D-Tagatose: A Rare Sugar with Functional Properties and Antimicrobial Potential against Oral Species.

Carbohydrates have a dietary role, but excessive consumption of high-calorie sugars can contribute to an increased incidence of metabolic diseases and dental caries. Recently, carbohydrates with sweetening properties and low caloric value, such as D-tagatose, have been investigated as alternative sugars. D-tagatose is a rare sugar that has nutritional and functional properties of great interest for health. This literature review presents an approach to the biological effects of D-tagatose, emphasizing its benefits for oral health. Studies report that D-tagatose has antioxidant and prebiotic effects, low digestibility, reduced glycemic and insulinemic responses, and the potential to improve the lipid profile, constituting an alternative for diabetes mellitus and obesity. It can also be observed that D-tagatose has an antioxidant action, favoring the elimination of free radicals and, consequently, causing a reduction in cellular oxidative stress. Furthermore, it also has antibacterial potential against oral species. Regarding oral health, studies have shown that D-tagatose efficiently reversed bacterial coaggregations, including periodontopathogenic species, and impaired the activity and growth of cariogenic bacteria, such as S. mutans. D-tagatose significantly inhibited biofilm formation, pH decrease and insoluble glucan synthesis in S. mutans cultures. Salivary S. mutans counts were also significantly reduced by the consumption of chewing gum containing D-tagatose and xylitol. In addition, there is evidence that tagatose is effective as an air-polishing powder for biofilm decontamination. The literature indicates that D-tagatose can contribute to the prevention of systemic diseases, also constituting a promising agent to improve oral health.

Biological Properties and Antimicrobial Potential of Cocoa and Its Effects on Systemic and Oral Health.

Cocoa is considered a functional food because it is a natural source of macro- and micronutrients. Thus, cocoa is rich in vitamins, minerals, fiber, fatty acids, methylxanthines and flavonoids. In addition to favoring the metabolism of lipids and carbohydrates, the bioactive components of cocoa can have an antioxidant, anti-inflammatory and antimicrobial effect, providing numerous benefits for health. This literature review presents an overview of the effects of cocoa, fruit of the Theobroma cacao tree, on systemic and oral health. Several studies report that cocoa intake may contribute to the prevention of cardiovascular, neurodegenerative, immunological, inflammatory, metabolic and bone diseases, in addition to reducing the risk of vascular alterations and cognitive dysfunctions. On oral health, in vitro studies have shown that cocoa extract exerted an inhibitory effect on the growth, adherence and metabolism of cariogenic and periodontopathogenic bacteria, also inhibiting acid production, glycosyltransferase enzyme activity and the synthesis of insoluble polysaccharides. Additionally, administration of cocoa extract reduced biofilm accumulation and caries development in animals infected with cariogenic species. Clinical studies also reported that the use of mouthwashes containing cocoa extract reduced Streptococcus mutans counts in saliva and dental biofilm formation. In short, these studies highlight the nutritional value of cocoa, considering its clinical applicability, stability and economic accessibility.

Application of Fibrin Associated with Photobiomodulation as a Promising Strategy to Improve Regeneration in Tissue Engineering: A Systematic Review.

Fibrin, derived from proteins involved in blood clotting (fibrinogen and thrombin), is a biopolymer with different applications in the health area since it has hemostasis, biocompatible and three-dimensional physical structure properties, and can be used as scaffolds in tissue regeneration or drug delivery system for cells and/or growth factors. Fibrin alone or together with other biomaterials, has been indicated for use as a biological support to promote the regeneration of stem cells, bone, peripheral nerves, and other injured tissues. In its diversity of forms of application and constitution, there are platelet-rich fibrin (PRF), Leukocyte- and platelet-rich fibrin (L-PRF), fibrin glue or fibrin sealant, and hydrogels. In order to increase fibrin properties, adjuvant therapies can be combined to favor tissue repair, such as photobiomodulation (PBM), by low-level laser therapy (LLLT) or LEDs (Light Emitting Diode). Therefore, this systematic review aimed to evaluate the relationship between PBM and the use of fibrin compounds, referring to the results of previous studies published in PubMed/MEDLINE, Scopus and Web of Science databases. The descriptors "fibrin AND low-level laser therapy" and "fibrin AND photobiomodulation" were used, without restriction on publication time. The bibliographic search found 44 articles in PubMed/MEDLINE, of which 26 were excluded due to duplicity or being outside the eligibility criteria. We also found 40 articles in Web of Science and selected 1 article, 152 articles in Scopus and no article selected, totaling 19 articles for qualitative analysis. The fibrin type most used in combination with PBM was fibrin sealant, mainly heterologous, followed by PRF or L-PRF. In PBM, the gallium-aluminum-arsenide (GaAlAs) laser prevailed, with a wavelength of 830 nm, followed by 810 nm. Among the preclinical studies, the most researched association of fibrin and PBM was the use of fibrin sealants in bone or nerve injuries; in clinical studies, the association of PBM with medication-related treatments osteonecrosis of the jaw (MRONJ). Therefore, there is scientific evidence of the contribution of PBM on fibrin composites, constituting a supporting therapy that acts by stimulating cell activity, angiogenesis, osteoblast activation, axonal growth, anti-inflammatory and anti-edema action, increased collagen synthesis and its maturation, as well as biomolecules.

