Beatriz Helena Dias Panariello

To compare the antibiofilm and antiacidogenic effects of a fluoride-free nano-hydroxyapatite (nHAp) dentifrice with a sodium fluoride (NaF) dentifrice against Streptococcus mutans biofilms in vitro. S. mutans UA159 biofilms were grown on hydroxyapatite discs and treated with a dentifrice containing nano-hydroxyapatite (nHAp) (Boka Ela Mint Fluoride Free Toothpaste), a 0.24% NaF dentifrice (Colgate Cavity Protection Toothpaste), 0.12% chlorhexidine (CHX, positive control), or sterile distilled water (negative control). Two experimental conditions were evaluated: treatment during biofilm development (twice-daily from 0 to 72 hours) and treatment of mature biofilms (treatments applied at 48 hours and evaluated at 72 hours). Outcomes included colony-forming unit (CFU) counts and pH of spent media. Data was analyzed using one-way ANOVA followed by Šídák multiple comparisons (α= 0.05). During biofilm development, both dentifrices significantly reduced bacterial viability compared with the negative control (NaF, P< 0.0001; nHAp, P= 0.0200). However, when directly comparing the two, NaF caused a significantly greater reduction in bacterial viability than nHAp (P< 0.0001). Biofilms treated with NaF maintained higher pH values over time, indicating reduced acid production by S. mutans, whereas nHAp-treated groups showed moderate acidification. In mature biofilms, CHX and NaF demonstrated comparable antibiofilm activity, with no statistically significant difference between them (P= 0.0670). In contrast, nHAp showed significantly higher CFU counts than both CHX and NaF (P< 0.0001), although it still demonstrated a measurable reduction in bacterial viability compared with water control. NaF treatments significantly increased pH at 72 hours, whereas nHAp produced a smaller increase in pH. Altogether, the NaF dentifrice demonstrated superior antibiofilm and antiacidogenic effects compared with the fluoride-free nHAp dentifrice under the tested conditions. The fluoride-free nano-hydroxyapatite dentifrice did not exhibit anticaries potential.

This in vitro study evaluated the efficacy of Zerumbone (ZER), a sesquiterpene phytochemical extracted from the rhizomes of Zingiber zerumbet (L.) Smith with reported antimicrobial properties, alone or combined with Dextranase (DEX) and DNase I (DNase), against polymicrobial biofilms of fluconazole-susceptible and fluconazole-resistant Candida albicans and Streptococcus mutans. Mixed-species biofilms were formed with C. albicans ATCC 90028 (CaS), C. albicans ATCC 96901 (CaR), and S. mutans UA159 and assessed in inhibition and disruption assays. Treatments included ZER, DEX, and DNase, individually or in combination. Efficacy was analyzed by total biofilm mass, metabolic activity (CFU/mm2), and live/dead cell assessment using CLSM. Data were analyzed by one- and two-way ANOVA followed by Tukey’s posthoc test (α = 0.05). In the biofilm inhibition assay, ZER and its combinations, particularly ZER + DEX, demonstrated enhanced activity against both C. albicans and S. mutans strains. For CaS + Sm biofilms, ZER, ZER + DEX, and DNase + DEX achieved similar and the greatest reduction in CaS viability (>2.7 log10), whereas, for S. mutans, DNase + DEX, ZER, and ZER + DEX were the most effective (>2.1 log10). ZER + DEX also significantly reduced total microbial load in CaR + Sm biofilm. Notably, ZER + Dextranase was the only treatment that significantly reduced dry weight in susceptible biofilms and produced the highest biomass reduction in both susceptible and resistant biofilms as measured by crystal violet staining. In the biofilm disruption assay, ZER + DNase caused the greatest reduction in CaS viability (2.08 log10), whereas ZER and ZER + DNase were most effective against S. mutans (>2.5 log10). For CaR + Sm biofilms, ZER + DEX and ZER + DNase were among the most effective treatments. The confocal microscopy results corroborated these findings, showing that ZER and all treatments combined with ZER significantly increased the proportion of dead cells under both tested conditions. Within the limitations of this in vitro study, ZER alone or in combination with matrix-degrading enzymes (DEX and DNase), showed enhanced activity against both inhibition and disruption of mixed-species biofilms of C. albicans and S. mutans, including fluconazole-resistant strains, suggesting potential for further investigation as an adjunctive antimicrobial approach.

