Synergistic effect of Salvadora persica and chitosan nanoparticles against oropharyngeal microorganisms.

Herbal medicine combined with nanoparticles has caught much interest in clinical dental practice, yet the incorporation of chitosan with Salvadora persica (S. persica) extract as an oral care product has not been explored. The aim of this study was to evaluate the combined effectiveness of Salvadora persica(S. persica) and Chitosan nanoparticles (ChNPs) against oropharyngeal microorganisms. Agar well diffusion, minimum inhibitory concentration, and minimal lethal concentration assays were used to assess the antimicrobial activity of different concentrations of ethanolic extracts of S. persica and ChNPs against selected fungal strains, Gram-positive, and Gram-negative bacteria. A mixture of 10% S. persica and 0.5% ChNPs was prepared (SChNPs) and its synergistic effect against the tested microbes was evaluated. Furthermore, the strain that was considered most sensitive was subjected to a 24-h treatment with SChNPs mixture; and examined using SEM, FT-IR and GC-MS analysis. S. persica extract and ChNPs exhibited concentration-dependent antimicrobial activities against all tested strains. S. persica extract and ChNPs at 10% were most effective against S. pneumoni, K. pneumoni, and C. albicans. SEM images confirmed the synergistic effect of the SChNPs mixture, revealing S. pneumonia cells with increased irregularity and higher cell lysis compared to the individual solutions. GC-MS and FT-IR analysis of SChNPs showed many active antimicrobial phytocompounds and some additional peaks, respectively. The synergy of the mixture of SChNPs in the form of mouth-rinsing solutions can be a promising approach for the control of oropharyngeal microbes that are implicated in viral secondary bacterial infections.

Gum-gut axis: The potential role of salivary biomarkers in the diagnosis and monitoring progress of inflammatory bowel diseases.

The gut mucosa is an extension of the oral mucosa, and both are directly linked. There is emerging evidence that pathogenic oral microbiome contributes greatly to the risk of developing Inflammatory Bowel Disease (IBD). Dysbiosis of the oral microbiota can interfere with the host immune system's ability to respond normally, thereby increasing the development of periodontitis which raises the risk of IBD, cancer, rheumatoid arthritis, cardiovascular disease, and other complex disease processes. Salivary biomarkers are possibly important for determining the incidence, severity, and remission of IBD. Nevertheless, clinical translation of biomarker knowledge from lab to clinical practice needs further studies that identify biomarkers related to the transitional phase between healthy and unhealthy. In this review, the bidirectional pathway between the gut and the oral cavity was investigated and several aspects were discussed.

Biomarkers of non-communicable chronic disease: an update on contemporary methods.

Chronic diseases constitute a major global burden with significant impact on health systems, economies, and quality of life. Chronic diseases include a broad range of diseases that can be communicable or non-communicable. Chronic diseases are often associated with modifications of normal physiological levels of various analytes that are routinely measured in serum and other body fluids, as well as pathological findings, such as chronic inflammation, oxidative stress, and mitochondrial dysfunction. Identification of at-risk populations, early diagnosis, and prediction of prognosis play a major role in preventing or reducing the burden of chronic diseases. Biomarkers are tools that are used by health professionals to aid in the identification and management of chronic diseases. Biomarkers can be diagnostic, predictive, or prognostic. Several individual or grouped biomarkers have been used successfully in the diagnosis and prediction of certain chronic diseases, however, it is generally accepted that a more sophisticated approach to link and interpret various biomarkers involved in chronic disease is necessary to improve our current procedures. In order to ensure a comprehensive and unbiased coverage of the literature, first a primary frame of the manuscript (title, headings and subheadings) was drafted by the authors working on this paper. Second, based on the components drafted in the preliminary skeleton a comprehensive search of the literature was performed using the PubMed and Google Scholar search engines. Multiple keywords related to the topic were used. Out of screened papers, only 190 papers, which are the most relevant, and recent articles were selected to cover the topic in relation to etiological mechanisms of different chronic diseases, the most recently used biomarkers of chronic diseases and finally the advances in the applications of multivariate biomarkers of chronic diseases as statistical and clinically applied tool for the early diagnosis of chronic diseases was discussed. Recently, multivariate biomarkers analysis approach has been employed with promising prospect. A brief discussion of the multivariate approach for the early diagnosis of the most common chronic diseases was highlighted in this review. The use of diagnostic algorithms might show the way for novel criteria and enhanced diagnostic effectiveness inpatients with one or numerous non-communicable chronic diseases. The search for new relevant biomarkers for the better diagnosis of patients with non-communicable chronic diseases according to the risk of progression, sickness, and fatality is ongoing. It is important to determine whether the newly identified biomarkers are purely associations or real biomarkers of underlying pathophysiological processes. Use of multivariate analysis could be of great importance in this regard.

