Atividade antifúngica de nanofibras de policaprolactona/nistatina: estudo in vitro e in vivo / Antifungal activity of polycaprolactone/nystatin nanofibers: in vitro and in vivo study

Este estudo avaliou a eficácia in vitro e in vivo de mantas de nanofibras (NF) de policaprolactona (PCL) incorporadas com nistatina (NIS) no tratamento da estomatite protética (EP) em modelos animais. NF foram sintetizadas com diferentes concentrações de NIS, totalizando quatro soluções: PCL puro, PCL/NIS 0,045 g, PCL/NIS 0,090 g e PCL/NIS 0,225 g. A liberação da NIS foi analisada por espectroscopia Ultravioleta-Visível. A capacidade das mantas de inibirem o biofilme de Candida albicans, principal fator etiológico da EP, dividindo-se cinco grupos (N=5) compostos por um grupo com controle de células de C. albicans e com PCL puro, além das três concentrações de NIS. A seguir, foi analisada a viabilidade celular em queratinócitos humanos (HaCat) por meio do teste colorimétrico de resazurina. Cinco grupos foram divididos (N=10): controle celular, PCL puro e as três concentrações de NIS. Em modelos animais de ratos Wistar albinos (N=18), dispositivos palatinos (DP) de resina acrílica foram confeccionados simulando próteses totais e utilizados para a indução da EP. Para isso, DP contaminados com C. albicans foram cimentados na região molar da cavidade bucal dos animais e permaneceram em boca por 48 h. Após esse período, os DP foram removidos e os animais foram divididos em três grupos: (C) controle; (B1) com tratamento por mantas de PCL/NIS 0,045 g e (B2) PCL/NIS 0,225 g, com N=6. Então novos DP, livres de contaminação, foram cimentados na cavidade oral dos animais e permaneceu por mais 48 h. Após esse período, os animais foram eutanasiados, a contagem de UFC/ mL foi realizada e os palatos foram coletados para a análise histológica. A curva padrão de NIS obtida apresentou R2 de 0,99. As três concentrações de NF apresentaram liberação de NIS, com pico no tempo de 6 h e valores de 66,26 µg/ mL para PCL/NIS 0,045 g, de 333,87 µg/ mL para PCL/NIS 0,090 g e 436,51 µg/ mL para PCL/NIS 0,225 g, constantes até o fim do experimento. Os grupos com NIS reduziram em 2,5 log10 de crescimento do biofilme fúngico em relação aos grupos sem tratamento, Controle e PCL, sem diferença estatística significativa. Não foi observada citotoxicidade nas células HaCat, com viabilidade celular de 93,7% para PCL/NIS 0,045 g, 72,6% para PCL/NIS 0,090 g e 72,4% para PCL/NIS 0,225 g. A indução da EP nos três grupos foi possível e, porém, sem redução significativa na contagem de UFC/ mL de C. albicans nos grupos B1 e B2. Na análise histológica do grupo C pôde-se observar infiltração de hifas de Candida na camada queratinizada, presença de células inflamatórias formando micro abscessos e um discreto infiltrado inflamatório no tecido conjuntivo subjacente ao epitélio infectado. Nos grupos B1 e B2 não foram encontradas alterações epiteliais, concluindo-se que as NF demonstraram atividade antifúngica in vitro e foram efetivas na prevenção da penetração de hifas no tecido palatino de animais com DP (AU)

This study evaluated the in vitro and in vivo efficacy of nanofiber (NF) mats of polycaprolactone (PCL) incorporated with nystatin (NIS) in the treatment of denture stomatitis (DS) in animal models. NFs were synthesized with different concentrations of NIS, totaling four solutions: pure PCL, PCL/NIS 0.045 g, PCL/NIS 0.090 g, and PCL/NIS 0.225 g. The release of NIS was analyzed by Ultraviolet-Visible spectroscopy. The ability of the mats to inhibit Candida albicans biofilm, the main etiological factor of DS, was assessed by dividing five groups (N=5) composed of a group with C. albicans cell control and with pure PCL, in addition to the three concentrations of NIS. Next, cell viability in human keratinocytes (HaCat) was analyzed using the resazurin colorimetric test. Five groups were divided (N=10): cell control, pure PCL, and the three concentrations of NIS. In albino Wistar rat animal models (N=18), palatal devices (PD) made of acrylic resin were fabricated to simulate total prostheses and used to induce DS. For this, PD contaminated with C. albicans were cemented in the molar region of the animals' oral cavity and remained in the mouth for 48 hours. After this period, the PDs were removed, and the animals were divided into three groups: (C) control; (B1) treated with PCL/NIS 0.045 g mats, and (B2) PCL/NIS 0.225 g, with N=6. Then new, uncontaminated PDs were cemented in the animals' oral cavity and remained for another 48 hours. After this period, the animals were euthanized, UFC/ mL counts were performed, and the palates were collected for histological analysis. The standard NIS curve obtained showed an R2 of 0.99. The three concentrations of NF showed NIS release, with a peak at 6 h and values of 66.26 µg/ mL for PCL/NIS 0.045 g, 333.87 µg/ mL for PCL/NIS 0.090 g, and 436.51 µg/ mL for PCL/NIS 0.225 g, remaining constant until the end of the experiment. The groups with NIS reduced fungal biofilm growth by 2.5 log10 compared to the untreated groups, Control and PCL, with no significant statistical difference. No cytotoxicity was observed in HaCat cells, with cell viability of 93.7% for PCL/NIS 0.045 g, 72.6% for PCL/NIS 0.090 g, and 72.4% for PCL/NIS 0.225 g. Induction of DS in the three groups was possible; however, there was no significant reduction in UFC/ mL counts of C. albicans in groups B1 and B2. Histological analysis of group C revealed infiltration of Candida hyphae in the keratinized layer, presence of inflammatory cells forming micro abscesses, and a discreet inflammatory infiltrate in the connective tissue underlying the infected epithelium. No epithelial alterations were found in groups B1 and B2, concluding that NFs demonstrated in vitro antifungal activity and were effective in preventing hyphal penetration into palatal tissue in animals with PD.(AU)

