CC BY 4.0 · Eur J Dent
DOI: 10.1055/s-0043-1768165
Original Article

Anticandidal Efficacy of Erythrosine with Nano-TiO2 and Blue LED-Mediated Photodynamic Therapy against Candida albicans Biofilms on Acrylic Resin: A Preliminary Study

Teerasak Damrongrungruang
1   Division of Oral Diagnosis, Department of Oral Biomedical Sciences, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
2   Melatonin Research Program, Khon Kaen University, Khon Kaen, Thailand
3   Laser in Dentistry Research Group, Khon Kaen University, Khon Kaen, Thailand
Subin Puasiri
4   Division of Dental Public Health, Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
Vichakorn Vongtavatchai
5   Division of Periodontology, Department of Oral Biomedical Sciences, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
Chatchai Saeng-on
5   Division of Periodontology, Department of Oral Biomedical Sciences, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
Teeruch Petcharapiruch
5   Division of Periodontology, Department of Oral Biomedical Sciences, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
Aroon Teerakapong
3   Laser in Dentistry Research Group, Khon Kaen University, Khon Kaen, Thailand
5   Division of Periodontology, Department of Oral Biomedical Sciences, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
Angkhana Sangpanya
5   Division of Periodontology, Department of Oral Biomedical Sciences, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
› Author Affiliations
Funding The research was funded by Research and Academic Services from the Faculty of Dentistry, Khon Kaen University (DTR6102) Thailand as well as the Melatonin Research Program, Khon Kaen University, Thailand.


Objective Incorporating an enhancer such as nano-titanium dioxide into antimicrobial photodynamic therapy can improve treatment outcome.

This study aimed to compare the anticandidal efficacy of photodynamic therapy by erythrosine with nano-titanium dioxide (nano-TiO2) stimulated by a blue light emitting diode with three standard dental antifungal agents.

Materials and MethodsCandida albicans biofilms on acrylic resin plates were treated for 15 minutes with either nystatin, fluconazole, Polident, 220µM erythrosine + 1% (w/w) nano-TiO2 + 15 J/cm2 blue light photodynamic therapy (Ery PDT), or distilled water. For the Ery PDT group, blue light was applied for 1 minute after incubation. After 1, 3, and 6 hours, the colony forming units in log10 (log10CFU/mL) were compared. The ultrastructure of C. albicans on the acrylic resin plates treated with erythrosine + nano-TiO2 + blue light was examined using transmission electron microscopy at magnification of 30,000x.

Results After 1 hour, nystatin, Polident, and Ery PDT indifferently inhibited C. albicans. At 6 hours, Ery PDT reduced the number of viable C. albicans in biofilms by 0.28log10 CFU/mL, which was equal to the effect of fluconazole and Polident. Transmission electron microscopy demonstrated that Ery PDT altered the C. albicans cell morphology by inducing cell wall/membrane rupture.

Conclusion Photodynamic therapy with erythrosine + nano-TiO2 + blue light at low light power density (15 J/cm2) was as effective at inhibiting C. albicans biofilm on acrylic resin as fluconazole and Polident.

