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Plaque Biofilm Management: Tailored – Comprehensive Oral Care Part C

Plaque Biofilm Management: Tailored – Comprehensive Oral Care Part C . Prof. John G. Thomas, Ph.D. Kerri Thomas, BS West Virginia University School of Dentistry . IN REMEMBERANCE OF MOM AND DAD: Kendall Paul (Pat) Thomas, BS, MS, DDS (1910-1987)

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Plaque Biofilm Management: Tailored – Comprehensive Oral Care Part C

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  1. Plaque Biofilm Management:Tailored – Comprehensive Oral CarePart C

    Prof. John G. Thomas, Ph.D. Kerri Thomas, BS West Virginia University School of Dentistry IN REMEMBERANCE OF MOM AND DAD: Kendall Paul (Pat) Thomas, BS, MS, DDS (1910-1987) Eleanor Ruth (Hannah) Thomas, BS, RDH, MS (1921-1993)
  2. Univ of Jakarta, SoD Outback? Univ of Jakarta, SoD Dutch West Indies Est. 1928
  3. Royal Indian University, SoD Mumbai How many dental schools in India??????
  4. I. Introduction/ Background (Problems) West Virginia University Biofilm Research Laboratory
  5. WHY??? Role of Dental Hygiene in Addressing Oral Biofilms What are PRESENT anti biofilm tools??? What is a Students/Researcher perspective??? What are EMERGING anti biofilm tools

  6. Tailored-Comprehensive Oral Care(T-COC)A Continuum from Birth to Death

    West Virginia University Biofilm Research Laboratory Adult ICU B Step-down Unit NICU/ PICU C IN-PATIENT A Birth Transition Stage Death Oral Care G Hospice D OUT-PATIENT Rehabilitation F Nursing Home Long-Term Care Assisted Living E
  7. Strategies in controlling the biofilm: HABITATS Mechanical Remove/reduce/disrupt habitat Maintenance of Oral Hygiene Chemical Anti bacterial Chlorexidine, Essential Oils, Triclosan, etc… Fluoride, Xylitol, Calcium, Phosphate Pre/Probiotic
  8. West Virginia University Biofilm Research Laboratory Tailoring – Comprehensive Oral Care Reestablishing Normal Flora 5 Parts Brushing 45° Angle (Nursing Homes) Scaling and Root Planing w/ Sonication PROBIOTICS Oral Balance Anti-Septic Mouth Rinse EO (w/wo OH) CHX (w/wo OH) 0.2% Dilmophinol Flossing Intra – Proximal Brushes

  9. Present Oral anti biofilm Tools

    Practice by habit???
  10. CH 3 + + O CH H C 3 3 ANTI-BIOFILM MOLECULES Chlorhexidine; a bisbiguanide MW 505.45 Penetration: SIZE Stability: pH range Polarity: NEUTRAL Hydrophobic: ENVIRONMENT Carrier Eucalyptol; 1,3,3-Trimethyl-2-oxabicyclo[2,2,2]-octane MW 154.25
  11. In vitro analyses of gram positive organism A using Poloxamer Live/dead stain (red = dead,green = live) Stage I-II
  12. Does size matter? “I should sit where?”
  13. “Tooth Mousse” / Recaldent™MI Paste University of Melbourne Casein Phospho-peptido-Amorphorus Calcium Phosphate (CPP-ACP) Inhibits enamel and dentin demineralization Slows progression of caries significantly Adjunct to Fluoride Treatment Rynolds EC. CPP-ACP – The Scientific Evidence. Adv. in Dental Res. 2009. 21; 25.

