Aims To test the effect of %0.4 stannous fluoride (SnF2) glycerin based gels on the bacterial ecology in both a clinical observational study and in vitro polymicobial biofilm model. Methods and Results The influence of stannous fluoride (0.4% SnF2) gels on bacteria was tested in both an observational study in children 6-12 years of age (n=20) and an in vitro biofilm model system. The plaque derived multi-species bacterial biofilm model was based on clinical bacterial strains derived directly from the clinical study. Potential changes in the plaque ecology were determined through the Human Oral Microbial Identification Microarray-HOMIM (n=10). The semiquantitative data resulting from this system were analyzed with cumulative logit models for each bacterial strain and Bonferroni adjustments were employed to correct for multiple hypothesis testing. Both hierarchical biclustering and principal components analysis were used to graphically assess reproducibility within subjects over time. Mixed effects models were used to examine changes in plaque scores and numbers of bacterial strains found in the various conditions. Conclusions Both the observational clinical study and the biofilm model showed that short-term use of 0.4% SnF2 gel has little effect on the bacterial plaque ecology. The amount of plaque accumulation on a subject's teeth, which was measured by plaque index scores failed to show statistical significant changes over the two baselines or after treatment (p=0.9928). The in vitro results were similar when examining the effect of 0.4% SnF2 gels on biofilm adherence through a crystal violet assay (p= 0.1157). Significance and Impact of the Study The bacteria within the dental biofilms showed resilience in maintaining the overall community diversity after exposure to 0.4% Stannous Fluoride Gels. The study supports that the immediate benefits of using these gels each night to manage caries in children may be strictly from fluoride ions inhibiting tooth demineralization.

The objective of this study was to develop a method to reliably and reproducibly assess the physical properties of in vitro multi-species plaque derived biofilms. A custom flow cell (FC) was designed to model oral cavity shear stresses on biofilms grown on hydroxyapatite (HA) discs. A finite-element program (ANSYS 13) modeled flow velocities and wall shear stresses on the interior 3D dimensions. For the experiment, 1% chlorhexidine (CHX), 5 M urea, and a 1× phosphate-buffered saline (PBS) were flown through the FC simulating oral rinsing. Near infrared cross-polarization optical coherence tomography (CP-OCT) non-destructively imaged the fluid immersed biofilms in real time (20 frames/s). During low flow, the swell of the biofilm caused from 5 M urea was quite pronounced increase in vertical dimension. Biofilms exposed to 1% CHX showed a slight collapse in the vertical dimension of the biofilm during low flow. During high flow/high sheer stress, the 5 M urea solution effectively removed the biofilm, while both 1% CHX and 1× PBS did not remove biofilms even under high velocity/shear stress conditions.

Future therapies for the treatment of dental decay have to consider the importance of preserving bacterial ecology while reducing biofilm adherence to teeth. A multi-species plaque derived (MSPD) biofilm model was used to assess how concentrations of N-acetyl-L-cysteine (0, 0.1%, 1%, 10%) affected the growth of complex oral biofilms. Biofilms were grown (n=96) for 24 hours on hydroxyapatite disks in BMM media with 0.5% sucrose. Bacterial viability and biomass formation was examined on each disk using a microtiter plate reader. In addition, fluorescence microscopy and Scanning Electron Microscopy was used to qualitatively examine the effect of NAC on bacterial biofilm aggregation, extracellular components, and bacterial morphology. The total biomass was significantly decreased after exposure of both 1% (from 0.48, with a 95% confidence interval of (0.44, 0.57) to 0.35, with confidence interval (0.31, 0.38)) and 10% NAC (0.14 with confidence interval (0.11, 0.17)). 16S rRNA amplicon sequencing analysis indicated that 1% NAC reduced biofilm adherence while preserving biofilm ecology.