Periodontitis is implicated in a range of systemic conditions, including cardiovascular disease, diabetes, and respiratory disorders. Emerging evidence suggests a link between periodontal infection, inflammation, and the neurodegenerative process of Alzheimer’s disease (AD). This paper aimed to systematically review observational studies examining the association of periodontal pathogens and their inflammatory products with AD neurodegeneration. The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO - No. CRD42020150043). Methods followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search (PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science, Scopus, Cochrane Library, grey literature) was conducted until September 2025 with no language or date restrictions. Two independent reviewers screened and extracted data. The risk of bias was assessed via the Risk Of Bias In Non-randomized Studies - of Exposures (ROBINS‑E) tool. Of 1,421 identified citations, eight studies met the inclusion criteria. Participant numbers ranged from 349 to 2,191, and ages ranged from 40 to 90 years old. Meta‑analysis was not feasible due to methodological heterogeneity. Risk of bias was moderate in five studies and serious in three. Findings indicated that higher serum IgG antibodies to periodontal pathogens and elevated inflammatory mediators, notably tumor necrosis factor-alpha (TNF‑α), correlated with greater cognitive decline and markers of AD neurodegeneration, including MRI outcomes and APOE ε4 status. In conclusion, the current body of evidence suggests a potential association between periodontitis‑related inflammatory mediators, particularly TNF‑α, and elevated antibody responses to periodontal pathogens with AD progression. However, causality remains unestablished. Future prospective cohort and interventional studies are warranted to clarify the role of periodontal infection and inflammation in AD and to guide clinical strategies that may improve outcomes in AD populations.

The rise of antibiotic resistance and the limitations of conventional therapies for managing biofilm-related oral infections highlight the urgent need for novel solutions, with low-temperature plasma (LTP) emerging as a promising alternative due to its potent antimicrobial effects, tissue-safety, and reduced risk of fostering resistance. This scoping review investigates the efficacy of LTP application for the management of oral biofilms associated with dental caries, peri-implantitis, endodontic infections, and oral candidiasis. This review was conducted in accordance with the PRISMA-ScR guidelines and registered with the Open Science Framework (OSF). Studies were identified through comprehensive searches of PubMed/MEDLINE, EBSCO (Medline Ultimate and e-journals), and Google Scholar, with no publication date restrictions, and were supplemented by manual reference screening. Eligible studies included original research, published in English, examining LTP’s effectiveness in oral biofilms. After systematically screening the literature, 51 studies were included in this scoping review, comprising mostly in vitro research, alongside ex vivo, in situ, and clinical studies. Data extraction revealed LTP’s broad-spectrum antimicrobial potential and promising clinical implications for dentistry. This review highlights key findings, identifies research gaps, and underscores the therapeutic potential of LTP in managing complex oral biofilm-related infections.

E-cigarettes, a form of electronic nicotine delivery system (ENDS), have gained significant popularity, particularly among adolescents who often view vaping as a “cool” lifestyle choice. This growing trend has spurred extensive research on the effects of ENDS on both oral and systemic health. By synthesizing data from systematic reviews and meta-analyses, this umbrella review offers a comprehensive evaluation of the impact of e-cigarettes on oral biofilm accumulation and microbiota composition. A systematic search was conducted up to 12 March 2025, across PubMed/MEDLINE, Google Scholar, Cochrane Library, and Scopus for studies published between 2015 and 2025. Ten studies met the eligibility criteria. The quality of the selected papers, as assessed using the AMSTAR 2 tool, ranged from moderate to high. The findings of this review suggest that e-cigarette use may contribute to dysbiosis in the oral microbiota and foster biofilm accumulation, thereby increasing the risk of oral diseases such as periodontitis, peri-implantitis, oral candidiasis, and caries. The findings also highlight the need for further research into the long-term effects of e-cigarette use on oral health. This review is registered with PROSPERO (CRD420251025639).

This cross-sectional study compared cone-beam computed tomography (CBCT) measurements with clinical presurgical and intrasurgical measurements in the lower molars with furcation involvements (FIs). The sample consisted of 22 lower molars diagnosed with FI. The presurgical clinical examination included assessments of the probing depth, clinical attachment level, and horizontal bone loss (H-BL). Tomographic and intrasurgical measurements were taken to evaluate the vertical bone loss (V-BL), the distance of the cementoenamel junction to the base of the bone defect (CEJ-B), the horizontal bone loss (H-BL), root trunk length (RT), and furcation entrance width (FEW). Statistical analysis was performed, and values with p < 0.05 were considered statistically significant. The study of horizontal bone involvement showed a high level of agreement between presurgical, intrasurgical, and tomographic assessments. Strong correlations were found between intrasurgical and CBCT measurements for H-BL and furcation entrance width. Regarding the intrasurgical evaluation, class I FI was more prevalent, while class II FI was more frequently identified in CBCT evaluations. H-BL was significantly greater in class II FI compared to class I lesions. Moreover, the V-BL was greater in subclass B FI than in subclass A lesions. We found a strong correlation between horizontal furcation involvement measurements from CBCT and intrasurgical exams. CBCT was more accurate in assessing furcation morphology and vertical bone defects, making it a valuable complementary tool for decision-making in the surgical management of furcation involvements.

