title: Effects of CO2 laser irradiation on tooth enamel coated with biofilm.
abstract: OBJECTIVE
  CO2 laser irradiation of tooth enamel can inhibit demineralization of tooth enamel, by changing enamel composition and resistance to acid attack. The aim of this work was to examine these effects of CO2 laser irradiation on enamel covered by biofilm.
  
  
  METHODS
  Streptococcus mutans was grown on bovine enamel surfaces for 48 hours to form a mature biofilm. Samples were irradiated by CO2 laser (wavelength of 10.6 µm) at a power of 0.08 W in a super-pulse mode for 1 second and 24 pulses/second, with an energy density of 0.77 J/cm(2) per pulse. Untreated controls and laser treated samples with and without biofilm were examined for the morphology of the biofilm and the enamel surface by scanning electron microscopy (SEM). Structural biofilm viability was assessed using confocal laser scanning microscopy with live/dead staining. The biofilm was removed in a sonication water bath and the non-treated and irradiated enamel samples were chemically analyzed using energy dispersive X-ray spectrometry (EDS) and Fourier transform infrared spectroscopy (FTIR).
  
  
  RESULTS
  Irradiated samples showed a melt zone with micro-cracks in the center of the irradiating beam position, which was smaller when irradiated enamel was covered by biofilm. Confocal microscopy images demonstrated higher proportion of dead bacteria at the margins of the irradiated spot area, while at the spot center the bacteria were evaporated exposing the enamel surface to direct laser irradiation. EDS analysis showed an increase in Ca/P ratio after irradiation of enamel covered with biofilm. FTIR analysis showed an approximately 40% carbonate loss in the irradiated enamel samples, including those with biofilms.
  
  
  CONCLUSIONS
  Biofilms protect enamel surfaces from possible morphological irradiation damage without interfering with the resultant chemical changes that may increase the enamel resistance to acid attack. Therefore, under certain exposure regimens that are thermally and mechanically safe for enamel, CO2 laser irradiation of biofilms on dental hard tissues is suggested as a potential novel preventive treatment for controlling dental caries.
authors.affiliation: Faculty of Dental Medicine, Institute of Dental Sciences, Hebrew University-Hadassah, Jerusalem, Israel; Faculty of Dental Medicine, Department of Prosthodontics, Hebrew University-Hadassah, Jerusalem, Israel.
authors.forename: Julie
authors.initials: J
authors.lastname: Cohen
authors.forename: John D B
authors.initials: JD
authors.lastname: Featherstone
authors.forename: Charles Q
authors.initials: CQ
authors.lastname: Le
authors.forename: Doron
authors.initials: D
authors.lastname: Steinberg
authors.forename: Osnat
authors.initials: O
authors.lastname: Feuerstein
mesh_terms: D000818:Animals; D018441:Biofilms / Q000528:radiation effects*; D002417:Cattle; D003731:Dental Caries / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D003743:Dental Enamel / Q000382:microbiology / Q000528:radiation effects*; D066298:In Vitro Techniques; D054020:Lasers, Gas / Q000627:therapeutic use*; D018613:Microscopy, Confocal; D008855:Microscopy, Electron, Scanning; D013052:Spectrometry, X-Ray Emission; D017550:Spectroscopy, Fourier Transform Infrared; D013295:Streptococcus mutans / Q000502:physiology* / Q000528:radiation effects
keywords: CO2; S. mutans; biofilm; caries; enamel; laser