Evaluating the pictorial warnings on tobacco products in Arabian Gulf countries against other international pictorial warnings.

BACKGROUND: Few assessments of pictorial warnings (PWs) on cigarette packs implemented in Gulf Cooperation Council (GCC) countries have been done. METHODS: This article includes two cross-sectional studies. In Study 1, convenience samples of adults from the Kingdom of Saudi Arabia (n=111) and USA (n=115) participated in a consumer survey to rate a total of nine PWs from the GCC, Australia and the UK. Outcome measures were affective responses to PWs and concerns about smoking. In Study 2, tobacco control experts (n=14) from multiple countries rated the same PWs on a potential efficacy scale and completed one open-ended question about each. The PWs were altered to mask their country of origin. Analyses compared ranking on multiple outcomes and examined ratings by country of origin and by smoking status. RESULTS: In the consumer survey, participants from both countries rated the PWs from GCC lower than PWs from other countries on the two measures. The mixed-model analysis showed significant differences between the PWs from Australia and those from the GCC and between the PWs from the UK and those from the GCC (p<0.001) in the consumer and expert samples. The experts' comments about the PWs implemented in the GCC were negative overall and confirmed previously identified themes about effective PWs. CONCLUSION: This study shows PWs originating from the GCC had significantly lower ratings than those implemented in Australia and the UK. The GCC countries may need to re-evaluate the currently implemented PWs and update them periodically.

Cytotoxic effect of Salvadora persica extracts on human gingival fibroblast cells.

OBJECTIVES: To assess the cytotoxic potential of Salvadora persica (S. persica) extracts on human gingival fibroblast (HGF) cells. METHODS: This study was conducted between January and May 2012 in collaboration with Dental Caries Research Chair, College of Dentistry, King Saud University, Riyadh, Saudi Arabia. Extracts of S. persica using hexane, ethylacetate, and ethanol as solvents at concentrations of 0.5 mg/ml and 1 mg/ml were evaluated for their cytotoxic activity against HGFs using the 3 cytotoxic assays: (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, a tetrazole) (MTS), lactic dehydrogenase (LDH), and crystal violet (CV). International standards for the evaluation of medical materials recommended cut-off value of cell survival >70% was used for interpretation of the results. RESULTS: Ethanol extract of S. persica at 0.5 mg/ml and 1 mg/ml and hexane extract of S. persica at 0.5 mg/ml were completely devoid of cytotoxic activity, hexane extract at 1 mg/ml in comparison with controls  demonstrated some cytotoxicity with cell survival of 88% (p=0.045) in MTS, 86% (p=0.01) in LDH, and 88% (p=0.002) in CV assays. Similarly, ethyl acetate extract of S. persica at 0.5 mg/ml maintained cell viability of 91% in MTS, 81% in LDH, and 80% in CV assays. Maximum cytotoxicity against HGFs was observed with ethyl acetate extract of S. persica at 1 mg/ml with cell survival of 60% in MTS, 40% in LDH, and 66% CV assays (p=0.0001).   CONCLUSION: The acceptable level of cytotoxicity associated with S. persica ethanol and hexane extracts requires further evaluation to be used as irrigation solutions in endodontic treatment. 

Effect of chloroform, orange solvent and eucalyptol on the accuracy of four electronic apex locators.

The aim of this study was to evaluate the effect of three retreatment solutions on the accuracy of four electronic apex locators, the Root ZX mini, the Mini Apex Locator, the Root ZX and the Elements Diagnostic Unit and Apex Locator. Forty extracted single-rooted human teeth were used in this study. The four electronic apex locators were operated according to the manufacturer's instructions to locate the 'apical constriction' in the presence of chloroform, orange solvent or eucalyptol in the canal. The accuracy of each apex locator was not affected by the type of retreatment solution present in the root canal. In addition, the accuracy of the four apex locators was similar in the presence of each of the tested solutions.

Evaluation of cyclic flexural fatigue resistance of 25/0.04 and 25/0.06 twisted file rotary nickel-titanium endodontic instruments.

