Assessment of microbiota diversity in dental unit waterline contamination

Background Dental unit waterlines (DUWLs) provide water for handpieces, air/water syringes, and mouth-rinse water outlets. DUWL contamination can negatively affect the operating environment and public health. Therefore, it is important to elucidate the bacterial concentrations and microbial composition in the DUWLs from different dental specialties. Methods We collected 350 5-mL dental water samples (from high-speed handpieces, air/water syringes, and mouth-rinse water outlets) from 60 dental chair units (DCUs) at a dental hospital to determine the bacterial concentrations by culture methods. Meanwhile, to investigate the diversity and community structure of microbe in the DUWLs, 17 high-quality DNA from 60 250-mL air/water syringe water samples, which were collected from the same 60 DCUs, were analyzed using 16S rDNA high-throughput sequencing. Results The median bacterial concentration was 166 (31.5, 672.5) CFU/mL and the range was 0–3,816,000 CFU/mL. Only 42.6% of the water samples had bacterial concentrations below 100 CFU/mL. The Kruskal–Wallis H-test revealed that the water samples from three dental specialties had significantly different bacterial concentrations (H = 27.441, P < 0.01). High-throughput sequencing results showed significant differences in bacterial community structure between periodontics and the other two dental specialties. In the samples from three dental specialties, 508 OTUs were detected, with 160, 182 and 176 OTUs unique to the periodontics, endodontics and prosthodontics specialties, respectively. Linear discriminant analysis (LDA) effect size (LEfSe) suggested that Hydrocarboniphaga, Zoogloea, Aquabacterium, and Hydrogenophaga were enriched in the periodontics specialty; Acinetobacter, Geothrix, and Desulfovibrio were enriched in the prosthodontics specialty; and Alistipes, Clostridium XIVa, and Serratia were enriched in the endodontics specialty. Seven potentially human-pathogenic genera (Pseudomonas, Acinetobacter, Sphingomonas, Ochrobactrum, Rhizobium, Brevundimonas, and Methylobacterium) with relative abundance exceeding 1% were also detected in the DUWLs. Conclusions The bacterial concentrations and microbial composition were influenced by different dental specialties, so a validated disinfection protocol should be used to control DUWL contamination in different dental specialties.

Microbiological and clinical effects of a Proanthocyanidin-enriched extract from Rumex acetosa in periodontally healthy carriers of Porphyromonas gingivalis

Rumex acetosa significantly inhibits the adhesion of Porphyromonas gingivalis (P.g.) to eukaryotic host cells in vitro. The objective of this randomized placebo-controlled pilot-trial was to analyze effects of a mouth rinse containing 0.8 % (w/w) of a quantified proanthocyanidin-enriched extract from Rumex acetosa (RA1) on microbiological, clinical, and cytological parameters in systemically healthy individuals without history of periodontitis, harboring P.g. intraorally. 35 subjects received a supragingival debridement (SD) followed by mouth rinsing (3 times daily) with either RA1 mouth rinse solution (test) or placebo (control) for 7 days as adjunct to routine oral hygiene. Supragingival biofilm samples were taken at screening visit, baseline (BL), 2, 4, 7 and 14 days after SD. P.g. and 11 other oral microorganisms were detected and quantified by rtPCR. Changes in the oral microbiota composition of one test and one control subject were assessed via high throughput 16S rRNS gene amplicon sequencing. Approximal Plaque Index (API) and the modified Sulcular Bleeding Index (SBI) were assessed at BL, 7- and 14-days following SD. Brush biopsies were taken at BL and 14 d following SD. Intergroup comparisons revealed no significant microbiological, cytological, and clinical differences at any timepoint. However, a significant reduction in SBI at day 14 (p=0.003) and API at day 7 (p=0.02) and day 14 (p=0.009) was found in the test group by intragroup comparison. No severe adverse events were observed. The results indicate that RA1 mouth rinse is safe but does not seem to inhibit colonization of P.g. or improve periodontal health following SD.

Clinical Audit of Two Standard Surgical Site Treatments Following Dental Extractions and The Impact on Incidence of Alveolar Osteitis Within a Specialist Dental Clinic

Background Alveolar osteitis is a painful condition following dental extraction associated with absence of blood clot and consequent exposure of underlying alveolar bone. It is a condition whose exact aetiology is unresolved and a known complication in up to 30-40% of dental extractions. The following report details a retrospective evaluation of two approved, long-standing wound care treatments used, post-extraction, within our clinic to assess for relationship with alveolar osteitis incidence. Methods Patients undergoing non-acute dental extraction at a dental out-patient clinic in the UK had received two different standard treatments for a period from 2000 to 2014. The treatments were mouth rinse with physiologic saline or surgical site irrigation and mouth rinse with physiologic saline-low dose aqueous chlorine used in wound and burn-site care. Retrospective, post-operative outcome analysis suggested improved outcomes with one of the standard treatments versus the other. A full retrospective audit of consecutive treatment outcomes was implemented to test the hypothesis. The audit data-collection was blinded to the treatment administered and to the identity of the treating clinician. Statistical analysis was carried out independently and blinded to the treatment modality. Results All patients were routinely reviewed within seven days and a determination of un-complicated healing vs alveolar osteitis (requiring further intervention) was made. Our results show that treatment with of aqueous chlorine in physiological saline significantly reduced the incidence of alveolar osteitis versus the control group who received physiologic saline without socket irrigation and chlorhexidine oral rinse home-care. (Odds Ratio 0.0146 Relative Risk 0.029 (95%CI 0.0093 to 0.0928) significance (p<0.001). Conclusions This is the first report to show an extremely significant reduction in the incidence of alveolar osteitis following treatment with low dose aqueous chlorine in physiological saline compared with those receiving the physiologic saline and saline mouth rinse or Corsodyl mouth rinse. This shows an approach to surgical site care is superior to the most common, reported, standard of care treatment. The impact of this has led to improved antibiotic stewardship within the clinic for dental extraction or elective oral surgery, including third molars.