Therapeutic Effects of Citrus Flavonoids Neohesperidin, Hesperidin and Its Aglycone, Hesperetin on Bone Health.

Flavonoids are natural phytochemicals that have therapeutic effects and act in the prevention of several pathologies. These phytochemicals can be found in seeds, grains, tea, coffee, wine, chocolate, cocoa, vegetables and, mainly, in citrus fruits. Neohesperidin, hesperidin and hesperetin are citrus flavonoids from the flavanones subclass that have anti-inflammatory and antioxidant potential. Neohesperidin, in the form of neohesperidin dihydrochalcone (NHDC), also has dietary properties as a sweetener. In general, these flavanones have been investigated as a strategy to control bone diseases, such as osteoporosis and osteoarthritis. In this literature review, we compiled studies that investigated the effects of neohesperidin, hesperidin and its aglycone, hesperetin, on bone health. In vitro studies showed that these flavanones exerted an antiosteoclastic and anti- inflammatory effects, inhibiting the expression of osteoclastic markers and reducing the levels of reactive oxygen species, proinflammatory cytokines and matrix metalloproteinase levels. Similarly, such studies favored the osteogenic potential of preosteoblastic cells and induced the overexpression of osteogenic markers. In vivo, these flavanones favored the regeneration of bone defects and minimized inflammation in arthritis- and periodontitis-induced models. Additionally, they exerted a significant anticatabolic effect in ovariectomy models, reducing trabecular bone loss and increasing bone mineral density. Although research should advance to the clinical field, these flavanones may have therapeutic potential for controlling the progression of metabolic, autoimmune or inflammatory bone diseases.

Effects of a Biocomplex Formed by Two Scaffold Biomaterials, Hydroxyapatite/Tricalcium Phosphate Ceramic and Fibrin Biopolymer, with Photobiomodulation, on Bone Repair.

There are several treatment methods available for bone repair, although the effectiveness becomes limited in cases of large defects. The objective of this pre-clinical protocol was to evaluate the grafting of hydroxyapatite/tricalcium phosphate (BCP) ceramic biomaterial (B; QualyBone BCP®, QualyLive, Amadora, Portugal) together with the heterologous fibrin biopolymer (FB; CEVAP/UNESP Botucatu, Brazil) and with photobiomodulation (PBM; Laserpulse®, Ibramed, Amparo, Brazil) in the repair process of bone defects. Fifty-six rats were randomly divided into four groups of seven animals each: the biomaterial group (G1/B), the biomaterial plus FB group (G2/BFB); the biomaterial plus PBM group (G3/B + PBM), and the biomaterial plus FB plus PBM group (G4/BFB + PBM). After anesthesia, a critical defect was performed in the center of the rats' parietal bones, then filled and treated according to their respective groups. The rats were euthanized at 14 and 42 postoperative days. Histomorphologically, at 42 days, the G4/BFB + PBM group showed a more advanced maturation transition, with more organized and mature bone areas forming concentric lamellae. A birefringence analysis of collagen fibers also showed a more advanced degree of maturation for the G4/BFB + PBM group. In the comparison between the groups, in the two experimental periods (14 and 42 days), in relation to the percentage of formation of new bone tissue, a significant difference was found between all groups (G1/B (5.42 ± 1.12; 21.49 ± 4.74), G2/BFB (5.00 ± 0.94; 21.77 ± 2.83), G3/B + PBM (12.65 ± 1.78; 29.29 ± 2.93), and G4/BFB + PBM (12.65 ± 2.32; 31.38 ± 2.89)). It was concluded that the use of PBM with low-level laser therapy (LLLT) positively interfered in the repair process of bone defects previously filled with the biocomplex formed by the heterologous fibrin biopolymer associated with the synthetic ceramic of hydroxyapatite and tricalcium phosphate.