Twisted files (TFs) are rotary nickel-titanium (NiTi) instruments that are produced with a newly developed manufacturing process that is supposed to improve their properties, especially flexibility and resistance to cyclic flexural fatigue failure. The aim of this study was to study the cyclic flexural fatigue failure resistance of tip size International Standards Organization 25 TFs with two tapers 0.04 and 0.06 and to compare them with the Profile (PF) rotary NiTi files of similar tip size and taper. Four groups of fifteen files were used in this study. TF (25/0.04), TF (25/0.06), PF (25/0.04) and PF (25/0.06) were tested using the cyclic flexural fatigue testing device. The time to failure during cyclic flexural fatigue testing was recorded. The mean time required for the instrument to fail under cyclic flexural fatigue testing was 235.5 ± 68 s for 25/0.04 TF, 188.5 ± 75 s for 25/0.06 TF, 180.3 ± 102 s for 25/0.04 PF and 156.3 ± 17 s for 25/0.06 PF. The difference between the time to failure of 25/0.04 TF and 25/0.06 TF was not statistically significant. The difference between the time to failure of TF and PF of similar tip size and taper was not statistically significant. The findings of this study indicate that size 25/0.04 and 25/0.06 TFs had similar resistance to cyclic flexural fatigue failure. In addition, TFs were not superior, in terms of resistance to cyclic flexural fatigue failure, to PF of similar tip size and taper.

Assessment of geometrical characteristics of dental endodontic micro-instruments utilizing X-ray micro computed tomography

OBJECTIVE: The aim of this study was to quantify the surface area, volume and specific surface area of endodontic files employing quantitative X-ray micro computed tomography (mXCT). MATERIAL AND METHODS: Three sets (six files each) of the Flex-Master Ni-Ti system (Nº 20, 25 and 30, taper .04) were utilized in this study. The files were scanned by mXCT. The surface area and volume of all files were determined from the cutting tip up to 16 mm. The data from the surface area, volume and specific area were statistically evaluated using the one-way ANOVA and SNK multiple comparison tests at α=0.05, employing the file size as a discriminating variable. The correlation between the surface area and volume with nominal ISO sizes were tested employing linear regression analysis. RESULTS: The surface area and volume of Nº 30 files showed the highest value followed by Nº 25 and Nº 20 and the differences were statistically significant. The Nº 20 files showed a significantly higher specific surface area compared to Nº 25 and Nº 30. The increase in surface and volume towards higher file sizes follows a linear relationship with the nominal ISO sizes (r²=0.930 for surface area and r²=0.974 for volume respectively). Results indicated that the surface area and volume demonstrated an almost linear increase while the specific surface area exhibited an abrupt decrease towards higher sizes. CONCLUSIONS: This study demonstrates that mXCT can be effectively applied to discriminate very small differences in the geometrical features of endodontic micro-instruments, while providing quantitative information for their geometrical properties.

Surgical and implant-supported fixed prosthetic treatment of a patient with ectodermal dysplasia: a case report.

Ectodermal dysplasia (ED) is a hereditary disorder that affects ectodermal structures. The main clinical oral manifestations of ED include oligodontia and deficient alveolar ridges. This case report presents the oral rehabilitation of a 15-year-old female patient who never received an accurate diagnosis or appropriate dental care. Treatment included a combination of surgical intervention, a maxillary tooth-supported fixed detachable telescopic prosthesis, and an implant-supported mandibular fixed partial denture. The results showed a significant improvement in the esthetics, function, and psychological status of the patient. This article stresses the importance of appropriate care in providing an acceptable quality of life for patients with ED.

Assessment of geometrical characteristics of dental endodontic micro-instruments utilizing X-ray micro computed tomography.

OBJECTIVE: The aim of this study was to quantify the surface area, volume and specific surface area of endodontic files employing quantitative X-ray micro computed tomography (mXCT). MATERIAL AND METHODS: Three sets (six files each) of the Flex-Master Ni-Ti system (Nº 20, 25 and 30, taper .04) were utilized in this study. The files were scanned by mXCT. The surface area and volume of all files were determined from the cutting tip up to 16 mm. The data from the surface area, volume and specific area were statistically evaluated using the one-way ANOVA and SNK multiple comparison tests at α=0.05, employing the file size as a discriminating variable. The correlation between the surface area and volume with nominal ISO sizes were tested employing linear regression analysis. RESULTS: The surface area and volume of Nº 30 files showed the highest value followed by Nº 25 and Nº 20 and the differences were statistically significant. The Nº 20 files showed a significantly higher specific surface area compared to Nº 25 and Nº 30. The increase in surface and volume towards higher file sizes follows a linear relationship with the nominal ISO sizes (r²=0.930 for surface area and r²=0.974 for volume respectively). Results indicated that the surface area and volume demonstrated an almost linear increase while the specific surface area exhibited an abrupt decrease towards higher sizes. CONCLUSIONS: This study demonstrates that mXCT can be effectively applied to discriminate very small differences in the geometrical features of endodontic micro-instruments, while providing quantitative information for their geometrical properties.

Comparison of the single cone and cold lateral compaction techniques in sealing 0.04 taper root canal preparations.

