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Published in: BMC Oral Health 1/2017

Open Access 01-12-2017 | Research article

Bactericidal effects of 310 nm ultraviolet light-emitting diode irradiation on oral bacteria

Authors: Ayuko Takada, Kenji Matsushita, Satoru Horioka, Yasushi Furuichi, Yasunori Sumi

Published in: BMC Oral Health | Issue 1/2017

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Abstract

Background

Ultraviolet (UV) light is used for phototherapy in dermatology, and UVB light (around 310 nm) is effective for treatment of psoriasis and atopic dermatitis. In addition, it is known that UVC light (around 265 nm) has a bactericidal effect, but little is known about the bactericidal effect of UVB light. In this study, we examined the bactericidal effects of UVB-light emitting diode (LED) irradiation on oral bacteria to explore the possibility of using a 310 nm UVB-LED irradiation device for treatment of oral infectious diseases.

Methods

We prepared a UVB (310 nm) LED device for intraoral use to examine bactericidal effects on Streptococcus mutans, Streptococcus sauguinis, Porphyromonas gingivalis, and Fusobacterium nucleatum and also to examine the cytotoxicity to a human oral epithelial cell line (Ca9–22). We also examined the production of nitric oxide and hydrogen peroxide from Ca9–22 cells after irradiation with UVB-LED light.

Results

Irradiation with the 310 nm UVB-LED at 105 mJ/cm2 showed 30–50% bactericidal activity to oral bacteria, though 17.1 mJ/cm2 irradiation with the 265 nm UVC-LED completely killed the bacteria. Ca9–22 cells were strongly injured by irradiation with the 265 nm UVC-LED but were not harmed by irradiation with the 310 nm UVB-LED. Nitric oxide and hydrogen peroxide were produced by Ca9–22 cells with irradiation using the 310 nm UVB-LED. P. gingivalis was killed by applying small amounts of those reactive oxygen species (ROS) in culture, but other bacteria showed low sensitivity to the ROS.