Research progress on neutrophil extracellular traps in oral infectious diseases / 口腔疾病防治

@#Eutrophils are the first innate immune cells to reach the site of inflammation. Neutrophils produce neutrophil extracellular traps (NETs) that can quickly capture and limit the spread of pathogens, facilitating the removal of pathogens and their debris. Neutrophils in the oral cavity are specifically transformed from circulating neutrophils in the blood, and the number of NETs released by oral neutrophils is much higher than that of circulating neutrophils, thus better maintaining the balance of the oral microenvironment. As a bimorphic fungus, only the mycelium phase of Candida albicans can induce NETs, which is related to the neutrophils' ability to sense the size of pathogenic microorganisms through neutrophil elastase. However, spherical Staphylococcus aureus are much smaller than Candida albicans, and they can still induce NETs. Porphyromonas gingivalis, as one of the microorganisms in the periodontitis complex, induces fewer NETs than Streptococcus oralis and Actinomycetes, which are two common oral microorganisms, and there may be a mechanism allowing them to escape neutrophilic immunity in the early stage of periodontitis. Although the two main pathways of NET production have been studied in detail, the mechanisms involved in the induction of NETs by different microorganisms, especially from oral neutrophils, are not well understood. This review describes the mechanism of the immune effects of pathogenic microorganisms on neutrophil NETs in the oral cavity, providing a reference for the search for therapeutic targets and the development of key drugs for treating oral infectious diseases.

Relation between the risk factors for the severity of denture stomatitis and quality of life of complete edentulous individuals: a cross-sectional study

Abstract Objective To assess the association between risk factors for developing denture stomatitis (DS) and oral health-related quality of life (OHRQoL) in complete denture wearers. Methodology Participants of both sexes, wearing complete dentures, were classified using the modified Newton classification for the absence or the severity of DS and allocated to groups Normal or zero, IA, IB, II, and III. Lifestyle, oral and denture history, and medication use were assessed using specific questionnaires; clinical parameters such as anatomical characteristics of support were evaluated with the Kapur classification; salivary flow (SF) was calculated by the volume of unstimulated saliva per minute; and microbial load was determined by counting colony forming units (CFU) of target microorganisms present in the biofilm collected from dentures and palate. OHIP-EDENT assessed the OHRQoL. Kendall's tau_b and Spearman tests were applied with a significance level of 5%. Results 184 patients (143 female and 41 male) aged 65.5 ± 6.8 years were evaluated. Positive correlations were found for sex (women; p=0.013, r=0.16), individuals who started to consume alcoholic beverages as a young adult (18-27 years) (p=0.008, r=0.22), CFU of Candida spp. (p<0.001, r=0.27 denture; p<0.001, r=0.31 palate); Candida albicans (p=0.004, r=0.22 denture; p=0.003, r=0.25 palate), and Candida glabrata (p=0.004, r=0.22 denture; p=0.001, r=0.27 palate). Moreover, negative correlations with DS were found for CFU of Staphylococcus spp. (p=0.004, r=-0.20 palate) and enterobacteria (p=0.002, r=-0.24 palate), as well as a negative correlation between SF (p=0.009, r=-0.193) and DS. The CFU of Staphylococcus spp. and enterobacteria on the palate significantly correlated with OHRQoL. Conclusion Being female, consuming alcoholic beverages as a young adult, CFU of Candida spp., Candida albicans, Candida glabrata, and salivary flow may be the most significant risk factors for DS. The microbial load of Staphylococcus spp. and enterobacteria seems to influence the quality of life for complete denture wearers.

Longitudinal Evaluation of Ethyl Cyanoacrylate Adhesives on Candida albicans Biofilm

ABSTRACT: The aim of this study is to evaluate the effect of two ethyl cyanoacrylate-based adhesives on the growth of Candida albicans biofilms on a heat-polymerized resin, after 7, 14, and 30 days of exposure. Ninety circular (10 x 2 mm) heat-polymerized resin specimens were equally divided into three groups: control, conventional ethyl cyanoacrylate (ECAc), and ethyl cyanoacrylate gel (ECAg). Two layers of 50 µL of each material were applied to the respective groups. C. albicans SC5314 strain was activated and standardized to 107 cells/mL-1. Specimens were immersed in 1 mL of artificial saliva and deposited in 1 mL fungal suspension, washed, and immersed in 1 mL of RPMI for 7, 14, and 30 days. The medium was changed at 48-hour intervals. The final suspension was diluted (10 -1 to 10-4) and deposited on Sabouraud dextrose agar for 48 h at 37 °C. After this period, the colonies were quantified using the CFU/mL calculation. Data were evaluated using one- way ANOVA and Tukey's test for post-hoc analysis (P=0.05). It was observed that both adhesives significantly reduced (P<0.05) biofilm formation compared to the control at all evaluated periods. In conclusion, an immediate and long-term inhibitory effect on C. albicans biofilm formation was observed.

RESUMEN: El objetivo del estudio fue evaluar el desarrollo microbiano en superficies de resina acrílica de termopolimerización, acondicionadas previamente, con adhesivos a base de etil cianoacrilato después de 7, 14 y 30 días de exposición en biofilm de Candida albicans. Noventa muestras circulares (10 x 2 mm) de resina acrílica de termopolimerización se dividieron por igual en tres grupos: control, etil cianoacrilato convencional (ECAc) y etil cianoacrilato en gel (ECAg). Se aplicaron dos capas de 50 µl de cada adhesivo en cada muestra. Simultáneamente, se activó la cepa C. albicans SC5314 y se estandarizó a 107 células/ml-1. Las muestras fueron sumergidas en 1 mL de saliva artificial por dos horas y luego se depositó 1 mL de suspensión fúngica por una hora. En seguida cada muestra se lavó y se sumergió en 1 mL de RPMI durante 7, 14 y 30 días, con cambios del medio a cada 48 horas. La suspensión final se diluyó (10-1 a 10-4) y se depositó en agar dextrose Sabouraud durante 48 h a 37° C. Después de este período, las colonias se cuantificaron mediante el cálculo de UFC / mL. Los datos obtenidos se evaluaron por medio del test ANOVA-one way y la prueba de Tukey para el análisis post- hoc (p = 0,05). Se observó que ambos adhesivos redujeron significativamente (P<0,05) la formación del biofilm de Candida albicans al ser comparados con el grupo control en todos los períodos evaluados. Los adhesivos a base de etil cianoacrilato poseen un efecto inhibidor de biofilm de Candida albicans de hasta 30 días, al ser aplicados dos veces en resinas acrílicas de termopolimerización.

