High microbicidal effect of peroxynitric acid on biofilm-infected dentin in a root carious tooth model and verification of tissue safety.

OBJECTIVES: Root-caries, which frequently occurs in elderly people, is more difficult to treat than caries in a tooth crown, especially in filling restorations. To overcome this difficulty, it is essential to find a strategy for sufficiently sterilizing the infected dentin; however, techniques for sterilizing carious pathogens inside the biofilm, called dental plaque, have not yet been established. Recently, dental applications of plasma sterilization technology have attracted attention. The mechanism of plasma sterilization became clear, and revealed that peroxynitric acid (PNA) is an effective sterilization substance. Highly concentrated PNA solutions can be chemically synthesized in large quantities without using plasma technology. We thought that the application of PNA solution could be a novel treatment for root caries, and examined the microbicidal effect and safety of PNA.

METHODS: A sterilization experiment was performed using an extracted tooth model infected with Streptococcus mutans. Subsequently, a biofilm of S. mutans and Candida albicans was formed on a plate or a dentin slice, and sterilization experiments were performed in comparison with chlorhexidine. Furthermore, a toxicity test of PNA was performed using an epithelial tissue model.

RESULTS: In the infection model, sterilization was achieved with a 22 mM PNA solution in only 10 s. In the biofilm model, a 22 mM PNA solution showed a higher microbicidal effect than 2.0% chlorhexidine. In the toxicity test, 2.0% chlorhexidine was toxic, but a 220 mM PNA solution showed no toxicity.

CONCLUSIONS: PNA is an unprecedented disinfectant that has high microbicidal activity on biofilm and is safe for tissues.