Abstract
BackgroundThe microbiome of Severe-Early Childhood Caries (S-ECC), is characterized by an ecosystem comprising bacterial and fungal species, with a predominance of Candida species. Hence, an anti-cariogen effective against both bacteria and fungi would be valuable in the management of S-ECC.Here we evaluate the antifungal effect of silver diamine fluoride (SDF) against 35-clinical yeast isolates (Ten-each of C. albicans, C. krusei, C. tropicalis and five C. glabrata strains) from dentinal caries-lesions from S-ECC.ResultsDisc-diffusion and time-kill assays as well as MIC50 and MIC90 evaluations against therapeutic concentrations confirmed the broad-spectrum anti-candidal potency of SDF. Ultrastructural images revealed morphologic aberrations of yeast-cell walls on exposure to SDF. All C. krusei and C. glabrata isolates were significantly more sensitive to SDF, relative to the standard antifungal fluconazole. Further, SDF appears to effectively abrogate filamentation of C. albicans even at very low concentrations.ConclusionsOur data, for the first time, elucidate the antifungal potency of SDF, in addition to its known antibacterial activity, in the management of S-ECC.
Highlights
The microbiome of Severe-Early Childhood Caries (S-ECC), is characterized by an ecosystem comprising bacterial and fungal species, with a predominance of Candida species
The effect of silver diamine fluoride (SDF) on different Candida species A total of 35 Candida isolates belonging to four different Candida spp., viz. C .albicans (10 strains), C krusei (10), C tropicalis (10) and C glabrata (5) were evaluated for their susceptibility to SDF using the classic, disc diffusion assay
We noted increasing concentration of SDF led to increased inhibitory zone diameters in all four species, implying a dose-response effect of SDF on all four tested Candida species (p < 0.001; Fig. 1)
Summary
The microbiome of Severe-Early Childhood Caries (S-ECC), is characterized by an ecosystem comprising bacterial and fungal species, with a predominance of Candida species. In addition to mutans streptococci several clinical studies have confirmed the high prevalence of the opportunistic fungal pathogen, Candida in plaque-biofilms, in severe early childhood caries (S-ECC) [6,7,8]. ECC lesions, and others have shown even higher prevalence frequencies in infected deep dentinal lesions [10] This curious, interspecies, fungal/bacterial cross-kingdom association of acidogenic and aciduric microbes is likely to be due to a sucrose-rich diet of caries prone individuals, that promotes acidification of the plaque biofilm matrix, leading to accelerated caries progression [2, 11, 12]. In clinical terms, an effective monotherapy, targeting both the fungal and the bacterial components of the plaque biofilm is urgently needed to manage caries, ECC
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