Desenvolvimento de formulações probióticas de isolados clínicos de Lactobacillus spp. para controle de Candida albicans / Development of probiotic formulations of clinical isolates of Lactobacillus spp. for the control of Candida albicans

O uso de probióticos tem sido considerado uma alternativa para o controle das candidoses bucais, como a estomatite protética. Recentemente, nosso grupo de pesquisa isolou cepas clínicas bucais de Lactobacillus rhamnosus (5.2) e Lactobacillus fermentum (20.4) com atividade antifúngica contra Candida albicans. Entretanto, é necessário o desenvolvimento de formulações para uso clínico dessas cepas probióticas na cavidade bucal. Assim, o objetivo desse projeto foi desenvolver formulações probióticas em hidrogel gellan gum com atividade antifúngica que possam ser usadas no controle da estomatite protética. Para o preparo das formulações probióticas, as cepas L. rhamnosus 5.2 ou L. fermentum 20.4 foram incorporadas em formulações com diferentes concentrações de gellan gum (0,6 a 1%). A viabilidade das células de Lactobacillus nas formulações e o sistema de liberação foram testados em diferentes condições de armazenamento, incluindo tempo e temperaturas de estocagem. A seguir, os efeitos das formulações probióticas foram avaliados sobre C. albicans pelo método de difusão em ágar e sobre biofilmes microcosmos por contagem de células viáveis e análise de microscopia eletrônica de varredura. Os resultados demonstraram que todas as concentrações do gellan foram capazes de manter a viabilidade das células de L. rhamnosus e L. fermentum em torno de 5 a 7 log, durante 14 semanas, independentemente da temperatura de armazenamento (4°C ou temperatura ambiente). No teste de difusão em ágar, verificou-se que as formulações probióticas levaram à inibição de cepas padrão e clínicas de C. albicans, demonstrando que as cepas de Lactobacillus incorporadas no gellan mantiveram sua atividade antifúngica. As formulações probióticas também conseguiram inibir os biofilmes microcosmos provenientes de pacientes com estomatite protética, reduzindo o número de células viáveis de Candida e desestruturando a arquitetura dos biofilmes. Concluiu-se que o gellan gum mostrou ser um biomaterial promissor como carreador das cepas probióticas de L. rhamnosus 5.2 e L. fermentum 20.4. Além disso, as formulações probióticas desenvolvidas apresentaram ação antifúngica sobre células de C. albicans e biofilmes de estomatite protética, podendo desta forma atuar na prevenção da candidose bucal. (AU)

The use of probiotics has been considered an alternative for the control of oral candidiasis such as denture stomatitis. Recently, our research group isolated oral clinical strains of Lactobacillus rhamnosus (5.2) and Lactobacillus fermentum (20.4) with antifungal activity against Candida albicans. However, it is necessary to develop formulations for clinical use of these probiotic strains in the oral cavity. Thus, the purpose of this project was to develop probiotic formulations in gellan gum hydrogel with antifungal activity that could be used in the control of denture stomatitis. For the preparation of probiotic formulations, the strains L. rhamnosus 5.2 or L. fermentum 20.4 were incorporated into formulations with different concentrations of gellan gum (0.6 to 1%). The viability of Lactobacillus cells in the formulations and the delivery system were tested under different storage conditions, including storage time and temperatures. Next, the effects of the probiotic formulations were evaluated on C. albicans by the agar diffusion method and on microcosm biofilms by viable cell count and scanning electron microscopy analysis. The results showed that all concentrations of gellan were able to maintain the viability of L. rhamnosus and L. fermentum cells around 5 to 7 log for 14 weeks, regardless of storage temperature (4°C or room temperature). In the agar diffusion test, it was found that the probiotic formulations led to the inhibition of standard and clinical strains of C. albicans, demonstrating that the Lactobacillus strains incorporated into gellan maintained their antifungal activity. Probiotic formulations were also able to inhibit microcosm biofilms from patients with denture stomatitis, reducing the number of viable Candida cells and disrupting the architecture of biofilms. As a conclusion, the gellan gum proved to be a promising biomaterial as a carrier of the probiotic strains of L. rhamnosus 5.2 and L. fermentum 20.4. In addition, the probiotic formulations developed showed antifungal action on C. albicans cells and denture stomatitis biofilms, thus being able to act in the prevention of oral candidiasis. (AU)

A novel acrylic resin palatal device contaminated with Candida albicans biofilm for denture stomatitis induction in Wistar rats

Abstract Denture stomatitis is the most frequent oral lesion in removable prosthesis wearers, with high recurrence rates and a complex treatment. Objective This study describes a protocol to obtain and to contaminate a palatal device with Candida albicans biofilm that could be used for an animal model of denture stomatitis. Methodology Acrylic resin devices (N=41) were obtained from impressions of the palates of Wistar rats with individual trays and polyether. The efficacy of microwave irradiation (MW), ultraviolet light (UV), or ultrasonic bath (US) was assessed by colony viability and spectrophotometric analyses (n=5) in order to select the most appropriate method for sterilizing the devices. Then, different devices (n=5) were contaminated with C. albicans and evaluated by CFU/mL determination, scanning electron microscopy, and laser confocal microscopy. Device stabilization was assessed with either autopolymerizing acrylic resins or a self-adhesive resin cement (n=2). The spectrophotometric data were analyzed by one-way ANOVA followed by the Tukey's HSD post-hoc test (α=0.05). Results MW was the only method capable of sterilizing the devices, and the contamination protocol developed a mature and viable C. albicans biofilm (~1.2 x 106 CFU/mL). The self-adhesive resin cement was the best stabilization material. Conclusions This acrylic resin palatal device was designed to be similar to the clinical situation of contaminated prostheses, with easy manufacturing and handling, effective stabilization, and satisfactory contamination. Thus, the acrylic device can be a valuable tool in the development of denture stomatitis in rats.

