Sulfate-Reducing Bacteria in Patients Undergoing Fixed Orthodontic Treatment.

OBJECTIVES: The oral microbiological environment may be implicated in the corrosion of orthodontic metals. This study aimed to examine the prevalence of sulfate-reducing bacteria (SRB) in orthodontic patients undergoing fixed appliance treatment. METHODS: Sixty-nine orthodontic and 69 healthy non-orthodontic participants were enrolled in the study. Supragingival and subgingivaloral biofilm were collected and tested for the presence of SRB. The DNA extraction, polymerase chain reaction (PCR), and 16sRNA Sanger sequencing method was performed from the SRB-positive samples. The sequenced PCR products were analysed and compared with databases to identify the bacterial genus. RESULTS: Amongst 69 orthodontic patients, characteristic black precipitates developed in 14, indicating the presence of iron sulfides which demonstrates the likelihood of SRB. Alternatively, 2 out of 69 showed the presence of SRB in healthy non-orthodontic participants (controls). Desulfovibrio spp was confirmed by analyses of 16sRNA sequencing, which revealed that the SRB prevalence was 20% in the examined participants with orthodontic appliances. CONCLUSIONS: The prevalence of SRB was found to be significantly higher amongst orthodontic patients compared to non-orthodontic participants. Presence of stainless steel in the oral environment may have facilitated the colonisation of SRB.

In-Vitro Assessment of the Corrosion Potential of an Oral Strain of Sulfate-Reducing Bacteria on Metallic Orthodontic Materials.

AIM: Orthodontic literature is scant when it comes to microbial corrosion. The oral prevalence of many bacteria which are capable of causing microbial corrosion is reported in the dental literature. The aim of this study is to experimentally determine the corrosive potential of an oral strain of Sulfate-reducing bacteria. MATERIALS AND METHODS: Stainless steel (SS) bracket, stainless steel archwire, NiTi archwire, Titanium molybdenum (TMA) archwire, and titanium miniscrew were immersed in five media which included Artificial saliva (group I), Sulfate rich artificial saliva (group II), API agar medium specific for SRB (group III), AS + API medium+ bacterial strain (group IV), SRAS+ API medium+ bacterial strain (group V). The materials were then subjected to Scanning electron microscopy and energy-dispersive X-ray analysis (EDX). RESULTS: Materials in groups I, II, and III did not show any surface changes whereas materials in groups IV and V which contained the bacteria showed surface changes which were erosive patches suggestive of corrosion. EDX analyses were in line with similar findings. CONCLUSION: This in vitro study suggested that the oral strain of Sulfate-reducing bacteria was able to induce corrosive changes in the experimental setup.

Microbial Corrosion in Orthodontics.

Even with the exponential popularity of the contemporary clear aligners, the main stream of orthodontic practice still remains to be metal braces especially in adolescent age-group.1 Along with the advantages of metal braces such as lower cost, reduced friction, etc., there goes the disadvantages such as corrosion possibility, reduced esthetics, etc. Corrosion of orthodontic appliances is a widely researched topic.2-5 It is surprising to learn that microbially induced corrosion (MIC) has not been addressed in orthodontic literature till date. Microbial corrosion is an interesting arena which requires knowledge of both corrosion science and microbiology. The microorganisms capable of corrosion include various bacteria, fungi, and algae. The most common among them which has been widely indicated in MIC are the bacteria belonging to the sulfur cycle especially the sulfate-reducing bacteria (SRB). The connecting knot with orthodontics is the reported prevalence of these SRB in the oral cavity. SRB is prevalent in healthy individuals,6,7 patients associated with periodontitis6-11 and patients with gastrointestinal issues.12-14 The prevalence of SRB in the oral cavity has a greater clinical implication since the SRB have been proven to cause corrosion of stainless steel.15-24 There is literature attributing SRB as a potential cause in periodontal diseases7-11 as well as gastrointestinal diseases such as ulcerative colitis, inflammatory bowel diseases, and Crohn's disease.12 With its presence in the healthy oral environment already reported in the previous studies,6,7,25,26 it further emphasizes the absolute need to be researching on its corrosion possibility in the intra oral environment. The genus generally found intraorally was Desulfovibrio and Desulfobacter10 which is commonly regarded as the most "opportunistic" and ubiquitous group of sulfate reducers.6,7 There is an interesting literature on the inhibition of Desulfovibrio spp. by human saliva, the reason being quoted as salivary nitrate and nitrite.14 The mechanism behind the antimicrobial action of nitrate and nitrite is that they increase the oxidative stress on the bacteria.27 However, concentrations of salivary nitrate vary depending on the food intake, endogenous production, and salivary flow rate.28,29 Despite there exist natural inhibitors, the prevalence in oral cavity is high, 22% in healthy and 86% in patients associated with periodontitis.7 There is a predilection for the bacteria to grow when favorable conditions exist. Biofilms is one such favorable medium for the growth of SRB. Paster et al.26 identified SRB in biofilms of patients associated with refractory periodontitis, periodontitis, acute necrotizing ulcerative gingivitis (ANUG), and also in healthy subjects. Biofilm is a surface film composed of organic and inorganic saliva components that are colonized with microorganisms in extracellular polymeric substances adsorbed on all surfaces in the oral cavity.30 The oral biofilm formation is a complex process involving interspecies aggregation, which is surrounded by a cohesive matrix, forms a complex structure which in turn facilitates anaerobic growth. It is the intrinsic nature of oral biofilms which make the survival of facultative anaerobes such as SRB in the oral cavity possible. Literatures31-35 report that there are increased biofilm formations in orthodontic patients due to increased retentive areas caused by the brackets, ligatures, wires, mini implants, force components, and archwires. Bacteria in dental plaque function as a metabolically, functionally, and physically integrated community.36 The study by Mystkowska et al.37 mentioned that biofilm per se play a critical role in corrosion process by forming corrosive microcells. With time-dependent association, the microbes in the biofilm, along with saliva acting as an electrolyte and components from food, causes a decreased pH in the areas immediately under the biofilms. The decreased pH along with a change of oxygenation releases metal oxides and hydroxides from the metal surface ultimately leading to the corrosion of metallic structures.37-41 The initial roughness also acts in a vicious form promoting more biofilm adherence and the process repeats causing more corrosion. With the biofilm itself serving to initiate and propagate corrosion, the increased prevalence of SRB in patients associated with orthodontics treatment all the more increases the possibility of MIC of orthodontic materials.