Potential of Fibrin Glue and Mesenchymal Stem Cells (MSCs) to Regenerate Nerve Injuries: A Systematic Review.

Cell-based therapy is a promising treatment to favor tissue healing through less invasive strategies. Mesenchymal stem cells (MSCs) highlighted as potential candidates due to their angiogenic, anti-apoptotic and immunomodulatory properties, in addition to their ability to differentiate into several specialized cell lines. Cells can be carried through a biological delivery system, such as fibrin glue, which acts as a temporary matrix that favors cell-matrix interactions and allows local and paracrine functions of MSCs. Thus, the aim of this systematic review was to evaluate the potential of fibrin glue combined with MSCs in nerve regeneration. The bibliographic search was performed in the PubMed/MEDLINE, Web of Science and Embase databases, using the descriptors ("fibrin sealant" OR "fibrin glue") AND "stem cells" AND "nerve regeneration", considering articles published until 2021. To compose this review, 13 in vivo studies were selected, according to the eligibility criteria. MSCs favored axonal regeneration, remyelination of nerve fibers, as well as promoted an increase in the number of myelinated fibers, myelin sheath thickness, number of axons and expression of growth factors, with significant improvement in motor function recovery. This systematic review showed clear evidence that fibrin glue combined with MSCs has the potential to regenerate nervous system lesions.

Solutions and Gels Containing a Sugarcane-Derived Cystatin (CaneCPI-5) Reduce Enamel and Dentin Erosion in vitro.

The effect of solutions and gels containing a sugarcane-derived cystatin (CaneCPI-5) on the protection against enamel and dentin erosion in vitro was evaluated. Bovine enamel and dentin specimens were divided into 2 groups (n = 135 and 153/group for enamel and dentin, respectively) that were treated with solutions or chitosan gels containing 0.1 or 0.25 mg/mL CaneCPI-5. The positive controls for solutions and gels were Elmex Erosion Protection™ solution and NaF gel (12,300 ppm F), respectively. Deionized water and chitosan gel served as controls, respectively. The solutions were first applied on the specimens for 1 min and the gels for 4 min. Stimulated saliva was collected from 3 donors and used to form a 2-h acquired pellicle on the specimens. Then, the specimens were submitted to an erosive pH cycling protocol 4 times/day for 7 days (0.1% citric acid pH 2.5/90 s, artificial saliva/2 h, and artificial saliva overnight). The solutions and gels were applied again during pH cycling, 2 times/day for 1 min and 4 min, respectively, after the first and last erosive challenges. Enamel and dentin losses (µm) were assessed by contact profilometry. Data were analyzed by 2-way ANOVA and Tukey's test (p < 0.05). All the treatments significantly reduced enamel and dentin loss in comparison with controls. Both CaneCPI-5 concentrations had a similar protective effect against enamel erosion, but only the higher concentration was as effective against dentin erosion as the positive control. Regarding the vehicles, only the 0.1 mg/mL gel performed worse than the positive control for dentin. CaneCPI-5 reduced enamel and dentin erosion to a similar extent as the fluoride-containing vehicles. However, dentin requires higher CaneCPI-5 concentrations, in the case of gels. Solutions or gels containing CaneCPI-5 might be a new approach to protect against dental erosion.

Effects of Therapy with Fibrin Glue combined with Mesenchymal Stem Cells (MSCs) on Bone Regeneration: A Systematic Review.