Publication History

Article published online:
27 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Chu X. Oral candidiasis: relation to systemic diseases and medications. Dentistry 2017; 5 (01) 1-5
  • 2 Belazi M, Velegraki A, Fleva A. et al. Candidal overgrowth in diabetic patients: potential predisposing factors. Mycoses 2005; 48 (03) 192-196
  • 3 Chandra J, Mukherjee PK, Leidich SD. et al. Antifungal resistance of candidal biofilms formed on denture acrylic in vitro . J Dent Res 2001; 80 (03) 903-908
  • 4 Han Y, Liu X, Cai Y. Effects of two peroxide enzymatic denture cleaners on Candida albicans biofilms and denture surface. BMC Oral Health 2020; 20 (01) 193
  • 5 Jeyapalan K, Kumar JK, Azhagarasan NS. Comparative evaluation of the effect of denture cleansers on the surface topography of denture base materials: an in-vitro study. J Pharm Bioallied Sci 2015; 7 (Suppl. 02) S548-S553
  • 6 Amin F, Iqbal S, Azizuddin S, Afridi FI. Effect of denture cleansers on the color stability of heat cure acrylic resin. J Coll Physicians Surg Pak 2014; 24 (11) 787-790
  • 7 Sartawi SY, Abu-Hammad S, A Salim N, Al-Omoush S. Denture stomatitis revisited: a summary of systematic reviews in the past decade and two case reports of papillary hyperplasia of unusual locations. Int J Dent 2021; 2021: 7338143
  • 8 Canabarro A, Valle C, Farias MR, Santos FB, Lazera M, Wanke B. Association of subgingival colonization of Candida albicans and other yeasts with severity of chronic periodontitis. J Periodontal Res 2013; 48 (04) 428-432
  • 9 Ramirez-Garcia A, Rementeria A, Aguirre-Urizar JM. et al. Candida albicans and cancer: can this yeast induce cancer development or progression?. Crit Rev Microbiol 2016; 42 (02) 181-193
  • 10 Garcez AS, Núñez SC, Baptista MS. et al. Antimicrobial mechanisms behind photodynamic effect in the presence of hydrogen peroxide. Photochem Photobiol Sci 2011; 10 (04) 483-490
  • 11 Hormdee D, Rinsathorn W, Puasiri S, Jitprasertwong P. Anti-early stage of bacterial recolonization effect of Curcuma longa extract as photodynamic adjunctive treatment. Int J Dent 2020; 2020: 8823708
  • 12 Rodríguez-Cerdeira C, Martínez-Herrera E, Fabbrocini G. et al. New applications of photodynamic therapy in the management of candidiasis. J Fungi (Basel) 2021; 7 (12) 1025
  • 13 Song HH, Lee JK, Um HS, Chang BS, Lee SY, Lee MK. Phototoxic effect of blue light on the planktonic and biofilm state of anaerobic periodontal pathogens. J Periodontal Implant Sci 2013; 43 (02) 72-78
  • 14 Teerakapong A, Damrongrungruang T, Sattayut S. et al. Fungicidal effect of combined nano TiO2 with erythrosine for mediated photodynamic therapy on Candida albicans: an in vitro study. Lasers Dent Sci 2017; 1: 101-106
  • 15 Kanpittaya K, Teerakapong A, Morales NP. et al. Inhibitory effects of erythro-sine/curcumin derivatives/nano-titanium dioxide-mediated photodynamic therapy on Candida albicans . Molecules 2021; 26 (09) 2405
  • 16 Abdullah M, Kamarudin SK. Titanium dioxide nanotubes (TNT) in energy and environmental applications: an overview. Renew Sustain Energy Rev 2017; 76: 212-225
  • 17 Mills RW, Jandt KD, Ashworth SH. Dental composite depth of cure with halogen and blue light emitting diode technology. Br Dent J 1999; 186 (08) 388-391
  • 18 Mima EG, Pavarina AC, Dovigo LN. et al. Susceptibility of Candida albicans to photodynamic therapy in a murine model of oral candidosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109 (03) 392-401
  • 19 Mima EG, Pavarina AC, Silva MM. et al. Denture stomatitis treated with photodynamic therapy: five cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112 (05) 602-608
  • 20 Ribeiro AP, Pavarina AC, Trindade FZ, Inada NM, Bagnato VS, de Souza Costa CA. Photodynamic therapy associating Photogem and blue LED on L929 and MDPC-23 cell culture. Cell Biol Int 2010; 34 (04) 343-351
  • 21 Gonçalves MLL, Santos EM, Renno ACM. et al. Erythrosine as a photosensitizer for antimicrobial photodynamic therapy with blue light-emitting diodes: an in vitro study. Photodiagn Photodyn Ther 2021; 35: 102445
  • 22 Thein ZM, Samaranayake YH, Samaranayake LP. In vitro biofilm formation of Candida albicans and non-albicans Candida species under dynamic and anaerobic conditions. Arch Oral Biol 2007; 52 (08) 761-767