Sensitivity to antifungals by Candida spp samples isolated from cases of chronic atrophic candidiasis (CAC) / Sensibilidade a antifúngicos por amostras de Candida spp isoladas de casos de candidíase atrófica crônica (CAC)

Abstract The treatment of choice for chronic atrophic candidiasis (CAC), also known as denture stomatitis, is topical antifungal therapy. This study aimed to isolate, identify, and assess the antifungal susceptibility of Candida species from mucosal sites in denture wearers with a diagnosis of CAC and determine the prevalence of associated variables. The sample consisted of 44 patients wearing complete or partial dentures who had a clinical diagnosis of CAC. Using sterile cotton swabs, specimens were collected from the oral mucosa of all patients and grown at 30ºC for 48 h in CHROMagar Candida, as a means of isolating and screening the species. The complementary identification of the species was performed using the VITEK 2 automated system (BioMérieux), as well as the determination of their susceptibility to antifungal agents. Data were analyzed using the chi-square test. STATA 13.1 was used for statistical analysis (α = 5%). Of 44 patients with CAC, 33 (75%) had lesions classified as Newton type II. Yeasts were isolated in 38 cases. The most prevalent species was Candida albicans. None of the isolates were resistant to the antifungals tested. Our findings suggest that current indications for antifungal agents are appropriate. Also, antifungal susceptibility testing and proper fungal identification can help dentists to determine the optimal course of treatment for CAC.

Resumo O tratamento de escolha para candidíase atrófica crônica (CAC), também conhecida como estomatite protética, é a terapia antifúngica tópica. Este estudo teve como objetivo isolar, identificar e avaliar a susceptibilidade antifúngica de espécies de Candida de locais mucosos em portadores de prótese com diagnóstico de CAC e determinar a prevalência de variáveis associadas. A amostra consistiu em 44 pacientes portadores de próteses completas ou parciais que tiveram um diagnóstico clínico de CAC. Usando swab estéril, foram coletados espécimes da mucosa oral de todos os pacientes e cultivados a 30ºC durante 48 h em CHROMagar Candida, como forma de isolamento e triagem das espécies. A identificação complementar das espécies foi realizada no sistema automatizado VITEK 2 (BioMérieux), bem como a determinação da susceptibilidade delas a agentes antifúngicos. Os dados foram analisados usando o teste do qui-quadrado. O STATA 13.1 foi utilizado para análise estatística (α = 5%). Dos 44 pacientes com CAC, 33 (75%) apresentaram lesões classificadas como Newton tipo II. As leveduras foram isoladas em 38 casos. A espécie mais prevalente foi Candida albicans. Nenhum dos isolados foi resistente aos antifúngicos testados. Nossas descobertas sugerem que as indicações atuais para os agentes antifúngicos são apropriadas. Além disso, testes de susceptibilidade antifúngicos e identificação fúngica adequada podem ajudar os dentistas a determinar o curso ótimo de tratamento para CAC.

Clinical application of laser selective melting titanium alloy for removable partial denture frameworks / 口腔疾病防治

Objective@#To investigate the effect of denture stomatitis of selective laser melting (SLM) titanium alloy for removable partial denture frameworks.@*Methods @#Twenty patients with dentition defects in our hospital were divided into two groups according to the different methods of creating a removable partial denture framework: the SLM group and casting group. The success rate, placement rate, masticatory efficiency and incidence of denture stomatitis were compared. Experimental data were analyzed with SPSS20.0.@*Results @# The success rate of the SLM framework group was 100.00%, which was higher than that of the casting group (90.00%) (P ＜ 0.01). The rate of framework placement in the SLM group was slightly lower than that in the casting group (P ＜ 0.05). The masticatory efficiency of the SLM group was higher than that of the casting group (0.783 ± 0.030 vs. 0.699 ± 0.037, P ＜ 0.001). The incidence of denture stomatitis (10.00%) in the SLM group was significantly lower than that in the casting group (30.00%) (P ＜ 0.001). @*Conclusion @#SLM is superior to the traditional casting method in mastication efficiency and reducing the incidence of denture stomatitis. This method can meet the clinical requirements, but the accuracy of the long-term stent needs to be improved.

Algunos factores de riesgo asociados a la estomatitis subprótesis / Some risk factors associated with stomatitis subprosthesis

RESUMEN Introducción: la estomatitis subprótesis es la inflamación de la mucosa bucal que está en contacto con la prótesis; generalmente se localiza en el paladar duro y es casi invariablemente asintomática. Constituye un importante problema de salud a nivel mundial y es de etiología multifactorial. Objetivo: identificar la posible asociación de algunos factores de riesgo con la aparición de estomatitis subprótesis en pacientes de 45-59 años de edad. Métodos: se realizó un estudio analítico observacional tipo casos y controles en la Clínica de Especialidades Estomatológicas desde Septiembre del 2016 hasta Marzo del 2018.El universo estuvo constituido por 981 pacientes y la muestra por 96 individuos, 32 casos y 64 controles. Se utilizó la regresión logística binaria o análisis univariado. Las variables empleadas fueron edad, sexo, estomatitis subprótesis, prótesis desajustadas, higiene inadecuada y el no descanso del uso de la aparatología. Resultados: el grupo de edad de 52-59 años y el sexo femenino fueron los más afectados por estomatitis subprótesis. La prótesis desajustada, la higiene inadecuada y el no descanso del uso de la aparatología constituyeron factores de riesgo altamente significativos.