Conclusions

Narrowband UVB-LED irradiation exhibited a weak bactericidal effect on oral bacteria but showed low toxicity to gingival epithelial cells. Its irradiation also induces the production of ROS from oral epithelial cells and may enhance bactericidal activity to specific periodontopathic bacteria. It may be useful as a new adjunctive therapy for periodontitis.
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Literature
1.
go back to reference Lapolla W, Yentzer BA, Bagel J, Halvorson CR, Feldman SR. A review of phototherapy protocols for psoriasis treatment. J Am Acad Dermatol. 2011;64(5):936–49.CrossRefPubMed Lapolla W, Yentzer BA, Bagel J, Halvorson CR, Feldman SR. A review of phototherapy protocols for psoriasis treatment. J Am Acad Dermatol. 2011;64(5):936–49.CrossRefPubMed
2.
3.
go back to reference Shintani Y, Yasuda Y, Kobayashi K, Maeda A, Morita A. Narrowband ultraviolet B radiation suppresses contact hypersensitivity. Photodermatol Photoimmunol Photomed. 2008;24(1):32–7.CrossRefPubMed Shintani Y, Yasuda Y, Kobayashi K, Maeda A, Morita A. Narrowband ultraviolet B radiation suppresses contact hypersensitivity. Photodermatol Photoimmunol Photomed. 2008;24(1):32–7.CrossRefPubMed
4.
go back to reference Fernandez-Guarino M, Aboin-Gonzalez S, Barchino L, Velazquez D, Arsuaga C, Lazaro P. Treatment of moderate and severe adult chronic atopic dermatitis with narrow-band UVB and the combination of narrow-band UVB/UVA phototherapy. Dermatol Ther. 2016;29(1):19–23.CrossRefPubMed Fernandez-Guarino M, Aboin-Gonzalez S, Barchino L, Velazquez D, Arsuaga C, Lazaro P. Treatment of moderate and severe adult chronic atopic dermatitis with narrow-band UVB and the combination of narrow-band UVB/UVA phototherapy. Dermatol Ther. 2016;29(1):19–23.CrossRefPubMed
5.
go back to reference Vangipuram R, Feldman SR. Ultraviolet phototherapy for cutaneous diseases: a concise review. Oral Dis. 2015;22(4):253–9.CrossRefPubMed Vangipuram R, Feldman SR. Ultraviolet phototherapy for cutaneous diseases: a concise review. Oral Dis. 2015;22(4):253–9.CrossRefPubMed
6.
go back to reference Gupta A, Avci P, Dai T, Huang YY, Hamblin MR. Ultraviolet radiation in wound care: sterilization and stimulation. Adv Wound Care. 2013;2(8):422–37.CrossRef Gupta A, Avci P, Dai T, Huang YY, Hamblin MR. Ultraviolet radiation in wound care: sterilization and stimulation. Adv Wound Care. 2013;2(8):422–37.CrossRef
7.
go back to reference Schweintzger N, Gruber-Wackernagel A, Reginato E, Bambach I, Quehenberger F, Byrne SN, Wolf P. Levels and function of regulatory T cells in patients with polymorphic light eruption: relation to photohardening. Br J Dermatol. 2015;173(2):519–26.CrossRefPubMedPubMedCentral Schweintzger N, Gruber-Wackernagel A, Reginato E, Bambach I, Quehenberger F, Byrne SN, Wolf P. Levels and function of regulatory T cells in patients with polymorphic light eruption: relation to photohardening. Br J Dermatol. 2015;173(2):519–26.CrossRefPubMedPubMedCentral
8.
go back to reference Wang L, Wang J, Jin Y, Gao H, Lin X. Oral administration of all-trans retinoic acid suppresses experimental periodontitis by modulating the Th17/Treg imbalance. J Periodontol. 2014;85(5):740–50.CrossRefPubMed Wang L, Wang J, Jin Y, Gao H, Lin X. Oral administration of all-trans retinoic acid suppresses experimental periodontitis by modulating the Th17/Treg imbalance. J Periodontol. 2014;85(5):740–50.CrossRefPubMed
9.
go back to reference Ebersole JL, Kirakodu S, Novak MJ, Stromberg AJ, Shen S, Orraca L, Gonzalez-Martinez J, Burgos A, Gonzalez OA. Cytokine gene expression profiles during initiation, progression and resolution of periodontitis. J Clin Periodontol. 2014;41(9):853–61.CrossRefPubMedPubMedCentral Ebersole JL, Kirakodu S, Novak MJ, Stromberg AJ, Shen S, Orraca L, Gonzalez-Martinez J, Burgos A, Gonzalez OA. Cytokine gene expression profiles during initiation, progression and resolution of periodontitis. J Clin Periodontol. 2014;41(9):853–61.CrossRefPubMedPubMedCentral
