The objectives were to synthesize a bioactive nanocomposite as an endodontic antimicrobial agent by loading previously synthesized electrosprayed chitosan nanoparticles (Ch-Np) into Zeolite-Y as a carrier and compare its antimicrobial activity against two endodontic pathogens using the agar diffusion test. Additionally, the effect of tissue inhibitors (dentin powder and serum albumin) on the antimicrobial activity of the Ch-Np-Zeolite nanocomposite was studied. Finally, the possible cytotoxicity of the novel nanocomposite against Balb/c 3T3 mouse fibroblast cells was evaluated.

 A concentration of 3% (w/v) electrosprayed Ch-Np was mixed with Zeolite-Y in a concentration of 53.3 (w/v) and characterized using high-resolution scanning electron microscopy (HR-SEM) and energy-dispersive X-ray spectroscopy (EDS) analysis. The antimicrobial activity was evaluated against Streptococcus mutans and Enterococcus faecalis using the agar diffusion test, and the time-kill test was performed using the broth microdilution technique in the presence of tissue inhibitors. The cytotoxicity was evaluated against 3T3 mouse fibroblast cells using the standard 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay.

 The difference between the antimicrobial activity of Ch-Np-Zeolite nanocomposite against S. mutans and E. faecalis was analyzed using the Mann-Whitney's U test. The effect of tissue inhibitors on the antimicrobial activity of Ch-Np-Zeolite nanocomposite was analyzed by comparing the mean of log colony-forming unit per milliliter over time. For the cytotoxicity assay, a statistically significant difference between each group and their control was made using a t-test with a probability value of p ≤ 0.05, considered a significant difference.

 HR-SEM of the dried paste-like mixture Ch-Np-Zeolite revealed the typical crystal habit of the supporting zeolite, and EDS analysis confirmed that the zeolite parent material retained its elemental composition after loading with Ch-Np. The antimicrobial activity of Ch-Np-Zeolite was demonstrated by the mean diameter inhibition zones of 9.57 and 7.85 mm for S. mutans and E. faecalis, respectively. Streptococcus mutans and E. faecalis were completely eradicated in the presence of tissue inhibitors. The Ch-Np-Zeolite nanocomposite significantly promoted the growth of 3T3 fibroblast cells (p < 0.05), supporting its lack of cytotoxicity.

 Zeolite-Y-loaded Ch-Np nanocomposite shows promising antimicrobial activity while maintaining its biocompatibility even in the presence of tissue inhibitors.

Researching disinfection strategies is pivotal because effectively eliminating bacteria and their byproducts during root canal treatment (RCT) remains a challenge. This study investigated the antimicrobial efficacy of natural antimicrobial compounds, propolis (PRO) and copaiba oil-resin (COR), compared to conventional agents in Endodontics. Antimicrobials were tested against endodontic pathogens via macrodilution with standardized inoculums to determine the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC). Biofilm killing efficacy were performed using two dual-species biofilms: Enterococcus faecalis (ATCC 29212) and Streptococcus mutans (ATCC 20523) and Streptococcus oralis (J22) and Actinomyces naeslundii (T14V-J1) grown on dentine discs. At the intratubular level (dentine cylinders), dentine tubule contamination was performed with E. faecalis and S. mutans. The specimens were exposed to antimicrobials to simulate their use at different sets of RCT and bacterial viability was quantified using Live/Dead staining via confocal laser scanning microscopy (CLSM). Biofilm characteristics and immediate removal of S. oralis and A. naeslundii biofilm model were evaluated employing optical coherence tomography (OCT) and CFU/mL counting. Statistical tests were applied according to data distribution for each analysis (α=0.05). Macrodilutions showed different effects against endodontic pathogens. Direct contact and intratubular analysis showed that PRO and COR promoted disinfection like conventional agents (p > 0.05). According to OCT analysis, PRO and COR showed similar biofilm reduction after immediate contact (p < 0.05). CFU/mL counting showed decontamination (p < 0.05) after using natural and conventional agents. PRO and COR showed antimicrobial effects, indicating their suitability as complementary approaches in RCT to eliminate as much microbial load as possible.