ABSTRACT Introduction: the subprosthesis stomatitis is the inflammation of the buccal mucosa that is in contact with the prosthesis; It is usually located on the hard palate and is almost invariably asymptomatic. It is an important health problem worldwide and is of multifactorial etiology. Objective: to identify the possible association of some risk factors with the appearance of subprosthesis stomatitis in patients aged 45-59 years. Methods: an observational analytical study of cases and controls wascarried out in the Stomatological Specialist Clinic from September 2016 to March 2018. The universe was made up of 981 patients and was studied by 96 individuals, 32 cases and 64 controls. We used binary logistic regression or univariate analysis. The variables used were age, sex, stomatitis, sub-prosthesis, misaligned prosthesis, inadequate hygiene and no rest from the use of the appliance. Results: the age group of 52-59 years and the female sex were the most affected by stomatitis subprosthesis. Improper prosthesis, inadequate hygiene and not resting from the use of the appliance constituted highly significant risk factors.

Factores de riesgo asociados a la estomatitis subprótesis. Clínica de Especialidades, Bayamo. 1er Semestre. 2017 / Risk factors associated with stomatitis subprosthesis. Specialty Clinic, Bayamo. 1st semester. 2017

RESUMEN La instalación de cualquier tipo de prótesis estomatológica, produce necesariamente cambios en el medio bucal, que lo obligan a reaccionar para adaptarse a la nueva situación. Entre las modificaciones no fisiológicas que pueden aparecer está la estomatitis subprótesis. Se realizó este trabajo con el objetivo de determinar posible asociación de algunos factores de riesgos con la aparición de estomatitis subprótesis en pacientes de 35-44 años ingresados en el servicio de atención primaria de la Clínica estomatológica, durante el primer semestre del año 2017. Se realizó un estudio analítico de casos y controles. Se utilizó una muestra de 66 pacientes; en el grupo casos con 22 y el grupo control con 44, todos cumplieron con los criterios de inclusión. En los pacientes estudiados se observó predominio en el grupo de casos de pacientes con prótesis desajustadas (86.4 %) y en los controles el (95.5 %) de pacientes con prótesis ajustadas. Se concluye que la morbilidad se relacionó principalmente con el desajuste de las prótesis y con el uso inadecuado y sin descanso del aparato protésico.

ABSTRACT The installation of any type of stomatological prosthesis, necessarily produces changes in the oral environment, which force him to react to adapt to the new situation. Among the nonphysiological modifications that may appear is the subprosthesis stomatitis. This work was carried out in order to determine possible association of some risk factors with the appearance of stomatitis subprosthesis in patients aged 35-44 years admitted to the primary care service of the Stomatology Clinic, during the first semester of 2017. He carried out an analytical study of cases and controls. A sample of 66 patients was used; in the group cases with 22 and the control group with 44, all met the inclusion criteria. In the patients studied, predominance was observed in the case group of patients with misaligned prostheses (86.4%) and in the controls (95.5%) of patients with adjusted prostheses. It is concluded that the morbidity was mainly related to the mismatch of the prosthesis and to the improper use and without rest of the prosthetic device.

Assessment of Denture Stomatitis Cases among Complete Denture Wearers

Background: Denture stomatitis (DS) is a common oraldisease in denture wearers and quite characteristic ofadvanced age. The present study was conducted to assess thecases of denture stomatitis among complete denture wearers.Materials & Methods: The present study was conducted on445 completely edentulous patients wearing completedentures. In all patients, careful examination was done toevaluate the degree of the DS-modified Newton’s index (NI): 0= no inflammation; 1 = pin-point hyperemia; 2 = diffuseerythema; and 3 = papillary hyperplasia) 4, 5 in the completedenture wearers.Results: Out of 445 patients, males were 245 and femaleswere 200. The difference was non- significant (P- 0.1). Out of445 cases, DS was seen in 210 (47.1%) cases. 52% ofmaxillary and 43 % of mandibular dentures showed 0 grading,25% maxillary and 20% mandibular dentures showed 1grading, 13% maxillary and 25% mandibular dentures showed2 grading and 10% maxillary and 12% mandibular dentureshad 3 grading. The difference was significant (P< 0.05).Conclusion: Denture wearing habits, denture hygiene habits,denture cleanness and oral hygiene instructions madesignificant influence on the degree of DS in CD wearers. Hencein complete denture wearers, education is must to ensureproper cleanliness of the denture to prevent DS.

The effect of nanodiamonds on candida albicans adhesion and surface characteristics of PMMA denture base material - an in vitro study

Abstract Candida albicans is the main causative pathogen of denture stomatitis, which affects many complete denture patients. Objective: To evaluate the effect of different concentrations of nanodiamonds (NDs) added to polymethyl methacrylate (PMMA) denture base material on Candida albicans adhesion as well as on surface roughness and contact angle. Methodology: Acrylic resin specimens sized 10×10×3 mm3 were prepared and divided into four groups (n=30) according to ND concentration (0%, 0.5%, 1%, 1.5% by wt). Surface roughness was measured with a profilometer, and the contact angle with a goniometer. The effect of NDs on Candida albicans adhesion was evaluated using two methods: 1) slide count and 2) direct culture test. Analysis of variance (ANOVA) and Tukey's post hoc test were used in the statistical analyses. Results: Addition of NDs decreased the Candida albicans count significantly more than in the control group (p<0.05), with a lowest of 1% NDs. Addition of NDs also significantly decreased the surface roughness (p<0.05), but the contact angle remained the same. Incorporation of NDs into the PMMA denture base material effectively reduced Candida albicans adhesion and decreased surface roughness. Conclusion: PMMA/NDs composites could be valuable in the prevention of denture stomatitis, which is considered one of the most common clinical problems among removable denture wearers.