10.
go back to reference Karthikeyan B, Talwar, Arun KV, Kalaivani S: Evaluation of transcription factor that regulates T helper 17 and regulatory T cells function in periodontal health and disease. J Pharm Bioallied Sci 2015, 7(Suppl 2):S672-676. Karthikeyan B, Talwar, Arun KV, Kalaivani S: Evaluation of transcription factor that regulates T helper 17 and regulatory T cells function in periodontal health and disease. J Pharm Bioallied Sci 2015, 7(Suppl 2):S672-676.
11.
go back to reference Wang L, Guan N, Jin Y, Lin X, Gao H. Subcutaneous vaccination with Porphyromonas gingivalis ameliorates periodontitis by modulating Th17/Treg imbalance in a murine model. Int Immunopharmacol. 2015;25(1):65–73.CrossRefPubMed Wang L, Guan N, Jin Y, Lin X, Gao H. Subcutaneous vaccination with Porphyromonas gingivalis ameliorates periodontitis by modulating Th17/Treg imbalance in a murine model. Int Immunopharmacol. 2015;25(1):65–73.CrossRefPubMed
12.
go back to reference Batista LF, Kaina B, Meneghini R, Menck CF. How DNA lesions are turned into powerful killing structures: insights from UV-induced apoptosis. Mutat Res. 2009;681(2–3):197–208.CrossRefPubMed Batista LF, Kaina B, Meneghini R, Menck CF. How DNA lesions are turned into powerful killing structures: insights from UV-induced apoptosis. Mutat Res. 2009;681(2–3):197–208.CrossRefPubMed
13.
go back to reference Coohill TP, Sagripanti JL. Overview of the inactivation by 254 nm ultraviolet radiation of bacteria with particular relevance to biodefense. Photochem Photobiol. 2008;84(5):1084–90.PubMed Coohill TP, Sagripanti JL. Overview of the inactivation by 254 nm ultraviolet radiation of bacteria with particular relevance to biodefense. Photochem Photobiol. 2008;84(5):1084–90.PubMed
14.
go back to reference Vatansever F, Ferraresi C, de Sousa MV, Yin R, Rineh A, Sharma SK, Hamblin MR. Can biowarfare agents be defeated with light? Virulence. 2013;4(8):796–825.CrossRefPubMedPubMedCentral Vatansever F, Ferraresi C, de Sousa MV, Yin R, Rineh A, Sharma SK, Hamblin MR. Can biowarfare agents be defeated with light? Virulence. 2013;4(8):796–825.CrossRefPubMedPubMedCentral
15.
go back to reference Batista LF, Roos WP, Kaina B, Menck CF. p53 mutant human glioma cells are sensitive to UV-C-induced apoptosis due to impaired cyclobutane pyrimidine dimer removal. Mol Cancer Res. 2009;7(2):237–46.CrossRefPubMed Batista LF, Roos WP, Kaina B, Menck CF. p53 mutant human glioma cells are sensitive to UV-C-induced apoptosis due to impaired cyclobutane pyrimidine dimer removal. Mol Cancer Res. 2009;7(2):237–46.CrossRefPubMed
16.
go back to reference Svobodova A, Walterova D, Vostalova J. Ultraviolet light induced alteration to the skin. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2006;150(1):25–38.CrossRefPubMed Svobodova A, Walterova D, Vostalova J. Ultraviolet light induced alteration to the skin. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2006;150(1):25–38.CrossRefPubMed
17.
go back to reference Jordan T. UVC irradiation. Is it the future of infection prevention in the clinical laboratory? MLO Med Lab Obs. 2015;47(6):41.PubMed Jordan T. UVC irradiation. Is it the future of infection prevention in the clinical laboratory? MLO Med Lab Obs. 2015;47(6):41.PubMed
18.
go back to reference Reeves EP, Lu H, Jacobs HL, Messina CG, Bolsover S, Gabella G, Potma EO, Warley A, Roes J, Segal AW. Killing activity of neutrophils is mediated through activation of proteases by K+ flux. Nature. 2002;416(6878):291–7.CrossRefPubMed Reeves EP, Lu H, Jacobs HL, Messina CG, Bolsover S, Gabella G, Potma EO, Warley A, Roes J, Segal AW. Killing activity of neutrophils is mediated through activation of proteases by K+ flux. Nature. 2002;416(6878):291–7.CrossRefPubMed
