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Ziziphus Joazeiro Martius and Ketoconazole added to Acrylic Resin Present Antifungal Activity
The research led by Rodrigo Neves-Silva, DDS, MSc, Ph.D., Brazil.
Vol: 06, Issue: 01
Abstract: C. albicans has been shown to be associated with denture-related stomatitis. This study aimed to evaluate the antifungal effect of a hydroalcoholic extract of Ziziphus joazeiro Martius (HEZJM) and ketoconazole. Ninety specimens were used, 10 in each group: GROUP I – 1% of the polymer replaced by HEZJM; GROUP II – 2% of the polymer replaced by HEZJM; GROUP III – 1% HEZJM added to the polymer; GROUP IV – 2% HEZJM added to the polymer; GROUP V - control group; GROUP VI – Polymer replaced by 1% ketoconazole; GROUP VII – polymer replaced by 2% ketoconazole; GROUP VIII – 1% ketoconazole added to the polymer; GROUP IX – 2% ketoconazole added to the polymer. The specimens were placed on plates containing Sabouraud agar with Candida albicans. Plates were then kept in a bacteriological incubator at a temperature of 37°C for 48 hours. In groups I and II, specimens were not colonized. In groups III and IV, there was no inhibition zone or adherence of colonies. In group V, the surfaces of five of the ten specimens were colonized. In group VI, all specimens showed fungistatic action. Group VII presented three specimens that formed halos of inhibition and four specimens that altered the growth pattern of the colonies. Group VIII altered the growth pattern of two specimens. In group IX, colonization of the specimens did not occur.
Introduction:
Denture-related stomatitis is an inflammatory process of the oral mucosa. Esthetic concerns often mean that patients use their dental prosthesis continuously, which can trigger inflammatory changes in the mucosa, particularly in the contact area at the base of the prosthesis. These patients often complain of a burning sensation, discomfort, or a bad taste. The etiology appears to be multifactorial and mainly affects patients who have an impaired immune system, advanced age, systemic disease, poor oral hygiene, a reduction in salivary flow, and in smokers and drinkers. Other factors including using dentures at night, denture trauma, the denture base material, the age of the dentures, the pH of the denture plaque, and dietary factors. Despite these predisposing factors, the presence of Candida spp. in the biofilm of the prosthesis is considered the most important factor for the development of this type of inflammation. Additionally, Candida-associated denture stomatitis is a commonly recurring disease, observed in approximately 11% to 67% of otherwise healthy denture wearers.
Clinically, denture-associated stomatitis presentation is variable and may be associated with chronic erythema located in the tissues under the prosthesis, sometimes accompanied by hemorrhagic petechiae, with a velvety to a rough aspect, and can present as generalized inflammation with papillary hyperplasia and lesions localized on the palate and alveolar ridge. Treatment involves a three-way approach: denture hygiene, correction of denture faults, and/or medication. This is necessary because the prosthesis has irregular and porous surfaces in which Candida spp. adheres easily; brushing cannot remove them. The incorporation of an antifungal agent as a coating on the prosthesis has been recommended for patients with prostheses who have trouble keeping an antifungal agent in the mouth for a few minutes. Several antifungal agents are being developed for the treatment of oral candidiasis, each with its advantages and disadvantages. However, the toxicity and resistance of these antifungals are problems that have led to variable results and a high rate of recurrence. Some natural products have been shown to be an alternative to synthetic chemicals. Furthermore, these medicinal plants can play a very important role in the treatment of denture stomatitis, because acrylic resins are prone to microbial adherence, especially by Candida albicans. Surface-charged resins alter the ionic interaction between the denture resin and Candida hyphae, and these resins are being developed as a means to reduce microbial colonization on the denture surface.
C. albicans has been shown to be associated with denture-related stomatitis, and taking into account that the surface of the acrylic resin used for dentures is prone to microbial adherence, especially C. albicans, and the display boards of this resin to oral fluids enhances this condition of adhesion, as demonstrated in vitro by Samaranayake et al., this study aimed to investigate changes in the resin composition used for prostheses to impair microbial adherence, because the role of candidal colonization of the oral cavity and dental prostheses in complete denture wearers is not clear in the literature. Therefore, the aim of this study was evaluate, in vitro, the antifungal effect of a hydroalcoholic extract of Ziziphus joazeiro Martius (HEZJM) and ketoconazole in thermally activated acrylic resin used as the base of dental prostheses against C. albicans. Our hypothesis was that HEZJM and ketoconazole would have an important antifungal effect against C. albicans.
The authors concluded that in the tested specimens there was no colonization of the surface, and replacing the polymer with 2% ketoconazole showed the best results.
This research article first published in "International Journal of Microbiology & Advanced Immunology".
Journal reference: Microbiology and advanced Immunology