Sodium bicarbonate: A review and its uses in dentistry

Denture stomatitis, periodontitis, and peri-implantitis are the growing problems in restorative dentistry. Chemicals play an important role as an adjuvant to mechanical cleaning of teeth, implants, surrounding tissues, and prostheses. Current mouth rinses are reported to affect the tissues and prostheses if used on a long-term basis. Sodium bicarbonate, the common baking soda, has been reported to be versatile. A search of the resources through Medline and Google Scholar was made to understand the current status of the mouth rinses and the use of sodium bicarbonate. Different MeSH and search criteria were used for the different search engines. Baking soda, being a common household item, with its ready availability, safety, minimal abrasivity, and bactericidal property makes it a patient-friendly mouthwash, component in the dentifrice, or chewing gum, which can be used on a long-term basis as an adjunct virtually free of any side effects.

Efecto de miconazol sobre el recuento de levaduras en candidiasis asociada a estomatitis protésica / Effect of miconazole on the yeast count in candidiasis associated with denture stomatitis

RESUMEN: Introducción: Estomatitis Subprotésica, proceso inflamatorio crónico de la mucosa adyacente a prótesis removible. 71,4% de los sujetos con esta condición es portador de Candida y la severidad se relaciona con la presencia de esta levadura. Para su tratamiento se indica antimicóticos tópicos de la familia de polienos o de azoles. El propósito del estudio fue determinar el recuento de levaduras del género Candida en adultos mayores con candidiasis oral, antes y después de ser tratados con miconazol. Materiales y métodos: Se consignaron antecedentes sistémicos y locales en 32 adultos mayores con estomatitis subprotésica. Se determinó recuento de levaduras del género Candida en saliva, antes y después del tratamiento tópico con Miconazol 2%. Se aceptaron diferencias estadísticamente significativas con un error alfa igual o menor a 0.05%. Resultados: Los recuentos de levaduras del inicio del estudio disminuyeron significativamente a los días 8 y 15 después del tratamiento (mediana 6.800, 163, 60, respectivamente). 56,2% de los individuos presentó persistencia de levaduras después del tratamiento; 21,8% de ellos con recuentos superiores a 400 UFC/ml de saliva. Conclusiones: En el 56,2% de los individuos del estudio se observó persistencia de levaduras del género Candida luego de 2 semanas de tratamiento con miconazol al 2%.

ABSTRACT: Introduction: Denture stomatitis is a chronic inflammatory process of the mucosa adjacent to removable prosthesis. 71.4% of the subjects with this condition are carriers of Candida and the severity is related to the presence of this yeast. Topical antimycotics belonging to the polyene or azole family are indicated for its treatment. Efficacy of miconazole is reported to be from 80% to 100%, although resistance is described in isolates of Candida. The purpose of the study was to determine the count of Candida in older adults with oral candidiasis, before and after being treated with miconazole. Methodology: Systemic and local antecedents were recorded in 32 elderly adults with denture stomatitis. Differences in number of the colony forming units of Candida yeast, were determined before and after topical treatment with Miconazole 2%. Statistical significances were set at a value of p < 0.05. Results: Yeast counts at the start of the study significantly decreased 8 and 15 days after treatment (median 6,800, 163, 60, respectively). 56.2% of the subjects presented persistence of yeasts after treatment; 21.8% of them with counts higher than 400 CFU / ml saliva. Conclusion: In 56.2% of the study subjects, persistence of Candida yeasts was observed after 2 weeks of treatment with 2% miconazole.

Denture wearers' recognition for their oral health status, denture cleansing methods, and insurance health system / 대한치과보철학회지

PURPOSE: The aim of the present investigation was to understand the incidence, prevalence of denture stomatitis in denture wearers, who were over 60 years old, and use the results for a fundamental data to promote public awareness about denture stomatitis and its education tools. MATERIALS AND METHODS: From August 21 to September 8 2017, 500 denture wearers, who were more than 60 years old in Seoul and 4 other metropolitan cities (Busan, Daegu, Gwangju, and Daejeon), received questionnaires. The questionnaires included denture wearers' demographic distributions, specific dental treatment experiences, discomforts with current dentures, their oral health conditions, and the method of denture cleansing. RESULTS: Thirty-two percent of 500 denture wearers responded that they have healthy oral conditions. Two hundred and eight respondents (41.6%) were aware of denture stomatitis. Only 131 (26.2%) were informed about the removable denture covered by national health insurance and 327 (65.4%) of denture wearers were using the improper denture cleansing methods. CONCLUSION: A large number of denture wearers still do not recognize the importance of proper treatment for denture stomatitis, insurance covered denture treatments, and adequate denture cleansing methods.

Efectividad del oleozón en el tratamiento de la estomatitis subprótesis en pacientes mayores de 60 años / Oleozon Effectiveness in Denture Subprostheses Stomatitis Treatment in Patients Older than 60 Years Old

Introducción: la estomatitis protésica es una enfermedad de etiología multifactorial que se manifiesta a la exploración clínica por cambios inflamatorios de la mucosa en la bóveda palatina cubierta por la prótesis. Objetivo: evaluar la efectividad del oleozón en el tratamiento de la estomatitis subprótesis grado I y II en pacientes mayores de 60 años. Métodos: se realizó un estudio cuasi experimental con grupo control entre mayo a septiembre del 2015 en el área de salud del Policlínico Cristino Naranjo. El universo estuvo constituido por 46 pacientes mayores de 60 años portadores de prótesis estomatológicas que cumplieron con los criterios de inclusión. Se analizaron las variables: tipo de tratamiento, grado inicial de la estomatitis, tiempo de mejoría y tiempo de curación. Resultados: se observó que 20 pacientes (86,9%) fueron curados entre los cuatro y siete días con aplicación diaria del ozono y descanso de la prótesis. En el grupo control, 16 pacientes (69,5%) fueron curados a los siete días o más con aplicación del nistatín y descanso nocturno de la prótesis. Conclusiones: el oleozón resultó ser eficaz en el tratamiento de la estomatitis subprótesis en los pacientes mayores de 60 años; se logró la curación de las lesiones en menor tiempo que en el tratamiento convencional, lo cual mejoró la calidad de vida de estos pacientes.