Effects of Essential Oil Containing Mouth Rinse in Children with Black Staining : Two Case Reports

Black staining of the teeth in children and adolescents does not cause pain or serious illness, but it can be socially debilitating for esthetic reasons. Black staining is easily removed through periodic professional mechanical tooth cleaning and ultrasonic scaling, but it can easily recur within few months. Using essential oil-containing mouth rinses diluted at 50% twice per day could prevent the black staining from returning after it is removed, reducing the need for mechanical treatments and improving esthetics.

Topical Cyclosporine in Oral Lichen Planus—A Series of 21 Open-Label, Biphasic, Single-Patient Observations

Topical cyclosporine (CSA) has been reported as an alternative treatment in steroid-refractory oral lichen planus (OLP), but evidence is limited and conflicting. An N-of-1 trial setting could be appropriate to evaluate interindividual differences in treatment response. We studied a series of 21 open-label, biphasic single-patient observations. Patients (15 women, 6 men) with OLP recalcitrant to topical steroids received four weeks of CSA mouth rinse (200 mg/twice daily) followed by four weeks of drug withdrawal. Pain (visual analogue scale (VAS) score), disease extent (physicians’ global assessment (PGA) score) and quality of life (Dermatology Life Quality Index (DLQI) score,) were assessed at baseline (T0), after four weeks of treatment (T1) and after another four weeks without treatment (T2). Median age was 58 years (interquartile range/IQR = 52–67) and median disease duration was 18 months (IQR = 12–44). Median baseline VAS score decreased significantly at T1 (p = 0.0003) and increased at T2 (p = 0.032) (T0 = 5 (IQR = 3–6.5); T1 = 2 (IQR = 0.5–3.4); T2 = 3 (IQR = 2–4.8)). Similarly, median baseline PGA score decreased significantly at T1 (p = 0.001) and increased at T2 (p = 0.007) (T0 = 2 (IQR = 1.3–2.5); T1 = 1 (IQR = 1–2); T2 = 2 (IQR = 1–2)). Median baseline DLQI score also decreased significantly at T1 (p =.027) but did not change at T2 (p = 0.5) (T0 = 2.5 (IQR = 1–5.8); T1 = 1 (IQR = 0–3); T2 = 1 (IQR = 1–4)). CSA responders (n = 16) had significantly higher median baseline VAS scores (5.2 (IQR = 5–6.5)) than nonresponders (n =5) (2 (IQR = 2–3.5) (p = 0.02). In our study, pain, disease extent and quality of life of patients with OLP improved significantly during therapy with low-dose CSA mouth rinse and exacerbated after drug withdrawal. Remarkably, patients with high initial VAS scores seemed to profit most.

Self Prepared Herbal Mouthwash Used As Pre-procedural Rinse in Reducing Dental Aerosol: A Substitute to Chemical Mouthrinse: A Clinico-Microbiological Study

Aim:To evaluate and compare the efficacy of pre-procedural mouth rinses in reducing microbial content of aerosol product during ultrasonic-scaling procedures by viable bacterial count.Materials And Methods:5 patients were assigned in each group: A- Neem, B -CHX, C-Triphala, D - Control Group.In Group A, B, C -Patient were asked to rinse their mouth with 10 ml mouthwash for 30 seconds before SRP, of which A and C are self- prepared herbal mouthwashes i.e Triphala and Neem. Aerosol will be collected, cultured and incubated on blood agar plates at specified sites from operator. CFU will be counted and result will be assessed statistically. Conclusion: The study suggests that 10 ml of Neem Mouth rinse when used 10 minutes prior to ultrasonic scaling is more potent in reducing the aerosol contamination as compared to the Triphala mouth rinse and commercially available 0.2 % Chlorhexidine mouthrinse. Also the reduction in aerosol content was seen in Tray location when rinsed with CHX and aerosol reduction in Spitoon and Chest location while rinsing with Neem mouthrinse.

Evaluation of Efficacy of Triphala as a Preprocedural Mouth Rinse - A Comparative Study

BACKGROUND The objective of the study was to determine the efficacy of Triphala as a preprocedural mouth rinse & comparing the efficacy with chlorhexidine and betadine in reducing the viable microbial load in dental aerosols. METHODS 32 patients with chronic periodontitis were randomly allocated into 4 groups (A, B, C & D) of 8 patients each who received 0.2 % chlorhexidine (CHX), 6 % Triphala (TRP), 2 % betadine and water respectively as a pre-procedural mouth rinse. Blood agar plates were placed on the operator’s chest area and the patient’s chest area for collecting the aerosols. The agar plates were then incubated at 370C for 48 hours and colony-forming units (CFUs) were counted. RESULTS CFU was significantly reduced in groups A, B & C compared to group D. Intergroup comparison showed no significant difference in the efficacy of 0.2 % CHX and 6 % TRP with P-value 0.058 in the operator’s area and with a significant difference of Pvalue 0.014 in the patient’s area. 2 % betadine was found to be least effective among the 3 test groups. The number of CFUs was greater at the patient’s chest area than that of the operator. CONCLUSIONS This study reinforces the importance of preprocedural mouth rinse. Triphala showed near equal efficacy to CHX, which is considered the gold standard in aerosol reduction and also better than 2 % betadine. Therefore, it can be considered as an alternative to CHX as a preprocedural mouth rinse. KEY WORDS Triphala, Chlorhexidine, Betadine, Aerosols, Colony Forming Units (CFUs)