Cell therapy strategies using mesenchymal stem cells (MSCs) carried in fibrin glue have shown promising results in regenerative medicine. MSCs are crucial for tissue healing because they have angiogenic, anti-apoptotic and immunomodulatory properties, in addition to the ability to differentiate into several specialized cell lines. Fibrin sealant or fibrin glue is a natural polymer involved in the coagulation process. Fibrin glue provides a temporary structure that favors angiogenesis, extracellular matrix deposition and cell-matrix interactions. Additionally, fibrin glue maintains the local and paracrine functions of MSCs, providing tissue regeneration through less invasive clinical procedures. Thus, the objective of this systematic review was to assess the potential of fibrin glue combined with MSCs in bone or cartilage regeneration. The bibliographic search was performed in the PubMed/MEDLINE, LILACS and Embase databases, using the descriptors ("fibrin sealant" OR "fibrin glue") AND "stem cells" AND "bone regeneration", considering articles published until 2021. In this case, 12 preclinical and five clinical studies were selected to compose this review, according to the eligibility criteria. In preclinical studies, fibrin glue loaded with MSCs, alone or associated with bone substitute, significantly favored bone defects regeneration compared to scaffold without cells. Similarly, fibrin glue loaded with MSCs presented considerable potential to regenerate joint cartilage injuries and multiple bone fractures, with significant improvement in clinical parameters and absence of postoperative complications. Therefore, there is clear evidence in the literature that fibrin glue loaded with MSCs, alone or combined with bone substitute, is a promising strategy for treating lesions in bone or cartilaginous tissue.

Updates in association of gastroesophageal reflux disease and dental erosion: systematic review.

Introduction: Dental erosion occurs by dissolving dental apatite when exposed to non-bacterial acids. One of the factors that predispose to dental erosion is gastroesophageal reflux disease (GERD) due to chronic regurgitation of gastric contents to the oropharynx. Thus, in addition to other extraesophageal symptoms, individuals with GERD may have erosive dental lesions.Areas covered: The objective of this systematic review was to evaluate the association and prevalence of erosive wear in patients with GERD. The bibliographic search was performed in the Pubmed and Web of Science databases, using the descriptors 'gastroesophageal reflux disease' AND 'dental erosion', considering clinical studies recently published from 2012 to 2020.Expert opinion: GERD can be considered a risk factor for the development of erosive dental lesions, whose prevalence was significantly higher in this group. However, several other factors can be commonly associated with the prevalence and severity of dental erosion among the world population, such as dietary habits, lifestyle, abrasion and bruxism. Thus, the prevalence and distribution of erosive lesions among healthy and GERD subjects varied widely among studies, which denotes the etiological complexity of dental erosion and reinforces the importance of careful and detailed anamnesis in order to establish an accurate diagnosis.

Saliva as a diagnostic tool for dental caries, periodontal disease and cancer: is there a need for more biomarkers?

Introduction: A biomarker is a biological indicator of normal or pathogenic processes. Identification of biomarkers is useful for the prevention, diagnosis and prognosis of diseases as well as for monitoring the progression of pathological disorders. Several types of molecules present in biological fluids can act as biomarkers such as DNA, coding and non-coding RNA, lipids, metabolites, proteins and even microbes. In this context, saliva emerges as a useful diagnostic tool for the detection of biomarkers involved with oral and systemic diseases, since it reflects the pathophysiological conditions of the organism and allows early, rapid, practical and noninvasive detection of biomarkers.Areas covered: This review discusses the properties of saliva as a diagnostic tool and addresses the main identified biomarkers related to dental caries, periodontal disease, head and neck cancer and other types of cancer of considerable incidence among the world population.Expert commentary: Despite extensive efforts which have been directed toward the identification of one or a combination of biomarkers with good predictive values for the early detection of dental caries, periodontal disease and cancer, these biomarkers still need validation before chairside point-of-care devices can be widely used in the clinic.