Introduction: denture stomatitis is disease of multifactorial etiology. Through clinical diagnosis, an erythema takes on the form of the limits of the prosthesis. Objective: to evaluate the effectiveness of the oleozon in denture stomatitis treatment in patients older than 60 years old. Methods: a quasi-experimental study between May 2015 and September 2015 in Cristino Naranjo health area was carried out. The universe consisted of 46 patients older than 60 years old who were using stomatology prosthesis who fulfilled the inclusion criteria. The variables analyzed were: type of treatment, initial degree of stomatitis, improvement and healing time. Results: the results showed that 20 patients (86.9%) were cured between four and seven days with daily application of ozone and taking out the prosthesis. In the control group, 16 patients (69.5%) were cured in seven days treated with nystatin, without using the prosthesis during the nights rest. Conclusions: the oeozon proved that was effective in denture stomatitis treatment in patients older than 60 years old, achieving the healing of lesions in less time, comparing with the use of conventional treatment, which improves the quality of life of these patients.

Phagocytosis and nitric oxide production by peritoneal adherent cells in response to Candida albicans in aging: a collaboration to elucidate the pathogenesis of denture stomatitis

Abstract Elderly denture wearers are commonly affected by Candida-associated denture stomatitis (DS), an inflammatory process of the oral mucosa strongly associated with Candida spp and other microorganisms, as well as local and systemic factors. The impaired immune response against pathogens is among the inherent host factors that have been also associated with the pathogenesis of DS. Mononuclear phagocytes respond to the pathogens through phagocytosis followed by the production of several substances inside the phagosomes, among them are the reactive nitrogen species (RNS). A failure in these mechanisms may contribute to the DS development. Objective The aim of this study was to investigate the influence of aging on the internalization and the production of nitric oxide (NO) by peritoneal adherent cells (PAC), in response to Candida albicans (C. albicans). Material and methods PAC obtained from young and aged mice were challenged with dead or viable C. albicans by using predetermined proportions (cells:yeast) for 30 and 120 minutes. Phagocytosis was analyzed by acridine orange dye, and NO production by the Griess reaction. Results C. albicans phagocytosis by PAC from aged mice was similar to that of young mice, although the cells from older mice cells present more internalized fungi compared with matched control. In addition, a tendency towards impaired NO production by peritoneal mononuclear phagocytes from aged mice was observed. Conclusions PAC from aged mice may capture and store many fungi, which in turn may mean that these cells are effectively unable to eliminate fungi, probably due to impaired NO production. Therefore, considering the important role of C. albicans overgrowth in the pathogenesis of DS and the aspects observed in this study, aging may favor the onset and severity of local candidosis such as DS and its systemic forms.

Surface Properties of Temporary Soft Liners Modified by Minimum Inhibitory Concentrations of Antifungals

Abstract Evaluating the addition of minimum inhibitory concentrations (MICs) of antifungals for Candida albicans biofilm on the hardness and roughness of temporary denture soft liners. Specimens (n=8; 36×7×6 mm) of tissue conditioner (Softone) and resilient liner (Trusoft) were produced either without (control) or with incorporation of drugs at MICs: nystatin (0.032 g/mL), chlorhexidine diacetate (0.064 g/mL), ketoconazole (0.128 g/mL), miconazole (0.256 g/mL) and itraconazole (0.256 g/mL). Specimens were stored in distilled water at 37 °C for 24 h, 7 days and 14 days prior to the hardness/roughness measurements. Data were analyzed by 3-way ANOVA and Tukey HSD test (α=0.05). The addition of the antifungals into both materials demonstrated no evident hardness change or decrease of this property compared with the control, except for miconazole in Softone, which increased the hardness after 14 days (p=0.003). The addition of nystatin into both materials, chlorhexidine in Trusoft and ketoconazole in Softone resulted in no significant changes of roughness compared with the control, after 7 days and 14 days (p>0.05). In these periods, itraconazole increased the roughness of both materials (p<0.001). The addition of all antifungals, except for the miconazole in Softone, resulted in no deleterious effects on the materials’ hardness over the evaluation time. The MICs of nystatin in both temporary soft lining materials, ketoconazole in Softone and chlorhexidine in Trusoft resulted in no deleterious effects for roughness up to 14 days.

Resumo Avaliar a adição de antifúngicos nas mínimas concentrações inibitórias (MCIs) para o biofilme de Candida albicans sobre a dureza e rugosidade da reembasadores resilientes temporários. Foram confeccionados corpos de prova (n=8; 36×7×6 mm) a partir de um condicionador de tecido (Softone) e um reembasador resiliente (Trusoft), sem (controle) ou com a incorporação de fármacos nas MCIs: nistatina (0,032 g/mL), diacetato de clorexidina (0,064 g/mL), cetoconazol (0,128 g/mL), miconazol (0,256 g/mL) e itraconazol (0,256 g/mL). Os corpos de prova foram armazenados em água destilada a 37 °C durante 24 h, 7 dias e 14 dias antes das mensurações de dureza e rugosidade. Os dados foram analisados por ANOVA 3-fatores e teste de Tukey HSD (α=0,05). A adição dos antifúngicos em ambos os materiais não demonstrou nenhuma alteração evidente na dureza ou diminuiu esta propriedade em comparação com o controle, exceto para o miconazol no Softone que aumentou a dureza após 14 dias (p=0,003). A adição de nistatina aos dois materiais, clorexidina no Trusoft e cetoconazol no Softone não resultou em alterações significativas de rugosidade em comparação com o controle após 7 e 14 dias (p>0,05). Nestes períodos, o itraconazol aumentou a rugosidade de ambos os materiais (p<0,001). A adição de todos os antifúngicos, exceto para o miconazol no Softone, não resultou em efeitos deletérios sobre a dureza dos materiais ao longo do tempo de avaliação. As MCIs de nistatina em ambos os materiais reembasadores resilientes temporários, cetoconazol no Softone e clorexidina no Trusoft não produziram efeitos deletérios para a rugosidade em até 14 dias.