  • 23 Figueiral MH, Fonseca P, Lopes MM, Pinto E, Pereira-Leite T, Sampaio-Maia B. Effect of denture-related stomatitis fluconazole treatment on oral Candida albicans susceptibility profile and genotypic variability. Open Dent J 2015; 9 (09) 46-51
  • 24 Sohnle PG, Hahn BL. Effect of prolonged fluconazole treatment on Candida albicans in diffusion chambers implanted into mice. Antimicrob Agents Chemother 2002; 46 (10) 3175-3179
  • 25 Castanheira M, Deshpande LM, Davis AP, Carvalhaes CG, Pfaller MA. Azole resistance in Candida glabrata clinical isolates from global surveillance is associated with efflux overexpression. J Glob Antimicrob Resist 2022; 29: 371-377
  • 26 Vila-Nova TEL, Leão RS, Santiago Junior JF, Pellizzer EP, Vasconcelos BCDE, Moraes SLD. Photodynamic therapy in the treatment of denture stomatitis: a systematic review and meta-analysis. J Prosthet Dent 2022; 128: x
  • 27 Afroozi B, Zomorodian K, Lavaee F, Zare Shahrabadi Z, Mardani M. Comparison of the efficacy of indocyanine green-mediated photodynamic therapy and nystatin therapy in treatment of denture stomatitis. Photodiagn Photodyn Ther 2019; 27: 193-197
  • 28 Ho JD, Tsai RJ, Chen SN, Chen HC. Cytotoxicity of indocyanine green on retinal pigment epithelium: implications for macular hole surgery. Arch Ophthalmol 2003; 121 (10) 1423-1429
  • 29 Lombardi A, Ouanounou A. Fungal infections in dentistry: clinical presentations, diagnosis, and treatment alternatives. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130 (05) 533-546
  • 30 Falah-Tafti A, Jafari AA, Lotfi-Kamran MH, Fallahzadeh H, Hayan RS. A comparison of the efficacy of nystatin and fluconazole incorporated into tissue conditioner on the in vitro attachment and colonization of Candida albicans . Dent Res J (Isfahan) 2010; 7 (01) 18-22
  • 31 Gunasegar S, Himratul-Aznita WH. Nicotine enhances the thickness of biofilm and adherence of Candida albicans ATCC 14053 and Candida parapsilosis ATCC 22019. FEMS Yeast Res 2019;19(02):
  • 32 Taweechaisupapong S, Ngaonee P, Patsuk P, Pitiphat W, Khunkiti W. Antibiofilm activity and post antifungal effect of lemongrass oil on clinical Candida dubliniensis isolate. S Afr J Bot 2012; 78: 37-43
  • 33 Hitti M. ed. FDA Warns of allergy to denture cleansers [Internet]. Atlanta, GA: WebMD; 2008. . Accessed September 24, 2018 at:
  • 34 Grande F, Tucci P. Titanium dioxide nanoparticles: a risk for human health?. Mini Rev Med Chem 2016; 16 (09) 762-769
  • 35 Gleiznys A, Zdanavičienė E, Žilinskas J. Candida albicans importance to denture wearers. A literature review. Stomatologija 2015; 17 (02) 54-66
  • 36 Costa AC, Rasteiro VM, Pereira CA, Rossoni RD, Junqueira JC, Jorge AO. The effects of rose bengal- and erythrosine-mediated photodynamic therapy on Candida albicans . Mycoses 2012; 55 (01) 56-63
  • 37 Cieplik F, Tabenski L, Buchalla W, Maisch T. Antimicrobial photodynamic therapy for inactivation of biofilms formed by oral key pathogens. Front Microbiol 2014; 5: 405
  • 38 Andrasik JS. Singlet Oxygen Generation using New Fluorene-based Photosensitizers under One- and Two-Photon Excitation [PhD dissertation]. Orlando, FL: University of Central Florida; 2007
  • 39 Wood S, Metcalf D, Devine D, Robinson C. Erythrosine is a potential photosensitizer for the photodynamic therapy of oral plaque biofilms. J Antimicrob Chemother 2006; 57 (04) 680-684
  • 40 Bairagi R, Ameta R. Photocatalytic degradation of erythrosine by using manganese doped TiO2 supported on zeolite. Int J Chem Sci 2016; 14 (03) 1768-1776
  • 41 Mao K, Wu X, Min X, Huang Z, Liu YG, Fang M. New efficient visible-light-driven photocatalyst of chitin-modified titanium dioxide/carbon fiber composites for wastewater. Sci Rep 2019; 9 (01) 16321
  • 42 Liu Z, Zhang M, Han X. et al. TiO2 nanoparticles cause cell damage independent of apoptosis and autophagy by impairing the ROS-scavenging system in Pichia pastoris . Chem Biol Interact 2016; 252: 9-18
  • 43 Lara HH, Romero-Urbina DG, Pierce C, Lopez-Ribot JL, Arellano-Jiménez MJ, Jose-Yacaman M. Effect of silver nanoparticles on Candida albicans biofilms: an ultrastructural study. J Nanobiotechnology 2015; 13: 91