This study compared the coronal sealing ability of three different combinations of obturation materials and techniques after root canals were prepared with 0.04 taper nickel titanium (NiTi) rotary instruments. This study utilized three experimental groups: Group 1 was obturated with 0.02 taper gutta-percha cones and AH 26 sealer cement, using the cold lateral compaction technique; Group 2 was obturated with 0.02 taper Resilon cones and Epiphany sealer, using the cold lateral compaction technique; and Group 3 was obturated with 0.04 taper Resilon cones and Epiphany sealer, using the single cone technique. Coronal microleakage was evaluated using dye penetration methodology. Microleakage results showed that the single cone Resilon obturation technique showed significantly more linear dye penetration than Resilon or gutta-percha subjected to cold lateral compaction. There was no significant difference between gutta-percha and Resilon when the cold lateral compaction technique was used. The results of this study suggest that the single cone Resilon obturation technique is inferior to cold lateral compaction of Resilon or gutta-percha.

Evaluation of cyclic flexural fatigue of M-wire nickel-titanium rotary instruments.

INTRODUCTION: This study was conducted to investigate cyclic flexural fatigue resistance of GT series X rotary files made from the newly developed M-wire nickel-titanium alloy compared with GT and Profile nickel-titanium files made from a conventional nickel-titanium alloy. METHODS: Fifteen files, size 30/0.04, of each type were used to evaluate the cyclic flexural fatigue resistance. A simple device was specifically constructed to measure the time each file type required to fail under cyclic flexural fatigue testing. RESULTS: The results of this experiment indicated that the GT series X files had superior cyclic flexural fatigue resistance than the other 2 file types made from a conventional nickel-titanium alloy (P = .004). On the other hand, the difference between the Profile and the GT files was not statistically significant. CONCLUSIONS: The findings of this study suggest that size 30/0.04 nickel-titanium rotary files made from the newly developed M-wire alloy have better cyclic flexural fatigue resistance than files of similar design and size made from the conventional nickel-titanium alloy.

Efficacy of two rotary NiTi instruments in the removal of Gutta-Percha during root canal retreatment.

The aim of this study was to evaluate the efficacy of ProTaper and K3 in the removal of gutta-percha during root canal retreatment in comparison with hand Hedstrom files. Time of gutta-percha removal and amount of apically extruded debris were also evaluated. Sixty extracted single-rooted anterior teeth and premolars were instrumented and obturated with laterally condensed gutta-percha technique. The teeth were cleared and randomly divided into three groups of 20 teeth each. The roots were split longitudinally, digital images were created using a scanner, and the areas of remaining filling material were traced using Ulead Photoimpact7 then calculated using SigmaScan software. The results indicated that the two rotary nickel-titanium instruments left significantly less remaining filling material than hand instruments (p < 0.001). The ProTaper and K3 required significantly less time for filling material removal than hand instruments (p < 0.001). There was no statistically significant difference among the three techniques regarding the amount of apically extruded debris (p = 0.159). In conclusion, ProTaper and K3 were found to be effective and faster in removing gutta-percha.

Efficacy of a new brush-covered irrigation needle in removing root canal debris: a scanning electron microscopic study.

The usefulness of NaviTip FX, a brush-covered irrigation needle, in endodontic therapy has never been reported. Therefore, the purpose of this investigation was to evaluate the cleaning efficacy of this new brush-covered irrigation needle, the NaviTip FX. Thirty single-rooted teeth were randomly divided into two equal groups and instrumented using the crown-down technique with 0.04 taper ProFile. Following each file use, the canals were irrigated with 1 ml of 5.25% NaOCl using the NaviTip FX needle for group 1 or using the same needle without the brush for group 2. At the end of instrumentation, the roots were cut longitudinally and each half was divided into three equal parts. The specimens were then routinely prepared for scanning electron microscopic evaluation. The results showed that using the NaviTip FX produced cleaner coronal thirds of instrumented root canals compared to the control group. On the other hand, the middle and apical thirds were not statistically significantly different between the two groups. Further development of this irrigation technique to improve cleanliness of the apical and middle thirds is required before the NaviTip FX can be recommended for routine use during root canal therapy.

In vitro evaluation of three techniques to obturate 0.06 taper canal preparations.

The aim of this study was to evaluate the ability of three obturation methods to seal root canals prepared using 0.06 taper rotary instruments. Forty-five extracted human single-rooted teeth were instrumented with 0.06 taper Profile nickel-titanium rotary files and randomly divided into three experimental groups containing 15 teeth each. The first group was obturated using the System B technique with 0.06 taper standardised gutta-percha points, the second group was obturated using the System B technique with non-standardised MF gutta-percha points, the third group was obturated by cold lateral condensation technique using standardised 0.02 taper master gutta-percha points. Apical leakage of the roots was evaluated by dye penetration using a stereomicroscope after sectioning the roots. The group obturated using System B and 0.06 taper gutta-percha points showed the least dye penetration. However, the difference in the linear extent of dye penetration was not statistically significant.