19.
go back to reference Rajaram K, Nelson DE. Chlamydia muridarum infection of macrophages elicits bactericidal nitric oxide production via reactive oxygen species and cathepsin B. Infect Immun. 2015;83(8):3164–75.CrossRefPubMedPubMedCentral Rajaram K, Nelson DE. Chlamydia muridarum infection of macrophages elicits bactericidal nitric oxide production via reactive oxygen species and cathepsin B. Infect Immun. 2015;83(8):3164–75.CrossRefPubMedPubMedCentral
20.
go back to reference Rastogi RP, Richa, Kumar A, Tyagi MB, Sinha RP: Molecular mechanisms of ultraviolet radiation-induced DNA damage and repair. J Nucleic Acids 2010, 2010:592980. Rastogi RP, Richa, Kumar A, Tyagi MB, Sinha RP: Molecular mechanisms of ultraviolet radiation-induced DNA damage and repair. J Nucleic Acids 2010, 2010:592980.
21.
go back to reference Polefka TG, Meyer TA, Agin PP, Bianchini RJ. Effects of solar radiation on the skin. J Cosmet Dermatol. 2012;11(2):134–43.CrossRefPubMed Polefka TG, Meyer TA, Agin PP, Bianchini RJ. Effects of solar radiation on the skin. J Cosmet Dermatol. 2012;11(2):134–43.CrossRefPubMed
22.
go back to reference Kim S, Kim J, Lim W, Jeon S, Kim O, Koh JT, Kim CS, Choi H, Kim O. In vitro bactericidal effects of 625, 525, and 425 nm wavelength (red, green, and blue) light-emitting diode irradiation. Photomed Laser Surg. 2013;31(11):554–62.CrossRefPubMedPubMedCentral Kim S, Kim J, Lim W, Jeon S, Kim O, Koh JT, Kim CS, Choi H, Kim O. In vitro bactericidal effects of 625, 525, and 425 nm wavelength (red, green, and blue) light-emitting diode irradiation. Photomed Laser Surg. 2013;31(11):554–62.CrossRefPubMedPubMedCentral
23.
go back to reference Cieplik F, Spath A, Leibl C, Gollmer A, Regensburger J, Tabenski L, Hiller KA, Maisch T, Schmalz G. Blue light kills Aggregatibacter actinomycetemcomitans due to its endogenous photosensitizers. Clin Oral Investig. 2014;18(7):1763–9.CrossRefPubMed Cieplik F, Spath A, Leibl C, Gollmer A, Regensburger J, Tabenski L, Hiller KA, Maisch T, Schmalz G. Blue light kills Aggregatibacter actinomycetemcomitans due to its endogenous photosensitizers. Clin Oral Investig. 2014;18(7):1763–9.CrossRefPubMed
24.
go back to reference Wainwright M. Photodynamic antimicrobial chemotherapy (PACT). J Antimicrob Chemother. 1998;42(1):13–28.CrossRefPubMed Wainwright M. Photodynamic antimicrobial chemotherapy (PACT). J Antimicrob Chemother. 1998;42(1):13–28.CrossRefPubMed
25.
go back to reference Maisch T, Hackbarth S, Regensburger J, Felgentrager A, Baumler W, Landthaler M, Roder B. Photodynamic inactivation of multi-resistant bacteria (PIB) - a new approach to treat superficial infections in the 21st century. J Dtsch Dermatol Ges. 2011;9(5):360–6.PubMed Maisch T, Hackbarth S, Regensburger J, Felgentrager A, Baumler W, Landthaler M, Roder B. Photodynamic inactivation of multi-resistant bacteria (PIB) - a new approach to treat superficial infections in the 21st century. J Dtsch Dermatol Ges. 2011;9(5):360–6.PubMed
26.
go back to reference Morimoto K, Ozawa T, Awazu K, Ito N, Honda N, Matsumoto S, Tsuruta D. Photodynamic therapy using systemic administration of 5-aminolevulinic acid and a 410-nm wavelength light-emitting diode for methicillin-resistant Staphylococcus aureus-infected ulcers in mice. Plos One. 2014;9(8):e105173.CrossRefPubMedPubMedCentral Morimoto K, Ozawa T, Awazu K, Ito N, Honda N, Matsumoto S, Tsuruta D. Photodynamic therapy using systemic administration of 5-aminolevulinic acid and a 410-nm wavelength light-emitting diode for methicillin-resistant Staphylococcus aureus-infected ulcers in mice. Plos One. 2014;9(8):e105173.CrossRefPubMedPubMedCentral
27.