An over-the-counter vasoconstrictive nasal solution with oxymetazoline (NS-OXY, 0.05%) has the potential to be used as a dental pulpal hemostatic medicament. A molecular engineering approach examined NS-OXY and its molecular constituent's antimicrobial and blood biomass removal efficacy.

An ex vivo cavity model was developed where standardized prepared teeth were exposed overnight to a model dentinal caries pathogen, S. mutans, and then exposed to sheep's blood for 10 min, which simulated a pulpal exposure. Cavity preparations were rinsed with OXY (0.05%), benzalkonium chloride (BKC-0.025%), NS-OXY (with OXY-0.05% and BKC), ferric sulfate (20%;ViscoStat, FS), and distilled water (DI). For examining the bactericidal effect of NS-OXY, a disk diffusion antimicrobial assay was used where S. mutans was grown (20 h) on brain heart infusion (BHI) w/0.5% glucose agar plates and exposed to the treatment groups.

NS-OXY-treated samples had a lower residual bacterial or blood biomass than FS (p = 0.003). The diffusion test showed that NS-OXY, BKC, and FS had zones of inhibition greater than 10 mm, with NS-OXY having higher activity against S. mutans than FS (p = 0.0002), but lower than BKC (p = 0.0082).

NS-OXY may be considered as a dental hemostatic agent after traumatic and carious pulpal exposure owing to NS-OXY's antimicrobial and vasoconstrictive properties.

Eradication of residual biofilm from root canal dentine is critical for the success of regenerative endodontic procedures (REPs).

To evaluate the influence of ultrasonically activated irrigants in concentrations used for REPs for removal of dual-species biofilm from three-dimensionally printed tooth models with attached dentine samples.

Seventy-two three-dimensionally printed teeth models were fabricated with a standardized slot in the apical third of the root to ensure a precise fit with a human root dentine specimen. Dual-species biofilms (comprising Enterococcus faecalis and Streptococcus mutans) were cultivated in the root canal for a period of three weeks. Models with dentine specimens were randomly assigned into 5 groups according to the irrigation protocol; G1(dis H2O): infected root canals irrigated with distilled water to serve as controls; G2(1.5% NaOCl): 1.5% NaOCl for five minutes; G3(1.5% NaOCl + PUI): 1.5% NaOCl + passive ultrasonic irrigation (PUI) for 30 s; G4(3% NaOCl): 3% NaOCl for five minutes; G5(3% NaOCl + PUI): 3% NaOCl + PUI for 30 s. Bacterial reduction was determined by colony-forming unit (CFU) counting (n = 12/G), whilst biofilms were analyzed using field emission scanning electron microscopy in additional samples.

The four experimental groups showed a significant reduction in CFU counts compared to the control group (p < 0.05). When compared with (dis H2O), the highest reduction in bacterial count was obtained in G5 (3% NaOCl + PUI) followed by G4 (3% NaOCl), then G3 (1.5% NaOCl + PUI), and finally G2 (1.5% NaOCl).

Results of the current study propose that a 3D-printed mature tooth model can be effectively used to analyze the antimicrobial effects of different irrigation protocols on dual-species biofilm. The use of NaOCl in concentrations used for regenerative endodontics can effectively remove bacterial biofilms. Furthermore, the use of PUI did not significantly enhance antibacterial effects of NaOCl.

Endodontic infection is a penetration of microorganisms into the dental pulp. Bacteria are the most common entities that induce an infection. This state is associated with significant pain and discomfort. Therapeutic intervention involves removal of infected pulp from the tooth and roots, which eliminates viable tissue, thus creating a tooth less resistant to mechanical pressure. Studies suggest that there are several types of bacteria most commonly associated with endodontic infections. Furthermore, it is considered that different types of pathogens could play a major role in primary and secondary endodontic infections. The aim of this review is to summarize major bacteria involved in the process of endodontic infection. Furthermore, we discuss the bacterial properties that allow them to penetrate dental pulp and hypothesize about possible future treatment strategies.