  14. Emerging Oral anti biofilm Tools

    Practice by science????
  15. Oral Health Rinse FDA Approved (Class II Device) (8 Double-Blind Studies) 0.2% Dilmophinol Hydrochloride 1.5% Alcohol, 2x/Day (All other oral anti-plaque/anti-gingivitis rinses are classified as drugs) Prevents Adhesion GUM PerioShield: www.sunstaramerica.com Formerly John O. Butler Company
  16. Probiotic Buster Sentinel Wellness Balance Likes leafy vegetables Can travel GUT or Oral location Outcompetes or neutralizes residential bacteria Godfather is Elie Metchnikoff
  17. Peter Kropotkin Viewed the theory of “survival of the fittest” as supporting co-operation rather than competition. In his book Mutual Aid: A Factor of Evolutionhe set out his analysis leading to the conclusion that the fittest was not necessarily the best at competing individually, but often the community made up of those best at working together. “The animal species, in which individual struggle has been reduced to its narrowest limits, and the practice of mutual aid has attained the greatest development, are invariably the most numerous, the most prosperous, and the most open to further progress." The “We” View = Biofilm Phenotype Elie Metchnikoff Born in the Ukraine in 1845 Was a Biologist/Immunologist and Nobel Prize winner Developed a theory that lactic acid in the GI tract, could, by preventing putrefaction, prolong life. Later restated that “Probiotics are viable bacteria that beneficially affect the host by improving its intestinal microbial balance.”
  18. West Virginia University Biofilm Research Laboratory Probiotics: Definition(WHO, 2002) Living microorganisms Provide a benefit when administered in adequate amounts Non-toxic Food Additive OR Medical Management/ Intervention and position of the FDA

  19. Prebiotics: An Overview

    Functional Food Ingredients (Japan, 1980) Non-Digestible Beneficial Effects through Selective Metabolism Complementary to Probiotics West Virginia University Biofilm Research Laboratory

  20. Tracking & Linking Disease by 6 Global Regions: The WHO Gradient - Probiotics

    2. Europe Fastest 45% Germany + UK Children GI Dental Japan/ Asia-Pacific 2nd Fastest GI Immunity 6. 1. 4. 5. US is $11.3 bill to $15 bill in 2013 Dental Caries 3. 30% of Population uses Probiotics $85.7 bill (Global) Growing $at least 15%/yr (Doubling since 1993) 3. African Region 5. South-East Asia Region 4. Eastern Mediterranean Region 2. European Region 1. Region of the Americas 6. Western Pacific Region http://www.who.int/about/regions/en/index.html
  21. Mechanisms of Action Of Oral Probiotics
  22. ORAL MICROBES AND INTRAORAL SITE DISTRIBUTION +++ = Many ++ = Some + = Few
  23. Probiotic Strains West Virginia University Biofilm Research Laboratory