go back to reference Kumar V, Sinha J, Verma N, Nayan K, Saimbi CS, Tripathi AK. Scope of photodynamic therapy in periodontics. Indian J Dent Res. 2015;26(4):439–42.CrossRefPubMed Kumar V, Sinha J, Verma N, Nayan K, Saimbi CS, Tripathi AK. Scope of photodynamic therapy in periodontics. Indian J Dent Res. 2015;26(4):439–42.CrossRefPubMed
28.
go back to reference McKenzie RM, Johnson NA, Aruni W, Dou Y, Masinde G, Fletcher HM. Differential response of Porphyromonas gingivalis to varying levels and duration of hydrogen peroxide-induced oxidative stress. Microbiology. 2012;158(Pt 10):2465–79.CrossRefPubMedPubMedCentral McKenzie RM, Johnson NA, Aruni W, Dou Y, Masinde G, Fletcher HM. Differential response of Porphyromonas gingivalis to varying levels and duration of hydrogen peroxide-induced oxidative stress. Microbiology. 2012;158(Pt 10):2465–79.CrossRefPubMedPubMedCentral
29.
go back to reference Lynch MC, Kuramitsu HK. Role of superoxide dismutase activity in the physiology of Porphyromonas gingivalis. Infect Immun. 1999;67(7):3367–75.PubMedPubMedCentral Lynch MC, Kuramitsu HK. Role of superoxide dismutase activity in the physiology of Porphyromonas gingivalis. Infect Immun. 1999;67(7):3367–75.PubMedPubMedCentral
30.
go back to reference Henningham A, Dohrmann S, Nizet V, Cole JN. Mechanisms of group A Streptococcus resistance to reactive oxygen species. FEMS Microbiol Rev. 2015;39(4):488–508.CrossRefPubMedPubMedCentral Henningham A, Dohrmann S, Nizet V, Cole JN. Mechanisms of group A Streptococcus resistance to reactive oxygen species. FEMS Microbiol Rev. 2015;39(4):488–508.CrossRefPubMedPubMedCentral
31.
go back to reference Kreth J, Zhang Y, Herzberg MC. Streptococcal antagonism in oral biofilms: Streptococcus sanguinis and Streptococcus gordonii interference with Streptococcus mutans. J Bacteriol. 2008;190(13):4632–40.CrossRefPubMedPubMedCentral Kreth J, Zhang Y, Herzberg MC. Streptococcal antagonism in oral biofilms: Streptococcus sanguinis and Streptococcus gordonii interference with Streptococcus mutans. J Bacteriol. 2008;190(13):4632–40.CrossRefPubMedPubMedCentral
32.
go back to reference Kreth J, Merritt J, Shi W, Qi F. Competition and Coexistence between Streptococcus mutans and Streptococcus sanguinis in the Dental Biofilm. J Bacteriol. 2005;187(21):7193–203.CrossRefPubMedPubMedCentral Kreth J, Merritt J, Shi W, Qi F. Competition and Coexistence between Streptococcus mutans and Streptococcus sanguinis in the Dental Biofilm. J Bacteriol. 2005;187(21):7193–203.CrossRefPubMedPubMedCentral
33.
go back to reference Chen L, Ge X, Dou Y, Wang X, Patel JR, Xu P. Identification of hydrogen peroxide production-related genes in Streptococcus sanguinis and their functional relationship with pyruvate oxidase. Microbiology. 2010;157(1):13–20.CrossRefPubMed Chen L, Ge X, Dou Y, Wang X, Patel JR, Xu P. Identification of hydrogen peroxide production-related genes in Streptococcus sanguinis and their functional relationship with pyruvate oxidase. Microbiology. 2010;157(1):13–20.CrossRefPubMed
34.
go back to reference Signat B, Roques C, Poulet P, Duffaut D. Fusobacterium nucleatum in periodontal health and disease. Curr Issues Mol Biol. 2011;13(2):25–36.PubMed Signat B, Roques C, Poulet P, Duffaut D. Fusobacterium nucleatum in periodontal health and disease. Curr Issues Mol Biol. 2011;13(2):25–36.PubMed
35.
go back to reference Tinberg CE, Tonzetich ZJ, Wang H, Do LH, Yoda Y, Cramer SP, Lippard SJ. Characterization of iron dinitrosyl species formed in the reaction of nitric oxide with a biological Rieske center. J Am Chem Soc. 2010;132(51):18168–76.CrossRefPubMedPubMedCentral Tinberg CE, Tonzetich ZJ, Wang H, Do LH, Yoda Y, Cramer SP, Lippard SJ. Characterization of iron dinitrosyl species formed in the reaction of nitric oxide with a biological Rieske center. J Am Chem Soc. 2010;132(51):18168–76.CrossRefPubMedPubMedCentral
36.