Frecuencia de candidiasis oral asociada al uso de prótesis dentales en pacientes de la clínica odontológica de la Universidad Anáhuac Norte / The frequency of oral candidiasis associated with the use of dental prostheses in patients of the dental clinic at the Anahuac University

La candidiasis es la infección micótica más común de la cavidad bucaly es causada por el hongo Candida. Dentro de la población geriátricala candidiasis oral es uno de los tres principales motivos de consulta. El crecimiento en superfi cies es parte natural del modo de vivir del hongo Candida y es común que colonice las prótesis dentales, dando como resultado estomatitis por uso de dentadura o estomatitis subplaca.El diagnóstico de estomatitis por dentadura es relevante, ya quealrededor de 50 por ciento de las personas de edad promedio de 65 a 74 años, y 70 por ciento de 75 a 84 años utilizan prótesis dentales removibles. El objetivo del presente estudio fue determinar la frecuencia de candidiasis oral asociada a prótesis dentales removibles en los pacientes de la ClínicaOdontológica de la Universidad Anáhuac México Norte durante el periodo enero-mayo de 2016. Material y métodos: Se realizó un estudiodescriptivo, transversal y observacional. La muestra estuvo conformada por pacientes portadores de prótesis dentales removibles que acudieron a la Clínica Odontológica de la Universidad Anáhuac México Norte.Se interrogó al paciente respecto al uso de la prótesis y su condición de salud, posterior a la exploración clínica se tomó la citología exfoliativa de la mucosa debajo de la prótesis removible. Resultados: La muestraestuvo constituida por 22 pacientes de la clínica de prótesis removible,seis eran portadores de prótesis, de éstos 83 por ciento fueron positivos a candidiasis. Conclusiones: La falta de indicaciones sobre el cuidado, uso ehigiene de las prótesis dentales o la falta de apego a estas indicacionespor parte del paciente ocasionan el desarrollo de estomatitis subplaca.

Candidiasis is the most common mycotic infection in oral cavity andcaused by fungi candid. Oral candidiasis is one of three principalreasons for consultation in a geriatric population. A natural part of theway of living of the fungi Candida is the growth on surfaces. It growthmakes common that the fungi Candida colonize the dental prostheses,so the denture stomatitis or dental-related stomatitis is development.Denture stomatitis diagnosis is quite important because from the totalpopulation using dental removable prostheses around of 50% is between65-74 years old and 70% is between 75-84 years old. The ofthis study was identifying oral candidiasis frequency related to dentalremovable prostheses in patients from Universidad Anahuac, DentalSchool (México Norte), from January 2016 to May 2016. Material andmethods: Was made a descriptive, cross and observational study. Thesample was integrated by patients using dental removable prostheses,who went to Universidad Anahuac’s dental school (México Norte). Thepatients were interrogated about dental removable prostheses use andtheir health condition, after clinic exploration and exfoliative cytologywas taken from mucosa below dental removable prostheses. Results: 22patients from dental service using removable prosthesis constituted thesample, from this 22 patients only 6 were using a removable prosthesisand from this 6 patients only 83% were positive to oral candidiasis.Conclusions: Instructions scare about care, use, and hygiene of dentalprosthesis as well as not follow these instructions for patient’s partmake possible denture stomatitis development.

Sensitivity to antifungals by Candida spp samples isolated from cases of chronic atrophic candidiasis (CAC)

Abstract The treatment of choice for chronic atrophic candidiasis (CAC), also known as denture stomatitis, is topical antifungal therapy. This study aimed to isolate, identify, and assess the antifungal susceptibility of Candida species from mucosal sites in denture wearers with a diagnosis of CAC and determine the prevalence of associated variables. The sample consisted of 44 patients wearing complete or partial dentures who had a clinical diagnosis of CAC. Using sterile cotton swabs, specimens were collected from the oral mucosa of all patients and grown at 30ºC for 48 h in CHROMagar Candida, as a means of isolating and screening the species. The complementary identification of the species was performed using the VITEK 2 automated system (BioMérieux), as well as the determination of their susceptibility to antifungal agents. Data were analyzed using the chi-square test. STATA 13.1 was used for statistical analysis ( = 5%). Of 44 patients with CAC, 33 (75%) had lesions classified as Newton type II. Yeasts were isolated in 38 cases. The most prevalent species was Candida albicans. None of the isolates were resistant to the antifungals tested. Our findings suggest that current indications for antifungal agents are appropriate. Also, antifungal susceptibility testing and proper fungal identification can help dentists to determine the optimal course of treatment for CAC.

Resumo O tratamento de escolha para candidíase atrófica crônica (CAC), também conhecida como estomatite protética, é a terapia antifúngica tópica. Este estudo teve como objetivo isolar, identificar e avaliar a susceptibilidade antifúngica de espécies de Candida de locais mucosos em portadores de prótese com diagnóstico de CAC e determinar a prevalência de variáveis associadas. A amostra consistiu em 44 pacientes portadores de próteses completas ou parciais que tiveram um diagnóstico clínico de CAC. Usando swab estéril, foram coletados espécimes da mucosa oral de todos os pacientes e cultivados a 30ºC durante 48 h em CHROMagar Candida, como forma de isolamento e triagem das espécies. A identificação complementar das espécies foi realizada no sistema automatizado VITEK 2 (BioMérieux), bem como a determinação da susceptibilidade delas a agentes antifúngicos. Os dados foram analisados usando o teste do qui-quadrado. O STATA 13.1 foi utilizado para análise estatística ( = 5%). Dos 44 pacientes com CAC, 33 (75%) apresentaram lesões classificadas como Newton tipo II. As leveduras foram isoladas em 38 casos. A espécie mais prevalente foi Candida albicans. Nenhum dos isolados foi resistente aos antifúngicos testados. Nossas descobertas sugerem que as indicações atuais para os agentes antifúngicos são apropriadas. Além disso, testes de susceptibilidade antifúngicos e identificação fúngica adequada podem ajudar os dentistas a determinar o curso ótimo de tratamento para CAC.