This case report highlights the clinical progression of a recurrent pyogenic granuloma (PG) in a 17-year-old male baseball player who experienced the transition of the lesion into a calcifying fibroblastic granuloma (CFG) extending into the periosteum and underlying bone. Adolescence, a period marked by significant hormonal changes and increased susceptibility to stress due to the demands of being an athlete, combined with a lack of proper oral hygiene, may have played a significant role in the lesion’s development, recurrence, and progression to CFG. The initial treatment involved excisional biopsy, followed by more extensive surgical intervention, including excision of the periosteum and bone curettage, to ensure complete removal of the recurrent lesion. The surgical site healed without complications. This case underscores the importance of accurate diagnosis and the need for thorough excision to prevent recurrence. Furthermore, it highlights the significance of maintaining proper oral hygiene and managing risk factors such as stress, which can influence the recurrence and progression of PGs to CFGs.

Objective This letter addresses the recent study by Braz et al. published in Clinical Oral Investigations in 2024 (https://doi.org/10.1007/s00784-024-05763-7), which reported that intentionally exposed d-PTFE membranes modulate microbial colonization in alveolar ridge preservation (ARP) sites, creating a more homogeneous and anaerobic community on both the inner and outer surfaces of the membrane. Materials and methods We argue that the study’s methodology may have skewed the results, particularly the inclusion of both intact and damaged extraction sockets (with loss of the buccal wall) and the absence of bone grafting. Results The absence of bone graft might have contributed to membrane dislodgement and increased microbial contamination rather than the membrane’s inherent properties. Conclusion This critique is significant because it challenges the conclusion that the d-PTFE membrane itself is responsible for microbial colonization, highlighting the need to consider extrinsic factors and study design limitations. Clinical Relevance: Our discussion aims to enhance the understanding of microbial dynamics in ARP procedures and emphasizes the need for caution when interpreting the study’s findings, given the context of established clinical practices and existing evidence.

Gingival enlargement (GE) is characterized by the overgrowth of gingival tissues, often exacerbated by dental biofilm and certain medications or substances. This report presents a case of severe GE in a 61-year-old male with generalized stage 4, grade C periodontitis linked to methamphetamine use, which the patient disclosed occurred during a period of homelessness. The treatment involved antibiotic therapy, extractions, gingivectomy, gingivoplasty, and osteoplasty to facilitate future oral rehabilitation. After treatment, the patient reported no pain and improved eating habits, significantly enhancing his quality of life. This case highlights the critical relationship between GE, substance abuse, and advanced periodontal disease, underscoring the need for increased awareness and interdisciplinary approaches in managing such patients.

The unique screw-shape design and microstructure of implants pose a challenge for mechanical debridement in removing biofilms. Biofilms exhibit increased resistance to antimicrobials relative to single planktonic cells, emphasizing the need for effective biofilm removal during periodontal therapy for peri-implantitis treatment. To tackle this issue, our team evaluated the effectiveness of low-temperature plasma (LTP) for disinfecting titanium discs contaminated with multispecies biofilms associated with peri-implantitis, specifically focusing on biofilms matured for 14 and 21 days as well as biofilms that had formed on Straumann^Ⓡ Ti-SLA implants for 21 days. The biofilms included Actinomyces naeslundii, Porphyromonas gingivalis, Streptococcus oralis, and Veillonella dispar, which were grown in anaerobic conditions. These biofilms were subjected to LTP treatment for 1, 3, and 5 min, using distances of 3 or 10 mm from the LTP nozzle to the samples. Control groups included biofilms formed on Ti discs or implants that received no treatment, exposure to argon flow at 3 or 10 mm of distance for 1, 3, or 5 min, application for 1 min of 14 μg/mL amoxicillin, 140 μg/mL metronidazole, or a blend of both, and treatment with 0.12% chlorhexidine (CHX) for 1 min. For the implants, 21-day-old biofilms were treated with 0.12% CHX 0.12% for 1 min and LTP for 1 min at a distance of 3 mm for each quadrant. Biofilm viability was assessed through bacterial counting and confocal laser scanning microscopy. The impact of LTP was investigated on reconstituted oral epithelia (ROE) contaminated with P. gingivalis, evaluating cytotoxicity, cell viability, and histology. The results showed that a 1 min exposure to LTP at distances of 3 or 10 mm significantly lowered bacterial counts on implants and discs compared to the untreated controls (p < 0.017). LTP exposure yielded lower levels of cytotoxicity relative to the untreated contaminated control after 12 h of contamination (p = 0.038), and cell viability was not affected by LTP (p ≥ 0.05); thus, LTP-treated samples were shown to be safe for tissue applications, with low cytotoxicity and elevated cell viability post-treatment, and these results were validated by qualitative histological analysis. In conclusion, the study's results support the effectiveness of 1 min LTP exposure in successfully disinfecting mature peri-implantitis multispecies biofilms on titanium discs and implants. Moreover, it validated the safety of LTP on ROE, suggesting its potential as an adjunctive treatment for peri-implantitis.