Fluconazole susceptibility was tested by E-test®. Microsatellite-primed PCR was performed to assess the genotypic variability of C. albicans isolates. The patientsâ mean age was 58.0±3.2 years, and 55.6%/44.4% had total/partial dentures. Before treatment, 22.2%, 44.4% and 33.3% of the patients presented DRS type I, II or III, respectively. Fluconazole treatment healed or improved DRS in 77.8% of the patients, accompanied by an 83.5% reduction in oral C. albicans load. However, after 6-months, oral C. albicans load increased significantly and DRS severity was similar to the one observed before treatment. Moreover, the prevalence of patients presenting fluconazole resistant isolates of C. albicans increased significantly throughout the study: T0-5.6%, Tat-10.0% and T6m-42.9%. A change in the genotypic variability of C. albicans isolates was also verified, being mostly associated to fluconazole susceptibility profile change. In conclusion, fluconazole presents a good short-term DRS treatment efficiency, but may be associated to a long-term emergence of C. albicans fluconazole resistance. © Figueiral et al.; Licensee Bentham Open

Oral Health in Down Syndrome

Oral health in Down Syndrome (DS) individuals has some peculiar aspects that must be considered in the follow up of these patients. In this chapter, we will focus on the oral and maxillofacial morphological alteration, the most prevalent oral pathologies as well as preventive measures and strategies for pathologies management in this population. Also, future research on oral health of DS will be discussed