Biofilm describes a microbially-derived sessile community in which microbial cells are firmly attached to the substratum and embedded in extracellular polymeric matrix. Microbial biofilms account for up to 80% of all bacterial and fungal infections in humans. Biofilm-associated pathogens are particularly resistant to antibiotic treatment, and thus novel antibiofilm approaches needed to be developed. Antimicrobial Photodynamic therapy (aPDT) had been recently proposed to combat clinically relevant biofilms such as dental biofilms, ventilator associated pneumonia, chronic wound infections, oral candidiasis, and chronic rhinosinusitis. aPDT uses non-toxic dyes called photosensitizers (PS), which can be excited by harmless visible light to produce reactive oxygen species (ROS). aPDT is a multi-stage process including topical PS administration, light irradiation, and interaction of the excited state with ambient oxygen. Numerous in vitro and in vivo aPDT studies have demonstrated biofilm-eradication or substantial reduction. ROS are produced upon photo-activation and attack adjacent targets, including proteins, lipids, and nucleic acids present within the biofilm matrix, on the cell surface and inside the microbial cells. Damage to non-specific targets leads to the destruction of both planktonic cells and biofilms. The review aims to summarize the progress of aPDT in destroying biofilms and the mechanisms mediated by ROS. Finally, a brief section provides suggestions for future research.

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Antimicrobial Photodynamic Therapy to Control Clinically Relevant Biofilm Infections.

In recent years there have been an increasing number of in vitro and in vivo studies that show positive results regarding antimicrobial photodynamic therapy (aPDT) used in dentistry. These include applications in periodontics, endodontics, and mucosal infections caused by bacteria present as biofilms. Antimicrobial photodynamic therapy is a therapy based on the combination of a non-toxic photosensitizer (PS) and appropriate wavelength visible light, which in the presence of oxygen is activated to produce reactive oxygen species (ROS). ROS induce a series of photochemical and biological events that cause irreversible damage leading to the death of microorganisms. Many light-absorbing dyes have been mentioned as potential PS for aPDT and different wavelengths have been tested. However, there is no consensus on a standard protocol yet. Thus, the goal of this review was to summarize the results of research on aPDT in dentistry using the PubMed database focusing on recent studies of the effectiveness aPDT in decreasing microorganisms and microbial biofilms, and also to describe aPDT effects, mechanisms of action and applications.

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The application of antimicrobial photodynamic therapy (aPDT) in dentistry: a critical review

Antimicrobial efficacy of methylene blue-mediated photodynamic therapy on titanium alloy surfaces in vitro.

Introduction Good oral hygiene is a challenge for orthodontic patients because food readily becomes trapped around the brackets and under the archwires, and appliances are an obstruction to mechanical brushing. The purpose of this study was to compare plaque removal efficacy of 3 toothbrush treatments in orthodontic subjects. Methods This was a replicate-use, single-brushing, 3-treatment, examiner-blind, randomized, 6-period crossover study with washout periods of approximately 24 hours between visits. Forty-six adolescent and young adult patients with fixed orthodontics from a university clinic in Germany were randomized, based on computer-generated randomization, to 1 of 3 treatments: (1) oscillating-rotating electric toothbrush with a specially designed orthodontic brush head (Oral-B Triumph, OD17; Procter & Gamble, Cincinnati, Ohio); (2) the same electric toothbrush handle with a regular brush head (EB25; Procter & Gamble); and (3) a regular manual toothbrush (American Dental Association, Chicago, Ill). The primary outcome was the plaque score change from baseline, which we determined using digital plaque image analysis. Results Forty-five subjects completed the study. The differences in mean plaque removal (95% confidence interval) between the electric toothbrush with an orthodontic brush head (6% [4.4%-7.6%]) or a regular brush head (3.8% [2.2%-5.3%]) and the manual toothbrush were significant ( P P  = 0.007) to the regular brush head. No adverse events were seen. Conclusions The electric toothbrush, with either brush head, demonstrated significantly greater plaque removal over the manual brush. The orthodontic brush head was superior to the regular head.

Efficacy of 3 toothbrush treatments on plaque removal in orthodontic patients assessed with digital plaque imaging: A randomized controlled trial

Antimicrobial photodynamic therapy—A discovery originating from the pre-antibiotic era in a novel periodontal therapy

Aggregatibacter actinomycetemcomitans biofilm can be inactivated by methylene blue-mediated photodynamic therapy

Objective: This parallel, randomized, examiner-blind clinical trial aimed to evaluate the efficacy of two different toothbrushes (manual and sonic) on plaque control in adolescents. Material and Methods: This study enrolled 56 volunteers, randomly allocated to two different groups: group A (n = 28) for the manual toothbrush (Curaprox 5460 Ultra Soft ® ) and group B (n = 28) for the sonic toothbrush (Edel White ® ). Mean age was 17.2 ± 1.1 years. A calibrated periodontist performed a periodontal evaluation to assess the presence of plaque with the Turesky Modification of the Quigley Hein Plaque Index (PI) and the gingival inflammation with the Silness & Loe Gingival Index (GI). Adolescents received instructions about the mechanical control of plaque at baseline (T0), with a reexamination after 3 months (T1) and 6 months (T2). Non-parametric Mann Whitney test was used to compare the differences between the two toothbrush groups and the Friedman test was used for the comparisons between times. Results: There has been PI reduction concerning the study times (T0, T1 and T2, p 0.05). As for GI there has been no significant difference between the groups and between the study times (p>0.05). Conclusion: Both toothbrushes were efficient in the control of supragingival plaque (visible biofilm).

http://www.scielo.br/pdf/pboci/v19/1519-0501-pboci-19-e4305.pdf

Efficacy of Two Different Toothbrushes on Plaque Control: A Randomized Clinical Study

Associação entre periodontite e doença pulmonar

Objective: To verify the association between periodontal disease and lung disease from an epidemiological, case and control survey, in patients who attended the first aid service of the Adriano Jorge Foundation Hospital, Manaus, Amazonas, Brazil, from June 2006 to February 2007. Methods: The sample consisted of 140 patients, among whom community-acquired pneumonia was present in 60% (n = 70), and chronic obstructive pulmonary disease in 40% (case-group); and 70 patients without respiratory disease (control group), ranging between 19 and 69 years of ages, with a mean age of 41.3, and standard deviation of 13.6 years. The clinical parameters for evaluating periodontal changes were obtained by means of pocket depth, bleeding on probing, plaque index and clinical attachment loss. Results: Both groups showed no significant difference in any of the control variables (p>0.05). The groups showed significant difference only in the plaque index (p 0.05). Due to the increase in the bacterial plaque index in the oral cavity of patients with respiratory diseases, further studies should be conducted to verify what the relationship between the two diseases is. Indexing terms: periodontics; periodontitis; lung diseases.

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Silvio Antonio dos Santos Pereira

Papers

Aggregatibacter actinomycetemcomitans biofilm can be inactivated by methylene blue-mediated photodynamic therapy

Efficacy of Two Different Toothbrushes on Plaque Control: A Randomized Clinical Study

Associação entre periodontite e doença pulmonar

Association between periodontitis and lung disease

Inter-relação das doenças periodontais com as doenças cardiovasculares e cerebrovasculares isquêmicas