Combined treatment potentiates anti-biofilm and anti-cariogenic efficacy

Iveta Ramonaite, Dental Tribune International

Tue. 31 October 2023

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PHILADELPHIA, US: According to research, dental caries is the most prevalent and costly biofilm-induced oral disease. Fluoride as the primary anti-cariogenic agent cannot both sufficiently control biofilm and prevent enamel demineralisation and can lead to risks associated with overexposure to fluoride, especially in children. However, a recent study has shown that using a combination of an iron oxide nanoparticle (ferumoxytol, Fer) approved by the US Food and Drug Administration and stannous fluoride (SnF₂), even at lower concentrations, can help inhibit both biofilm accumulation and enamel damage. The study has the potential to prevent dental caries and to reduce fluoride exposure in patients.

“Traditional treatments often come short in managing the complex biofilm environment in the mouth,” senior researcher Dr Hyun (Michel) Koo, a co-founding director of the Center for Innovation and Precision Dentistry and a professor in the Department of Orthodontics at the University of Pennsylvania, said in a press release. “Our combined treatment not only amplifies the effectiveness of each agent but does so with a lower dosage, hinting at a potentially revolutionary method for caries prevention in high-risk individuals,” he continued.

The researchers found that Fer can stabilise SnF₂ and that it shows increased catalytic activity when combined with SnF₂. Additionally, they discovered that fluoride, iron and tin form a protective film on tooth enamel to protect it against further demineralisation. It was also reported that the combined therapy did not disrupt the ecological balance of the oral microbiota and showed no side effects on the surrounding host tissue.

Senior author Dr David Cormode, an associate professor of radiology at the university, commented: “What excites us most about these findings is the multifaceted approach to caries prevention. It’s not just about inhibiting bacterial growth or protecting the enamel; it’s a holistic method that targets both the biological and physicochemical aspects of dental caries.”

“While we are happy with these initial findings, we still aim to dig deeper in understanding the intricate ways Fer and SnF₂ synergise to boost the therapeutic effects,” Dr Koo added.

Since both Fer and SnF₂ are commercially available, the research findings could quickly be translated into clinical practice. However, further research is needed to closely examine the mechanisms of interaction between SnF₂ and Fer, the process of reactive oxygen species generation and the formation and efficacy of the protective enamel film. “There’s potential here not just in dental care but in exploring how this combination can be targeted against other biofilms,” Dr Cormode said.

The study, titled “Iron oxide nanozymes stabilize stannous fluoride for targeted biofilm killing and synergistic oral disease prevention”, was published online on 29 September 2023 in Nature Communications.

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