Different Streptococcal species including Streptococcus mutans, Streptococcus sobrinus and Enterococcus faecalis are commonly isolated in root canal infections including refractory, recurrent, and persistent cases. Calcium hydroxide (Ca (OH)2) has been widely used in endodontics as an intracanal medicament. However, using new antimicrobial herbal alternatives offers promising potentials which can be additionally enhanced by using nanoparticles (NPs). In this study, we evaluate the antimicrobial efficacy and antibiofilm effect of Neem oil including its NPs preparations and we compare the effect of conventional Ca (OH)2 to Ca (OH)2 NPs using standard disc diffusion method and quantitative microtitre dish biofilm formation assay against common pathogens isolated from root canal samples. Molecular docking was used to test the binding of 10 Streptococcal macromolecules to 5 candidate neem active constituents. Neem NPs 0.125 mg/ml showed better antibacterial effect than both Neem 15 mg/ml and Neem 0.15 mg/ml. Ca (OH)2 NPs 0.125 mg/ml also showed better antibacterial effect than each of Ca (OH)2 10 mg/ml and Ca (OH)2 0.1 mg/ml. Best biofilm mass inhibition was achieved by Neem oil 0.15 mg/ml at 74.55% ( IQ: 67.36-87.65) and Neem NPs 0.0125 mg/ml at 59.33% (IQ: 51--75.27). For Ca (OH)2, the best biofilm mass inhibition was observed with Ca (OH)2 NPs 0.125 mg/ml at 54.7% (IQ: 42.37- 77.25). Both neem oil and neem NPs show promising antibacterial and antibiofilm potential against Mutans Streptococci group at low concentrations and hence are good candidates for use as endodontic medications. In silico analysis shows that both Sitosterol and Gedunin appear to be important active constituents of neem and possible drug candidates. Additionally, Ca (OH)2 NPs showed significantly higher antimicrobial effect against Mutans streptococci group than conventional Ca (OH)2 preparations.

The oral cavity harbors more than 700 species of bacteria, which play crucial roles in the development of various oral diseases including caries, endodontic infection, periodontal infection, and diverse oral diseases.

To investigate the antimicrobial action of Cymbopogon Schoenanthus and Pelargonium graveolens essential oils against Streptococcus mutans, Staphylococcus aureus, Candida albicans, Ca. dubliniensis, and Ca. krusei.

Minimum microbicidal concentration was determined following Clinical and Laboratory Standards Institute documents. The synergistic antimicrobial activity was evaluated using the Broth microdilution checkerboard method, and the antibiofilm activity was evaluated with the 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide assay. Data were analyzed by one-way analysis of variance followed by the Tukey post-hoc test (P ≤ 0.05).

C. schoenanthus and P. graveolens essential oils were as effective as 0.12% chlorhexidine against S. mutans and St. aureus monotypic biofilms after 24 h. After 24 h P. graveolens essential oil at 0.25% was more effective than the nystatin group, and C. schoenanthus essential oil at 0.25% was as effective as the nystatin group.

C. schoenanthus and P. graveolens essential oils are effective against S. mutans, St. aureus, Ca. albicans, Ca. dubliniensis, and Ca. krusei at different concentrations after 5 min and 24 h.