Effect of Fluoridated Mouthwashes on Corrosion Property of Orthodontic Appliances: A Narrative Review.

OBJECTIVE: To analyze the effects of various fluoride agents on metallic orthodontic materials. DESIGN: PubMed, Google Scholar, and Embase were searched using keyword combinations such as fluoride mouthwash and orthodontic appliance and corrosion, fluoride and fixed appliance, and metal degradation. RESULTS: Of 315 articles, 20 were selected for inclusion in the review. All types of fluoride agents, especially the acidulated form of fluoride, seemed to influence the corrosion of orthodontic metallic appliances. CONCLUSION: Since most of the studies reported suggest that fluoride ions are capable of causing corrosion of metallic orthodontic appliances, attention should be paid while prescribing fluoride agents for orthodontic patients. The degree of corrosion seems to be directly correlated with the acidity of the medium and the concentration of fluoride ions. Co-Cr brackets are resistant to corrosion by fluoride while stainless steel and Ti brackets are susceptible. CLINICAL SIGNIFICANCE: It allows making the right choice while choosing the orthodontic brackets in relation to their susceptibility to corrosion by fluoride ions.

Assessing the Potential Association Between Microbes and Corrosion of Intra-Oral Metallic Alloy-Based Dental Appliances Through a Systematic Review of the Literature.

Objective: Systematic review assessing the association between oral microorganisms and corrosion of intra-oral metallic alloy-based dental appliances. Design: PubMed, Scopus, and Web of Science were searched using keyword combinations such as microbes and oral and corrosion; microbes and dental and corrosion; microorganisms and oral and corrosion; microorganisms and dental and corrosion. Results: Out of 141 articles, only 25 satisfied the selection criteria. Lactobacillus reuteri, Streptococcus mutans, Streptococcus sanguis, Streptococcus mitis, Streptococcus sobrinus, Streptococcus salivarius, sulfate-reducing bacteria, sulfate oxidizing bacteria, Veilonella, Actinomyces, Candida albicans were found to have a potential association with corrosion of intraoral metallic alloys such as stainless steel, titanium, nickel, cobalt-chromium, neodymium-iron-boron magnets, zirconia, amalgam, copper aluminum, and precious metal alloys. Conclusion: The included studies inferred an association between oral microorganisms and intra-oral metallic alloys-based dental appliances, although, it is vital to acknowledge that most studies in the review employed an in-vitro simulation of the intra-oral condition.

Is the Stability of a Standard Stable Reference Stable Enough?

The dogmatic approach of following the past principles has made many significant features of science go unnoticed and unquestioned. One such is the concept of immutability of the anterior contour of the sella turcica. For many decades, we have been using the anterior contour of sella turcica as a stable reference structure to study the growth of the craniofacial skeleton.1 This was based on the usage by Björk and Skieller. But on analyzing the various studies on the growth and disease of the pituitary gland and its influence on the size and morphology of sella turcica, it seems that the anterior contour of the sella turcica may not be a stable parameter of reference. This article is an attempt to throw light on the intricacies of the association between pituitary gland and sella turcica.

Assessment of the dental and skeletal effects of fan-type rapid maxillary expansion screw and Hyrax screw on craniofacial structures.

AIMS AND OBJECTIVES: The purpose of the study was to assess the skeletal and dental effects of fan-type rapid maxillary expansion (RME) appliance and Hyrax RME appliance on the craniofacial structures. MATERIALS AND METHODS: The sample of the study included 12 patients with constricted maxillary arches. Acrylic bonded type of attachment was used for both groups. Changes in sagittal, vertical, and transverse relationship were assessed with lateral and frontal cephalograms, respectively. Intercanine and intermolar widths were measured with stone models. Pre- and immediate post-treatment records were statistically analyzed with Wilcoxon signed-rank test. The differences between the groups were evaluated using Mann-Whitney U-test. Since the data pertaining to intercanine width and intermolar width were normally distributed, parametric test of significance (unpaired t-test) was used to compare them. RESULTS: Results showed that Hyrax presented with significantly greater increments for both nasal cavity width and maxillary width when compared to fan-type RME. Both groups had retroclination of incisors. The increase in the intercanine width was almost similar in both groups. CONCLUSION: Fan-type RME caused only minimal expansion of the intermolar width when compared to the Hyrax. The ratio between the intercanine and intermolar width expansion was nearly 4:1 in the fan-type RME and 0.75:1 in Hyrax.

The Enigma behind Pituitary and Sella Turcica.

The pituitary gland's role as a functional matrix for sella turcica has not been suggested in orthodontic literature. This paper is an attempt to correlate the role of pituitary gland in the development of sella turcica. A case report of dwarfism associated with hypopituitarism is presented to highlight the above hypothesis.