go back to reference Boutrin MC, Yu Y, Wang C, Aruni W, Dou Y, Shi L, Fletcher HM. A putative TetR regulator is involved in Nitric Oxide stress resistance in Porphyromonas gingivalis. Mol Oral Microbiol. 2015;31(4):340–53.CrossRefPubMed Boutrin MC, Yu Y, Wang C, Aruni W, Dou Y, Shi L, Fletcher HM. A putative TetR regulator is involved in Nitric Oxide stress resistance in Porphyromonas gingivalis. Mol Oral Microbiol. 2015;31(4):340–53.CrossRefPubMed
38.
go back to reference Loser K, Apelt J, Voskort M, Mohaupt M, Balkow S, Schwarz T, Grabbe S, Beissert S. IL-10 Controls Ultraviolet-Induced Carcinogenesis in Mice. J Immunol. 2007;179(1):365–71.CrossRefPubMed Loser K, Apelt J, Voskort M, Mohaupt M, Balkow S, Schwarz T, Grabbe S, Beissert S. IL-10 Controls Ultraviolet-Induced Carcinogenesis in Mice. J Immunol. 2007;179(1):365–71.CrossRefPubMed
39.
go back to reference Abo Elnazar SY, Ghazy AA, Ghoneim HE, Taha AR, Abouelella AM. Effect of ultra violet irradiation on the interplay between Th1 and Th2 lymphocytes. Front Pharmacol. 2015;6:56.CrossRefPubMedPubMedCentral Abo Elnazar SY, Ghazy AA, Ghoneim HE, Taha AR, Abouelella AM. Effect of ultra violet irradiation on the interplay between Th1 and Th2 lymphocytes. Front Pharmacol. 2015;6:56.CrossRefPubMedPubMedCentral
40.
go back to reference Moretti S, Bartolommei L, Galosi C, Renga G, Oikonomou V, Zamparini F, Ricci G, Borghi M, Puccetti M, Piobbico D, et al. Fine-tuning of Th17 Cytokines in Periodontal Disease by IL-10. J Dent Res. 2015;94(9):1267–75.CrossRefPubMed Moretti S, Bartolommei L, Galosi C, Renga G, Oikonomou V, Zamparini F, Ricci G, Borghi M, Puccetti M, Piobbico D, et al. Fine-tuning of Th17 Cytokines in Periodontal Disease by IL-10. J Dent Res. 2015;94(9):1267–75.CrossRefPubMed
41.
go back to reference Rivas M, Rojas E, Araya MC, Calaf GM. Ultraviolet light exposure, skin cancer risk and vitamin D production. Oncol Lett. 2015;10(4):2259–64.PubMedPubMedCentral Rivas M, Rojas E, Araya MC, Calaf GM. Ultraviolet light exposure, skin cancer risk and vitamin D production. Oncol Lett. 2015;10(4):2259–64.PubMedPubMedCentral
42.
go back to reference Piotrowska A, Wierzbicka J, Zmijewski MA. Vitamin D in the skin physiology and pathology. Acta Biochim Pol. 2016;63(1):89–95.CrossRefPubMed Piotrowska A, Wierzbicka J, Zmijewski MA. Vitamin D in the skin physiology and pathology. Acta Biochim Pol. 2016;63(1):89–95.CrossRefPubMed
43.
go back to reference Hong SP, Kim MJ, Jung MY, Jeon H, Goo J, Ahn SK, Lee SH, Elias PM, Choi EH. Biopositive effects of low-dose UVB on epidermis: coordinate upregulation of antimicrobial peptides and permeability barrier reinforcement. J Invest Dermatol. 2008;128(12):2880–7.CrossRefPubMed Hong SP, Kim MJ, Jung MY, Jeon H, Goo J, Ahn SK, Lee SH, Elias PM, Choi EH. Biopositive effects of low-dose UVB on epidermis: coordinate upregulation of antimicrobial peptides and permeability barrier reinforcement. J Invest Dermatol. 2008;128(12):2880–7.CrossRefPubMed
44.
go back to reference Hong SP, Oh Y, Jung M, Lee S, Jeon H, Cho MY, Lee SH, Choi EH. Topical calcitriol restores the impairment of epidermal permeability and antimicrobial barriers induced by corticosteroids. Br J Dermatol. 2010;162(6):1251–60.CrossRefPubMed Hong SP, Oh Y, Jung M, Lee S, Jeon H, Cho MY, Lee SH, Choi EH. Topical calcitriol restores the impairment of epidermal permeability and antimicrobial barriers induced by corticosteroids. Br J Dermatol. 2010;162(6):1251–60.CrossRefPubMed
Metadata
Title
Bactericidal effects of 310 nm ultraviolet light-emitting diode irradiation on oral bacteria
Authors
Ayuko Takada
Kenji Matsushita
Satoru Horioka
Yasushi Furuichi
Yasunori Sumi
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2017
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-017-0382-5

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