  24. Various probiotic administrations for oral health

  25. Lactobacillus reuteri (Prodentis) 200x106 CFU/each PerioBalance
  26. WHO Barcelona 2008 Probiotics
  27. Clinical study in Turkey Randomised, placebo-controlled clinical trial, Istanbul. Design: 3 week study. Healthy volunteersL. reuteri vs placebo in straws or tablets Assessments: S. mutans in saliva day 0 S. mutans in saliva day 21 Caglar et al. ActaOdontologicaScandinavica. 2006;64:314-318.
  28. Krasse et al. Swed Dent J . 2006;30:55-60.
  29. Krasse et al. Swed Dent J 30: 55-60 (2006)
  30. West Virginia University Biofilm Research Laboratory Treatment with GUM PerioBalance chewing gum
  31. Level of S. mutans after experiment (both groups) Nikawa et al. Int J Food Microbiol 95: 219-223 (2004)
  32. PerioBalance® Daily Dental Probiotic Clinically shown to reduce plaque and promote healthy teeth and gums Clinical research showed healthier gums in 28 days Naturally promotes a balanced oral environment Mint-flavored lozenge An effective adjunct to scaling and root planing 40
  33. New Paradigms THM “Restorative Microbiology” “Custodians” of Oral, Normal Flora “Stewards” of Oral health /Oral Benifical Flora
  34. WVUH Oral-Facial Microbiology Laboratory VII. Laboratory The Center for Oral Health Research in Appalachia (COHRA) 2002-2009 WVU SoD University of Pittsburgh SoD http://www.silvermandental.com/new_site/photo_edits/big_root_canal.jpg WWW.WVUHLAB.COM
  35. Periodontal Case Study 30-year old Caucasian Female A. Background: Contributing Factors: Good oral hygiene Never smoked Tetracycline—6 months previous Scaling and Root Planing—6 months previous Site Sampled: Two 7mm depths One 8mm depth Diagnosis: Localized Aggressive Periodontitis (Localized Juvenile Periodontitis) Type IV Microbiology Results Darkfield Microscopy Several organisms and epithelial cells under low-power field 1. Small spirochetes 1% 2. Intermediate spirochetes 22% 3. Large spirochetes 4% 4. Motile Rods 12% 5. Cocci 18% 6. Non-motile Rods 36% 7. Fusiforms 2% 8. Filaments 5% http://www.hsc.wvu.edu/som/pathology/Facultybio/thomas.asp Click on “Oral/Dental Microbiology: Management and Cases”
  36. Periodontal Case, Continued B. Microbiology Results Continued Culture Observations Total anaerobic counts 175,000,000 CFU Fusobacterium nucleatum 16,000 CFU Eikenella corrodens 250,000 CFU Tannerella forsythia 6,000 CFU Campylobacter rectus 50,000 CFU A. actinomycetemcomitans 40,000 CFU Susceptibility Eikenella corrodens 250,000 CFU Drug MIC ug/ml Interpretation Ampicillin 0.25 Susceptible Ciprofloxacin 0.125 Susceptible Metronidazole 192 Resistant Doxycycline 8 Intermediate Clindamycin 48 Resistant Erythromycin 24 Resistant
  37. Periodontal Case, Continued B. Microbiology Results Continued Campylobacter rectus 50,000 CFU Drug MIC ug/ml Interpretation Ampicillin 0.064 Susceptible Ciprofloxacin 0.064 Susceptible Metronidazole 0.75 Susceptible Clindamycin <0.016 Susceptible Erythromycin 6 Resistant Doxycycline 0.50 Susceptible Amoxicillin 500mg/TID for 5-7 days Metronidazole 250mg/TID for 5-7 days C. Biofilm Staging (I-IV) and Oral Microbial Signature (OMS) Stage I Stage II Stage III Stage IV OMS (5 is the Highest Infectious Disease Burden):5/5 Phenotype Ratio: Biofilm: Planktonic : 6.3 D. Traditional Recommendation: (TEAM DENTAL) E. New Recommendation Probiotic for 30 Days after Antibiotic Treatment
  38. Antibiotics/Probiotics (PK/PD) Similarities Storage: Refrigerated vs. Non-Refrigerated Composition: 1, 2, 3, and/or 4 Organisms Carrier: Prebiotics Administration Oral Enteral Swab/Sponge Other Dose/Frequency/Duration MOA Target/Anatomic Location Disease Organism Health (Immune System) Side Effects Consequence IF Administered Concurrently with Antibiotics
  39. Other Uses!!!!
  40. Tumor Specific Entry and Replication of VV I.V. injection Metastasis Primary tumor
  41. Shabahang and Szalay, 2001
  42. BUG Bifidobacterium (Yellow) TUMOR Prostate Cancer (Orange) Co-Reconstruction (Reporter Gene) of Tumor/Biofilm Administered as Probiotic
  43. West Virginia University Biofilm Research Laboratory Salmonella Treatment for Cancer TAPET (Tumor Amplified Protein Expression Therapy) Genetically engineered Salmonellatyphimurium strain targets and retards tumors. Concept derived from the observation that Neoplasms (cancerous tissue) regress after acute infections. Toxic effects (i.e. septic shock) are reduced by 10,000 times. Accumulates in tumor tissue 500 times more than in non-cancerous tissue. TAPET is applicable to tumor therapy and delivery of diagnostic imaging markers. http://news.bbc.co.uk/1/health/315690.stm
  44. “We Live in a Microbial World: Head to Toe” “The distinction between dental and medical microbiology is a man-made fabrication via our simplistic attitude of a very complex total body ecosystem that is just now being uncovered”
  45. Future of Biofilms and ProbioticsAnd the Dental Office Theragnostics: Dx/Rx Tumor Detection Tumor management . Molecular medicine Enters the Mouth Saliva vs Blood in Dx
  46. “Half the world is composed of people who have something to say and can’t, and the other half who have nothing to say and keep on saying it.”-Robert Frost(1875-1963)
  47. Team Biofilm: Family Support Dr. Kimberly P. Thomas, M.S., D.D.S.
  48. 70!!!
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