The use of medicinal plant preparations to clean and disinfect root canal infection is gaining popularity. The aim of this study was to evaluate the bioactive composition of leaf extracts of Moringa oleifera plants cultivated in Iraq (specifically Baghdad) and their antimicrobial activity against selected root canal pathogens for potential application in endodontic treatment. Materials and Methods. Moringa leaf extracts were prepared either through cold maceration or warm digestion techniques to perform an ethanolic or aqueous extraction, respectively. Phytochemical detection was performed before thin layer chromatography (TLC) and high-performance liquid chromatography (HPLC) to measure flavonoids and phenolic compounds within both extracts. Then, their antimicrobial activities were investigated against Streptococcus mutans, Enterococcus faecalis, and Candida albicans through minimal inhibitory concentration (MIC), minimal bactericidal concentration (MBC), and agar well diffusion assay in comparison to NaOCl and Ca(OH)2. Results. Phytochemical screening showed several active ingredients but with higher expression of flavonoids and phenolic compounds. Also, different types of these compounds were detected through TLC and quantified by HPLC. MIC values for ethanolic extract against Streptococcus mutans, Enterococcus faecalis, and Candida albicans were 60, 65, and 55, respectively, while for aqueous extract, MIC values were 70, 80, and 50, respectively. Aqueous extract showed a higher inhibition zone than ethanolic extract for both Streptococcus mutans and Enterococcus faecalis with a statistically significant difference (p ≤ 0.001) for all tested materials except with NaOCl and Ca(OH)2 in Streptococcus mutans and Enterococcus faecalis, respectively. The ethanolic extract showed a higher inhibition zone against Candida albicans, with a statistically significant difference (p ≤ 0.001) for all tested materials. Conclusion. Ethanolic and aqueous extracts of Moringa oleifera leaves cultivated in Baghdad contain considerable quantities of phytochemicals, especially flavonoid and phenolic compounds, and demonstrated antimicrobial activities against selected endodontic pathogens. Therefore, Moringa leaf extracts could be suggested as an alternative antimicrobial material in endodontic treatment.

Dental pathologies of endodontic origin are varied in nature, and include infectious and non-infectious causes. Through this review, we aim to provide a deeper understanding of the role of bacterial involvement and in the pathogenesis of endodontic pathologies, by reviewing the relevant literature on the most common bacterial species involved, and their capacity to organize as biofilms. Furthermore, we focus on the most important recent updates in the management of endodontic infections, from a multidisciplinary perspective.

Quaternary ammonium compounds (QACs) have been widely used due to their excellent antimicrobial activity. However, using the technology where nanomaterials are employed as drug carriers to deliver QAC drugs has not been fully explored. In this study, mesoporous silica nanoparticles (MSNs) with short rod morphology were synthesized in a one-pot reaction using an antiseptic drug cetylpyridinium chloride (CPC). CPC-MSN were characterized via various methods and tested against three bacterial species (Streptococcus mutans, Actinomyces naeslundii, and Enterococcus faecalis), which are associated with oral infections, caries, and endodontic pathology. The nanoparticle delivery system used in this study prolonged the release of CPC. The manufactured CPC-MSN effectively killed the tested bacteria within the biofilm, and their size allowed them to penetrate into dentinal tubules. This CPC-MSN nanoparticle delivery system demonstrates potential for applications in dental materials.

Dental pulp and periapical diseases are common conditions in stomatology, caused by various pathogenic microorganisms. Antimicrobial peptides, as new antibiotics, offer promising applications in the irrigation and disinfection medicaments for root canals.One patient with chronic periapical periodontitis was selected to extract the clinical pathogenic bacteria. Porphyromonas gingivalis (Pg) (ATCC 33,277), Streptococcus mutans (Sm) (ATCC 25,175), and Prevotella intermedius (Pi) (ATCC 25,611) were used as test strains. The effects of plantaricin (Pln) 149 on the biofilm formation and growth in infected root canals were evaluated by RT-PCR, laser confocal scanning microscopy, and bacterial diversity analysis. In addition, the cytotoxicity of Pln 149 (100 µg/mL) to human dental pulp stem cells (hDPSCs) was assessed using an MTT assay. Pln 149 exhibited significant inhibitory effects on Pg Sm and Pi (P < 0.05), with significant differences in the biofilm images of the laser confocal scanning microscope (P < 0.05). There were no significant differences in hDPSCs viability or proliferation between the Pln 149 and control groups. Considering the excellent antimicrobial effects and low cytotoxicity, we suggest that Pln 149 might be a promising option for root canal irrigation solutions.