Anticaries Potential of Low Fluoride Dentifrices Found in The Brazilian Market

Abstract Low-fluoride (F) dentifrices (<600 µg F/g) are widely available worldwide, but evidence to recommend the use of such dentifrices, with either regular or improved formulations, is still lacking. Therefore, the aim of this study was to evaluate the anticaries potential of low-F dentifrices found in the Brazilian market, using a validated and tested pH-cycling model. Enamel blocks were selected by surface hardness (SH) and randomized into four treatment groups (n=12): non-F dentifrice (negative control), low-F dentifrice (500 μg F/g), low-F acidulated dentifrice (550 μg F/g) and 1,100 μg F/g dentifrice (positive control). The blocks were subjected to pH-cycling regimen for 8 days and were treated 2x/day with dentifrice slurries prepared in water (1:3, w/v). The pH of the slurries was checked, and only the acidulated one had low pH. After the pH cycling, SH was again determined and the percentage of surface hardness loss was calculated as indicator of demineralization. Loosely- and firmly-bound F concentrations in enamel were also determined. The 1,100 μg F/g dentifrice was more effective than the low-F ones to reduce enamel demineralization and was the only one that differed from the non-F (p<0.05). All F dentifrices formed higher concentration of loosely-bound F on enamel than the non-F (p<0.05), but the 1,100 μg F/g was the only one that differed from the non-F in the ability to form firmly-bound F. The findings suggest that the low-F dentifrices available in the Brazilian market, irrespective of their formulation, do not have anticaries potential.

Resumo Dentifrícios de baixa concentração de fluoreto (F) (< 600 µg F/g) estão amplamente disponíveis no mundo, mas ainda não há evidência para recomendar seu uso, quer seja em formulações regulares ou melhoradas. Assim, o objetivo deste estudo foi avaliar o potencial anticárie de dentifrícios de baixa concentração de fluoreto encontrados no mercado brasileiro, utilizando um modelo de ciclagens de pH validado e testado. Blocos de esmalte bovinos foram selecionados pela dureza de superfície e randomizados em quatro grupos (n=12): dentifrício sem fluoreto (controle negativo), dentifrício de baixa concentração de fluoreto (500 μg F/g), dentifrício acidulado de baixa concentração de fluoreto (550 μg F/g) e dentifrício de 1100 μg F/g (controle positivo). Os blocos foram submetidos ao regime de ciclagem de pH por 8 dias e tratados 2 x/dia com suspensões aquosas dos dentifrícios (1:3 p/v). O pH das suspensões foi checado, e apenas o acidulado tinha baixo pH. Após a ciclagem de pH, a dureza de superfície foi novamente determinada e a porcentagem de perda de dureza foi calculada como indicador de demineralização. As concentrações de fluoreto fracamente e firmemente ligado ao esmalte também foram determinadas. O dentifrício de 1.100 μg F/g foi mais efetivo do que os de baixa concentração na redução da desmineralização do esmalte e foi o único que diferiu significativamente do não fluoretado (p<0,05). Todos os dentifrícios fluoretados foram capazes de formar maiores concentrações de fluoreto fracamente ligado ao esmalte do que o não fluoretado (p<0,05), mas o de 1.100 μg F/g foi o único que diferiu do não fluoretado na capacidade de formar fluoreto firmemente ligado ao esmalte. Os resultados sugerem que dentifrícios de baixa concentração de fluoreto disponíveis no mercado brasileiro, independentemente da formulação, não têm potencial anticárie.

Anticaries Potential of Low Fluoride Dentifrices Found in The Brazilian Market.

Low-fluoride (F) dentifrices (<600 µg F/g) are widely available worldwide, but evidence to recommend the use of such dentifrices, with either regular or improved formulations, is still lacking. Therefore, the aim of this study was to evaluate the anticaries potential of low-F dentifrices found in the Brazilian market, using a validated and tested pH-cycling model. Enamel blocks were selected by surface hardness (SH) and randomized into four treatment groups (n=12): non-F dentifrice (negative control), low-F dentifrice (500 µg F/g), low-F acidulated dentifrice (550 µg F/g) and 1,100 µg F/g dentifrice (positive control). The blocks were subjected to pH-cycling regimen for 8 days and were treated 2x/day with dentifrice slurries prepared in water (1:3, w/v). The pH of the slurries was checked, and only the acidulated one had low pH. After the pH cycling, SH was again determined and the percentage of surface hardness loss was calculated as indicator of demineralization. Loosely- and firmly-bound F concentrations in enamel were also determined. The 1,100 µg F/g dentifrice was more effective than the low-F ones to reduce enamel demineralization and was the only one that differed from the non-F (p<0.05). All F dentifrices formed higher concentration of loosely-bound F on enamel than the non-F (p<0.05), but the 1,100 µg F/g was the only one that differed from the non-F in the ability to form firmly-bound F. The findings suggest that the low-F dentifrices available in the Brazilian market, irrespective of their formulation, do not have anticaries potential.