To determine the microorganism in root canal systems of root filled teeth with periapical disease and their relationship with clinical symptoms using next-generation sequencing.

The roots of 10 extracted teeth were collected from 10 patients who presented with post-treatment apical periodontitis (PTAP; six with symptoms and four without symptoms). Each root was divided horizontally into two parts (apical and coronal segments) and cryo-pulverized. Microbial communities were detected using 16S rDNA hypervariable V3-V4 region. The diversity, principal coordinate analysis and linear discriminant analysis effect size were performed in the symptomatic and asymptomatic groups (apical and coronal parts respectively). A Mann-Whitney test and an analysis of similarities were applied for intergroup analysis, at a significance level of 5%.

A total of 23 phyla, 257 genera and 425 species were detected. Firmicutes was the most abundant phylum in all samples. Three phyla (Fusobacteria, Synergistetes and unidentified_Bacteria) and seven genera (Fusobacterium, Porphyromonas, Phocaeicola, Olsenella, Campylobacter, Tannerella and Fretibacterium) were significantly more abundant in the symptomatic patients (p < .05), whereas asymptomatic patients had more Sphingomonas. The species more significantly abundant in the symptomatic samples were Porphyromonas gingivalis, Phocaeicola abscessus, Campylobacter showae, Tannerella forsythia and Olsenella uli (p < .05).

A greater microbial diversity was observed in root filled teeth with PTAP compared to earlier reports. Several genera and species in root canal systems might be associated with clinical symptoms of PTAP.

Endodontic biomaterials have significantly improved dental treatment techniques in several aspects now that they can be used for vital pulp treatments, as temporary intracanal medication, in definitive fillings, in apical surgeries, and for regenerative procedures. Calcium silicate-based cement is a class of dental material that is used in endodontics in direct contact with the dental structures, connective tissue, and bone. Because the material interacts with biological tissues and stimulates biomineralization processes, its properties are of major importance. The main challenge in endodontic treatments is the elimination of biofilms that are present in the root canal system anatomical complexities, as it remains even after chemical-mechanical preparation and disinfection procedures. Thus, an additional challenge for these biomaterials is to exert antimicrobial activity while maintaining their biological properties in parallel. This article reviews the literature for studies considering the antimicrobial properties of calcium silicate-based dental biomaterials used in endodontic practice. Considering the reviewed studies, it can be affirmed that the reduced antimicrobial effect exhibited by calcium silicate-based endodontic materials clearly emphasizes that all clinical procedures prior to their use must be carefully performed. Future studies for the evaluation of these materials, and especially newly proposed materials, under poly-microbial biofilms associated with endodontic diseases will be necessary.

Vascular dementia is the second leading cause of dementia after Alzheimer's disease in the elderly population worldwide. Cerebral microbleeds (CMBs) are frequently observed in MRI of elderly subjects and considered as a possible surrogate marker. The number and location of CMBs reflect the severity of diseases and the underlying pathologies may involve cerebral amyloid angiopathy or hypertensive vasculopathy. Accumulating evidence demonstrated the clinicopathological discrepancies of CMBs, the clinical significance of CMBs associated with other MRI markers of cerebral small vessel disease, cognitive impairments, serum, and cerebrospinal fluid biomarkers. Moreover, emerging evidence has shown that genetic factors and gene-environmental interactions might shed light on the underlying etiologies of CMBs, focusing on blood-brain-barrier and inflammation. In this review, we introduce recent genetic and microbiome studies as a cutting-edge approach to figure out the etiology of CMBs through the "microbe-brain-oral axis" and "microbiome-brain-gut axis." Finally, we propose novel concepts, "microvascular matrisome" and "imbalanced proteostasis," which may provide better perspectives for elucidating the pathophysiology of CMBs and future development of therapeutics for vascular dementia using CMBs as a surrogate marker.